title: The case for using the correction index obtained from chest radiography for evaluation of pectus excavatum.
abstract: BACKGROUND
  We previously reported the use of a computed tomography (CT)-based Correction Index (CI) as a more accurate assessment of pectus excavatum (PE) severity than the historically used Haller Index (HI). This study examines the diagnostic capabilities of the CI as assessed by lateral chest radiography (CXR).
  
  
  METHODS
  A database of PE patients receiving preoperative CXR and CT was created. For each patient, a radiologist calculated a CT-based CI, while two pediatric surgeons independently calculated CXR CIs.
  
  
  RESULTS
  The database was composed of 69 patients. Significant correlations were found between CXR CI estimates of the two observers and between the CXR and CT CI for each observer. Per our previous work, CT CIs were used in this study for identifying patients meeting surgical criteria (CT CI≥28%). Observed CXR CIs demonstrated good interrater reliability. The sensitivity (0.83) and specificity (0.77) of CXR in diagnosing severe PE (CT CI≥28%) was high. However, sensitivity (0.89) markedly improved when only considering measured CXR CIs≤26%, and combined specificity rose to 0.86 when only considering measured CXR CIs≥30%.
  
  
  CONCLUSIONS
  We recommend the CI as measured by lateral CXR for the preoperative evaluation of PE, with CT used as a confirmatory test in patients measured to have a CXR CI between 26% and 30%.
authors.affiliation: Pediatric Cardiac Surgery, University of Iowa Hospitals and Clinics, University of Iowa Children's Hospital, 200 Hawkins Dr, SE 520 GH, Iowa City, IA 52242-1062, USA.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Poston
authors.affiliation: Pediatric Cardiac Surgery, University of Iowa Hospitals and Clinics, University of Iowa Children's Hospital, 200 Hawkins Dr, SE 520 GH, Iowa City, IA 52242-1062, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: McHugh
authors.affiliation: Pediatric Cardiac Surgery, University of Iowa Hospitals and Clinics, University of Iowa Children's Hospital, 200 Hawkins Dr, SE 520 GH, Iowa City, IA 52242-1062, USA.
authors.forename: Nicholas O
authors.initials: NO
authors.lastname: Rossi
authors.affiliation: Pediatric Cardiology, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA.
authors.forename: Sonali S
authors.initials: SS
authors.lastname: Patel
authors.affiliation: Radiology, University of Iowa Hospitals and Clinics, University of Iowa Children's Hospital, 200 Hawkins Dr, 3773 JPP, Iowa City, IA 52242-1062, USA.
authors.forename: Maheen
authors.initials: M
authors.lastname: Rajput
authors.affiliation: Pediatric Cardiac Surgery, University of Iowa Hospitals and Clinics, University of Iowa Children's Hospital, 200 Hawkins Dr, SE 520 GH, Iowa City, IA 52242-1062, USA. Electronic address: joseph-turek@uiowa.edu.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Turek
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D016208:Databases, Factual; D005260:Female; D005660:Funnel Chest / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D015588:Observer Variation; D011300:Preoperative Care; D013902:Radiography, Thoracic / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: Congenital deformity; Correction Index; Haller Index; Pectus excavatum