Chest Radiography: General Practitioners’ Compliance with Recommendations

Introduction: Chest radiography is the most frequently prescribed imaging test in general practice in France. We aimed to assess the extent to which general practitioners follow the recommendations of the French National Authority for Health in prescribing chest radiography. Methodology: We conducted a retrospective analysis study, in two radiology centers belonging to the same group in Saint-Omer and Aire-sur-la-Lys, of requests for chest radiography sent by general practitioners over the winter period between December 22, 2013, and March 21, 2014, for patients aged over 18 years. Results: One hundred and seventy-seven requests for chest X-rays were analyzed, 71.75% of which complied with recommendations. The most frequent reason was the search for bronchopulmonary infection, accounting for 70.08% of prescriptions, followed by 11.2% for requests to rule out pulmonary neoplasia, whereas the latter reason did not comply with recommendations. Chest X-rays contributed to a positive diagnosis in 28.81% of cases. The positive diagnosis was given by 36.22% of the recommended chest X-rays, versus 10% for those not recommended. Conclusion: In most cases, general practitioners follow HAS recommendations for prescribing chest X-rays. Non-recommended chest X-rays do not appear to make a major contribution to diagnosis or patient management, confirming the value of following the recommendations of the French National Authority for Health.

Optimal Synergic Deep Learning for COVID-19 Classification Using Chest X-Ray Images

A chest radiology scan can significantly aid the early diagnosis and management of COVID-19 since the virus attacks the lungs.Chest X-ray(CXR)gained much interest after the COVID-19 outbreak thanks to its rapid imaging time,widespread availability,low cost,and portability.In radiological investigations,computer-aided diagnostic tools are implemented to reduce intra-and inter-observer variability.Using lately industrialized Artificial Intelligence(AI)algorithms and radiological techniques to diagnose and classify disease is advantageous.The current study develops an automatic identification and classification model for CXR pictures using Gaussian Fil-tering based Optimized Synergic Deep Learning using Remora Optimization Algorithm(GF-OSDL-ROA).This method is inclusive of preprocessing and classification based on optimization.The data is preprocessed using Gaussian filtering(GF)to remove any extraneous noise from the image’s edges.Then,the OSDL model is applied to classify the CXRs under different severity levels based on CXR data.The learning rate of OSDL is optimized with the help of ROA for COVID-19 diagnosis showing the novelty of the work.OSDL model,applied in this study,was validated using the COVID-19 dataset.The experiments were conducted upon the proposed OSDL model,which achieved a classification accuracy of 99.83%,while the current Convolutional Neural Network achieved less classification accuracy,i.e.,98.14%.

Histogram Matched Chest X-Rays Based Tuberculosis Detection Using CNN

Tuberculosis(TB)is a severe infection that mostly affects the lungs and kills millions of people’s lives every year.Tuberculosis can be diagnosed using chest X-rays(CXR)and data-driven deep learning(DL)approaches.Because of its better automated feature extraction capability,convolutional neural net-works(CNNs)trained on natural images are particularly effective in image cate-gorization.A combination of 3001 normal and 3001 TB CXR images was gathered for this study from different accessible public datasets.Ten different deep CNNs(Resnet50,Resnet101,Resnet152,InceptionV3,VGG16,VGG19,DenseNet121,DenseNet169,DenseNet201,MobileNet)are trained and tested for identifying TB and normal cases.This study presents a deep CNN approach based on histogram matched CXR images that does not require object segmenta-tion of interest,and this coupled methodology of histogram matching with the CXRs improves the accuracy and detection performance of CNN models for TB detection.Furthermore,this research contains two separate experiments that used CXR images with and without histogram matching to classify TB and non-TB CXRs using deep CNNs.It was able to accurately detect TB from CXR images using pre-processing,data augmentation,and deep CNN models.Without histogram matching the best accuracy,sensitivity,specificity,precision and F1-score in the detection of TB using CXR images among ten models are 99.25%,99.48%,99.52%,99.48%and 99.22%respectively.With histogram matching the best accuracy,sensitivity,specificity,precision and F1-score are 99.58%,99.82%,99.67%,99.65%and 99.56%respectively.The proposed meth-odology,which has cutting-edge performance,will be useful in computer-assisted TB diagnosis and aids in minimizing irregularities in TB detection in developing countries.

COVID-19 Detection from Chest X-Ray Images Using Convolutional Neural Network Approach

COVID-19 is a respiratory illness caused by the SARS-CoV-2 virus, first identified in 2019. The primary mode of transmission is through respiratory droplets when an infected person coughs or sneezes. Symptoms can range from mild to severe, and timely diagnosis is crucial for effective treatment. Chest X-Ray imaging is one diagnostic tool used for COVID-19, and a Convolutional Neural Network (CNN) is a popular technique for image classification. In this study, we proposed a CNN-based approach for detecting COVID-19 in chest X-Ray images. The model was trained on a dataset containing both COVID-19 positive and negative cases and evaluated on a separate test dataset to measure its accuracy. Our results indicated that the CNN approach could accurately detect COVID-19 in chest X-Ray images, with an overall accuracy of 97%. This approach could potentially serve as an early diagnostic tool to reduce the spread of the virus.

Impact of Standardized Scheme on the Detection of Chest X-Ray Abnormalities and Radiographic Diagnosis of Pulmonary Tuberculosis in Adult

Purpose: The complexity of chest radiography (CXR) is a source of variability in its interpretation. We assessed the effect of an interpretation grid on the detection of CXR anomalies and radio- graphic diagnosis of tuberculosis in an endemic area for tuberculosis. Methods: The study was conducted in Yaounde (Cameroon). Six observers (2 pulmonologists, 2 radiologists and 2 senior residents in medical imaging) interpreted 47 frontal CXR twice two months apart without (R1) and with (R2) the aid of an interpretation grid. We focused on the detection of micro nodules (n = 16), cavitations (n = 12), pleural effusion (n = 6), adenomegaly (n = 6), and diagnosis of tuberculosis (n = 23) and cancer (n = 7). Results: The average score for accurate detection of elementary lesions was 40.4% [95%CI: 25% - 58.3%] in R1 and 52.1% [36.9% - 65.3%] in R2. The highest im- provement was observed for micro nodules (19.8%). Cavitations had the highest proportions of accurate detections (58.3% in R1 and 65.3% in R2). The average score of accurate diagnosis was 46.1% in R1 and 57.4% in R2. Accurate diagnosis improved by 3.6% for tuberculosis and 19% for cancer between R1 and R2. Intra-observer agreement was higher for the diagnosis of cancers (0.22 ≤ k ≤ 1) than for diagnosing tuberculosis (0.21 ≤ k ≤ 0.68). Inter-observer agreement was highly variable with a modest improvement for the diagnosis of tuberculosis in R2. Conclusion: Standardized interpretation scheme improved the detection of CXR anomalies and diagnosis of tuberculosis. It significantly improved inter-observer’s agreement in diagnosing tuberculosis but not in detecting most lesions.

Robust Machine Learning Technique to Classify COVID-19 Using Fusion of Texture and Vesselness of X-Ray Images

Manual investigation of chest radiography(CXR)images by physicians is crucial for effective decision-making in COVID-19 diagnosis.However,the high demand during the pandemic necessitates auxiliary help through image analysis and machine learning techniques.This study presents a multi-threshold-based segmentation technique to probe high pixel intensity regions in CXR images of various pathologies,including normal cases.Texture information is extracted using gray co-occurrence matrix(GLCM)-based features,while vessel-like features are obtained using Frangi,Sato,and Meijering filters.Machine learning models employing Decision Tree(DT)and RandomForest(RF)approaches are designed to categorize CXR images into common lung infections,lung opacity(LO),COVID-19,and viral pneumonia(VP).The results demonstrate that the fusion of texture and vesselbased features provides an effective ML model for aiding diagnosis.The ML model validation using performance measures,including an accuracy of approximately 91.8%with an RF-based classifier,supports the usefulness of the feature set and classifier model in categorizing the four different pathologies.Furthermore,the study investigates the importance of the devised features in identifying the underlying pathology and incorporates histogrambased analysis.This analysis reveals varying natural pixel distributions in CXR images belonging to the normal,COVID-19,LO,and VP groups,motivating the incorporation of additional features such as mean,standard deviation,skewness,and percentile based on the filtered images.Notably,the study achieves a considerable improvement in categorizing COVID-19 from LO,with a true positive rate of 97%,further substantiating the effectiveness of the methodology implemented.

Tuberculosis Diagnosis and Visualization with a Large Vietnamese X-Ray Image Dataset

Tuberculosis is a dangerous disease to human life,and we need a lot of attempts to stop and reverse it.Significantly,in theCOVID-19 pandemic,access to medical services for tuberculosis has become very difficult.The late detection of tuberculosis could lead to danger to patient health,even death.Vietnamis one of the countries heavily affected by the COVID-19 pandemic,andmany residential areas as well as hospitals have to be isolated for a long time.Reality demands a fast and effective tuberculosis diagnosis solution to deal with the difficulty of accessingmedical services,such as an automatic tuberculosis diagnosis system.In our study,aiming to build that system,we were interested in the tuberculosis diagnosis problem from the chest X-ray images of Vietnamese patients.The chest X-ray image is an important data type to diagnose tuberculosis,and it has also received a lot of attention from deep learning researchers.This paper proposed a novel method for tuberculosis diagnosis and visualization using the deeplearning approach with a large Vietnamese X-ray image dataset.In detail,we designed our custom convolutional neural network for the X-ray image classification task and then analyzed the predicted result to provide visualization as a heat-map.To prove the performance of our network model,we conducted several experiments to compare it to another study and also to evaluate it with the dataset of this research.To support the implementation,we built a specific annotation system for tuberculosis under the requirements of radiologists in the Vietnam National Lung Hospital.A large experiment dataset was also from this hospital,and most of this data was for training the convolutional neural network model.The experiment results were evaluated regarding sensitivity,specificity,and accuracy.We achieved high scores with a training accuracy score of 0.99,and the testing specificity and sensitivity scores were over 0.9.Based on the X-ray image classification result,we visualize prediction results as heat-maps and also analyze them in comparison with annotated symptoms of radiologists.

Radiography Image Classification Using Deep Convolutional Neural Networks

Research has shown that chest radiography images of patients with different diseases, such as pneumonia, COVID-19, SARS, pneumothorax, etc., all exhibit some form of abnormality. Several deep learning techniques can be used to identify each of these anomalies in the chest x-ray images. Convolutional neural networks (CNNs) have shown great success in the fields of image recognition and image classification since there are numerous large-scale annotated image datasets available. The classification of medical images, particularly radiographic images, remains one of the biggest hurdles in medical diagnosis because of the restricted availability of annotated medical images. However, such difficulty can be solved by utilizing several deep learning strategies, including data augmentation and transfer learning. The aim was to build a model that would detect abnormalities in chest x-ray images with the highest probability. To do that, different models were built with different features. While making a CNN model, one of the main tasks is to tune the model by changing the hyperparameters and layers so that the model gives out good training and testing results. In our case, three different models were built, and finally, the last one gave out the best-predicted results. From that last model, we got 98% training accuracy, 84% validation, and 81% testing accuracy. The reason behind the final model giving out the best evaluation scores is that it was a well-fitted model. There was no overfitting or underfitting issues. Our aim with this project was to make a tool using the CNN model in R language, which will help detect abnormalities in radiography images. The tool will be able to detect diseases such as Pneumonia, Covid-19, Effusions, Infiltration, Pneumothorax, and others. Because of its high accuracy, this research chose to use supervised multi-class classification techniques as well as Convolutional Neural Networks (CNNs) to classify different chest x-ray images. CNNs are extremely efficient and successful at reducing the number of parameters while maintaining the quality of the primary model. CNNs are also trained to recognize the edges of various objects in any batch of images. CNNs automatically discover the relevant aspects in labeled data and learn the distinguishing features for each class by themselves.

Transfer Learning Approach to Classify the X-Ray Image that Corresponds to Corona Disease Using ResNet50 Pre-Trained by ChexNet

The COVID-19 pandemic has had a widespread negative impact globally. It shares symptoms with other respiratory illnesses such as pneumonia and influenza, making rapid and accurate diagnosis essential to treat individuals and halt further transmission. X-ray imaging of the lungs is one of the most reliable diagnostic tools. Utilizing deep learning, we can train models to recognize the signs of infection, thus aiding in the identification of COVID-19 cases. For our project, we developed a deep learning model utilizing the ResNet50 architecture, pre-trained with ImageNet and CheXNet datasets. We tackled the challenge of an imbalanced dataset, the CoronaHack Chest X-Ray dataset provided by Kaggle, through both binary and multi-class classification approaches. Additionally, we evaluated the performance impact of using Focal loss versus Cross-entropy loss in our model.

Automatic Detection of COVID-19 Using Chest X-Ray Images and Modified ResNet18-Based Convolution Neural Networks

The latest studies with radiological imaging techniques indicate that X-ray images provide valuable details on the Coronavirus disease 2019(COVID-19).The usage of sophisticated artificial intelligence technology(AI)and the radiological images can help in diagnosing the disease reliably and addressing the problem of the shortage of trained doctors in remote villages.In this research,the automated diagnosis of Coronavirus disease was performed using a dataset of X-ray images of patients with severe bacterial pneumonia,reported COVID-19 disease,and normal cases.The goal of the study is to analyze the achievements for medical image recognition of state-of-the-art neural networking architectures.Transfer Learning technique has been implemented in this work.Transfer learning is an ambitious task,but it results in impressive outcomes for identifying distinct patterns in tiny datasets of medical images.The findings indicate that deep learning with X-ray imagery could retrieve important biomarkers relevant for COVID-19 disease detection.Since all diagnostic measures show failure levels that pose questions,the scientific profession should determine the probability of integration of X-rays with the clinical treatment,utilizing the results.The proposed model achieved 96.73%accuracy outperforming the ResNet50 and traditional Resnet18 models.Based on our findings,the proposed system can help the specialist doctors in making verdicts for COVID-19 detection.

COVID-DeepNet: Hybrid Multimodal Deep Learning System for Improving COVID-19 Pneumonia Detection in Chest X-ray Images

Coronavirus(COVID-19)epidemic outbreak has devastating effects on daily lives and healthcare systems worldwide.This newly recognized virus is highly transmissible,and no clinically approved vaccine or antiviral medicine is currently available.Early diagnosis of infected patients through effective screening is needed to control the rapid spread of this virus.Chest radiography imaging is an effective diagnosis tool for COVID-19 virus and followup.Here,a novel hybrid multimodal deep learning system for identifying COVID-19 virus in chest X-ray(CX-R)images is developed and termed as the COVID-DeepNet system to aid expert radiologists in rapid and accurate image interpretation.First,Contrast-Limited Adaptive Histogram Equalization(CLAHE)and Butterworth bandpass filter were applied to enhance the contrast and eliminate the noise in CX-R images,respectively.Results from two different deep learning approaches based on the incorporation of a deep belief network and a convolutional deep belief network trained from scratch using a large-scale dataset were then fused.Parallel architecture,which provides radiologists a high degree of confidence to distinguish healthy and COVID-19 infected people,was considered.The proposed COVID-DeepNet system can correctly and accurately diagnose patients with COVID-19 with a detection accuracy rate of 99.93%,sensitivity of 99.90%,specificity of 100%,precision of 100%,F1-score of 99.93%,MSE of 0.021%,and RMSE of 0.016%in a large-scale dataset.This system shows efficiency and accuracy and can be used in a real clinical center for the early diagnosis of COVID-19 virus and treatment follow-up with less than 3 s per image to make the final decision.

Covid-19 Detection from Chest X-Ray Images Using Advanced Deep Learning Techniques

Like the Covid-19 pandemic,smallpox virus infection broke out in the last century,wherein 500 million deaths were reported along with enormous economic loss.But unlike smallpox,the Covid-19 recorded a low exponential infection rate and mortality rate due to advancement inmedical aid and diagnostics.Data analytics,machine learning,and automation techniques can help in early diagnostics and supporting treatments of many reported patients.This paper proposes a robust and efficient methodology for the early detection of COVID-19 from Chest X-Ray scans utilizing enhanced deep learning techniques.Our study suggests that using the Prediction and Deconvolutional Modules in combination with the SSD architecture can improve the performance of the model trained at this task.We used a publicly open CXR image dataset and implemented the detectionmodelwith task-specific pre-processing and near 80:20 split.This achieved a competitive specificity of 0.9474 and a sensibility/accuracy of 0.9597,which shall help better decision-making for various aspects of identification and treat the infection.

Monte Carlo simulation for bremsstrahlung and photoneutron yields in high-energy x-ray radiography

This paper reports on the results of calculations using a Monte Carlo code （MCNP5） to study the properties of photons, electrons and photoneutrons obtained in the converted target and their transportations in x-ray radiography. A comparison between measurements and calculations for bremsstrahlung and photoneutrons is presented. The radiographic rule and the effect of the collimator on the image are studied with the experimental model. The results provide exact parameters for the optimal design of radiographic layout and shielding systems.

Diagnostic Value of the Thoracic Ultrasonography Compared to Conventional Chest X-Rays in Pneumonia for Children between 0 to 15 Years: Case Study in Two Hospitals in Yaoundé

Introduction: The diagnosis of pneumonia is usually made based on clinical manifestations and chest X-ray. The use of ultrasound in detecting pulmonary diseases in general, and especially consolidation syndrome has been demonstrated. The objective of this study was to determine the accuracy of thoracic ultrasound compared to chest X-ray in the diagnosis of infectious pneumonia in children. Methods: Children between 0 to 15 years were included in our study. The lung ultrasound results obtained were compared with those of the chest X-ray used as the reference. Our data were introduced into the EpiInfo 3.5.4 software and analyzed with the EpiInfo 3.5.4 and IBMSPSS Statistics version 20.0 softwares. Microsoft Office Excel 2016 was used to produce Charts. Continuous quantitative variables were presented. Cohen’s Kappa concordance test was applied with confidence interval of 95%. Results: 52 children were enrolled in the study. In imaging, the dominant sign was consolidation syndrome (75.0%) of cases by chest radiography, and in 78.8% of cases by lung ultrasound (p Conclusion: Our study demonstrated that lung echography is a non-ionizing and reliable tool in the diagnosis of childhood’s pneumonia.

Inter-Observer Variability in the Detection and Interpretation of Chest X-Ray Anomalies in Adults in an Endemic Tuberculosis Area

Purpose: To assess the inter-observer agreement in reading adults chest radiographs (CXR) and determine the effectiveness of observers in radiographic diagnosis of pulmonary tuberculosis (PTB) in a tuberculosis endemic area. Methods: A quasi-observational study was conducted in the Pneumology Department of Yaounde Jamot Hospital (Cameroon) from January to March 2014. This included six observers (two chest physicians, two radiologists, two end-training residents in medical imaging) and 47 frontal CXRs (4 of diffuse interstitial lung disease, 6 normal, 7 of lung cancers, 7 of bacterial pneumonia, 23 of PTB). The sample size was calculated on the basis of an expected 0.47 Kappa with a spread of 0.13 (α = 5%, CI = 95%) for six observers and five diagnostic items. The analysis of concordance was focused on the detection of nodules, cavitary lesions, pleural effusion, adenomegaly and diagnosis of PTB and lung cancer. These intervals of kappa coefficient were considered: discordance (0.81). Results: The average score for the detection of caverns was the highest (58.3%) followed by that of the correct diagnosis of tuberculosis (49.3%). Pneumologists had the highest proportions of correct diagnosis of tuberculosis (69.6% and 73.9%) and better inter-observer agreement (k = 0.71) for PTB diagnosis. Observers were more in agreement for the detection of nodules (0.32 - 0.74), adenomegalies (0.43 - 0.69), and for the diagnosis of cancer (0.22 - 1) than for the diagnosis of tuberculosis (0.19 - 0.71). Disagreements were more frequent for the detection of pleural effusions (-0.08 - 0.73). Conclusion: The inter-observer agreement varies with the type of lesions and diagnosis. Pneumologists were most effective for the diagnosis of pulmonary tuberculosis. Observers were more in agreement for the detection of nodules and the diagnosis of cancer than for the diagnosis of pulmonary tuberculosis.

Detecting Tuberculosis from Vietnamese X-Ray Imaging Using Transfer Learning Approach

Deep learning created a sharp rise in the development of autonomous image recognition systems,especially in the case of the medical field.Among lung problems,tuberculosis,caused by a bacterium called Mycobacterium tuberculosis,is a dangerous disease because of its infection and damage.When an infected person coughs or sneezes,tiny droplets can bring pathogens to others through inhaling.Tuberculosis mainly damages the lungs,but it also affects any part of the body.Moreover,during the period of the COVID-19(coronavirus disease 2019)pandemic,the access to tuberculosis diagnosis and treatment has become more difficult,so early and simple detection of tuberculosis has been more and more important.In our study,we focused on tuberculosis diagnosis by using the chestX-ray image,the essential input for the radiologist’s profession,and researched the effectiveness of the transfer learning approach in the case study of Vietnamese chest X-ray images.We proposed four strategies to clarify our hypothesis in different ways of applying transfer learning and different training set types.We also prepared a Vietnamese X-ray image dataset with the support of the VRPACS team to provide the basis for training and testing deep learning models.Our experiments were carried out by applying three different architectures,Alexnet,Resnet,and Densenet,on international,Vietnamese,and combined X-ray image datasets.After training,all models were verified on a pure Vietnamese X-rays set.The results show that transfer learning is suitable in the case study of Vietnamese chest X-ray images with high evaluating metrics in terms of AUC(Area under the Receiver Operating Characteristic Curve),sensitivity,specificity,and accuracy.In the best strategy,most of the scores were more than 0.93,and all AUCs were more than 0.98.

Flash X-ray radiography technique to study the high velocity impact of soft projectile on E-glass/epoxy composite material

In the present paper, the high velocity impact of 9 mm soft lead projectile on 10 mm and 30 mm thick Eglass/epoxy composites was studied using a 450 kV Flash X-ray radiography(FXR) system. The basic parameters of FXR imaging, such as effect of ratio of target to film(TF) and source to target(ST) distances and X-ray penetration thickness of the composite material were optimized based on clarity and the actual dimensions of the objects. The optimized parameters were used in the FXR imaging of the ballistic event of 9 mm soft projectile on E-glass/epoxy composite. The real time deformation patterns of both the projectile and composite target during the ballistic impact were captured and studied at different time intervals. The notable failure modes of the 10 mm thick target with time include fibre breakage, bulging on the back side, delamination, recovery of the bulging, reverse bulging and its recovery. However, with increase in thickness of the target to 30 mm the only failure mechanism observed is the breaking of fibres. The ballistic impact event was also numerically simulated using commercially available LS-DYNA software. The numerically simulated deformation patterns of the projectile and target at different time intervals are closely matching with the corresponding radiographic images.

Does shifting to professional emergency department staffing affect the decision for chest radiography?

BACKGROUND: The study aims to determine whether shifting to professional emergency department(ED) teams leads to a higher rate of radiologic workup.METHODS: We retrospectively analyzed a total of 2,000 patients presenting to the ED of a tertiary teaching hospital in two time periods: group 1(G1) comprised 1,000 consecutive patients enrolled from December 21, 2012 to January 5, 2013(all patients were examined by an internal medicine specialist);group 2(G2) comprised 1,000 consecutive patients enrolled from December 21, 2018 to January 3, 2019(all patients were examined by an emergency physician).RESULTS: The chest X-ray(CXR) was performed in 40.6% of all patients. There was no difference in the frequency of CXR(38.9% in G1 vs. 42.3% in G2, P=0.152). More CXRs were performed in G2 patients older than 65 years, in female patients older than 65 years, in patients presenting during the evening and night shifts or off-hours, in patients with a history of malignancy, in patients with gastrointestinal bleeding, and in patients with bradycardia, but fewer in patients presenting with arrhythmia. No difference in the rates of pathological CXR was found(47.3% in G1 vs. 52.2% in G2, P=0.186). Compared with G2, higher sensitivity and specificity were obtained for the binary logistic regression model predicting pathological findings in G1.CONCLUSIONS: Shifting to professional ED teams does not increase radiologic workup. By implementing deliberate usage of ultrasound, some self-governing procedures, case-oriented investigations, and center-specific recommendations, unnecessary radiologic workup can be avoided. Professional ED teams could lead to a higher standard of emergency care.

Low Energy Plasma Focus as an Intense X-ray Source for Radiography

Study on X-ray emission from a low energy (1.8 kJ) plasma focus devicepowered by a 9 μF capacitor bank, charged at 20 kV and giving peak discharge current of about 175kA by using a lead-inserted copper-tapered anode is reported. The X-ray yield in different energywindows is measured as a function of hydrogen filling pressure. The maximum yield in 4π-geometry isfound to be (27.3+-1.1) J and corresponding wall plug efficiency for X-ray generation is 1.52+-0.06%. X-ray emission, presumably due to bombarding activity of electrons in current sheath at theanode tip was dominant, which is confirmed by the pinhole images. The feasibility of the device asan intense X-ray source for radiography is demonstrated.

Chest radiography findings and hematological values: Early findings on COVID-19 patients from Turkey

Objective:To investigate the chest radiography findings,hematological values and the risk factors of the mortality of coronavirus disease 2019(COVID-19).Methods:Patients who were diagnosed with COVID-19 in a secondary-level state hospital in Turkey from March to April 2020 were included in the study.COVID-19 diagnosis was confirmed by reverse transcriptase-polymerase chain reaction.Initial routine blood tests and chest radiography findings were examined.The relationship between chest radiography findings and hematological values and risk factors of the mortality of COVID-19 were assessed.Results:In total,94 patients with confirmed COVID-19 diagnosis were included in the study.Among them,33 patients did not have lung involvement(RALE score of 0),and 42 had moderate lung involvement(RALE score of 1 to 4),and 19 had severe lung involvement(RALE score of 5 to 8).Patients with higher RALE scores were significantly elder(P=0.000)and had significantly lower lymphocyte count(P=0.032).Patients in need of intensive care had a lower mean number of platelets compared to patients who did not require intensive care(P=0.007).The receiver operating characteristic analysis revealed that RALE score(P=0.005),age(P=0.002),duration of symptoms(P=0.006),neutrophil-lymphocyte ratio(P=0.007),and lymphocyte percentage(P=0.012)were significantly associated with the risk of mortality.Conclusions:Patients with severe lung involvement have lower lymphocyte values and ratios.Age,RALE score,duration of symptoms,neutrophils/lymphocytes ratio,lymphocytes percentage are risk factors of mortality of COVID-19.