Background: In mechanically ventilated patients, Portable chest radiography (CXR) can provide important information for selecting the optimal therapeutic approach. This study aimed to determine the diagnostic and therapeutic efficacies of Portable recruited chest radiography with maximum inspiratory volume and pause in comparison with conventional Portable radiography. Materials and Methods: This diagnostic accuracy study was conducted on 75 mechanically ventilated patients admitted to the intensive care unit (ICU) of Imam Khomeini Hospital in Sari, Iran, during 2013-2015. For every patient, in addition to conventional Portable CXR, another CXR was performed with mechanical ventilator adjustments (tidal volume up to 10-12 ml/kg to maintain the inspiratory plateau pressure below 35 cmH2O and inspiratory time of 2-3 seconds). CXR was performed after 5-10 respiratory cycles, synchronized with the inspiratory pause. The radiographs were acquired using a Shimadzu Portable radiography system in the anteroposterior supine position and randomly presented to two radiologists for reporting. Results: The mean age of the patients was 63. 5± 14 years. Overall, 43 (57. 3%) patients were male, and 32 (42. 7%) were female. Therapeutic interventions were performed for only 8% of cases with conventional CXR versus 21. 3% of cases with recruited CXR; the difference was found to be statistically significant (P<0. 05). The diagnostic efficacy of Portable recruited CXR versus conventional Portable CXR was 45% versus 18. 6%. Also, the therapeutic efficacy of Portable recruited CXR versus conventional Portable CXR was 21. 3% versus 8%. Conclusion: Portable recruited CXR seems to be a valuable diagnostic approach for clinical decision-making, with higher diagnostic and therapeutic efficacies in mechanically ventilated patients.

Background: chest X-ray (CXR) is known as the most common radiography used for adult and pediatric patients worldwide. Improper X-ray field collimation can result in excessive radiation dose on non-thoracic organs in chest radiographs. Objectives: This study was to investigate X-ray field collimation quality in neonatal chest radiography. Methods: A total of 213 chest radiographs of neonates from three hospitals were analyzed for collimation quality assessment in a retrospective study. Accordingly, ideal imaging field (IIF) and current imaging field (CIF) were initially defined. The margins of the IIF included acromioclavicular (AC) level to lower costal margin (i. e. top to bottom) and one centimeter beyond the broadest area of the chest on each side (that is, right to left). The CIF size was also defined as the square borders of collimators. Results: The findings revealed that the area of the CIF was 1. 65 ,0. 39 times to the ideal imaging firlddd (IIF) for three hospitals, suggesting that collimation quality in neonatal chest radiographs was not accurate and it had defects. According to the results, acceptable collimation percentage (36. 6%) in Hospital A was more than that in two other centers, and the given center also provided the lowest radiation due to the exposure of non-thoracic structures to primary beams. Conclusions: It was concluded that training radiographers and using patient immobilization devices and stabilizers were important points that could reduce radiation exposure to non-thoracic organs in pediatric CXR.

I read, with interest, the article entitled "Clinical and Para-clinical Presentations of Endobronchial Tuberculosis" by Ahmadi Hoseini H. S. et al. (1) published in this journal. I would like to focus on some details about the chest X-ray of patients as elaborated by the authors in the results section.

Atelectasis after endobronchial intubation (ETT) is a known complication of general anesthesia. In-bed auscultation of lungs and use of the 21/23 rule are the two suggestive, but not reliable, methods for the early detection of this event,however, none of them guarantees its prevention. The Portable chest 1 radiograph (CXR) is a simple, quick method to detect atelectasis and proper placement of the endotracheal tube in the intensive care unit (ICU). A case of postsurgical, ICU-admitted patient was presented in the report, demonstrating left (LT) lung atelectasis in immediate Portable CXR without any evidence of respiratory or hemodynamic abnormality. Portable CXR showed that the tip of the endotracheal tube was located in the lumen of the right main bronchus, leading to LT lung total atelectasis. After repositioning of ETT to the lumen of the trachea, atelectasis was disappeared in early follow-up CXR.