Evidence map›Paper›PMID 39881037›Full record

Trial reportEuropean radiology2025

Diagnostic accuracy of ultra-low-dose chest CT vs chest X-ray for acute non-traumatic pulmonary diseases.

Maadrika M N P Kanglie, Inge A H van den Berk, Tjitske S R van Engelen, Shandra Bipat, Patrick M M Bossuyt, Jan M Prins, Jaap Stoker, OPTIMACT study group

Abstract readComparative StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in European radiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors.

Maadrika M N P KanglieDepartment of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. m.m.kanglie@amsterdamumc.nl.ORCID http://orcid.org/0000-0001-6786-5859
Inge A H van den BerkDepartment of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Tjitske S R van EngelenDivision of Infectious Diseases, Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Shandra BipatDepartment of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Patrick M M BossuytDepartment of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Jan M PrinsDivision of Infectious Diseases, Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Jaap StokerDepartment of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
OPTIMACT study group

Funding

ZonMw 843001806
6 · The paper itself

Abstract

objectivesTo compare the diagnostic accuracy of ULDCT to CXR for detecting non-traumatic pulmonary diseases at the emergency department (ED) and to study diagnostic confidence levels.

methodsSecondary analysis of the prospective OPTIMACT trial (2418 ED participants randomly allocated to ULDCT or CXR). Diagnoses at imaging at the ED were compared to the reference diagnosis on day 28. Ratios of positive diagnoses, true positives (TP), false positives (FP), false negatives (FN), and positive predictive values (PPV) were assessed with 95% confidence intervals (CI). The diagnostic confidence levels of the radiologists were studied.

resultsOne thousand one hundred sixty-one ULDCT participants (mean age, 59 years ± 18 [standard deviation], 587 female) and 1151 CXR participants (mean age, 59 years ± 18 [standard deviation], 561 female) were evaluated. With ULDCT, pneumonia was 1.55 times (95% CI: 1.33-1.80) more often diagnosed at imaging at the ED, with significantly more TP (ratio 1.50; 95% CI: 1.26-1.76) and fewer FN (0.61; 95% CI: 0.37-0.99) but more FP (1.75; 95% CI: 1.19-2.58); a similar pattern was observed for other lower respiratory tract infections (LRTI). Pulmonary congestion was less often observed with ULDCT (0.45; 95% CI: 0.34-0.61), with fewer TP (0.50; 95% CI: 0.34-0.73), and FP (0.40; 95% CI: 0.24-0.65). PPVs were not significantly different. With ULDCT, radiologists were more often certain in diagnosing pneumonia (ULDCT 121/324, 37% vs CXR 48/208, 23%), LRTI (84/192, 44% vs 18/63, 29%), and no established disease (350/382, 92% vs 447/544, 82%).

conclusionCompared to CXR, ULDCT led to more TP but also more FP in detecting pneumonia and LRTI, while fewer TP and FP were found for pulmonary congestion. PPVs were comparable. KEY POINTS: Question Is ultra-low dose CT (ULDCT) more accurate than chest X-ray (CXR) for identifying non-traumatic pulmonary diseases in patients presenting at the ED? Findings ULDCT detects more pulmonary infections in patients presenting at the ED with non-traumatic pulmonary complaints, while CXR detects more pulmonary congestion. Clinical relevance ULDCT is superior to CXR in detecting pneumonia and other LRTI in ED patients, while CXR is superior in detecting pulmonary congestion. ULDCT can be an alternative for CXR in a selected group of patients.

Indexed as

Lung DiseasesRadiography, ThoracicTomography, X-Ray ComputedAcute DiseaseAdultAgedEmergency Service, HospitalFemaleHumansMaleMiddle AgedProspective StudiesRadiation DosageReproducibility of ResultsSensitivity and SpecificityEmergency service (hospital)PneumoniaRespiratory tract infectionsThoracic diseasesTomography (X-ray computed)

Identifiers

PMID39881037

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.