Thesis (MMed)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Background: The LODOX Statscan is a whole-body digital X-ray scanning device which was
adapted for medical usage. The LODOX has an established role in the field of Forensic Pathology
where it shows high sensitivity and specificity for the detection of skeletal pathology and foreign
bodies. The role of the scanner in the detection of soft tissue pathology in the lungs of adults has not
been reported and this study aims to review the radio-pathological correlation and the applicability of
LODOX as a viable screening tool in the detection of lung pathology in post mortem cases.
Methods: We prospectively reviewed cases which were referred for medico-legal autopsy between
November 2012 and March 2013 to the Tygerberg Forensic Pathology Service mortuary, Cape Town,
South Africa. All cases meeting the prescribed inclusion criteria underwent LODOX scanning as well
as macroscopic and microscopic evaluation of the lungs as permitted by the Inquests Act 58 of 1959.
The macroscopic and microscopic variables were considered the “gold standard” when compared with
the results of the LODOX. The sensitivity, specificity, positive and negative predictive values were
assessed.
Results: One hundred and fifty nine cases (159) were included in the study. The most common
radiographic patterns reported were the presence of ground glass opacities and consolidation. Overall,
low to moderate sensitivity of these LODOX patterns in the prediction of pneumonic microscopic
pathology (oedema, acute and chronic inflammation and features of diffuse alveolar damage) was
noted. These values were lower than that reported for pneumonia using conventional X-rays.
Additionally, these LODOX patterns have a high probability of representing oedema or
autolytic/decomposition change. Pneumothorax was the most common pleural pathology detected on
LODOX, but autopsy correlation could not be performed. Poor to no correlation was noted with the
variables of cavity, malignant tumour, and bronchiectasis, but the prevalence of these conditions in
our cohort was low. In general, LODOX predictions were better at excluding pathology which was
not present rather than confirming pathology which was present.
Conclusions: The LODOX offers excellent evidentiary value in the demonstration of a pneumothorax
but currently has limited value as a “stand alone” test in the field of Forensic Pathology. However the
continued use of the LODOX as an adjunct examination, as well as prospective study of its
applicability, is advised. / AFRIKAANSE OPSOMMING: Agtergrond: Die LODOX Statscan is ‘n heel-liggaam digitale X-straal skandeer apparaat wat
aangepas is vir mediese gebruik. Die LODOX het ‘n gevestigde rol in Geregtelike Patologie, waar dit
‘n hoë sensitiwiteit en spesifisiteit het in die opsporing van skeletale patologie en vreemde voorwerpe.
Die rol van die skandeerder in die opspoor van sagte weefsel patologie in die longe van volwassenes
is nog nie gerapporteer nie, en hierdie studie ondersoek die radio-patologiese korrelasie en
toepaslikheid van LODOX as ‘n doeltreffende siftingsmeganisme om long patologie op te spoor in
post-mortale gevalle.
Metode: Gevalle wat verwys is na die Tygerberg Geregtelike Patologie Diens lykshuis in Kaapstad,
Suid-Afrika vir medies-geregtelike outopsies tussen November 2012 en Maart 2013, is prospektief
geëvalueer. Alle gevalle wat die voorgeskrewe insluitingskriteria nagekom het, het LODOX
skandering asook makroskopiese en mikroskopiese ondersoek van die longe ondergaan, soos
toegelaat deur die Wet op Geregtelike Doodsondersoeke Nr 58 van 1959. Die makroskopiese en
mikroskopiese veranderlikes is beskou as die “goud standaard” in vergelyking met die resultate van
die LODOX. Die sensitiwiteit, spesifisiteit, positiewe en negatiewe voorspellingswaardes is
beoordeel.
Resultate: Eenhonderd-nege-en-vyftig gevalle (159) is ingesluit in die studie. Die algemeenste
radiografiese pattroon wat gerapporteer is, was die teenwoordigheid van gemaalde glas opasiteit en
konsolidasie. In geheel is lae to matige sensitiwiteit van hierdie LODOX beelde waargeneem in die
voorspelling van pneumoniese mikroskopiese patologie (edeem, akute en chroniese ontsteking, en
eienskappe van diffuse alveolêre skade). Hierdie waardes was laer as die wat gerapporteer is vir
pneumonie met konvensionele X-strale. Verder het hierdie LODOX beelde ‘n hoë waarskynlikheid
om edeem en/of outolise/ontbinding uit te beeld. Pneumotoraks was die algemeenste pleurale
patologie wat waargeneem is met die LODOX, maar outopsie korrelasie kon nie gedoen word nie.
Swak tot geen korrelasie is gemerk vir die veranderlikes kaviteit, maligne tumor en brongi-ektase,
maar die prevalensie van hierdie toestande in ons kohort was laag. Oor die algemeen was LODOX
voorspellings beter om patologie wat nie teenwoordig is nie, uit te skakel, eerder as om patologie wat
teenwoordig is, te bevestig.
Gevolgtrekking: The LODOX is ‘n uitstekende bewysstuk in die aantoon van ‘n pneumotoraks, maar
huidiglik het dit beperkte waarde as onafhanklike toets in die veld van Geregtelike Patologie.
Desnieteenstaande word die verdere gebruik van LODOX as bydraende ondersoek, sowel as die
prospektiewe studie van sy toepaslikheid aanbeveel.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/96682 |
| Date | 04 1900 |
| Creators | Quarrie, Karisha Claudia |
| Contributors | Burger, Elsie Helena, Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Pathology. Forensic Medicine. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | English |
| Type | Thesis |
| Format | xii, 59 pages |
| Rights | Stellenbosch University |
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