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Table 3 Chest X-ray interpretation (WHO 2001)

From: Assessment of severe malaria in a multicenter, phase III, RTS, S/AS01 malaria candidate vaccine trial: case definition, standardization of data collection and patient care

Classification of quality of chest x-rays

Quality X-ray parameters

Classification of quality of chest x-rays (enter result in CRF)

• ID on the right side

• Position: clavicles and ribs symmetric on each side of the spine

• Boundaries: rib cage and costophrenics angles seen

• Inspiration: dome of the diaphragm is below the anterior tip of the 6th right rib

• Movement: heart, diaphragm, central vessels and ribs sharply defined, without blurring

• Exposure: vascular shadows can be seen in lung periphery, thoracic vertebrae and large lower lobe vessels visible through cardiac silhouette

• Contrast: background outside patient's silhouette is black. Bones and airway easily distinguished from soft tissue

• Uninterpretable: if the features of the image are not interpretable without additional images. No further reading should be made for such images

• Suboptimal: if the features allow interpretation of primary endpoint but not of other infiltrates or findings. No entries should be made for other infiltrates for such images

• Adequate: if the features allow confident interpretation of endpoint as well as other infiltrates

Classification of findings of chest x-rays

• Consolidation or pleural effusion :

   ▪ where consolidation is defined as a dense opacity that may be a fluffy consolidation of a portion or whole of a lobe or of the entire lung, often containing air bronchograms*

   ▪ where pleural effusion is defined if it occurs in the lateral pleural space (and not just in the minor or oblique fissure) and is spatially associated with a pulmonary parenchymal infiltrate (including other infiltrate) or if the effusion obliterates enough of the hemithorax to obscure an opacity

* atelectasis of an entire lobe that produces a dense opacity and a positive silhouette sign with the mediastinal border will be considered to be an endpoint consolidation

• Other infiltrate linear and patchy densities (interstitial infiltrate) in a lacy pattern involving both lungs, featuring peribronchial thickening and multiple areas of atelectasis. Lung inflation is normal to increased. It also includes minor patchy infiltrates that are not of sufficient magnitude to constitute primary end-point consolidation, and small areas of atelectasis which in children can be difficult to distinguish from consolidation.

• No consolidation, infiltrate or effusion