A simple method for identifying image orientation of chest radiographs by use of the center of gravity of the image

Bedside chest radiography is a frequent X-ray examination when patients are physically incapacitated. An X-ray cassette with an imaging plate is inserted below the patient’s body, and the image orientation of the radiograph is determined by the direction of insertion. Therefore, an incorrect direction of insertion would yield an incorrect image orientation for diagnosis, if no correction was performed on the resulting image data. We aimed to develop a computerized method that identifies the image orientation of chest radiographs by using the center of gravity (COG) of the images in terms of pixel values. To develop the computerized method, we used 247 chest images contained in the Japanese Society of Radiological Technology database as training cases, and 1833 bedside chest radiographs obtained in our institution for validation testing. As a result for the 247 training images, the angles which were obtained from directions between the COG of pixel values and the center of the image were distributed between 162.7° and 224.4° in a clockwise direction. We used the angle of the COG to identify the correct view orientation. The range of angles (139.1°–229.0°) for the COG in the chest image with correct image orientation was determined with a 99 % confidence interval for the angles of the COGs obtained from the training images. As a result of the validation test based on the range of angles determined, 99.7 % of the 1833 test images were identified correctly.