Image guided lung biopsy.

Image guided lung biopsy is vital in the evaluation of pulmonary abnormalities. Various modalities can be used including Ultrasound, Computed Tomography and Navigational Bronchoscopy. In this paper, we review the indications, techniques, diagnostic accuracy and complications of image guided biopsies and the role of novel techniques such as navigational and robot-assisted bronchoscopy.

Percutaneous image-guided thermal ablation of lung cancer: What is the evidence?

Thermal ablation techniques have now been used for more than twenty years in the treatment of primary lung tumours, predominantly non-small cell lung cancer (NSCLC). Although primarily used for the treatment of early-stage disease in non-surgical patients, thermal ablation is now also being used in selected patients with oligometastatic and oligoprogressive disease. This review discusses the techniques available for thermal ablation, the evidence for use of thermal ablation in primary lung tumours in early- and advanced-stage disease and compares thermal ablation to alternative treatment strategies.

Imaging the Abdominal Manifestations of Cystic Fibrosis.

Cystic fibrosis (CF) is a multisystem disease with a range of abdominal manifestations including those involving the liver, pancreas, and kidneys. Recent advances in management of the respiratory complications of the disease has led to a greater life expectancy in patients with CF. Subsequently, there is increasing focus on the impact of abdominal disease on quality of life and survival. Liver cirrhosis is the most important extrapulmonary cause of death in CF, yet significant challenges remain in the diagnosis of CF related liver disease. The capacity to predict those patients at risk of developing cirrhosis remains a significant challenge. We review representative abdominal imaging findings in patients with CF selected from the records of two academic health centres, with a view to increasing familiarity with the abdominal manifestations of the disease. We review their presentation and expected imaging findings, with a focus on the challenges facing diagnosis of the hepatic manifestations of the disease. An increased familiarity with these abdominal manifestations will facilitate timely diagnosis and management, which is paramount to further improving outcomes for patients with cystic fibrosis.

Contrast monitoring techniques in CT pulmonary angiography: An important and underappreciated contributor to breast dose.

OBJECTIVE: The aims of our study were to evaluate the contribution of contrast-monitoring techniques to breast dose in pregnant and non-pregnant women, and to investigate the effect of a reduced peak kilovoltage (kV) monitoring scan protocol on breast dose and Computed Tomography Pulmonary Angiography (CTPA) diagnostic quality. MATERIALS AND METHODS: Single center retrospective study of 221 female patients undergoing a reduced kV 80kV contrast-monitoring CTPA protocol compared to 281 patients using the conventional 120kV contrast-monitoring protocol (Siemens Somatom Definition AS+). 99 pregnant patients analyzed separately. ImPACT dosimetry software was used to calculate dose. Group subsets were evaluated to assess CTPA diagnostic quality. RESULTS: The contrast-monitoring component of a CTPA study constituted 27% of the overall breast dose when using a standard 120kV protocol compared to only 7% of the overall breast dose in the 80kV study group. The dose to the breast from the contrast-monitoring component alone was reduced by 79% in the non-pregnant patients (0.36mGy±0.37 versus 1.7mGy±1.02; p<0.001), and by 88% in the pregnant population (0.25mGy±0.67 versus 2.24mGy±1.61; p<0.001). There was no statistical difference in CTPA diagnostic quality or timing. CONCLUSION: Despite a short scan length and relatively small DLP, contrast-monitoring techniques (test-bolus or bolus-tracked) set at 120kV can account for 27% of the overall breast dose accrued from a CTPA study. By decreasing the kilovoltage of the contrast-monitoring component, a significant reduction in breast dose for pregnant and non-pregnant female patients can be achieved without affecting CTPA quality or timing.

CT colonography and transient bacteraemia: implications for antibiotic prophylaxis.

OBJECTIVES: To determine the prevalence of transient bacteraemia after CT colonography (CTC). METHODS: Blood cultures were obtained at 5, 10 and 15 min after CTC from 100 consecutive consenting patients. Blood samples were cultured in both aerobic and anaerobic media and positive blood culture samples were analysed by a microbiologist. RESULTS: Blood culture samples were positive for growth in sixteen patients. All positive blood culture samples were confirmed skin contaminants. There were no cases of significant bacteraemia. The estimated significant bacteraemia rate as a result of CTC is 0-3.7%, based on 95% confidence intervals around extreme results using Wilson's score method. CONCLUSIONS: American Heart Association and National Institute for Clinical Excellence guidelines advise that antibiotic prophylaxis before lower gastrointestinal endoscopy is not indicated in patients with at risk cardiac lesions (ARCL) as the risk of a transient bacteraemia leading to infective endocarditis is low. These data show that the prevalence of transient bacteraemia after CTC is also low. It follows that patients with ARCL do not require antibiotic prophylaxis before CTC.

Imaging in patients with a first seizure.

Neuroimaging has important applications in the diagnosis and treatment of patients with seizures and epilepsy and can contribute to the proper classification of certain epileptic disorders. When a patient presents to the Accident and Emergency Department with a first seizure, the clinician may request brain imaging to determine the cause of the seizure. In new onset seizures or epilepsy with suspected focal pathology, computed tomography (CT) of the brain should be performed if the patient has not fully recovered or if magnetic resonance imaging (MRI) is not available within a reasonable time period. Otherwise, it is reasonable to forego CT and perform MRI. This report emphasises the need for appropriate imaging for accurate diagnosis of suspected new-onset partial epilepsy.