Embracing Remote Academic Radiologists.

Over the past two years at our large academic center, we successfully developed a formal remote academic radiologist division - composed of permanent fully remote radiologists across multiple subspecialties, living geographically distant from our institution. In this article, we share our experience implementing a remote radiologist division, review the benefits and challenges of this approach, discuss expectations of academic remote radiologists as clinicians, educators, and scholars, and provide tips for success.

A case report of COVID-19 in an asymptomatic patient with newly diagnosed breast cancer.

COVID-19 can be especially dangerous in vulnerable populations such as those with cancer undergoing treatment. When it is discovered in an asymptomatic patient through imaging, there is a paucity of evidence-based treatment recommendations.

CT pulmonary angiography of adult pulmonary vascular diseases: Technical considerations and interpretive pitfalls.

Computed tomography pulmonary angiography (CTPA) has become the primary imaging modality for evaluating the pulmonary arteries. Although pulmonary embolism is the primary indication for CTPA, various pulmonary vascular abnormalities can be detected in adults. Knowledge of these disease entities and understanding technical pitfalls that can occur when performing CTPA are essential to enable accurate diagnosis and allow timely management. This review will cover a spectrum of acquired abnormalities including pulmonary embolism due to thrombus and foreign bodies, primary and metastatic tumor involving the pulmonary arteries, pulmonary hypertension, as well as pulmonary artery aneurysms and stenoses. Additionally, methods to overcome technical pitfalls and interventional treatment options will be addressed.

Emphysema predicts hospitalisation and incident airflow obstruction among older smokers: a prospective cohort study.

BACKGROUND: Emphysema on CT is common in older smokers. We hypothesised that emphysema on CT predicts acute episodes of care for chronic lower respiratory disease among older smokers. MATERIALS AND METHODS: Participants in a lung cancer screening study age ≥ 60 years were recruited into a prospective cohort study in 2001-02. Two radiologists independently visually assessed the severity of emphysema as absent, mild, moderate or severe. Percent emphysema was defined as the proportion of voxels ≤ -910 Hounsfield Units. Participants completed a median of 5 visits over a median of 6 years of follow-up. The primary outcome was hospitalization, emergency room or urgent office visit for chronic lower respiratory disease. Spirometry was performed following ATS/ERS guidelines. Airflow obstruction was defined as FEV1/FVC ratio <0.70 and FEV1<80% predicted. RESULTS: Of 521 participants, 4% had moderate or severe emphysema, which was associated with acute episodes of care (rate ratio 1.89; 95% CI: 1.01-3.52) adjusting for age, sex and race/ethnicity, as was percent emphysema, with similar associations for hospitalisation. Emphysema on visual assessment also predicted incident airflow obstruction (HR 5.14; 95% CI 2.19-21.1). CONCLUSION: Visually assessed emphysema and percent emphysema on CT predicted acute episodes of care for chronic lower respiratory disease, with the former predicting incident airflow obstruction among older smokers.

A case of colorectal cancer with metastasis to the chest wall and subsequent hematoma formation.

We report a rare case of a patient with colorectal cancer with chest wall metastases. The development of bleeding at the site of the metastasis ultimately resulted in the development of a hematoma, necessitating resection of the tumor along with part of the chest wall. Literature on chest wall metastases of colonic adenocarcinoma is reviewed and discussed. The teaching point is that a chest wall mass seen on imaging should prompt consideration of metastatic cancer in the differential diagnosis. The colon is a rare though reported primary site.

Lung pathologic findings in a local residential and working community exposed to World Trade Center dust, gas, and fumes.

OBJECTIVE: To describe pathologic findings in symptomatic World Trade Center-exposed local workers, residents, and cleanup workers enrolled in a treatment program. METHODS: Twelve patients underwent surgical lung biopsy for suspected interstitial lung disease (group 1, n = 6) or abnormal pulmonary function tests (group 2, n = 6). High-resolution computed axial tomography and pathologic findings were coded. Scanning electron microscopy with energy-dispersive x-ray spectroscopy was performed. RESULTS: High-resolution computed axial tomography showed reticular findings (group 1) or normal or airway-related findings (group 2). Pulmonary function tests were predominantly restrictive. Interstitial fibrosis, emphysematous change, and small airway abnormalities were seen. All cases had opaque and birefringent particles within macrophages, and examined particles contained silica, aluminum silicates, titanium dioxide, talc, and metals. CONCLUSIONS: In symptomatic World Trade Center-exposed individuals, pathologic findings suggest a common exposure resulting in alveolar loss and a diverse response to injury.

Adenocarcinoma of the lung: current concepts in radiologic diagnosis and management.

PURPOSE OF REVIEW: Since the introduction especially of multidetector computed tomography scanners, detection of peripheral pulmonary nodules as small as 2-3 mm is now a frequent event even in individuals without a significant smoking history. This preponderance of small indeterminate nodules has necessitated reconsideration of the natural history of malignant lung tumors, in particular peripheral adenocarcinomas, as well as current clinical and radiologic guidelines to aid in the management of these lesions. RECENT FINDINGS: New information within the radiologic, pathologic and surgical literature is currently redefining nodule characterization. Most important has been the growing awareness of the prevalence of 'so-called' sub-solid pulmonary nodules, with important implications for revising our understanding of the natural history of these lesions as it impacts guidelines for nodule management. SUMMARY: Reassessment of our approach to small pulmonary nodules, while controversial, is now requisite as newer insights into the computed tomography appearance and natural history of small adenocarcinomas of the lung become apparent. Recognition of suspicious morphology and accurate measurements of volume doubling time, in particular, should aid in the management of these lesions.

Clinical predictors of metastatic disease to the brain from non-small cell lung carcinoma: primary tumor size, cell type, and lymph node metastases.

PURPOSE: To retrospectively assess possible clinical predictors of metastatic disease to the brain in patients with non-small cell lung carcinoma (NSCLC). MATERIALS AND METHODS: Institutional review board approval was obtained, informed consent was waived, and data and other information were obtained prior to implementation of HIPAA. A review was performed of 264 patients (mean age, 65 years; 158 men and 106 women) with NSCLC who had undergone imaging studies of the chest and head. Hierarchical logistic regression was used to determine the predicted probability of metastatic disease to the brain as a function of patient age and sex and of size, cell type, peripheral versus central location, and lymph node stage of the primary NSCLC. RESULTS: Ninety-five (36%) patients had evidence of metastatic disease to the brain. Mean diameter of the primary tumors was 4.0 cm +/- 2.2 (standard deviation). Cell types included adenocarcinoma (136 [52%] patients), undifferentiated (68 [26%] patients), and squamous (47 [18%] patients), for which metastatic disease to the brain occurred in 43%, 41%, and 13% (P = .003) of patients, respectively. The predicted probability of metastatic disease to the brain correlated positively with size of the primary tumor (P < .001), cell type (adenocarcinoma and undifferentiated vs squamous, P = .001), and lymph node stage (P < .017) but did not correlate with age, sex, or primary tumor location. For primary adenocarcinoma without lymph node spread, the predicted probabilities of metastatic disease to the brain from 2- and 6-cm primary tumors were .14 (95% confidence interval: .06, .27) and .72 (95% confidence interval: .48, .88), respectively (P < .02). CONCLUSION: The probability of metastatic disease to the brain from primary NSCLC is correlated with size of the primary tumor, cell type, and intrathoracic lymph node stage.

Missed non-small cell lung cancer: radiographic findings of potentially resectable lesions evident only in retrospect.

PURPOSE: To assess for change in the 1990s in the failure of detection at chest radiography of potentially resectable non-small cell lung cancer (NSCLC) lesions compared with experience in the previous decade. MATERIALS AND METHODS: From 1993 to 2001, an observational cohort was identified that consisted of 40 instances of NSCLC evident retrospectively at chest radiography but undetected by a radiologist at a time when the cancer was potentially resectable for cure. Sizes and locations of the tumors were assessed. Pearson chi(2) testing was performed to compare the sex distribution of lung cancer in the present series with population data for the sex distribution of lung cancer in the United States during the present study. RESULTS: Twenty-five (62%) undetected NSCLCs were in men and 15 (38%) were in women, yielding a ratio not significantly different from that for the sex distribution of NSCLC according to national data (chi(2) = 0.22, P =.64). Median patient age was 62 years (range, 37-87 years). Median diameter of the missed cancers was 1.9 cm. Missed cancers were most commonly located in the upper lobes (right, 45%; left, 28%; total, 72%), especially in the apical and posterior segments/subsegments (60% of all the missed cancers). A clavicle obscured 22% of the missed cancers. Eighty-five percent of the missed cancers were in peripheral locations. CONCLUSION: Potentially resectable NSCLC lesions missed at chest radiography were characterized by predominantly peripheral (85%) and upper lobe (72%) locations and by apical and posterior segmental/subsegmental locations in an upper lobe (60%). Distribution by sex of the missed cancers was comparable to national data for NSCLC. The missed cancers had a median diameter of 1.9 cm.