Medical imaging utilization in migrants compared with nonmigrants in a universal healthcare system: A population-based matched cohort study.

BACKGROUND: Medical imaging is an integral part of healthcare. Globalization has resulted in increased mobilization of migrants to new host nations. The association between migration status and utilization of medical imaging is unknown. METHODS AND FINDINGS: A retrospective population-based matched cohort study was conducted in Ontario, Canada from April 1, 1995 to December 31, 2016. A total of 1,848,222 migrants were matched 1:1 to nonmigrants in the year of migration on age, sex, and geography. Utilization of computed tomography (CT), magnetic resonance imaging (MRI), radiography, and ultrasonography was determined. Rate differences per 1,000 person-years comparing migrants to nonmigrants were calculated. Relative rates were calculated using a recurrent event framework, adjusting for age, sex, and time-varying socioeconomic status, comorbidity score, and access to a primary care provider. Estimates were stratified by migration age: children and adolescents (≤19 years), young adults (20 to 39), adults (40 to 59), and older adults (≥60). Utilization rates of CT, MRI, and radiography were lower for migrants across all age groups compared with Ontario nonmigrants. Increasing age at migration was associated with larger differences in utilization rates. Older adult migrants had the largest gap in imaging utilization. The longer the time since migration, the larger the gap in medical imaging use. In multivariable analysis, the relative rate of imaging was approximately 20% to 30% lower for migrants: ranging from 0.77 to 0.88 for CT and 0.72 to 0.80 for MRI imaging across age groups. Radiography relative rates ranged from 0.84 to 0.90. All migrant age groups, except older adults, had higher rates of ultrasonography. The indication for imaging was not captured, thus it was not possible to determine if the imaging was necessary. CONCLUSIONS: Migrants utilized less CT, MRI, and radiography but more ultrasonography. Older adult migrants used the least amount of imaging compared with nonmigrants. Future research should evaluate whether lower utilization is due to barriers in healthcare access or health-seeking behaviors within a universal healthcare system.

Trends in CT examination utilization in the emergency department during and after the COVID-19 pandemic.

BACKGROUND: The increasing use of CT imaging in emergency departments, despite efforts of reducing low-value imaging, is not fully understood, especially during and after the COVID-19 pandemic. The aim of this study was to investigate the impact of COVID-19 pandemic related measures on trends and volume in CT examinations requested in the emergency department. METHODS: CT examinations of the head, chest, and/or abdomen-pelvis (n = 161,008), and chest radiographs (n = 113,240) performed at our tertiary care hospital between 01/2014 and 12/2023 were retrospectively analyzed. CT examinations (head, chest, abdomen, dual-region and polytrauma) and chest radiographs requested by the emergency department during (03/2020-03/2022) and after the COVID-19 pandemic (04/2022-12/2023) were compared to a pre-pandemic control period (02/2018-02/2020). Analyses included CT examinations per emergency department visit, and prediction models based on pre-pandemic trends and inpatient data. A regular expressions text search algorithm determined the most common clinical questions. RESULTS: The usage of dual-region and chest CT examinations were higher during (+ 116,4% and + 115.8%, respectively; p < .001) and after the COVID-19 pandemic (+ 88,4% and + 70.7%, respectively; p < .001), compared to the control period. Chest radiograph usage decreased (-54.1% and - 36.4%, respectively; p < .001). The post-pandemic overall CT examination rate per emergency department visit increased by 4.7%. The prediction model underestimated (p < .001) the growth (dual-region CT: 22.3%, chest CT: 26.7%, chest radiographs: -30.4%), and the rise (p < .001) was higher compared to inpatient data (dual-region CT: 54.8%, chest CT: 52.0%, CR: -32.3%). Post-pandemic, the number of clinical questions to rule out "pulmonary infiltrates", "abdominal pain" and "infection focus" increased up to 235.7% compared to the control period. CONCLUSIONS: Following the COVID-19 pandemic, chest CT and dual-region CT usage in the emergency department experienced a disproportionate and sustained surge compared to pre-pandemic growth.

Effects of low dose computed tomography (LDCT) on lung cancer screening on incidence and mortality in regions with high tuberculosis prevalence: A systematic review.

BACKGROUND: Lung cancer screening (LCS) using low-dose computed tomography (LDCT) is a strategy for early-stage diagnosis. The implementation of LDCT screening in countries with a high prevalence/incidence of tuberculosis (TB) is controversial. This systematic review and meta-analysis aim to identify whether LCS using LDCT increases early-stage diagnosis and decreases mortality, as well as the false-positive rate, in regions with a high prevalence of TB. METHODS/DESIGN: Studies were identified by searching BVS, PUBMED, EMBASE, and SCOPUS. RCT and cohort studies (CS) that show the effects of LDCT in LC screening on mortality and secondary outcomes were eligible. Two independent reviewers evaluated eligibility and a third judged disagreements. We used the Systematic Review Data Repository (SRDR+) to extract the metadata and record decisions. The analyses were stratified by study design and incidence of TB. We used the Cochrane "Risk of bias" assessment tool. RESULTS: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) were used. Thirty-seven papers were included, referring to 22 studies (10 RCTs and 12 cohorts). Few studies were from regions with a high incidence of TB (One RCT and four cohorts). Nonetheless, the evidence is compatible with European and USA studies. RCTs and CS also had consistent results. There is an increase in early-stage (I-II) diagnoses and reduced LC mortality in the LCDT arm compared to the control. Although false-positive rates varied, they stayed within the 20 to 30% range. DISCUSSION: This is the first meta-analysis of LDCT for LCS focused on its benefits in regions with an increased incidence/prevalence of TB. Although the specificity of Lung-RADS was higher in participants without TB sequelae than in those with TB sequelae, our findings point out that the difference does not invalidate implementing LDCT LCS in these regions. TRIAL REGISTRATION: Systematic review registration Systematic review registration PROSPERO CRD42022309581.

Using Natural Language Processing (GPT-4) for Computed Tomography Image Analysis of Cerebral Hemorrhages in Radiology: Retrospective Analysis.

BACKGROUND: Cerebral hemorrhage is a critical medical condition that necessitates a rapid and precise diagnosis for timely medical intervention, including emergency operation. Computed tomography (CT) is essential for identifying cerebral hemorrhage, but its effectiveness is limited by the availability of experienced radiologists, especially in resource-constrained regions or when shorthanded during holidays or at night. Despite advancements in artificial intelligence-driven diagnostic tools, most require technical expertise. This poses a challenge for widespread adoption in radiological imaging. The introduction of advanced natural language processing (NLP) models such as GPT-4, which can annotate and analyze images without extensive algorithmic training, offers a potential solution. OBJECTIVE: This study investigates GPT-4's capability to identify and annotate cerebral hemorrhages in cranial CT scans. It represents a novel application of NLP models in radiological imaging. METHODS: In this retrospective analysis, we collected 208 CT scans with 6 types of cerebral hemorrhages at Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, between January and September 2023. All CT images were mixed together and sequentially numbered, so each CT image had its own corresponding number. A random sequence from 1 to 208 was generated, and all CT images were inputted into GPT-4 for analysis in the order of the random sequence. The outputs were subsequently examined using Photoshop and evaluated by experienced radiologists on a 4-point scale to assess identification completeness, accuracy, and success. RESULTS: The overall identification completeness percentage for the 6 types of cerebral hemorrhages was 72.6% (SD 18.6%). Specifically, GPT-4 achieved higher identification completeness in epidural and intraparenchymal hemorrhages (89.0%, SD 19.1% and 86.9%, SD 17.7%, respectively), yet its identification completeness percentage in chronic subdural hemorrhages was very low (37.3%, SD 37.5%). The misidentification percentages for complex hemorrhages (54.0%, SD 28.0%), epidural hemorrhages (50.2%, SD 22.7%), and subarachnoid hemorrhages (50.5%, SD 29.2%) were relatively high, whereas they were relatively low for acute subdural hemorrhages (32.6%, SD 26.3%), chronic subdural hemorrhages (40.3%, SD 27.2%), and intraparenchymal hemorrhages (26.2%, SD 23.8%). The identification completeness percentages in both massive and minor bleeding showed no significant difference (P=.06). However, the misidentification percentage in recognizing massive bleeding was significantly lower than that for minor bleeding (P=.04). The identification completeness percentages and misidentification percentages for cerebral hemorrhages at different locations showed no significant differences (all P>.05). Lastly, radiologists showed relative acceptance regarding identification completeness (3.60, SD 0.54), accuracy (3.30, SD 0.65), and success (3.38, SD 0.64). CONCLUSIONS: GPT-4, a standout among NLP models, exhibits both promising capabilities and certain limitations in the realm of radiological imaging, particularly when it comes to identifying cerebral hemorrhages in CT scans. This opens up new directions and insights for the future development of NLP models in radiology. TRIAL REGISTRATION: ClinicalTrials.gov NCT06230419; https://clinicaltrials.gov/study/NCT06230419.

Public Heterogeneous Preferences for Low-Dose Computed Tomography Lung Cancer Screening Service Delivery in Western China: A Discrete Choice Experiment.

BACKGROUND: Lung cancer screening (LCS) with low-dose computed tomography (LDCT) is an efficient method that can reduce lung cancer mortality in high-risk individuals. However, few studies have attempted to measure the preferences for LDCT LCS service delivery. This study aimed to generate quantitative information on the Chinese population's preferences for LDCT LCS service delivery. METHODS: The general population aged 40 to 74 in the Sichuan province of China was invited to complete an online discrete choice experiment (DCE). The DCE required participants to answer 14 discrete choice questions comprising five attributes: facility levels, facility ownership, travel mode, travel time, and out-of-pocket cost. Choice data were analyzed using mixed logit and latent class logit (LCL) models. RESULTS: The study included 2529 respondents, with 746 (29.5%) identified as being at risk for lung cancer. Mixed logit model (MLM) analysis revealed that all five attributes significantly influenced respondents' choices. Facility levels had the highest relative importance (44.4%), followed by facility ownership (28.1%), while out-of-pocket cost had the lowest importance (6.4%). The at-risk group placed relatively more importance on price and facility ownership compared to the non-risk group. LCL model identified five distinct classes with varying preferences. CONCLUSION: This study revealed significant heterogeneity in preferences for LCS service attributes among the Chinese population, with facility level and facility ownership being the most important factors. The findings underscore the need for tailored strategies targeting different subgroup preferences to increase screening participation rates and improve early detection outcomes.

[CT-scan in the emergency department : the right indications, the right timing]. / CT-scan aux urgences : la bonne indication, au bon moment.

A general increase in the use of CT-scans was observed during the last decade, in part due to its ease of access but also due to the increasing precision of this exam in establishing a diagnosis. This is particularly true in emergency departments where the increase in the number of CT-scan prescribed may impact patient's flow. A reminder of the recommendations for prescribing CT-scans and the time required to obtain them for the most frequently encountered pathologies could help to better target patients who are most likely to benefit from this examination and reduce the consequences of its over-use (radiation, increased costs, timing).

Depuis plusieurs années, nous notons une augmentation du recours au CT-scan comme outil diagnostique, grâce à sa grande accessibilité et à l'augmentation de sa précision. Ceci est particulièrement vrai dans les services d'urgences où l'augmentation de son utilisation peut impacter le flux des patients. Cet article se veut un rappel des recommandations de prescription et des délais recommandés d'obtention des CT-scan pour les pathologies les plus fréquemment rencontrées, afin de mieux cibler les patient-e-s qui devraient en bénéficier, et de réduire les conséquences de sa surutilisation (irradiation, augmentation des coûts, délais).

Rates of Concurrent Computed Tomography Imaging Following Ultrasound for Pediatric Patients With Appendicitis.

INTRODUCTION: Imaging guidelines recommend an ultrasound (US)-first approach to evaluate appendicitis to minimize radiation. However, the association between US and computed tomography (CT) utilization remains unclear. We aimed to determine how increased US utilization correlated with the rate of CT evaluation of pediatric acute appendicitis. METHODS: We conducted a retrospective cohort study using the 2019 Nationwide Emergency Department Sample. Eligible patients were aged less than 18 y with a diagnosis of appendicitis. Imaging was determined by Current Procedural Terminology codes. Concurrent imaging was defined as US and CT use during the same encounter. We calculated the hospital rate of concurrent imaging and categorized hospitals into tertiles: low (< 20%), medium (20%-40%), and high (> 40%). We developed generalized ordinal logistic regression models with inverse probability weighting to assess patient characteristics and hospital rates of concurrent imaging associations. RESULTS: Our analysis included 485 hospitals and 23,976 patients. Thirty four percent were treated at hospitals in the lowest, 35% at the middle, and 31% at the highest tertile hospitals. We observed a negative correlation (-0.27, P < 0.001) between increasing US use and concurrent imaging use. The odds of presenting to a higher concurrent imaging rate hospital were significantly lower for Blacks (adjusted odds ratio [aOR] [95% confidence interval {CI}]: 0.6, [0.4-0.9]) and Hispanics (aOR [95% CI]: 0.7 [0.5-0.9]) in comparison to Whites. The odds of presenting to a higher concurrent imaging rate hospital were higher for patients in the second (aOR [95% CI]: 1.9 [1.2-3.2]) and lowest income quartile (aOR [95% CI]: 3.7 [1.1-13.1]) compared to the highest income quartile. CONCLUSIONS: Increased US use correlated with decreased CT utilization for diagnosing appendicitis. White children and those in lower socioeconomic neighborhoods are more likely to visit hospitals with high concurrent imaging use.

Retrospective Validation of Brain Injury Guidelines in a Rural Level II Trauma Center.

INTRODUCTION: The routine transfer of mild to moderate traumatic brain injuries (TBIs) to trauma centers with neurosurgical capabilities has recently been re-evaluated. The Brain Injury Guidelines (BIG) were developed to categorize TBI patients into three categories (BIG-1, BIG-2, and BIG-3), each representing a progressively increasing risk of clinical deterioration. This classification system has been previously validated at both level I and level III trauma centers. The authors hypothesized the population of their rural level II trauma center would further validate the BIG criteria. METHODS: Using the institutional trauma registry, a retrospective analysis was performed on all patients with isolated TBIs who presented to our rural level II trauma center from 2018 to 2022. Patients were categorized according to the previously validated BIG criteria. All head computed tomography (CT) imaging studies were reviewed by one neurosurgeon. Outcomes and adverse events were compared to previously published data. RESULTS: Four hundred fifty four patients were captured with our inquiry; 138 matched BIG-1 criteria, 51 matched BIG-2 criteria, and 263 matched BIG-3 criteria. Two patients in BIG-1 (6%) and two patients in BIG-2 (12.5%) showed progression of their bleed on CT. No patients in BIG-1 or BIG-2 groups, including those showing progression on repeat CT, required a neurosurgical intervention. CONCLUSIONS: Our results support the suppositions of the BIG authors who suggest patients categorized as BIG-1 or BIG-2 do not require repeat head CT scans, neurosurgery consultation, or transfer to a tertiary center.

Association of Prenatal Congenital Lung Malformation Volume Ratio to Postnatal Computed Tomography Characteristics.

INTRODUCTION: Congenital lung malformations (CLMs) are diverse and readily diagnosed on prenatal ultrasound. Postnatal computed tomography (CT) characteristics, including volume, are used in centers for the clinical decision-making of asymptomatic CLM. We aim to evaluate the relationship of prenatal CLM volume ratio (CVR) to postnatal CT characteristics by suspected prenatal diagnosis and postnatal radiological diagnosis. METHODS: We performed a single-center retrospective review of all patients evaluated with prenatally diagnosed CLM (May 2015-December 2022). Demographics, prenatal imaging findings at initial evaluation, and postnatal radiological diagnosis/imaging findings were analyzed with descriptive statistics. Pairwise correlation coefficient tests were performed to analyze the correlation between prenatal CVR and postnatal CT lesion size stratified by diagnosis. RESULTS: Of 123 patients referred and evaluated, suspected prenatal diagnoses consisted of 68 bronchial atresia (BA), 20 intralobar bronchopulmonary sequestration (iBPS), 20 extralobar bronchopulmonary sequestration (eBPS), and nine congenital pulmonary airway malformation (CPAM). Postnatal radiological diagnoses consisted of 53 BA, 22 iBPS, 14 eBPS, and 20 CPAM. Overall correlation coefficient of prenatal CVR to postnatal CT lesion size volume was 0.56. By suspected prenatal diagnosis, correlation coefficients were 0.61 (BA), 0.59 (iBPS), 0.29 (eBPS), and 0.51 (CPAM). For postnatal radiological diagnosis, correlation coefficients were 0.58 (BA), 0.56 (iBPS), 0.33 (eBPS), and 0.62 (CPAM). CONCLUSIONS: Our results indicate that initial CVR is overall consistent with the postnatal CT lesion size. This correlation is present in suspected prenatal diagnoses of BA and iBPS and postnatal radiological diagnoses of BA, iBPS, and CPAM. Additional studies analyzing long-term follow-up should be conducted to specify the safety of patients who undergo observation rather than surgical intervention.

Prediction-Augmented Shared Decision-Making and Lung Cancer Screening Uptake.

Importance: Addressing poor uptake of low-dose computed tomography lung cancer screening (LCS) is critical, especially for those having the most to gain-high-benefit persons with high lung cancer risk and life expectancy more than 10 years. Objective: To assess the association between LCS uptake and implementing a prediction-augmented shared decision-making (SDM) tool, which enables clinicians to identify persons predicted to be at high benefit and encourage LCS more strongly for these persons. Design, Setting, and Participants: Quality improvement interrupted time series study at 6 Veterans Affairs sites that used a standard set of clinical reminders to prompt primary care clinicians and screening coordinators to engage in SDM for LCS-eligible persons. Participants were persons without a history of LCS who met LCS eligibility criteria at the time (aged 55-80 years, smoked ≥30 pack-years, and current smoking or quit <15 years ago) and were not documented to be an inappropriate candidate for LCS by a clinician during October 2017 through September 2019. Data were analyzed from September to November 2023. Exposure: Decision support tool augmented by a prediction model that helps clinicians personalize SDM for LCS, tailoring the strength of screening encouragement according to predicted benefit. Main outcome and measure: LCS uptake. Results: In a cohort of 9904 individuals, the median (IQR) age was 64 (57-69) years; 9277 (94%) were male, 1537 (16%) were Black, 8159 (82%) were White, 5153 (52%) were predicted to be at intermediate (preference-sensitive) benefit and 4751 (48%) at high benefit, and 1084 (11%) received screening during the study period. Following implementation of the tool, higher rates of LCS uptake were observed overall along with an increase in benefit-based LCS uptake (higher screening uptake among persons anticipated to be at high benefit compared with those at intermediate benefit; primary analysis). Mean (SD) predicted probability of getting screened for a high-benefit person was 24.8% (15.5%) vs 15.8% (11.8%) for a person at intermediate benefit (mean absolute difference 9.0 percentage points; 95% CI, 1.6%-16.5%). Conclusions and Relevance: Implementing a robust approach to personalized LCS, which integrates SDM, and a decision support tool augmented by a prediction model, are associated with improved uptake of LCS and may be particularly important for those most likely to benefit. These findings are timely given the ongoing poor rates of LCS uptake.

The utility of axial imaging among selected patients in the early postoperative period after pancreatectomy.

BACKGROUND: Postoperative computed tomography imaging has been shown to play an important role in avoiding failure-to-rescue. We sought to examine the impact of the timing of such imaging studies on outcomes after pancreatectomy. METHODS: Patients who underwent pancreatic resection at our institution from 2017 to 2022 were reviewed retrospectively to identify those undergoing computed tomography for any indication before discharge. Patients were subdivided by the postoperative day that the first computed tomography scan was obtained: immediate (postoperative day <3), early (postoperative day 3-7), and delayed (postoperative day >7). RESULTS: Of 370 patients, 110 (30%) had a computed tomography during the initial surgical stay. The 3 timing groups were similar in age, comorbidities, pathology, operative time, and number of scans. When comparing the early with the delayed group, we found that antibiotic usage, percutaneous drainage, and overall invasive interventions during surgical stay were all similar. However, those patients who were scanned in the early period had significantly shorter length of stay (17.05 vs 22.82, P = .0008) and fewer composite days hospitalized (20.1 vs 24.9, P = .01) relative to the delayed group. Importantly, early computed tomography imaging was found to be the only independent predictor of a postoperative length of stay ≤15 days on multivariate analysis. Surgical stay mortality rates were significantly lower in the early compared with delayed group (0% vs 11%, P = .02). A change in treatment was observed in 59% after computed tomography, with 15% undergoing invasive interventions, 27% treated medically, and 16% with expectant management. CONCLUSION: In our cohort, patients imaged early after pancreatectomy experienced shorter hospital stays and lower inpatient mortality relative to those scanned after the first postoperative week.

Utility of Torso Imaging for Elderly Patients Sustaining Ground-Level Falls.

INTRODUCTION: Computed tomography (CT) of the torso has become increasingly common for assessment of fall patients in the emergency department. Some data suggest that older adults (≥65) may benefit from torso imaging more than younger patients. We sought to evaluate the usage and utility of CT imaging for elderly patients presenting after ground-level falls (GLFs) from 1 meter or less at our level 1 trauma center. METHODS: Patients ≥18 presenting with GLF in 2015-2019 were included. Data were obtained through chart and trauma registry review. Descriptive statistics were used to summarize the use of CT imaging for patients younger than versus older than 65 y old. Three multivariate logistic regression models with age as a continuous, binary (<65 versus ≥65), or categorical (in multiples of 5) variable were used to investigate whether age is associated with an increased identification of traumatic injury not previously suspected or known based on physical exam (PE) or plain radiograph after GLF. RESULTS: A total of 522 patients <65 and 673 patients ≥65 y old were included. Older patients were significantly more likely to receive screening chest radiograph, screening pelvic radiograph, brain CT, and neck CT (all P < 0.001), but not torso (chest, abdomen, and pelvis) CT (P = 0.144). On multivariate logistic regression, age was not significantly associated with an increased odds of identification of traumatic injury after torso CT (continuous: adjusted odds ratio [aOR] = 1.01, 95% confidence interval [CI] = 0.99-1.03, P = 0.379; binary: aOR = 0.86, 95% CI = 0.46-1.58, P = 0.619; categorical: aOR = 1.03, 95% CI = 0.94-1.14, P = 0.453). A positive PE was the only variable associated with significantly increased odds of having an abnormal torso CT scan in all models. Only two patients ≥65 y old had injuries identified on torso CT in the context of a negative PE and negative screening imaging. CONCLUSIONS: The rate of torso injury identification in patients sustaining GLF is not associated with age, but is strongly associated with positive PE findings. In the subset of elderly GLF patients without positive torso PE findings, more conservative use of CT imaging could decrease health-care utilization costs without compromising patient care.

Racial difference in receiving computed tomography for head injury patients in emergency departments.

STUDY OBJECTIVE: Prior studies have suggested potential racial differences in receiving imaging tests in emergency departments (EDs), but the results remain inconclusive. In addition, most prior studies may only have limited racial groups for minority patients. This study aimed to investigate racial differences in head computed tomography (CT) administration rates in EDs among patients with head injuries. METHODS: Patients with head injuries who visited EDs were examined. The primary outcome was patients receiving head CT during ED visits, and the primary exposure was patient race/ethnicity, including Asian, Hispanic, Non-Hispanic Black (Black), and Non-Hispanic White (White). Multivariable logistic regression analyses were performed using the National Hospital Ambulatory Medical Care Survey database, adjusting for patients and hospital characteristics. RESULTS: Among 6130 patients, 51.9% received a head CT scan. Asian head injury patients were more likely to receive head CT than White patients (59.1% versus 54.0%, difference 5.1%, p < 0.001). This difference persisted in adjusted results (odds ratio, 1.52; 95% CI, 1.06-2.16, p = 0.022). In contrast, Black and Hispanic patients have no significant difference in receiving head CT than White patients after the adjustment. CONCLUSIONS: Asian head injury patients were more likely to receive head CT than White patients. This difference may be attributed to the limited English proficiency among Asian individuals and the fact that there is a wide variety of different languages spoken by Asian patients. Future studies should examine rates of receiving other diagnostic imaging modalities among different racial groups and possible interventions to address this difference.

A 12-year Retrospective Cohort Study of Point-of-care Ultrasound and Aortic Dissection Risk Score in Type A Aortic Dissection.

BACKGROUND: Aortic dissection (AD) is a vascular emergency with time-dependent mortality. Point-of-care ultrasound (POCUS) and AD risk score (ADRS) have been proposed as diagnostic tools to risk stratify patients and reduce time to diagnosis. STUDY OBJECTIVE: We evaluate POCUS findings and ADRS in a retrospective cohort of patients with known type A AD. The objective of this study is to describe the prevalence of POCUS findings and ADRS in this population. METHODS: This is a retrospective cohort study of patients with acute type A AD as confirmed on computed tomography scan over a 12-year period from 2008 to 2020, with a subgroup analysis of patients who received POCUS in the emergency department. ADRS was calculated and POCUS findings were reviewed. Descriptive statistics were used to describe the distribution of POCUS findings. RESULTS: Ninety-one patients met inclusion criteria. POCUS was performed in 41 but only 35 had images of adequate quality for inclusion. Of the POCUS images available, 30/35 (86%) patients had a POCUS finding consistent with dissection and 5/35 (14%) had no findings on POCUS. Twelve percent (11/91) of patients had ADRS = 0. Two patients with ADRS = 0 received POCUS, and one patient had no findings on POCUS. CONCLUSION: Although POCUS provides rapid information in the diagnosis of type A AD, 14% of patients with images available for review had no findings on POCUS. Of the whole cohort, 12% had an ADRS = 0. Further studies are needed to identify an optimal diagnostic pathway for this catastrophic disease.

[Compensation of occupational diseases during monitoring of the ARDCO cohort]. / Les reconnaissances en maladie professionnelle lors du suivi de la cohorte ARDCO.

INTRODUCTION: Questions concerning under-reporting of occupational diseases (OD) linked to asbestos exposure are regularly voiced in France. Monitoring of the French multicenter Asbestos-Related Disease Cohort (ARDCO), which ensures post-occupational medical surveillance of subjects having been exposed to asbestos, provides information on (1) the medico-legal steps taken following screening by computed tomography (CT) for benign thoracic diseases, and (2) recognition of OD as a causal factor in malignant diseases. METHODS: OD recognition - and possible compensation - was analyzed in July 2021 among 13,289 volunteers in the cohort recruited between 2003 and 2005. RESULTS: Fifteen percent of the subjects in the cohort were found to have at least one recognized asbestos-related OD (78.2% benign pleural disease, 10.3% asbestosis, 14.2% lung cancer, and 6.0% mesothelioma). Only 58% of pleural plaques reported by the radiologist who performed the CT resulted in their recognition as ODs. On a parallel track, 88.7% of the mesotheliomas identified based on French National health insurance data and 46.9% of lung cancers were recognized as ODs. CONCLUSIONS: This study confirms the feasibility of a system designed to facilitate recognition, leading to possible compensation, of asbestos-related occupational diseases. The system could be improved by better training of the medical actors involved.

Prevalence of Umbilical Hernias by Computed Tomography.

INTRODUCTION: Umbilical hernias (UHs) are commonly underdiagnosed due to their asymptomatic presentation. The aim was to determine the prevalence of UHs by computed tomography (CT) in a trauma center, to assess the magnitude of their underdiagnosis. METHODS: A cross-sectional study was designed, using CT studies to evaluate the integrity of the abdominal wall. The images were obtained from consecutive cases of adult patients (≥18 y) from the database of the radiology and imaging service during a 4-mo period. The sociodemographic features, type of CT scan, and description of the abdominal wall were obtained and compared with the radiology report. In the case of UH presence, the transversal, cephalocaudal, and anteroposterior lengths, as well as its content, were registered. RESULTS: A total of 472 CT scans were included with a 67.6% (n = 319) prevalence of UH. These were most common in men (58.9%, n = 188/319), but women were more likely to have UH ≥ 10 mm (55%, n = 72/131). Of those with UH, 63.6% were unreported by radiology. The most common content was peritoneal fat (87.5%). UH had medians (interquartile range) of 9.1 mm (6.8, 12.5), 8.3 mm (6, 11.5), and 12.8 mm (8.6, 18.2) in its transversal, cephalocaudal, and anteroposterior lengths, respectively. Transversal length had a high positive correlation with cephalocaudal length (r = 0.877). This datum relationship can be explained by at least 76% due to this factor. Interobserver reliability analyses resulted in substantial reliability (ICC>0.85 and k > 0.85). CONCLUSIONS: CT is an effective imaging tool for diagnosing UH. There is a high prevalence among the general adult population, with a high radiologic underreporting.

Prevalence and clinical significance of incidental findings in chest and abdominopelvic CT scans of trauma patients; A cross-sectional study.

BACKGROUND: Imaging may inadvertently reveal pathologies unrelated to their performing purpose, known as incidental findings (IF). This study aimed to assess the prevalence, clinical significance, and documentation of IFs in chest and abdominopelvic computed tomography (CT) scans of trauma patients. METHODS: This observational study was conducted at two urban level-1 trauma centers from March 2019 through April 2022. Official radiology reports of trauma patients who underwent chest and/or abdominopelvic CT scans at the emergency department (ED) were explored, and IF were extracted. Predictive factors of the presence of IFs and their documenting were investigated. RESULTS: Out of 656 chest and 658 abdominopelvic CT scans, 167 (25.37%) and 212 (32.31%) scans harbored at least one IF, respectively. Patients with IFs tended to be of higher age and female in both chest (age: 48 [IQR: 35-62] vs. 34 [IQR: 25-42.5]; female: 31.14% vs 14.66%, p < 0.001 for both) and abdominopelvic CT scans (age: 41 [IQR: 30-57.5] vs 33 [IQR: 25-43], female: 26.42% vs. 13.96%, p < 0.001 for both). As for documentation of significant IFs, only 49 of 112 chest IFs (43.8%) and 55 of 176 abdominopelvic IFs (31.3%) were documented. Investigating factors associated with documentation of clinically significant IFs, shorter length of hospital stay (1.5 (IQR: 0-4) vs. 3 (IQR: 2-8), p = 0.003), and discharging by ED physicians (documentation rate: 13.2% vs 42.6%, p < 0.001) were associated with poorer documentation of IFs only in abdominopelvic scans. CONCLUSION: CT imaging in ED trauma patients often reveals incidental findings, especially in older patients. Over 50% of these findings are clinically significant, yet they are frequently ignored and not documented. Physicians need to be more vigilant in recognizing and documenting these incidental findings and informing patients of the need for further evaluation.

Lung Cancer Screening in the US, 2022.

Importance: The US Preventive Services Task Force (USPSTF) recommends annual lung cancer screening (LCS) with low-dose computed tomography in high-risk individuals (age 50-80 years, ≥20 pack-years currently smoking or formerly smoked, and quit <15 years ago) for early detection of LC. However, representative state-level LCS data are unavailable nationwide. Objective: To estimate the contemporary prevalence of up-to-date (UTD) LCS in the US nationwide and across the 50 states and the District of Columbia. Design, Setting, and Participants: This cross-sectional study used data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) population-based, nationwide, state-representative survey for respondents aged 50 to 79 years who were eligible for LCS according to the 2021 USPSTF eligibility criteria. Data analysis was performed from October 1, 2023, to March 20, 2024. Main Outcomes and Measures: The main outcome was self-reported UTD-LCS (defined as past-year) prevalence according to the 2021 USPSTF eligibility criteria in respondents aged 50 to 79 years. Adjusted prevalence ratios (APRs) and 95% CIs compared differences. Results: Among 25 958 sample respondents eligible for LCS (median [IQR] age, 62 [11] years), 61.5% reported currently smoking, 54.4% were male, 64.4% were aged 60 years or older, and 53.0% had a high school education or less. The UTD-LCS prevalence was 18.1% overall, but varied across states (range, 9.7%-31.0%), with relatively lower levels in southern states characterized by high LC mortality burden. The UTD-LCS prevalence increased with age (50-54 years: 6.7%; 70-79 years: 27.1%) and number of comorbidities (≥3: 24.6%; none: 8.7%). A total of 3.7% of those without insurance and 5.1% of those without a usual source of care were UTD with LCS, but state-level Medicaid expansions (APR, 2.68; 95% CI, 1.30-5.53) and higher screening capacity levels (high vs low: APR, 1.93; 95% CI, 1.36-2.75) were associated with higher UTD-LCS prevalence. Conclusions and Relevance: This study of data from the 2022 BRFSS found that the overall prevalence of UTD-LCS was low. Disparities were largest according to health care access and geographically across US states, with low prevalence in southern states with high LC burden. The findings suggest that state-based initiatives to expand access to health care and screening facilities may be associated with improved LCS rates and reduced disparities.

The utility of computed tomography at a district-level public hospital in Cape Town.

BACKGROUND:  Computed tomography (CT) has become an invaluable aid in medical diagnostic workup, and its global usage has been shown to be consistently increasing across all departments. While typically located in regional or central hospitals in South Africa, its recent introduction at the district level has many foreseeable benefits. We evaluated its utility at one of the first district hospitals in the Western Cape to obtain a CT suite. OBJECTIVES:  This study aimed to describe the type of CT scans ordered, the clinical indications, the prevalence of significant abnormal findings and the agreement between the clinical opinion and radiological diagnosis. METHODS:  A descriptive cross-sectional study was conducted over a 1-year period at Khayelitsha Hospital, an entry-level hospital just outside of Cape Town. RESULTS:  A total of 3242 CT scans were analysed. The mean age of patients was 46 years; 51.4% were males. A mean of 13 scans were performed per working day. The head and neck area were the most scanned region (n = 1841, 52.3%). Predominantly requested by the Emergency Centre (n = 1382, 42.6%), indications were mainly for general medical conditions workup (n = 2151, 66.4%). Most scans showed abnormalities (n = 2710, 83.6%), with 2115 (65.2%) considered relevant ('positive yield'). Clinical and CT diagnoses agreed in 1610 (49.7%) cases. CONCLUSION:  Computed tomography usage at the district level demonstrated positive yield rates comparable to that of tertiary centres. This implies an appropriate utilisation of the service with a potential decrease in the burden on the referral centre.Contribution: Computed tomography scanners at district-level facilities are appropriately utilised and can provide greater access to care while potentially decreasing the burden on referral centres.