Review of radiological screening programmes for breast, lung and pancreatic malignancy.

The premise of medical screening is to identify clinically occult disease, facilitating intervention at an early stage with the intention of improving prognosis. Identifying solid organ malignancy before nodal or distal metastases have occurred unanimously offers the best chance of successful radical treatment, thus there is clearly a potential significant mortality benefit for successful oncological screening programmes. However, the negative consequences of screening have to be considered, particularly the impact of intervening in asymptomatic populations. Diagnostic radiology has an invaluable ability to non-invasively detect disease and has developed an essential role in several oncological screening programmes with new programmes emerging. These include the established mammography screening programme for breast carcinoma, the emerging CT screening programme for lung carcinoma and a new proposed radiological screening programme for pancreatic carcinoma. Results from published randomized controlled trials analysing the benefits of radiological screening have been convoluted and conflicting. Cancer screening remains a widely contested topic and it is a challenge for both radiologist and clinician to assess the risks and benefits at both a population and individual patient level. In this article, we discuss radiological screening and analyse the current literature on these programmes, with evaluation of recently published studies and ongoing trials.

Computed tomography in congenital heart disease: how generic principles can be applied to create bespoke protocols in the Fontan circuit.

Cardiac computed tomography (CCT) has become an invaluable cross-sectional imaging modality in congenital heart disease (CHD) patients. However, altered anatomical connections and cardiovascular physiology makes CHD arguably the most challenging area in CCT imaging, which remains a complimentary modality to cardiac magnetic resonance and echocardiography. A bespoke CT protocol is often required to achieve a diagnostic examination; this can be achieved through careful consideration of the basic principles of image acquisition and contrast administration. This article reviews these principles and demonstrates how they can be applied to CCT in CHD using the Fontan circulation as an example.