Lung cancer screening utilization rate varies based on patient, provider, and hospital factors.

OBJECTIVE: Low-dose computed tomography has been proven to reduce mortality, yet utilization remains low. The purpose of this study is to identify factors that impact the utilization of lung cancer screening. METHODS: We performed a retrospective review of our institution's primary care network from November 2012 to June 2022 to identify patients who were eligible for lung cancer screening. Eligible patients were 55 to 80 years of age and current or former smokers with at least a 30 pack-year history. Analyses were performed on the screened populations and patients who met eligibility criteria but were not screened. RESULTS: A total of 35,279 patients in our primary care network were current/former smokers aged 55 to 80 years. A total of 6731 patients (19%) had a 30 pack-year or more cigarette history, and 11,602 patients (33%) had an unknown pack-year history. A total of 1218 patients received low-dose computed tomography. The utilization rate of low-dose computed tomography was 18%. The utilization rate was significantly lower (9%) if patients with unknown pack-year history were included (P < .001). The utilization rates between primary care clinic locations were significantly different (range, 18% vs 41%, P < .05). Utilization of low-dose computed tomography on multivariate analysis was associated with Black race, former smoker, chronic obstructive pulmonary disease, bronchitis, family history of lung cancer, and number of primary care visits (all P < .05). CONCLUSIONS: Lung cancer screening utilization rates are low and vary significantly on the basis of patient comorbidities, family history of lung cancer, primary care clinic location, and accurate documentation of pack-year cigarette history. The development of programs to address patient, provider, and hospital-level factors is needed to ensure appropriate lung cancer screening.

A Structured Program Maximizes Benefit of Lung Cancer Screening in an Area of Endemic Histoplasmosis.

BACKGROUND: Lung cancer screening with low-dose computed tomography has demonstrated at least a 20% decrease in lung cancer-specific mortality, but it has the potential harm of unnecessary invasive procedures performed because of false-positive results. This study reports the outcomes of a structured multidisciplinary lung cancer screening program in an area of endemic histoplasmosis. METHODS: A retrospective review of patients undergoing lung cancer screening from December 2012 to March 2019 was conducted. Findings suggestive of lung cancer were presented to a multidisciplinary thoracic tumor board. Patients were assigned to interval imaging follow-up, additional diagnostic imaging, or referral for an invasive procedure. Invasive procedures were then compared between benign and malignant diseases. RESULTS: A total of 4087 scans were performed on 2129 patients; 372 (9.1%) were suspicious and were presented to a multidisciplinary thoracic tumor board. Ultimately, 108 procedures were performed: 55 bronchoscopies, 7 percutaneous biopsies, and 46 operations. A total of 25 patients (1.2%) underwent bronchoscopy resulting in benign pathologic findings, significantly associated with an indication of an endobronchial lesion (P = .01). All percutaneous biopsy specimens revealed malignancy. Five patients (0.2%) who underwent resection had benign disease. Lung cancer was diagnosed in 67 patients (3.1% of the entire cohort), 46 of whom had stage I or II disease. CONCLUSIONS: Lung cancer screening in a structured, multidisciplinary program successfully identifies patients with early-stage lung cancer with limited unnecessary surgical interventions. Patients with isolated endobronchial lesions should undergo short interval imaging follow-up to avoid bronchoscopy for benign disease. Future studies to minimize unnecessary procedures could incorporate biomarkers and advanced imaging analysis into risk assessment models.

Recover Wisely From COVID-19: Responsible Resumption of Nonurgent Radiology Services.

RATIONALE AND OBJECTIVES: Following state and institutional guidelines, our Radiology department launched the "Recover Wisely" for all nonurgent radiology care on May 4, 2020. Our objective is to report our practice implementation and experience of COVID-19 recovery during the resumption of routine imaging at a tertiary academic medical center. MATERIALS AND METHODS: We used the SQUIRE 2.0 guidelines for this practice implementation. Recover Wisely focused on a data driven, strategic rescheduling and redesigning patient flow process. We used scheduling simulations and meticulous monitoring and control of outpatient medical imaging volumes to achieve a linear restoration to our pre-COVID imaging studies. We had a tiered plan to address the backlog of rescheduled patients with gradual opening of our imaging facilities, while maintaining broad communication with our patients and referring clinicians. RESULTS: Recover Wisely followed our anticipated linear modeling. Considering the last 10 weeks in the recovery, outpatient growth was linear with an increase of approximately 172 cases per week, (R2 =0.97). We achieved an overall recovery of 102% in week 10, as compared to average weekly pre-COVID outpatient volumes. The modalities recovered as follows in outpatient volumes: CT (113%), MRI (101%), nuclear medicine including PET (138%), mammograms (97%), ultrasound (99%) and interventional radiology (106%). When compared to identical 2019 calendar weeks (May 4, 2020-July 10, 2020), the total 2020 radiology volume was 11% reduced from the 2019 volume. The reduction in total weighted relative value units was 8% in this time period, as compared to 2019. CONCLUSION: Our department utilized a data-driven, team approach based on our guiding principles to "Recover Wisely." We created and implemented a methodology that achieved a linear increase in outpatient studies over a 10-week recovery period.

Review of the Chest CT Differential Diagnosis of Ground-Glass Opacities in the COVID Era.

Coronavirus disease 2019 (COVID-19), a recently emerged lower respiratory tract illness, has quickly become a pandemic. The purpose of this review is to discuss and differentiate typical imaging findings of COVID-19 from those of other diseases, which can appear similar in the first instance. The typical CT findings of COVID-19 are bilateral and peripheral predominant ground-glass opacities. As per the Fleischner Society consensus statement, CT is appropriate in certain scenarios, including for patients who are at risk for and/or develop clinical worsening. The probability that CT findings represent COVID-19, however, depends largely on the pretest probability of infection, which is in turn defined by community prevalence of infection. When the community prevalence of COVID-19 is low, a large gap exists between positive predictive values of chest CT versus those of reverse transcriptase polymerase chain reaction. This implies that with use of chest CT there are a large number of false-positive results. Imaging differentiation is important for management and isolation purposes and for appropriate disposition of patients with false-positive CT findings. Herein the authors discuss differential pathology with close imaging resemblance to typical CT imaging features of COVID-19 and highlight CT features that may help differentiate COVID-19 from other conditions.

Rescheduling Nonurgent Care in Radiology: Implementation During the Coronavirus Disease 2019 (COVID-19) Pandemic.

OBJECTIVE: To meet hospital preparedness for the coronavirus disease 2019 pandemic, the Centers for Disease Control and Prevention and ACR recommended delay of all nonemergent tests and elective procedures. The purpose of this article is to report our experience for rescheduling nonemergent imaging and procedures during the pandemic at our tertiary academic institution. METHODS: We rescheduled the nonemergent imaging and procedures in our hospitals and outpatient centers from March 16 to May 4, 2020. We created a tiered priority system to reschedule patients for whom imaging could be delayed with minimal clinical impact. The radiologists performed detailed chart reviews for decision making. We conducted daily virtual huddles with discussion of rescheduling strategies and issue tracking. RESULTS: Using a snapshot during the rescheduling period, there was a 53.4% decrease in imaging volume during the period of March 16 to April 15, 2020, compared with the same time period in 2019. The total number of imaging studies decreased from 38,369 in 2019 to 17,891 in 2020 during this period. Although we saw the largest reduction in outpatient imaging (72.3%), there was also a significant decrease in inpatient (40.5%) and emergency department (48.9%) imaging volumes. DISCUSSION: The use of multiple communication channels was critical in relaying the information to all our stakeholders, patients, referring physicians, and the radiology workforce. Teamwork, quick adoption, and adaptation of changing strategies was important given the fluidity of the situation.

Pictorial review of coronary anomalies in Tetralogy of Fallot.

Tetralogy of Fallot (TOF) classically consists of four characteristic features-right ventricular outflow obstruction, right ventricular hypertrophy, ventricular septal defect and an overriding aorta. In addition there are multiple other associated cardiac anomalies, including coronary artery anomalies. In this review, the role of CT angiography and the spectrum of coronary anomalies will be discussed along with importance of such anomalies in the context of surgery.

Pulmonary Vein Stenosis After Minimally Invasive Stand-alone Surgical Ablation of Atrial Fibrillation.

We report a case of pulmonary vein stenosis following a standalone minimally invasive surgical ablation for atrial fibrillation. The etiology, diagnosis, and management of this complication are the subject of this review.

Where there is blood, there is a way: unusual collateral vessels in superior and inferior vena cava obstruction.

Obstruction of the superior vena cava (SVC) or inferior vena cava (IVC) is most commonly an acquired condition, typically caused by malignancy, benign conditions such as mediastinal fibrosis, and iatrogenic causes such as venous catheterization. In the event of chronic occlusion, collateral pathways must develop to maintain venous drainage. The major collateral pathways seen with SVC or IVC obstruction are well described and include the azygos-hemiazygos, internal and external mammary, lateral thoracic, and vertebral pathways. In addition, several unusual collateral pathways may be seen with SVC or IVC obstruction; these include systemic-to-pulmonary venous, cavoportal, and intrahepatic collateral pathways. In patients with systemic-to-pulmonary venous collateral vessels, the systemic veins drain directly into the left side of the heart, resulting in a right-to-left shunt. The collateral veins consist of mediastinal connections between the innominate veins and the superior pulmonary veins through bronchial venous plexuses around the airways, hilar vessels, and pleura. The cavoportal collateral pathways consist of collateral formation between the SVC or IVC and a tributary to the portal system. They include the caval-superficial-umbilical-portal pathway, caval-mammary-phrenic-hepatic capsule-portal pathway, caval-mesenteric-portal pathway, caval-renal-portal pathway, caval-retroperitoneal-portal pathway, and intrahepatic cavoportal pathway. These types of collateral pathways may result in unusual enhancement patterns in the liver. An understanding of these unusual collateral pathways is essential in a patient with caval occlusion who presents with signs and symptoms of a right-to-left shunt or has unusual enhancing lesions in the liver.

Cysts within and adjacent to the lesser tuberosity and their association with rotator cuff abnormalities.

OBJECTIVE: The purpose of our study was to determine the incidence of cysts in and adjacent to the lesser tuberosity and their association with rotator cuff abnormalities and subcoracoid impingement. MATERIALS AND METHODS: A retrospective review of 1,000 consecutive MRI examinations of the shoulder was performed by consensus of two radiologists. Cysts were grouped by location into one of two groups: those within the lesser tuberosity and those adjacent to the lesser tuberosity. The rotator cuff was defined as intact, partial tear or tendinosis, or full-thickness tear. The shortest distance from the coracoid to the humeral head was measured on axial images. RESULTS: Forty-eight patients (26 women, 22 men; age range, 35-79 years; mean age, 61 years) had cysts adjacent to or within the lesser tuberosity. Thirty-two patients (67%) had cysts just superior to the tuberosity and 16 (33%) had cysts in the lesser tuberosity, resulting in an incidence of 3.2% and 1.6%, respectively. All 16 patients (100%) with lesser tuberosity cysts had subscapularis and supraspinatus tendon abnormalities including 11 (69%) full-thickness supraspinatus tears. Patients with cysts superior to the tuberosity had 20 (63%, p = 0.004) abnormal subscapularis tendons and 28 (88%) abnormal supraspinatus tendons, including six (19%) full-thickness tears (p = 0.002). The coracohumeral distance was noted to be less than 10 mm in 10 patients (63%) with lesser tuberosity cysts as compared with 10 patients (31%, p = 0.06) with cysts superior to the tuberosity. CONCLUSION: Cysts located within the lesser tuberosity are rare and are indicative of subscapularis and supraspinatus tendon abnormalities.

Acute knee dislocation: review of an elusive entity.

The knee consists of three articulations: the patellofemoral, the tibiofemoral, and the proximal tibiofibular joint. Any of these joints can dislocate. Dislocations are uncommon, tend to spontaneously reduce, and can be difficult to detect on clinical examination. There are, however, telltale imaging features and the radiologist may be the first to suggest the correct diagnosis. A timely diagnosis is important as some forms are associated with limb-threatening complications. Lateral patellofemoral dislocation, in the acute setting, is typically an injury of young athletes and usually spontaneously reduces at the time of trauma. In transient lateral dislocation, contusions may be seen in the inferomedial pole of the patella and the anterior lateral aspect of the nonarticular portion of the femur. The important magnetic resonance imaging findings include this characteristic contusion pattern and injury to the medial patellar soft-tissue restraints. These are frequently associated with osteochondral fractures, which may be an indication for surgery. Recurrent patellofemoral dislocations tend to be associated with abnormalities of bony and/or soft-tissue restraints. The important imaging considerations are the length of patellar tendon, the depth of trochlear groove, and the position of patella in relation to the trochlear groove. Tibiofemoral dislocations are rare and are usually associated with high-impact trauma. These are multi-ligamentous injuries, which most often involve both cruciate ligaments with either medial and/or lateral ligament tears. There is an associated risk of popliteal artery and peroneal nerve injury, even if reduced, at the time of presentation. Dislocations of the tibiofibular joint are also rare and are classified based on location of fibular head. The tibiofibular joint is lax in flexion, and thus, most dislocations tend to occur in the flexed knee position. Anterolateral dislocation is the most common, while posteromedial dislocation is frequently associated with peroneal nerve injury. The purpose of this article is to review the epidemiology of knee dislocations, important imaging findings, and the most common complications.