Imaging characteristics of BRAF-mutant non-small cell lung cancer by functional class.

OBJECTIVES: Mutations in the BRAF gene have emerged as a validated molecular target in the treatment of non-small cell lung cancer (NSCLC). These mutations can be classified into three functional classes based on their mechanisms of oncogenesis. The relationship between these functional classes and their imaging features has not been systematically investigated. The goal of this work is to determine if imaging features of the primary tumor and the pattern of metastasis correlate with the functional class of BRAF mutation. METHODS: We reviewed pre-treatment computed tomography (CT) images of patients with BRAF-mutated NSCLC with known functional class. We assessed and recorded the features of the primary tumor and the patterns of lymphadenopathy and distant metastasis. Wilcoxon rank-sum test and Kruskal-Wallis test were performed to compare continuous characteristics, and Fisher's exact test was used to compare categorical features between groups. RESULTS AND CONCLUSIONS: 105 patients with BRAF-mutant NSCLC had pre-treatment imaging available for review (n = 43 class I, n = 40 class II, and n = 22 class III). Approximately half of the primary tumors were considered masses (n = 54/105, 51%) and most were solid (n = 81/105, 77%). There were no statistically significant differences in imaging features of the primary tumor among the three functional classes. Intrathoracic metastases occurred more frequently in class I tumors compared to tumors with class II and III mutations (p = 0.03). The odds of class I mutation were higher among tumors involving the pleural space (OR: 4.39, 95% CI: 1.11-17.4) and lower among tumors disseminating to the abdomen (OR: 0.25, 95% CI: 0.07-0.92). Our findings suggest that class I (V600) mutated NSCLC may be more likely to have intrathoracic metastases, while classes II and III (non-V600) mutated NSCLC may be more likely to have intra-abdominal metastases at the time of presentation.

Process improvement for reducing side discrepancies in radiology reports.

BACKGROUND: Laterality errors in radiology reports can lead to serious errors in management. PURPOSE: To reduce errors related to side discrepancies in radiology reports from thoracic imaging by 50% over a six-month period with education and voice recognition software tools. MATERIAL AND METHODS: All radiology reports at the Thoracic Imaging Division from the fourth quarter of 2016 were reviewed manually for presence of side discrepancies (baseline data). Side discrepancies were defined as a lack of consistency in side labeling of any abnormality in the "Findings" to "Impression" sections of the reports. Process map and Ishikawa fishbone diagram (Microsoft Visio) were created. All thoracic radiologists were educated on side-related errors in radiology reports for plan-design-study-act cycle 1 (PDSA #1). Two weeks later, voice recognition software was configured to capitalize sides (RIGHT and LEFT) in the reports during dictated (PDSA# 2). Radiology reports were analyzed to determine side-discrepancy errors following each PDSA cycle (post-interventional data). Statistical run charts were created using QI Macros statistical software. RESULTS: Baseline data revealed 33 side-discrepancy errors in 47,876 reports with an average of 2.5 errors per week (range = 1-8 errors). Following PDSA #1, there were seven errors pertaining to side discrepancies over a two-week period. Errors declined following implementation of PDSA #2 to meet the target of 0.85 side-discrepancy error per week over seven weeks. CONCLUSION: Automated processes (such as capitalization of sides) help reduce left/right errors substantially without affecting reporting turnaround time.

Atrioesophageal fistula after catheter pulmonary venous ablation for atrial fibrillation: imaging features.

Atrioesophageal fistula is a rare but highly morbid complication of catheter-mediated pulmonary vein ablation for the treatment of atrial fibrillation. Among patients who do not exsanguinate from upper gastrointestinal tract bleeding, presentation includes sepsis and embolic cerebrovascular disease. We present a case of atrioesophageal fistula after pulmonary venous ablation as a treatment for atrial fibrillation, focusing on the imaging features of this diagnosis.