Interpreting Lung Cancer Screening CTs: Practical Approach to Lung Cancer Screening and Application of Lung-RADS.

Lung cancer screening via low-dose computed tomography (CT) reduces mortality from lung cancer, and eligibility criteria have recently been expanded to include patients aged 50 to 80 with at least 20 pack-years of smoking history. Lung cancer screening CTs should be interepreted with use of Lung Imaging Reporting and Data System (Lung-RADS), a reporting guideline system that accounts for nodule size, density, and growth. The revised version of Lung-RADS includes several important changes, such as expansion of the definition of juxtapleural nodules, discussion of atypical pulmonary cysts, and stepped management for suspicious nodules. By using Lung-RADS, radiologists and clinicians can adopt a uniform approach to nodules detected during CT lung cancer screening and reduce false positives.

Financial Impact of a Radiology Safety Net Program for Resolution of Clinically Necessary Follow-up Imaging Recommendations.

OBJECTIVE: Health care safety net (SN) programs can potentially improve patient safety and decrease risk associated with missed or delayed follow-up care, although they require financial resources. This study aimed to assess whether the revenue generated from completion of clinically necessary recommendations for additional imaging (RAI) made possible by an IT-enabled SN program could fund the required additional labor resources. METHODS: Clinically necessary RAI generated October 21, 2019, to September 24, 2021, were tracked to resolution as of April 13, 2023. A new radiology SN team worked with existing schedulers and care coordinators, performing chart review and patient and provider outreach to ensure RAI resolution. We applied relevant Current Procedural Terminology, version 4 codes of the completed imaging examinations to estimate total revenue. Coprimary outcomes included revenue generated by total performed examinations and estimated revenue attributed to SN involvement. We used Student's t test to compare the secondary outcome, RAI time interval, for higher versus lower revenue-generating modalities. RESULTS: In all, 24% (3,243) of eligible follow-up recommendations (13,670) required SN involvement. Total estimated revenue generated by performed recommended examinations was $6,116,871, with $980,628 attributed to SN. Net SN-generated revenue per 1.0 full-time equivalent was an estimated $349,768. Greatest proportion of performed examinations were cross-sectional modalities (CT, MRI, PET/CT), which were higher revenue-generating than non-cross-sectional modalities (x-ray, ultrasound, mammography), and had shorter recommendation time frames (153 versus 180 days, P < .001). DISCUSSION: The revenue generated from completion of RAI facilitated by an IT-enabled quality and safety program supplemented by an SN team can fund the required additional labor resources to improve patient safety. Realizing early revenue may require 5 to 6 months postimplementation.

A pictorial review of lung torsion using 3D CT cinematic rendering.

Lung torsion is the abnormal rotation of a lobe or lung around its bronchovascular pedicle. It most commonly occurs in the setting of pulmonary resection, though it has also been described after large-volume thoracentesis and video-assisted thoracic surgery, as well as spontaneously. Resulting ischemia can lead to infarction, making this an emergent diagnosis. As findings are often nonspecific, a high index of suspicion is required, especially in the postsurgical setting. 2D CT angiography findings are subtle and include direct signs of pedicle rotation on CT as well as indirect findings including loss of normal parenchymal enhancement, atelectasis of torsed lobe/lung, and abnormal fissure position. These direct and indirect findings are often appreciated on different window presets and upon review of images in multiple planes, with need to collate the information subsequently. 3D cinematic rendering (CR) using multi-planar light sources can readily highlight spatial relationships of vasculature in the chest and may be able to assist in the confident diagnosis of this sometimes subtle but life-threatening pathology. We have provided the first characterization of common lung torsion findings on 3D CR.

Paragangliomas Throughout the Body: Hereditary Syndromes and Imaging Features Including 3D Cinematic Rendering.

Paragangliomas are highly vascular neuroendocrine tumors that arise from embryonic neural crest cells. They may either be hormonally active (sympathetic) or silent (parasympathetic). Approximately one-third are hereditary, and patients may develop multiple paragangliomas. Presurgical planning involves medical management as well as interventional and/or surgical techniques that must address vascular supply. Contrast-enhanced CT is the best initial anatomical study and shows the hypervascularity and feeding vessels. 3D cinematic rendering using multiplanar light sources can highlight spatial relationships of a mass to adjacent structures and help in surgical planning. This article will review the clinical presentation of paragangliomas, genetic syndromes, presurgical management, and tumor behavior and imaging appearance by location with a particular emphasis on 3D cinematic rendering.

Relationship of breast MRI to recurrence rates in patients undergoing breast-conservation treatment.

PURPOSE: The effect of pre-operative MRI on the in-breast tumor recurrence rate (IBTR) of patients undergoing breast-conservation treatment (BCT) remains uncertain. We began to routinely perform pre-operative MRI in 2006. Our goal was to determine the effect of pre-operative MRI on IBTR. METHODS: Retrospective review of a prospective database of all patients undergoing BCT (n = 1396) from 2000 to 2010. IBTR were calculated using Kaplan-Meier estimates. RESULTS: 664 (47.6%) patients underwent pre-operative MRI. The use of MRI increased from 13.9% in 2000-2005 to 80.7% in 2006-2010. Ten percent of patients who underwent MRI were found to have an additional ipsilateral cancer, with a mean diameter of 1.6 cm. The IBTR for patients with and without MRI were 4% vs. 8% at 8 years (p = 0.04). In multivariate analysis, radiation therapy and endocrine therapy were associated with decreased IBTR, but MRI was not (RR 0.77 (0.45-1.28)). For 1030 patients with invasive cancer, the IBTR at 8 years with and without MRI was 4.2% vs. 7.3% (p = 0.28). For 366 DCIS patients with and without MRI, the IBTR was 3.6% vs. 10.9% (p = 0.06). In the subgroup of DCIS patients who did not receive radiation, the IBTR with and without MRI was 0% vs. 18.2% (p = 0.08). Patients with an additional cancer found by MRI had a higher IBTR at 8 years (10.1% vs. 3.3%, p = 0.02). CONCLUSIONS: In a study analyzing BCT patients from one time period who rarely had a pre-operative MRI and a subsequent time period where most patients had MRI, the use of MRI was associated with a decrease in the IBTR on univariate, but not multivariate analysis. Patients who had additional cancers detected had a significantly higher IBTR.

The Hippocratic oath: a comparative analysis of the ancient text's relevance to American and Indian modern medicine.

Hippocrates (460-375 B.C.), an ancient Greek physician considered the "Father of Medicine," constructed the groundwork for the principles of ethics in medicine over 2,500 years ago in his establishment of the Hippocratic Oath. One of the oldest binding documents in history, the text has remained the ethical template for physicians to this day. The changing cultural and social environment of modern society, accompanied by the advancement in scientific knowledge and therapeutic tools, has surfaced the need to reframe ethical perspective in modern medicine. Progress in aspects such as organ transplantation, stem cell technology, and genetic engineering has welcomed a new set of ethical dilemmas. These dilemmas have become intimately intertwined with the impact of commercialization, as seen by the interplay between legislation, health care, and pharmaceutical businesses. This paper seeks to dissect the principles of the original Hippocratic Oath and analyze the template in relation to the ethical dilemmas presented by contemporary medicine. Examination will provide a deeper understanding of the paradigm shift in modern medical ethics. Both the value of the Oath and the level of awareness of modern ethical dilemmas through the lens of American and Indian medical graduates will be assessed.