ACR Appropriateness Criteria® Workup of pleural effusion or pleural disease

Pleural effusions are categorized as transudative or exudative, with transudative effusions usually reflecting the sequala of a systemic etiology and exudative effusions usually resulting from a process localized to the pleura. Common causes of transudative pleural effusions include congestive heart failure, cirrhosis, and renal failure, whereas exudative effusions are typically due to infection, malignancy, or autoimmune disorders. This document summarizes appropriateness guidelines for imaging in four common clinical scenarios in patients with known or suspected pleural effusion or pleural disease. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

ACR Appropriateness Criteria® Workup of Pleural Effusion or Pleural Disease.

Pleural effusions are categorized as transudative or exudative, with transudative effusions usually reflecting the sequala of a systemic etiology and exudative effusions usually resulting from a process localized to the pleura. Common causes of transudative pleural effusions include congestive heart failure, cirrhosis, and renal failure, whereas exudative effusions are typically due to infection, malignancy, or autoimmune disorders. This document summarizes appropriateness guidelines for imaging in four common clinical scenarios in patients with known or suspected pleural effusion or pleural disease. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

ACR Appropriateness Criteria® Incidentally Detected Indeterminate Pulmonary Nodule.

Incidental pulmonary nodules are common. Although the majority are benign, most are indeterminate for malignancy when first encountered making their management challenging. CT remains the primary imaging modality to first characterize and follow-up incidental lung nodules. This document reviews available literature on various imaging modalities and summarizes management of indeterminate pulmonary nodules detected incidentally. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

RadioGraphics Update: Lung-RADS 2022.

Editor's Note.-RadioGraphics Update articles supplement or update information found in full-length articles previously published in RadioGraphics. These updates, written by at least one author of the previous article, provide a brief synopsis that emphasizes important new information such as technological advances, revised imaging protocols, new clinical guidelines involving imaging, or updated classification schemes.

ACR Appropriateness Criteria® Lung Cancer Screening: 2022 Update.

Lung cancer remains the leading cause of cancer-related mortality for men and women in the United States. Screening for lung cancer with annual low-dose CT is saving lives, and the continued implementation of lung screening can save many more. In 2015, the CMS began covering annual lung screening for those who qualified based on the original United States Preventive Services Task Force (USPSTF) lung screening criteria, which included patients 55 to 77 year of age with a 30 pack-year history of smoking, who were either currently using tobacco or who had smoked within the previous 15 years. In 2021, the USPSTF issued new screening guidelines, decreasing the age of eligibility to 80 years of age and pack-years to 20. Lung screening remains controversial for those who do not meet the updated USPSTF criteria, but who have additional risk factors for the development of lung cancer. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Psychogeriatric care in times of COVID. Lessons learned and proposals for similar situations.

The objective is to describe the problems related to outpatient psychogeriatric care in the context of the SARS-CoV-2 pandemic, as well as the proposed and implemented solutions for optimizing care for elderly people with mental disorders during the pandemic, that can also be applied in emerging similar situations in the future.

Atención psicogeriátrica en tiempos de COVID. Lecciones aprendidas y propuestas para situaciones similares / Psychogeriatric care in times of Covid. Lessons learned and proposals for similar situations

Introducción: El objetivo es describir los problemas relacionados con la atención psicogeriátrica ambulatoria en elcontexto de la pandemia SARS-CoV-2, así como las soluciones propuestas e implementadas para optimizar la atencióna las personas mayores con trastornos mentales durante lapandemia, que también pueden aplicarse en situaciones similares emergentes en el futuro.Metodología. Se recogió información sobre prestaciónde asistencia sanitaria y problemas clínicos en la práctica psicogeriátrica durante un año de la pandemia de COVID-19como base para propuestas de actuación por consenso depsiquiatras expertos en psicogeriatría. Entorno: servicios deatención psicogeriátrica ambulatoria en la Comunidad deMadrid.Resultados. Se identificaron ocho temas relacionadoscon las dificultades en la prestación de la atención psicogeriátrica (acceso a los servicios, adherencia al tratamiento, derivaciones y contacto, continuidad de cuidados, aislamiento,residencias de ancianos y pruebas de laboratorio) y se llegóa un acuerdo sobre 14 posibles soluciones. Además, se identificaron 7 problemas clínicos de especial relevancia (duelo,sueño, tratamientos psicofarmacológicos, deterioros físico,cognitivo-conductual y social, y violencia) y se propusieron17 posibles soluciones.Conclusiones. La pandemia de SARS-CoV-2 supone unelevado riesgo vital para la población geriátrica. Medidascomo el confinamiento y la limitación de contactos, ejercenun riesgo directo para la salud mental y un riesgo indirectodebido a las mayores dificultades para acceder a la atenciónpsicogeriátrica. Es necesario detectar estas situaciones e implementar cambios en la manera de proporcionar atención aesta población altamente vulnerable. Proponemos una seriede posibles soluciones a las situaciones problemáticas detectadas que pueden ser de ayuda en diferentes contextos deatención psicogeriátrica. (AU)

Introduction: The objective is to describe the problemsrelated to outpatient psychogeriatric care in the contextof the SARS-CoV-2 pandemic, as well as the proposed andimplemented solutions for optimizing care for elderly peoplewith mental disorders during the pandemic, that can also beapplied in emerging similar situations in the future.Methods. Data on healthcare provision and clinical problemsin psychogeriatric practice over the course of one year ofthe COVID-19 pandemic were collected as the basis forproposals for action by a consensus of psychiatrists expertin psychogeriatrics. Setting: Outpatient psychogeriatric careservices in the Madrid region, Spain. Results. Eight topics relating to difficulties in the provisionof psychogeriatric care were identified (access to services,treatment adherence, referrals and contact, continuity ofcare, isolation, nursing homes and laboratory tests) andagreement was reached on 14 possible solutions. In addition,7 clinical problems of particular relevance were identified(bereavement, sleep, psychopharmacological treatments,physical, cognitive-behavioural and social deterioration, andviolence) and 17 possible solutions proposed.Conclusions. The SARS-CoV-2 pandemic poses a highrisk to life for the geriatric population. Measures suchas lockdowns and limiting contacts, exert a direct risk tomental health and an indirect risk due to greater difficultiesin accessing psychogeriatric care. It is necessary to detectthese situations and implement changes in how care isprovided to this highly vulnerable population. We proposea series of possible solutions to the problematic situationsdetected that may be helpful in a variety of psychogeriatriccare contexts. (AU)

ACR Appropriateness Criteria® Staging and Follow-Up of Esophageal Cancer.

This document provides recommendations regarding the role of imaging in the staging and follow-up of esophageal cancer. For initial clinical staging, locoregional extent and nodal disease are typically assessed with esophagogastroduodenoscopy and esophageal ultrasound. FDG-PET/CT or CT of the chest and abdomen is usually appropriate for use in initial clinical staging as they provide additional information regarding distant nodal and metastatic disease. The detection of metastatic disease is critical in the initial evaluation of patients with esophageal cancer because it will direct patients to a treatment pathway centered on palliative radiation rather than surgery. For imaging during treatment, particularly neoadjuvant chemotherapy, FDG-PET/CT is usually appropriate, because some studies have found that it can provide information regarding primary lesion response, but more importantly it can be used to detect metastases that have developed since the induction of treatment. For patients who have completed treatment, FDG-PET/CT or CT of the chest and abdomen is usually appropriate for evaluating the presence and extent of metastases in patients with no suspected or known recurrence and in those with a suspected or known recurrence. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

ACR Appropriateness Criteria® Suspected Pulmonary Hypertension: 2022 Update.

Pulmonary hypertension may be idiopathic or related to a large variety of diseases. Various imaging examinations may be helpful in diagnosing and determining the etiology of pulmonary hypertension. Imaging examinations discussed in this document include chest radiography, ultrasound echocardiography, ventilation/perfusion scintigraphy, CT, MRI, right heart catheterization, and pulmonary angiography. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Predictors of CT Colonography Use: Results From the 2019 National Health Interview Cross-Sectional Survey.

PURPOSE: CT colonography (CTC) is a minimally invasive screening test with high sensitivity for colonic polyps (>1 cm). Prior studies suggest that CTC utilization remains low. However, there are few studies evaluating recent CTC utilization and predictors of CTC utilization. Our purpose was to estimate recent nationwide CTC utilization and evaluate predictors of CTC utilization using 2019 nationally representative cross-sectional survey data. METHODS: Participants between ages 50 and 75 without colorectal cancer history in the 2019 National Health Interview Survey cross-sectional data were included. The proportion of participants reporting utilization of CTC was estimated, accounting for complex survey design elements. Multiple variable logistic regression analyses evaluated predictors of CTC utilization. Analyses were conducted accounting for complex survey design elements to obtain valid estimates for the civilian, noninstitutionalized US population. RESULTS: In all, 13,709 respondents were included, and 1.4% reported undergoing CTC, of whom 39.9% underwent CTC within the last year, 18.5% within the last 2 years, 13.0% within the last 3 years, 7.8% within the last 5 years, 11.2% within the last 10 years, and 9.6% underwent CTC 10 years ago or more. Multiple variable logistic regression analyses revealed that Hispanic (odds ratio 2.67, 95% confidence interval 1.66-4.29, P < .001) and Black (odds ratio 2.47, 95% confidence interval 1.60-3.82, P < .001) participants were more likely than White participants to undergo CTC. CONCLUSION: Survey results suggest that nationwide utilization of CTC remains low. Black and Hispanic participants were more likely than White participants to report undergoing CTC. Promotion of CTC may reduce racial and ethnic disparities in colorectal cancer screening.

Viruses and Mycoplasma pneumoniae are the main etiological agents of community-acquired pneumonia in hospitalized pediatric patients in Spain.

OBJECTIVES: To describe the etiology of community-acquired pneumonia (CAP) in hospitalized children in Spain and analyze the predictors of the etiology. HYPOTHESIS: The different etiological groups of pediatric CAP are associated with different clinical, radiographic, and analytical data. DESIGN: Observational, multicenter, and prospective study. PATIENT SELECTION: This study included children aged 1 month to 17 years with CAP, who were hospitalized between April 2012 and May 2019. METHODS: An extensive microbiological workup was performed. The clinical, radiographic, and analytical parameters were analyzed for three etiological groups. RESULTS: Among the 495 children included, at least one causative pathogen was identified in 262 (52.9%): pathogenic viruses in 155/262 (59.2%); atypical bacteria (AB), mainly Mycoplasma pneumonia, in 84/262 (32.1%); and typical bacteria (TyB) in 40/262 (15.3%). Consolidation was observed in 89/138 (64.5%) patients with viral CAP, 74/84 (88.1%) with CAP caused by AB, and 40/40 (100%) with CAP caused by TyB. Para-pneumonic pleural effusion (PPE) was observed in 112/495 (22.6%) patients, of which 61/112 (54.5%) presented a likely causative pathogen: viruses in 12/61 (19.7%); AB in 23/61 (37.7%); and TyB in 26/61 (42.6%). Viral etiology was significantly frequent in young patients and in those with low oxygen saturation, wheezing, no consolidation, and high lymphocyte counts. CAP patients with AB as the etiological agent had a significantly longer and less serious course as compared to those with other causative pathogens. CONCLUSIONS: Viruses and M. pneumoniae are the main causes of pediatric CAP in Spain. Wheezing, young age, and no consolidation on radiographs are indicative of viral etiology. Viruses and AB can also cause PPE. Since only a few cases can be directly attributed to TyB, the indications for antibiotics must be carefully considered in each patient.

Blastomycosis: The Great Pretender.

Blastomycosis is an endemic fungal infection caused by Blastomyces, a soil-dwelling dimorphic fungus found predominantly in North America. In this pictorial essay, we illustrate the varied imaging features of blastomycosis along with a brief description of the epidemiology, clinical aspects, and differential diagnosis, emphasizing clues that can help radiologists arrive at this diagnosis.

ACR Appropriateness Criteria® Chronic Cough.

Chronic cough is defined by a duration lasting at least 8 weeks. The most common causes of chronic cough include smoking-related lung disease, upper airway cough syndrome, asthma, gastroesophageal reflux disease, and nonasthmatic eosinophilic bronchitis. The etiology of chronic cough in some patients may be difficult to localize to an isolated source and is often multifactorial. The complex pathophysiology, clinical presentation, and variable manifestations of chronic cough underscore the challenges faced by clinicians in the evaluation and management of these patients. Imaging plays a role in the initial evaluation, although there is a lack of high-quality evidence guiding which modalities are useful and at what point in time the clinical evaluation should be performed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Mycophenolate therapy in interstitial pneumonia with autoimmune features: a cohort study.

OBJECTIVES: International experts recently characterized interstitial pneumonia with autoimmune features (IPAF) as a provisional diagnosis for patients with interstitial lung disease who have characteristics of autoimmune disease but do not meet criteria for a specific autoimmune disease. We describe clinical characteristics of IPAF patients and examine responses to mycophenolate as a therapy for IPAF. METHODS: This retrospective cohort included adult patients meeting European Respiratory Society/American Thoracic Society classification criteria for IPAF. Sociodemographic, clinical, and pulmonary function test data were abstracted for patients with and without mycophenolate treatment and followed longitudinally from interstitial lung disease diagnosis for change in pulmonary function test results. RESULTS: We identified 52 patients who met criteria for IPAF. Of 52 IPAF patients, 24 did not receive mycophenolate and 28 did, with median time to mycophenolate treatment 22 months. Changes in FVC% and percentage predicted lung diffusion capacity for carbon monoxide (DLCO%) between the mycophenolate-treated and untreated groups were not significantly different (FVC% change P=0.08, DLCO% change P=0.17). However, there was a trend toward more rapid baseline decline of both FVC% and DLCO% in the mycophenolate-treated cohort before vs after mycophenolate therapy. The slope of both FVC% and DLCO% values improved after onset of mycophenolate exposure for the treated group, although this finding was not statistically significant. CONCLUSION: Patients with IPAF might benefit from mycophenolate therapy. Larger prospective clinical trials are needed to evaluate the efficacy of mycophenolate for patients who meet criteria for IPAF.

Lung-RADS: Pushing the Limits.

In response to the recommendation of the U.S. Preventive Services Task Force and the coverage decision by the Centers for Medicare and Medicaid Services for lung cancer screening (LCS) computed tomography (CT), the American College of Radiology introduced the Lung CT Screening Reporting and Data System (Lung-RADS) in 2014 to standardize the reporting and management of screening-detected lung nodules. As with many first-edition guidelines, questions arise when such reporting systems are used in daily practice. In this article, a collection of 15 LCS-related scenarios are presented that address situations in which the Lung-RADS guidelines are unclear or situations that are not currently addressed in the Lung-RADS guidelines. For these 15 scenarios, the authors of this article provide the reader with recommendations that are based on their collective experiences, with the hope that future versions of Lung-RADS will provide additional guidance, particularly as more data from widespread LCS are collected and analyzed. ©RSNA, 2017.

Thermodynamic Scaling of the Dynamics of a Strongly Hydrogen-Bonded Glass-Former.

We probe the temperature- and pressure-dependent specific volume (v) and dipolar dynamics of the amorphous phase (in both the supercooled liquid and glass states) of the ternidazole drug (TDZ). Three molecular dynamic processes are identified by means of dielectric spectroscopy, namely the α relaxation, which vitrifies at the glass transition, a Johari-Goldstein ß JG relaxation, and an intramolecular process associated with the relaxation motion of the propanol chain of the TDZ molecule. The lineshapes of dielectric spectra characterized by the same relaxation time (isochronal spectra) are virtually identical, within the studied temperature and pressure ranges, so that the time-temperature-pressure superposition principle holds for TDZ. The α and ß JG relaxation times fulfil the density-dependent thermodynamic scaling: master curves result when they are plotted against the thermodynamic quantity Tv γ , with thermodynamic exponent γ approximately equal to 2. These results show that the dynamics of TDZ, a system characterized by strong hydrogen bonding, is characterized by an isomorphism similar to that of van-der-Waals systems. The low value of γ can be rationalized in terms of the relatively weak density-dependence of the dynamics of hydrogen-bonded systems.

Idiopathic Pulmonary Fibrosis.

Idiopathic pulmonary fibrosis (IPF) is the most common fibrosing lung disease and is associated with a very poor prognosis. IPF manifests histopathologically as usual interstitial pneumonia (UIP) and as subpleural and basal predominant reticulation with honeycombing on high-resolution computed tomography (HRCT) of the chest. When a high-confidence radiologic diagnosis of UIP is made on HRCT, surgical biopsy is rarely required. Therefore, radiologists should recognize a UIP pattern on HRCT as well as recognize other patterns of fibrosing lung disease such as nonspecific interstitial pneumonia or chronic hypersensitivity pneumonitis, both of which can be mistaken for UIP. This article reviews the clinical, CT, and histopathologic features of IPF, discusses the impact of CT findings on prognosis, and describes complications associated with IPF.

Weight of the resected specimen after transurethral resection as a new predictive variable for recurrence of non-muscle-invasive bladder tumour.

OBJECTIVE: To evaluate the role of the weight of the resected specimen after transurethral resection as a predictive factor for recurrence and progression of non-muscle-invasive bladder tumour (NMIBT). PATIENTS AND METHODS: The weight of the resected tumour was measured consecutively in 144 subjects who underwent transurethral resection of bladder tumours at our institution. The median (interquartile range [IQR]) follow-up was 58 (61.3) months. The probability of recurrence and progression at 1 and 5 years were calculated using the currently accepted variables. Thresholds for the specimen weight were determined according to percentiles and receiver-operating characteristic curves. RESULTS: The median (IQR) weight of the specimen was 6 (16) g. Multivariate analysis showed that the weight of the resected specimen was an independent predictive risk factor for recurrence at a threshold value of 6 g with a hazard ratio of 1.7 (95% confidence interval: 1.048-2.761) P = 0.03. Progression was not associated with the weight of the resected specimen. CONCLUSIONS: The weight of the resected specimen is a new variable for predicting the risk of recurrence of NMIBT. Tumours weighing >6 g, according to the present data, have a 1.7-fold higher likelihood of recurrence than those tumours that weigh less.

A new pathologic mitochondrial DNA mutation in the cytochrome oxidase subunit I (MT-CO1).

A disorder of mitochondrial energy metabolism may be missed in children with a very mild phenotype. Here, we described a patient with a moderate mental retardation and a mild exercise intolerance. This child harboured a mtDNA transition (m.6955G>A) in the subunit I of the cytochrome oxidase (MT-CO1) that fulfils most of the requirements to be pathologic. Despite this subunit is the second longest polypeptide encoded in the mtDNA, only one other missense mutation associated with a myopathy has been described. This suggests that we are missing other phenotypes and that the mitochondrial pathology field is broader that previously thought.

El Sistema Internacional de Sonidos Afectivos (IADS): adaptación española / The International Affective Digitized Sounds (IADS): Spanish Norms

Este trabajo recoge los valores normativos de la adaptación española del Sistema Internacional de Sonidos Afectivos (IADS). El IADS es un conjunto estandarizado de 110 sonidos digitalizados, fiable y válido, para el estudio experimental de los procesos emocionales, construido a partir del modelo dimensional de las emociones propuesto por Peter J. Lang. En la adaptación española participaron 1.716 estudiantes universitarios (1.136 mujeres) que evaluaron los sonidos utilizando las escalas gráficas del Self-Assessment Manikin en sus tres dimensiones de valencia afectiva, activación y dominancia. Los resultados muestran que, al igual que en la población universitaria estadounidense, la distribución de los sonidos en el espacio bidimensional definido por la valencia afectiva y la activación adopta la típica forma de boomerang. No se observaron diferencias significativas en el conjunto de los sonidos entre hombres y mujeres ni diferencias culturales entre la muestra española y la estadounidense. Se discuten los resultados con relación al Sistema Internacional de Imágenes Afectivas (IAPS) y se presentan las tablas con los datos normativos para cada uno de los sonidos (AU)

The Spanish norms for the International Affective Digitized Sounds (IADS) are reported. The IADS is a standardized set of 110 digitalized sounds which are both reliable and valid for the experimental study of emotional processes. The construction of the IADS is based on Peter J. Lang’s dimensional model of emotions. Participants were 1.716 university students (1.136 women) who assessed the sounds using the three scales of the Self-Assessment Manikin: affective valence, arousal, and dominance. The results show a distribution of the sounds, within the bidimensional plot defined by valence and arousal, similar to the North-American student population with a typical boomerang shape. No significant differences were found when comparing men and women nor when comparing the Spanish and North-American samples in the total set of sounds. The results are discussed in relation to the International Affective Picture System (IAPS). The norms for each of the 110 sounds are presented in an annexed table (AU)