A practical and adaptive approach to lung cancer screening: a review of international evidence and position on CT lung cancer screening in the Singaporean population by the College of Radiologists Singapore.

Lung cancer is the leading cause of cancer-related death around the world, being the top cause of cancer-related deaths among men and the second most common cause of cancer-related deaths among women in Singapore. Currently, no screening programme for lung cancer exists in Singapore. Since there is mounting evidence indicating a different epidemiology of lung cancer in Asian countries, including Singapore, compared to the rest of the world, a unique and adaptive approach must be taken for a screening programme to be successful at reducing mortality while maintaining cost-effectiveness and a favourable risk-benefit ratio. This review article promotes the use of low-dose computed tomography of the chest and explores the radiological challenges and future directions.

Outpatient treatment of primary spontaneous pneumothorax using a small-bore chest drain with a Heimlich valve: the experience of a Singapore emergency department.

AIM: To review the outcomes and safety profile of small-bore (8 Fr) chest drains with a Heimlich valve for the treatment of primary spontaneous pneumothorax. METHODOLOGY: A retrospective casenotes review was carried out for pneumothorax cases treated with a small-bore chest drain and connected to a Heimlich valve in the emergency department during a 14-month period from 1 August 2009 to 30 September 2010. Inclusion criteria were primary spontaneous pneumothorax, first episode, unilateral, at least 2-cm rim of air and no or minimal associated pleural effusion. Exclusion criterion was tension pneumothorax. Key outcomes studied were the success rate, as defined by sustained, complete lung re-expansion without the need for alternative intervention (e.g. conventional chest tube or surgery) or admission and complication rates. RESULTS: A total of 55 patients fulfilled the inclusion criteria and were treated with an 8 Fr chest tube and a Heimlich valve. The study population was predominantly (87.3%) male. The age range was 14-48 years (median 20). The overall success rate (as defined above) was 65.5% [95% confidence interval (CI): 51.4-77.8%]. The rate of surgical pleurodesis was 23.6% (95% CI: 13.2-37%). Complications encountered were tube blockage by haemoserous discharge (1.8%; 95% CI: 0-9.7%) and tube dislodgement (5.5%; 95% CI: 1.1-15.1%). CONCLUSION: Our results suggest that the use of a small-bore chest drain and a Heimlich valve is a safe and efficacious mode of treatment for primary spontaneous pneumothorax, which enables management of the majority of these patients as outpatients.