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Safari S, Dizaji SR, Yousefifard M, Taheri MS, Sharifi A. Prevalence and clinical significance of incidental findings in chest and abdominopelvic CT scans of trauma patients; A cross-sectional study. Am J Emerg Med 2024; 82:117-124. [PMID: 38901332 DOI: 10.1016/j.ajem.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 04/21/2024] [Accepted: 06/07/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Imaging may inadvertently reveal pathologies unrelated to their performing purpose, known as incidental findings (IF). This study aimed to assess the prevalence, clinical significance, and documentation of IFs in chest and abdominopelvic computed tomography (CT) scans of trauma patients. METHODS This observational study was conducted at two urban level-1 trauma centers from March 2019 through April 2022. Official radiology reports of trauma patients who underwent chest and/or abdominopelvic CT scans at the emergency department (ED) were explored, and IF were extracted. Predictive factors of the presence of IFs and their documenting were investigated. RESULTS Out of 656 chest and 658 abdominopelvic CT scans, 167 (25.37%) and 212 (32.31%) scans harbored at least one IF, respectively. Patients with IFs tended to be of higher age and female in both chest (age: 48 [IQR: 35-62] vs. 34 [IQR: 25-42.5]; female: 31.14% vs 14.66%, p < 0.001 for both) and abdominopelvic CT scans (age: 41 [IQR: 30-57.5] vs 33 [IQR: 25-43], female: 26.42% vs. 13.96%, p < 0.001 for both). As for documentation of significant IFs, only 49 of 112 chest IFs (43.8%) and 55 of 176 abdominopelvic IFs (31.3%) were documented. Investigating factors associated with documentation of clinically significant IFs, shorter length of hospital stay (1.5 (IQR: 0-4) vs. 3 (IQR: 2-8), p = 0.003), and discharging by ED physicians (documentation rate: 13.2% vs 42.6%, p < 0.001) were associated with poorer documentation of IFs only in abdominopelvic scans. CONCLUSION CT imaging in ED trauma patients often reveals incidental findings, especially in older patients. Over 50% of these findings are clinically significant, yet they are frequently ignored and not documented. Physicians need to be more vigilant in recognizing and documenting these incidental findings and informing patients of the need for further evaluation.
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Affiliation(s)
- Saeed Safari
- Research Center for Trauma in Police Operations, Directorate of Health, Rescue and Treatment, Police Headquarter, Tehran, Iran; Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shayan Roshdi Dizaji
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mahmoud Yousefifard
- Pediatric Chronic Kidney Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran; Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Sanei Taheri
- Radiology Department, Shohadaye Tajrish Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Sharifi
- Hepatopancreaticobiliary and Organ Transplantation Surgery Department, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
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2
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Lin Y, Khurelsukh K, Li IG, Wu CT, Wu YM, Lin G, Toh CH, Wan YL. Incidental Findings in Lung Cancer Screening. Cancers (Basel) 2024; 16:2600. [PMID: 39061238 PMCID: PMC11274500 DOI: 10.3390/cancers16142600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/18/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024] Open
Abstract
While low-dose computed tomography (LDCT) for lung cancer screening (LCS) has been recognized for its effectiveness in reducing lung cancer mortality, it often simultaneously leads to the detection of incidental findings (IFs) unrelated to the primary screening indication. These IFs present diagnostic and management challenges, potentially causing unnecessary anxiety and further invasive diagnostic procedures for patients. This review article provides an overview of IFs encountered in LDCT, emphasizing their clinical significance and recommended management strategies. We categorize IFs based on their anatomical locations (intrathoracic-intrapulmonary, intrathoracic-extrapulmonary, and extrathoracic) and discuss the most common findings. We highlight the importance of utilizing guidelines and standardized reporting systems by the American College of Radiology (ACR) to guide appropriate follow-ups. For each category, we present specific IF examples, their radiologic features, and the suggested management approach. This review aims to provide radiologists and clinicians with a comprehensive understanding of IFs in LCS for accurate assessment and management, ultimately enhancing patient care. Finally, we outline a few key aspects for future research and development in managing IFs.
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Affiliation(s)
- Yenpo Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan; (Y.L.); (K.K.); (C.-T.W.); (Y.-M.W.); (G.L.); (C.-H.T.)
| | - Khulan Khurelsukh
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan; (Y.L.); (K.K.); (C.-T.W.); (Y.-M.W.); (G.L.); (C.-H.T.)
| | - I-Gung Li
- Department of Medical Imaging and Intervention, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan;
| | - Chen-Te Wu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan; (Y.L.); (K.K.); (C.-T.W.); (Y.-M.W.); (G.L.); (C.-H.T.)
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| | - Yi-Ming Wu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan; (Y.L.); (K.K.); (C.-T.W.); (Y.-M.W.); (G.L.); (C.-H.T.)
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan; (Y.L.); (K.K.); (C.-T.W.); (Y.-M.W.); (G.L.); (C.-H.T.)
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| | - Cheng-Hong Toh
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan; (Y.L.); (K.K.); (C.-T.W.); (Y.-M.W.); (G.L.); (C.-H.T.)
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| | - Yung-Liang Wan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan City 333, Taiwan; (Y.L.); (K.K.); (C.-T.W.); (Y.-M.W.); (G.L.); (C.-H.T.)
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
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3
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Martin MD, Kanne JP, Broderick LS, Kazerooni EA, Meyer CA. RadioGraphics Update: Lung-RADS 2022. Radiographics 2023; 43:e230037. [PMID: 37856315 DOI: 10.1148/rg.230037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
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.
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Affiliation(s)
- Maria D Martin
- From the Department of Radiology, University of Wisconsin School of Medicine, 600 Highland Ave, Madison, WI 53792-3252 (M.D.M., J.P.K., L.S.B., C.A.M.); and Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (E.A.K.)
| | - Jeffrey P Kanne
- From the Department of Radiology, University of Wisconsin School of Medicine, 600 Highland Ave, Madison, WI 53792-3252 (M.D.M., J.P.K., L.S.B., C.A.M.); and Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (E.A.K.)
| | - Lynn S Broderick
- From the Department of Radiology, University of Wisconsin School of Medicine, 600 Highland Ave, Madison, WI 53792-3252 (M.D.M., J.P.K., L.S.B., C.A.M.); and Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (E.A.K.)
| | - Ella A Kazerooni
- From the Department of Radiology, University of Wisconsin School of Medicine, 600 Highland Ave, Madison, WI 53792-3252 (M.D.M., J.P.K., L.S.B., C.A.M.); and Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (E.A.K.)
| | - Cristopher A Meyer
- From the Department of Radiology, University of Wisconsin School of Medicine, 600 Highland Ave, Madison, WI 53792-3252 (M.D.M., J.P.K., L.S.B., C.A.M.); and Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (E.A.K.)
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4
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Martin MD, Henry TS, Berry MF, Johnson GB, Kelly AM, Ko JP, Kuzniewski CT, Lee E, Maldonado F, Morris MF, Munden RF, Raptis CA, Shim K, Sirajuddin A, Small W, Tong BC, Wu CC, Donnelly EF. ACR Appropriateness Criteria® Incidentally Detected Indeterminate Pulmonary Nodule. J Am Coll Radiol 2023; 20:S455-S470. [PMID: 38040464 DOI: 10.1016/j.jacr.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
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.
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Affiliation(s)
- Maria D Martin
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
| | | | - Mark F Berry
- Stanford University Medical Center, Stanford, California; Society of Thoracic Surgeons
| | - Geoffrey B Johnson
- Mayo Clinic, Rochester, Minnesota; Commission on Nuclear Medicine and Molecular Imaging
| | | | - Jane P Ko
- New York University Langone Health, New York, New York; IF Committee
| | | | - Elizabeth Lee
- University of Michigan Health System, Ann Arbor, Michigan
| | - Fabien Maldonado
- Vanderbilt University Medical Center, Nashville, Tennessee; American College of Chest Physicians
| | | | - Reginald F Munden
- Medical University of South Carolina, Charleston, South Carolina; IF Committee
| | | | - Kyungran Shim
- John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois; American College of Physicians
| | | | - William Small
- Loyola University Chicago, Stritch School of Medicine, Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Maywood, Illinois; Commission on Radiation Oncology
| | - Betty C Tong
- Duke University School of Medicine, Durham, North Carolina; Society of Thoracic Surgeons
| | - Carol C Wu
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Edwin F Donnelly
- Specialty Chair, Ohio State University Wexner Medical Center, Columbus, Ohio
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5
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O'Dowd EL, Tietzova I, Bartlett E, Devaraj A, Biederer J, Brambilla M, Brunelli A, Chorostowska J, Decaluwe H, Deruysscher D, De Wever W, Donoghue M, Fabre A, Gaga M, van Geffen W, Hardavella G, Kauczor HU, Kerpel-Fronius A, van Meerbeeck J, Nagavci B, Nestle U, Novoa N, Prosch H, Prokop M, Putora PM, Rawlinson J, Revel MP, Snoeckx A, Veronesi G, Vliegenthart R, Weckbach S, Blum TG, Baldwin DR. ERS/ESTS/ESTRO/ESR/ESTI/EFOMP statement on management of incidental findings from low dose CT screening for lung cancer. Eur J Cardiothorac Surg 2023; 64:ezad302. [PMID: 37804174 PMCID: PMC10876118 DOI: 10.1093/ejcts/ezad302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/06/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Screening for lung cancer with low radiation dose computed tomography has a strong evidence base, is being introduced in several European countries and is recommended as a new targeted cancer screening programme. The imperative now is to ensure that implementation follows an evidence-based process that will ensure clinical and cost effectiveness. This European Respiratory Society (ERS) task force was formed to provide an expert consensus for the management of incidental findings which can be adapted and followed during implementation. METHODS A multi-European society collaborative group was convened. 23 topics were identified, primarily from an ERS statement on lung cancer screening, and a systematic review of the literature was conducted according to ERS standards. Initial review of abstracts was completed and full text was provided to members of the group for each topic. Sections were edited and the final document approved by all members and the ERS Science Council. RESULTS Nine topics considered most important and frequent were reviewed as standalone topics (interstitial lung abnormalities, emphysema, bronchiectasis, consolidation, coronary calcification, aortic valve disease, mediastinal mass, mediastinal lymph nodes and thyroid abnormalities). Other topics considered of lower importance or infrequent were grouped into generic categories, suitable for general statements. CONCLUSIONS This European collaborative group has produced an incidental findings statement that can be followed during lung cancer screening. It will ensure that an evidence-based approach is used for reporting and managing incidental findings, which will mean that harms are minimised and any programme is as cost-effective as possible.
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Affiliation(s)
- Emma L O'Dowd
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham, Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Ilona Tietzova
- Charles University, First Faculty of Medicine, Department of Tuberculosis and Respiratory Diseases, Prague, Czech Republic
| | - Emily Bartlett
- Royal Brompton and Harefield NHS Foundation Trust, Radiology, London, UK
| | - Anand Devaraj
- Royal Brompton and Harefield NHS Foundation Trust, Radiology, London, UK
| | - Jürgen Biederer
- University of Heidelberg, Diagnostic and Interventional Radiology, Heidelberg, Germany
- German Center for Lung Research DZL, Translational Lung Research Center TLRC, Heidelberg, Germany
- University of Latvia, Faculty of Medicine, Riga, Latvia
- Christian-Albrechts-Universität zu Kiel, Faculty of Medicine, Kiel, Germany
| | - Marco Brambilla
- Azienda Ospedaliero-Universitaria Maggiore della Carità di Novara, Novara, Italy
| | | | - Joanna Chorostowska
- Institute of Tuberculosis and Lung Diseases, Warsaw, Genetics and Clinical Immunology, Warsaw, Poland
| | | | - Dirk Deruysscher
- Maastricht University Medical Centre, Department of Radiation Oncology (MAASTRO Clinic), GROW-School for Oncology and Developmental Biology, Limburg, The Netherlands
| | - Walter De Wever
- Universitaire Ziekenhuizen Leuven, Radiology, Leuven, Belgium
| | | | - Aurelie Fabre
- University College Dublin School of Medicine, Histopathology, Dublin, Ireland
| | - Mina Gaga
- Sotiria General Hospital of Chest Diseases of Athens, 7th Respiratory Medicine Department, Athens, Greece
| | - Wouter van Geffen
- Medical Centre Leeuwarden, Department of Respiratory Medicine, Leeuwarden, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands
| | - Georgia Hardavella
- Sotiria General Hospital of Chest Diseases of Athens, Respiratory Medicine, Athens, Greece
| | - Hans-Ulrich Kauczor
- University of Heidelberg, Diagnostic and Interventional Radiology, Heidelberg, Germany
- German Center for Lung Research DZL, Translational Lung Research Center TLRC, Heidelberg, Germany
| | - Anna Kerpel-Fronius
- National Koranyi Institute of Pulmonology, Department of Radiology, Budapest, Hungary
| | | | - Blin Nagavci
- Institute for Evidence in Medicine, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Ursula Nestle
- Kliniken Maria Hilf GmbH Monchengladbach, Nordrhein-Westfalen, Germany
| | - Nuria Novoa
- University Hospital of Salamanca, Thoracic Surgery, Salamanca, Spain
| | - Helmut Prosch
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Vienna, Austria
| | - Mathias Prokop
- Radboud University Nijmegen Medical Center, Department of Radiology, Nijmegen, The Netherlands
| | - Paul Martin Putora
- Kantonsspital Sankt Gallen, Radiation Oncology, Sankt Gallen, Switzerland
- Inselspital Universitatsspital Bern, Radiation Oncology, Bern, Switzerland
| | | | - Marie-Pierre Revel
- Cochin Hospital, APHP, Radiology Department, Paris, France
- Université de Paris, Paris, France
| | | | - Giulia Veronesi
- Humanitas Research Hospital, Division of Thoracic and General Surgery, Rozzano, Italy
| | | | - Sabine Weckbach
- UniversitatsKlinikum Heidelberg, Heidelberg, Germany
- Bayer AG, Research and Development, Pharmaceuticals, Radiology, Berlin, Germany
| | - Torsten G Blum
- HELIOS Klinikum Emil von Behring GmbH, Lungenklinik Heckeshorn, Berlin, Germany
| | - David R Baldwin
- University of Nottingham, Faculty of Medicine and Health Sciences, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Department of Respiratory Medicine, Nottingham, UK
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6
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O'Dowd EL, Tietzova I, Bartlett E, Devaraj A, Biederer J, Brambilla M, Brunelli A, Chorostowska-Wynimko J, Decaluwe H, Deruysscher D, De Wever W, Donoghue M, Fabre A, Gaga M, van Geffen W, Hardavella G, Kauczor HU, Kerpel-Fronius A, van Meerbeeck J, Nagavci B, Nestle U, Novoa N, Prosch H, Prokop M, Putora PM, Rawlinson J, Revel MP, Snoeckx A, Veronesi G, Vliegenthart R, Weckbach S, Blum TG, Baldwin DR. ERS/ESTS/ESTRO/ESR/ESTI/EFOMP statement on management of incidental findings from low dose CT screening for lung cancer. Eur Respir J 2023; 62:2300533. [PMID: 37802631 DOI: 10.1183/13993003.00533-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/06/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Screening for lung cancer with low radiation dose computed tomography has a strong evidence base, is being introduced in several European countries and is recommended as a new targeted cancer screening programme. The imperative now is to ensure that implementation follows an evidence-based process that will ensure clinical and cost effectiveness. This European Respiratory Society (ERS) task force was formed to provide an expert consensus for the management of incidental findings which can be adapted and followed during implementation. METHODS A multi-European society collaborative group was convened. 23 topics were identified, primarily from an ERS statement on lung cancer screening, and a systematic review of the literature was conducted according to ERS standards. Initial review of abstracts was completed and full text was provided to members of the group for each topic. Sections were edited and the final document approved by all members and the ERS Science Council. RESULTS Nine topics considered most important and frequent were reviewed as standalone topics (interstitial lung abnormalities, emphysema, bronchiectasis, consolidation, coronary calcification, aortic valve disease, mediastinal mass, mediastinal lymph nodes and thyroid abnormalities). Other topics considered of lower importance or infrequent were grouped into generic categories, suitable for general statements. CONCLUSIONS This European collaborative group has produced an incidental findings statement that can be followed during lung cancer screening. It will ensure that an evidence-based approach is used for reporting and managing incidental findings, which will mean that harms are minimised and any programme is as cost-effective as possible.
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Affiliation(s)
- Emma L O'Dowd
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham, Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Ilona Tietzova
- Charles University, First Faculty of Medicine, Department of Tuberculosis and Respiratory Diseases, Prague, Czech Republic
| | - Emily Bartlett
- Royal Brompton and Harefield NHS Foundation Trust, Radiology, London, UK
| | - Anand Devaraj
- Royal Brompton and Harefield NHS Foundation Trust, Radiology, London, UK
| | - Jürgen Biederer
- University of Heidelberg, Diagnostic and Interventional Radiology, Heidelberg, Germany
- German Center for Lung Research DZL, Translational Lung Research Center TLRC, Heidelberg, Germany
- University of Latvia, Faculty of Medicine, Riga, Latvia
- Christian-Albrechts-Universität zu Kiel, Faculty of Medicine, Kiel, Germany
| | - Marco Brambilla
- Azienda Ospedaliero-Universitaria Maggiore della Carità di Novara, Novara, Italy
| | | | | | | | - Dirk Deruysscher
- Maastricht University Medical Centre, Department of Radiation Oncology (MAASTRO Clinic), GROW-School for Oncology and Developmental Biology, Limburg, The Netherlands
| | - Walter De Wever
- Universitaire Ziekenhuizen Leuven, Radiology, Leuven, Belgium
| | | | - Aurelie Fabre
- University College Dublin School of Medicine, Histopathology, Dublin, Ireland
| | - Mina Gaga
- Sotiria General Hospital of Chest Diseases of Athens, 7th Respiratory Medicine Department, Athens, Greece
| | - Wouter van Geffen
- Medical Centre Leeuwarden, Department of Respiratory Medicine, Leeuwarden, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands
| | - Georgia Hardavella
- Sotiria General Hospital of Chest Diseases of Athens, Respiratory Medicine, Athens, Greece
| | - Hans-Ulrich Kauczor
- University of Heidelberg, Diagnostic and Interventional Radiology, Heidelberg, Germany
- German Center for Lung Research DZL, Translational Lung Research Center TLRC, Heidelberg, Germany
| | - Anna Kerpel-Fronius
- National Koranyi Institute of Pulmonology, Department of Radiology, Budapest, Hungary
| | | | - Blin Nagavci
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Ursula Nestle
- Kliniken Maria Hilf GmbH Monchengladbach, Nordrhein-Westfalen, Germany
| | - Nuria Novoa
- University Hospital of Salamanca, Thoracic Surgery, Salamanca, Spain
| | - Helmut Prosch
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Vienna, Austria
| | - Mathias Prokop
- Radboud University Nijmegen Medical Center, Department of Radiology, Nijmegen, The Netherlands
| | - Paul Martin Putora
- Kantonsspital Sankt Gallen, Radiation Oncology, Sankt Gallen, Switzerland
- Inselspital Universitatsspital Bern, Radiation Oncology, Bern, Switzerland
| | | | - Marie-Pierre Revel
- Cochin Hospital, APHP, Radiology Department, Paris, France
- Université de Paris, Paris, France
| | | | - Giulia Veronesi
- Humanitas Research Hospital, Division of Thoracic and General Surgery, Rozzano, Italy
| | | | - Sabine Weckbach
- UniversitatsKlinikum Heidelberg, Heidelberg, Germany
- Bayer AG, Research and Development, Pharmaceuticals, Radiology, Berlin, Germany
| | - Torsten G Blum
- HELIOS Klinikum Emil von Behring GmbH, Lungenklinik Heckeshorn, Berlin, Germany
| | - David R Baldwin
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- University of Nottingham, Faculty of Medicine and Health Sciences, Nottingham, UK
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7
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Felsen A, McClelland A, Kobi M, Bello JA, Burns J. Health Systems Science - A Primer for Radiologists. Acad Radiol 2023; 30:2079-2088. [PMID: 36966069 DOI: 10.1016/j.acra.2023.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 03/27/2023]
Abstract
Health systems science (HSS) is an educational framework designed to promote improved care through enhanced citizenship and the training of systems-fluent individuals trained in the science of health care delivery. HSS education in residency builds upon foundations established during medical school, emphasizing practical skills development, and fostering a growth mindset among trainees. The HSS framework organizes elements of system-based practice for radiology trainees, promoting practice-readiness for providing safe, timely, effective, efficient, equitable and patient centered radiological care. This paper serves as a primer for radiologists to understand and apply the HSS framework. Additionally, we highlight radiology-specific curricular elements aligned with the HSS framework, and provide teaching resources both for classroom education and for resident self-study.
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Affiliation(s)
- Amanda Felsen
- Albert Einstein College of Medicine, Montefiore New Rochelle Hospital; Bronx, NY
| | - Andrew McClelland
- Department of Radiology, NYU Grossman School of Medicine; New York, NY
| | - Mariya Kobi
- Department of Radiology, Columbia University Medical Center; New York, NY
| | | | - Judah Burns
- Department of Radiology, Montefiore Medical Center; Bronx, NY; Albert Einstein College of Medicine; Bronx, NY.
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8
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Tisi S, Creamer AW, Dickson J, Horst C, Quaife S, Hall H, Verghese P, Gyertson K, Bowyer V, Levermore C, Hacker AM, Teague J, Farrelly L, Nair A, Devaraj A, Hackshaw A, Hurst JR, Janes S. Prevalence and clinical characteristics of non-malignant CT detected incidental findings in the SUMMIT lung cancer screening cohort. BMJ Open Respir Res 2023; 10:e001664. [PMID: 37321665 PMCID: PMC10277548 DOI: 10.1136/bmjresp-2023-001664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/26/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Pulmonary and extrapulmonary incidental findings are frequently identified on CT scans performed for lung cancer screening. Uncertainty regarding their clinical significance and how and when such findings should be reported back to clinicians and participants persists. We examined the prevalence of non-malignant incidental findings within a lung cancer screening cohort and investigated the morbidity and relevant risk factors associated with incidental findings. We quantified the primary and secondary care referrals generated by our protocol. METHODS The SUMMIT study (NCT03934866) is a prospective observational cohort study to examine the performance of delivering a low-dose CT (LDCT) screening service to a high-risk population. Spirometry, blood pressure, height/weight and respiratory history were assessed as part of a Lung Health Check. Individuals at high risk of lung cancer were offered an LDCT and returned for two further annual visits. This analysis is a prospective evaluation of the standardised reporting and management protocol for incidental findings developed for the study on the baseline LDCT. RESULTS In 11 115 participants included in this analysis, the most common incidental findings were coronary artery calcification (64.2%) and emphysema (33.4%). From our protocolised management approach, the number of participants requiring review for clinically relevant findings in primary care was 1 in 20, and the number potentially requiring review in secondary care was 1 in 25. CONCLUSIONS Incidental findings are common in lung cancer screening and can be associated with reported symptoms and comorbidities. A standardised reporting protocol allows systematic assessment and standardises onward management.
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Affiliation(s)
- Sophie Tisi
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Andrew W Creamer
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Jennifer Dickson
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Carolyn Horst
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Samantha Quaife
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Helen Hall
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Priyam Verghese
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Kylie Gyertson
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Vicky Bowyer
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Claire Levermore
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Anne-Marie Hacker
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Jonathon Teague
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Laura Farrelly
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Arjun Nair
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Anand Devaraj
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton and Harefield NHS Trust, London, UK
| | - Allan Hackshaw
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Samuel Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
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9
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Türk F, Kökver Y. Detection of Lung Opacity and Treatment Planning with Three-Channel Fusion CNN Model. ARABIAN JOURNAL FOR SCIENCE AND ENGINEERING 2023:1-13. [PMID: 37361471 PMCID: PMC10103673 DOI: 10.1007/s13369-023-07843-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 03/20/2023] [Indexed: 06/28/2023]
Abstract
Lung opacities are extremely important for physicians to monitor and can have irreversible consequences for patients if misdiagnosed or confused with other findings. Therefore, long-term monitoring of the regions of lung opacity is recommended by physicians. Tracking the regional dimensions of images and classifying differences from other lung cases can provide significant ease to physicians. Deep learning methods can be easily used for the detection, classification, and segmentation of lung opacity. In this study, a three-channel fusion CNN model is applied to effectively detect lung opacity on a balanced dataset compiled from public datasets. The MobileNetV2 architecture is used in the first channel, the InceptionV3 model in the second channel, and the VGG19 architecture in the third channel. The ResNet architecture is used for feature transfer from the previous layer to the current layer. In addition to being easy to implement, the proposed approach can also provide significant cost and time advantages to physicians. Our accuracy values for two, three, four, and five classes on the newly compiled dataset for lung opacity classifications are found to be 92.52%, 92.44%, 87.12%, and 91.71%, respectively.
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Affiliation(s)
- Fuat Türk
- Department of Computer Engineering, Çankırı Karatekin University, 18100 Çankırı, Turkey
| | - Yunus Kökver
- Department of Computer Technologies, Elmadağ Vocational School, Ankara University, 06780 Ankara, Turkey
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10
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Sharpe RE, Huffman RI, McLaughlin CG, Blubaugh P, Strobel MJ, Palen T. Applying Implementation Science Principles to Systematize High-Quality Care for Potentially Significant Imaging Findings. J Am Coll Radiol 2023; 20:324-334. [PMID: 36922106 DOI: 10.1016/j.jacr.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/29/2022] [Accepted: 11/16/2022] [Indexed: 03/14/2023]
Abstract
OBJECTIVE Use principles of implementation science to improve the diagnosis and management of potentially significant imaging findings. METHODS Multidisciplinary stakeholders codified the diagnosis and management of potentially significant imaging findings in eight organs and created a finding tracking management system that was embedded in radiologist workflows and IT systems. Radiologists were trained to use this system. An automated finding tracking management system was created to support consistent high-quality care through care pathway visualizations, increased awareness of specific findings in the electronic medical record, templated notifications, and creation of an electronic safety net. Primary outcome was the rate of quality reviews related to eight targeted imaging findings. Secondary outcome was radiologist use of the finding tracking management tool. RESULTS In the 4 years after implementation, the tool was used to track findings in 7,843 patients who received 10,015 ultrasound, CT, MRI, x-ray, and nuclear medicine examinations that were interpreted by all 34 radiologists. Use of the tool lead to a decrease in related quality reviews (from 8.0% to 0.0%, P < .007). Use of the system increased from 1.7% of examinations in the early implementation phase to 3.1% (+82%, P < .00001) in the postimplementation phase. Each radiologist used the tool on an average of 294.6 unique examinations (SD 404.8). Overall, radiologists currently use the tool approximately 4,000 times per year. DISCUSSION Radiologists frequently used a finding tracking management system to ensure effective communication and raise awareness of the importance of recommended future follow-up studies. Use of this system was associated with a decrease in the rate of quality review requests in this domain.
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Affiliation(s)
- Richard E Sharpe
- Division Chair of Breast Imaging and Radiologist, Mayo Clinic, Phoenix, Arizona; Member, ACR Peer Learning Committee; Member, ACR Appropriateness Panel for Breast Imaging; and Member, ACR Commission on Screening & Emerging Technology Committee.
| | - Ryan I Huffman
- Radiologist, Scripps Clinic Medical Group, La Jolla, California
| | - Christopher G McLaughlin
- Radiologist, Department Technical Lead, Radiology, Colorado Permanente Medical Group, Denver, Colorado
| | | | - Mary Jo Strobel
- Director, Clinical Quality Oversight, Quality, Risk, and Patient Safety, Kaiser Permanente Colorado, Denver, Colorado
| | - Ted Palen
- Internal Medicine Physician and Scientific Investigator, Colorado Permanente Medical Group, Denver, Colorado
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11
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Munden R. Incidentalomas in chest CT. Br J Radiol 2023; 96:20211368. [PMID: 35315291 PMCID: PMC9975517 DOI: 10.1259/bjr.20211368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/15/2022] [Accepted: 03/07/2022] [Indexed: 01/27/2023] Open
Abstract
Advances in imaging technology have dramatically increased the resolution of CT and improved detection of disease; these advances also have led to an increase in incidentalomas or incidental findings that often do not represent significant disease. Incidental findings on thoracic CT are common and can be problematic and expensive to evaluate. Thoracic imagers often are having to make recommendations for appropriate management which adds to the burden. Thoracic CT incidental findings are broad and include those of the lungs, heart, mediastinum, pleura, chest wall, thoracic soft tissues as well as the lower neck and upper abdomen. Of these, incidental pulmonary nodules have garnered the most interest over the years, but all incidentals may be proven to represent significant disease. In the USA, the American College of Radiology has generated white papers on incidentals that have proven useful. Currently, a number of investigations to utilize artificial intelligence for qualification and management of incidentals are ongoing. Likewise, the radiology/imaging community must support efforts to collaboratively address incidental findings and management concerns. As such, continued efforts to establish guidelines for appropriate identification, classification and management of incidentals is important to improve patient care and assure fiscally responsible assessment.
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12
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Horst C, Patel S, Nair A. Reporting and management of incidental lung findings on computed tomography: beyond lung nodules. Br J Radiol 2023; 96:20220207. [PMID: 36124681 PMCID: PMC9975526 DOI: 10.1259/bjr.20220207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 08/03/2022] [Accepted: 08/30/2022] [Indexed: 01/27/2023] Open
Abstract
Non-nodular incidental lung findings can broadly be categorised as airway- or airspace-related abnormalities and diffuse parenchymal abnormalities. Airway-related abnormalities include bronchial dilatation and thickening, foci of low attenuation, emphysema, and congenital variants. Diffuse parenchymal abnormalities relate to the spectrum of diffuse parenchymal lung diseases cover a spectrum from interstitial lung abnormalities (ILAs) and pulmonary cysts to established diffuse parenchymal lung abnormalities such as the idiopathic interstitial pneumonias and cystic lung diseases. In this review, we discuss the main manifestations of these incidental findings, paying attention to their prevalence and importance, descriptors to use when reporting, the limits of what can be considered "normal", and conclude each section with some pragmatic reporting recommendations. We also highlight technical and patient factors which can lead to spurious abnormalities.
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Affiliation(s)
- Carolyn Horst
- Cancer Imaging Department, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | | | - Arjun Nair
- University College London Hospitals NHS Foundation Trust, London, UK
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13
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Dyer DS, White C, Conley Thomson C, Gieske MR, Kanne JP, Chiles C, Parker MS, Menchaca M, Wu CC, Kazerooni EA. A Quick Reference Guide for Incidental Findings on Lung Cancer Screening CT Examinations. J Am Coll Radiol 2023; 20:162-172. [PMID: 36509659 DOI: 10.1016/j.jacr.2022.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE The US Preventive Services Task Force has recommended lung cancer screening (LCS) with low-dose CT (LDCT) in high-risk individuals since 2013. Because LDCT encompasses the lower neck, chest, and upper abdomen, many incidental findings (IFs) are detected. The authors created a quick reference guide to describe common IFs in LCS to assist LCS program navigators and ordering providers in managing the care continuum in LCS. METHODS The ACR IF white papers were reviewed for findings on LDCT that were age appropriate for LCS. A draft guide was created on the basis of recommendations in the IF white papers, the medical literature, and input from subspecialty content experts. The draft was piloted with LCS program navigators recruited through contacts by the ACR LCS Steering Committee. The navigators completed a survey on overall usefulness, clarity, adequacy of content, and user experience with the guide. RESULTS Seven anatomic regions including 15 discrete organs with 45 management recommendations were identified as relevant to the age of individuals eligible for LCS. The draft was piloted by 49 LCS program navigators from 32 facilities. The guide was rated as useful and clear by 95% of users. No unexpected or adverse experiences were reported in using the guide. On the basis of feedback, relevant sections were reviewed and edited. CONCLUSIONS The ACR Lung Cancer Screening CT Incidental Findings Quick Reference Guide outlines the common IFs in LCS and can serve as an easy-to-use resource for ordering providers and LCS program navigators to help guide management.
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Affiliation(s)
- Debra S Dyer
- Chair, Department of Radiology, Director, Lung Cancer Screening Program, and Director, Incidental Lung Nodule Program & Lung Nodule Registry, National Jewish Health, Denver, Colorado.
| | - Charles White
- Vice Chair, Clinical Affairs, University of Maryland School of Medicine, Baltimore, Maryland. https://twitter.com/
| | - Carey Conley Thomson
- Chair, Department of Medicine and Director, Multidisciplinary Thoracic Oncology and Lung Cancer Screening Program, Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, Massachusetts; and Harvard Medical School, Boston, Massachusetts
| | - Michael R Gieske
- Director, Lung Cancer Screening Physician, Director, Virtual Health Director, Primary Care East Department, Lead Provider, Ft. Mitchell St. Elizabeth Primary Care, Physician Director, Policy and Government Relations, St Elizabeth Healthcare, Edgewood, Kentucky
| | - Jeffrey P Kanne
- Chief, Thoracic Imaging and Vice Chair, Quality and Safety, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. https://twitter.com/
| | - Caroline Chiles
- Director, Lung Cancer Screening Program, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina. https://twitter.com/
| | - Mark S Parker
- Director, Thoracic Imaging Section and Director, Thoracic Imaging Fellowship Program, Early Detection Lung Screening Program, VCU Health Systems, Richmond, Virginia
| | - Martha Menchaca
- Department of Radiology, University of Illinois at Chicago, Chicago, Illinois
| | - Carol C Wu
- Deputy Chair Ad Interim, Department of Thoracic Imaging, MD Anderson Cancer Center, Houston, Texas. https://twitter.com/
| | - Ella A Kazerooni
- Associate Chief Clinical Officer for Diagnostics and Clinical Information Management, University of Michigan Medical School, Ann Arbor, Michigan. https://twitter.com/
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14
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Lee JE, Jeong WG, Lee HJ, Kim YH, Chae KJ, Jeong YJ. Relationship between Incidental Abnormalities on Screening Thoracic Computed Tomography and Mortality: A Long-Term Follow-Up Analysis. Korean J Radiol 2022; 23:998-1008. [PMID: 36175001 PMCID: PMC9523229 DOI: 10.3348/kjr.2022.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/04/2022] [Accepted: 07/18/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The present study aimed to assess the relationship between incidental abnormalities on thoracic computed tomography (CT) and mortality in a general screening population using a long-term follow-up analysis. MATERIALS AND METHODS We retrospectively collected the medical records and CT images of 840 participants (mean age ± standard deviation [SD], 58.5 ± 6.7 years; 564 male) who underwent thoracic CT at a single health promotion center between 2007 and 2010. Two thoracic radiologists independently reviewed all CT images and evaluated any incidental abnormalities (interstitial lung abnormality [ILA], emphysema, coronary artery calcification [CAC], aortic valve [AV] calcification, and pulmonary nodules). Kaplan-Meier analysis with log-rank and z-tests was performed to assess the relationship between incidental CT abnormalities and all-cause mortality in the subsequent follow-up. Cox proportional hazards regression was performed to further identify risk factors of all-cause mortality among the incidental CT abnormalities and clinical factors. RESULTS Among the 840 participants, 55 (6%), 171 (20%), 288 (34%), 396 (47%), and 97 (11%) had findings of ILA, emphysema, CAC, pulmonary nodule, and AV calcification, respectively, on initial CT. The participants were followed up for a mean period ± SD of 10.9 ± 1.4 years. All incidental CT abnormalities were associated with all-cause mortality in univariable analysis (p < 0.05). However, multivariable analysis further revealed fibrotic ILA as an independent risk factor for all-cause mortality (hazard ratio, 2.52 [95% confidence interval, 1.02-6.22], p = 0.046). ILA were also identified as an independent risk factor for lung cancer or respiratory disease-related deaths. CONCLUSION Incidental abnormalities on screening thoracic CT were associated with increased mortality during the long-term follow-up. Among incidental CT abnormalities, fibrotic ILA were independently associated with increased mortality. Appropriate management and surveillance may be required for patients with fibrotic ILA on thoracic CT obtained for general screening purposes.
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Affiliation(s)
- Jong Eun Lee
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Won Gi Jeong
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
| | - Hyo-Jae Lee
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Yun-Hyeon Kim
- Department of Radiology, Chonnam National University Hospital, Gwangju, Korea
| | - Kum Ju Chae
- Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Yeon Joo Jeong
- Department of Radiology and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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15
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Barrett TW, Garland NM, Freeman CL, Klar K, Dahlke J, Lancaster P, Prisco L, Chang SS, Goff LW, Russ S, Jones ID. Catching Those Who Fall Through the Cracks: Integrating a Follow-Up Process for Emergency Department Patients with Incidental Radiologic Findings. Ann Emerg Med 2022; 80:235-242. [PMID: 35752517 DOI: 10.1016/j.annemergmed.2022.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/15/2022] [Accepted: 04/20/2022] [Indexed: 11/01/2022]
Abstract
STUDY OBJECTIVE Abnormal findings unrelated to the indication for testing are identified on emergency department (ED) imaging studies. We report the design and implementation of an electronic health record-based interdisciplinary referral system and our experience from the first 13 months of ensuring that patients with incidental radiology findings were connected with the appropriate outpatient surveillance. METHODS Our informatics team standardized the contemporaneous reporting of critical radiology alerts using our ED trackboard and created a companion follow-up request form for the treating ED clinicians to complete. The forms were routed to nurse case managers, who arranged follow-ups based on the findings and clinical significance. The primary outcome was the proportion of ED patient visits with identified incidental findings that had documented communication of the incidental findings and surveillance plans. RESULTS Over the first 13 months after implementation, 932 ED patient visits had critical radiology alert referrals, for a total of 982 incidental findings. The primary outcome (confirmed post-ED communication and documented follow-up plan) was attained in 888 (95.3%, 95% confidence interval [CI] 93.9% to 96.6%) ED patient visits with confirmed post-ED communication and documented follow-up plans. The team was unable to contact or confirm follow-up with 44 (4.7%, 95% CI 3.4 to 6.1) patients by telephone or through the health care system's electronic communication tools. CONCLUSION We report the implementation of a standardized notification and referral system for ED patients with incidental radiology findings. The development of a reliable notification and follow-up system is an important patient safety intervention given the opportunity to potentially identify undiagnosed malignancies.
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Affiliation(s)
- Tyler W Barrett
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN.
| | - Nicholas M Garland
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Clifford L Freeman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Katharine Klar
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Jan Dahlke
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Penny Lancaster
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Larry Prisco
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Sam S Chang
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Laura W Goff
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Stephan Russ
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Ian D Jones
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
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16
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Pinto E, Penha D, Hochhegger B, Monaghan C, Marchiori E, Taborda-Barata L, Irion K. Incidental chest findings on coronary CT angiography: a pictorial essay and management proposal. JORNAL BRASILEIRO DE PNEUMOLOGIA : PUBLICACAO OFICIAL DA SOCIEDADE BRASILEIRA DE PNEUMOLOGIA E TISILOGIA 2022; 48:e20220015. [PMID: 35584528 PMCID: PMC9064655 DOI: 10.36416/1806-3756/e20220015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/07/2022] [Indexed: 11/17/2022]
Abstract
Many health systems have been using coronary CT angiography (CCTA) as a first-line examination for ischaemic heart disease patients in various countries. The rising number of CCTA examinations has led to a significant increase in the number of reported incidental extracardiac findings, mainly in the chest. Pulmonary nodules are the most common incidental findings on CCTA scans, as there is a substantial overlap of risk factors between the population seeking to exclude ischaemic heart disease and those at risk of developing lung cancer (i.e., advanced age and smoking habits). However, most incidental findings are clinically insignificant and actively pursuing them could be cost-prohibitive and submit the patient to unnecessary and potentially harmful examinations. Furthermore, there is little consensus regarding when to report or actively exclude these findings and how to manage them, that is, when to trigger an alert or to immediately refer the patient to a pulmonologist, a thoracic surgeon or a multidisciplinary team. This pictorial essay discusses the current literature on this topic and is illustrated with a review of CCTA scans. We also propose a checklist organised by organ and system, recommending actions to raise awareness of pulmonologists, thoracic surgeons, cardiologists and radiologists regarding the most significant and actionable incidental findings on CCTA scans.
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Affiliation(s)
- Erique Pinto
- . Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - Diana Penha
- . Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal.,. Imaging Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Bruno Hochhegger
- . Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | - Colin Monaghan
- . Imaging Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Edson Marchiori
- . Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil.,. Faculdade de Medicina, Universidade Federal Fluminense, Niterói (RJ) Brasil
| | - Luís Taborda-Barata
- . Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - Klaus Irion
- . Imaging Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
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17
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Silva M, Picozzi G, Sverzellati N, Anglesio S, Bartolucci M, Cavigli E, Deliperi A, Falchini M, Falaschi F, Ghio D, Gollini P, Larici AR, Marchianò AV, Palmucci S, Preda L, Romei C, Tessa C, Rampinelli C, Mascalchi M. Low-dose CT for lung cancer screening: position paper from the Italian college of thoracic radiology. LA RADIOLOGIA MEDICA 2022; 127:543-559. [PMID: 35306638 PMCID: PMC8934407 DOI: 10.1007/s11547-022-01471-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 02/18/2022] [Indexed: 12/24/2022]
Abstract
Smoking is the main risk factor for lung cancer (LC), which is the leading cause of cancer-related death worldwide. Independent randomized controlled trials, governmental and inter-governmental task forces, and meta-analyses established that LC screening (LCS) with chest low dose computed tomography (LDCT) decreases the mortality of LC in smokers and former smokers, compared to no-screening, especially in women. Accordingly, several Italian initiatives are offering LCS by LDCT and smoking cessation to about 10,000 high-risk subjects, supported by Private or Public Health Institutions, envisaging a possible population-based screening program. Because LDCT is the backbone of LCS, Italian radiologists with LCS expertise are presenting this position paper that encompasses recommendations for LDCT scan protocol and its reading. Moreover, fundamentals for classification of lung nodules and other findings at LDCT test are detailed along with international guidelines, from the European Society of Thoracic Imaging, the British Thoracic Society, and the American College of Radiology, for their reporting and management in LCS. The Italian College of Thoracic Radiologists produced this document to provide the basics for radiologists who plan to set up or to be involved in LCS, thus fostering homogenous evidence-based approach to the LDCT test over the Italian territory and warrant comparison and analyses throughout National and International practices.
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Affiliation(s)
- Mario Silva
- Department of Medicine and Surgery (DiMeC), University of Parma, Via Gramsci 14, Parma, Italy.
- Unit of "Scienze Radiologiche", University Hospital of Parma, Pad. Barbieri, Via Gramsci 14, 43126, Parma, Italy.
| | - Giulia Picozzi
- Istituto Di Studio Prevenzione E Rete Oncologica, Firenze, Italy
| | - Nicola Sverzellati
- Department of Medicine and Surgery (DiMeC), University of Parma, Via Gramsci 14, Parma, Italy
- Unit of "Scienze Radiologiche", University Hospital of Parma, Pad. Barbieri, Via Gramsci 14, 43126, Parma, Italy
| | | | | | | | | | | | | | - Domenico Ghio
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Anna Rita Larici
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore Di Roma, Roma, Italy
| | - Alfonso V Marchianò
- Department of Radiology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, MI, Italy
| | - Stefano Palmucci
- UOC Radiologia 1, Dipartimento Scienze Mediche Chirurgiche E Tecnologie Avanzate "GF Ingrassia", Università Di Catania, AOU Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Lorenzo Preda
- IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
- Dipartimento Di Scienze Clinico-Chirurgiche, Diagnostiche E Pediatriche, Università Degli Studi Di Pavia, Pavia, Italy
| | | | - Carlo Tessa
- Radiologia Apuane E Lunigiana, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | | | - Mario Mascalchi
- Istituto Di Studio Prevenzione E Rete Oncologica, Firenze, Italy
- Università Di Firenze, Firenze, Italy
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