1
|
Kim Y, Lee J, Lee E, Lim J, Kim Y, Lee CT, Jang SH, Paek YJ, Lee WC, Lee CW, Kim HY, Goo JM, Choi KS, Park B, Lee DH, Seo HG. Strategies to Improve Smoking Cessation for Participants in Lung Cancer Screening Program: Analysis of Factors Associated with Smoking Cessation in Korean Lung Cancer Screening Project (K-LUCAS). Cancer Res Treat 2024; 56:92-103. [PMID: 37562437 PMCID: PMC10789955 DOI: 10.4143/crt.2022.1598] [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: 12/08/2022] [Accepted: 08/05/2023] [Indexed: 08/12/2023] Open
Abstract
PURPOSE Smoking cessation intervention is one of the key components of successful lung cancer screening program. We investigated the effectiveness and related factors of smoking cessation services provided to the participants in a population-based lung cancer screening trial. MATERIALS AND METHODS The Korean Lung Cancer Screening Project (K-LUCAS) is a nationwide, multi-center lung cancer screening trial that evaluates the feasibility of implementing population-based lung cancer screening. All 5,144 current smokers who participated in the K-LUCAS received a mandatory smoking cessation counseling. Changes in smoking status were followed up using a telephone survey in 6 months after lung cancer screening participation. The lung cancer screening's impact on smoking cessation is analyzed by variations in the smoking cessation interventions provided in screening units. RESULTS Among 4,136 survey responders, participant's motivation to quit smoking increased by 9.4% on average after lung cancer screening. After 6 months from the initial screening, 24.3% of participants stopped smoking, and 10.6% of participants had not smoked continuously for at least 6 months after screening. Over 80% of quitters stated that participation in lung cancer screening motivated them to quit smoking. Low-cost public smoking cessation program combined with lung cancer screening increased the abstinence rates. The smokers were three times more likely to quit smoking when the smoking cessation counseling was provided simultaneously with low-dose computed tomography screening results than when provided separately. CONCLUSION A mandatory smoking cessation intervention integrated with screening result counselling by a physician after participation in lung cancer screening could be effective for increasing smoking cessation attempts.
Collapse
Affiliation(s)
- Yeol Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Jaeho Lee
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Eunju Lee
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Juntae Lim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Yonghyun Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Choon-Taek Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Hun Jang
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Yu-Jin Paek
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Won-Chul Lee
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chan Wha Lee
- Department of Diagnostic Radiology, National Cancer Center, Goyang, Korea
| | - Hyae Young Kim
- Department of Diagnostic Radiology, National Cancer Center, Goyang, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Kui Son Choi
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Boyoung Park
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Duk Hyoung Lee
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Hong Gwan Seo
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| |
Collapse
|
2
|
Gorenstein L, Onn A, Green M, Mayer A, Segev S, Marom EM. A Novel Artificial Intelligence Based Denoising Method for Ultra-Low Dose CT Used for Lung Cancer Screening. Acad Radiol 2023; 30:2588-2597. [PMID: 37019699 DOI: 10.1016/j.acra.2023.02.019] [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: 11/14/2022] [Revised: 01/23/2023] [Accepted: 02/19/2023] [Indexed: 04/05/2023]
Abstract
RATIONALE AND OBJECTIVES To assess ultra-low-dose (ULD) computed tomography as well as a novel artificial intelligence-based reconstruction denoising method for ULD (dULD) in screening for lung cancer. MATERIALS AND METHODS This prospective study included 123 patients, 84 (70.6%) men, mean age 62.6 ± 5.35 (55-75), who had a low dose and an ULD scan. A fully convolutional-network, trained using a unique perceptual loss was used for denoising. The network used for the extraction of the perceptual features was trained in an unsupervised manner on the data itself by denoising stacked auto-encoders. The perceptual features were a combination of feature maps taken from different layers of the network, instead of using a single layer for training. Two readers independently reviewed all sets of images. RESULTS ULD decreased average radiation-dose by 76% (48%-85%). When comparing negative and actionable Lung-RADS categories, there was no difference between dULD and LD (p = 0.22 RE, p > 0.999 RR) nor between ULD and LD scans (p = 0.75 RE, p > 0.999 RR). ULD negative likelihood ratio (LR) for the readers was 0.033-0.097. dULD performed better with a negative LR of 0.021-0.051. Coronary artery calcifications (CAC) were documented on the dULD scan in 88(74%) and 81(68%) patients, and on the ULD in 74(62.2%) and 77(64.7%) patients. The dULD demonstrated high sensitivity, 93.9%-97.6%, with an accuracy of 91.7%. An almost perfect agreement between readers was noted for CAC scores: for LD (ICC = 0.924), dULD (ICC = 0.903), and for ULD (ICC = 0.817) scans. CONCLUSION A novel AI-based denoising method allows a substantial decrease in radiation dose, without misinterpretation of actionable pulmonary nodules or life-threatening findings such as aortic aneurysms.
Collapse
Affiliation(s)
- Larisa Gorenstein
- Department of Diagnostic Radiology, Sheba Medical Center, Tel Hashomer, Israel; Diagnostic Radiology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Amir Onn
- Institute of Pulmonology, Division of Internal Medicine, Sheba Medical Center, Tel Hashomer, Israel
| | - Michael Green
- Department of Computer Science, Ben-Gurion University of the Negev
| | - Arnaldo Mayer
- Department of Diagnostic Radiology, Sheba Medical Center, Tel Hashomer, Israel; Diagnostic Radiology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Segev
- Institute for Medical Screening, Division of Internal Medicine, Sheba Medical Center, Tel Hashomer, Israel
| | - Edith Michelle Marom
- Department of Diagnostic Radiology, Sheba Medical Center, Tel Hashomer, Israel; Diagnostic Radiology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
3
|
The Role of Multimodality Cardiac Imaging in Patients Undergoing Cancer Treatment. Curr Cardiol Rep 2023; 25:1-8. [PMID: 36527535 DOI: 10.1007/s11886-022-01825-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Modern therapeutics have led to improved survival for many types of cancer but have also been associated with adverse effects including potentially life-threatening cardiotoxicities. We sought to review the uses of multimodality cardiac imaging for risk stratification, prevention, and identification of cardiotoxicities in patients undergoing cancer treatment. RECENT FINDINGS Advancements in both echocardiography and emerging modalities, like cardiac magnetic resonance imaging and cardiac computed tomography, continue to improve the pre- and during therapy cardiac evaluation of cancer patients. Echocardiography and cardiac magnetic resonance imaging, with the incorporation of global longitudinal strain, can identify overt and subclinical cancer therapy-related cardiac dysfunction and myocarditis, and stress echocardiography and cardiac computed tomography can noninvasively screen and monitor for coronary artery disease. Multimodality cardiac imaging is an evolving and critical tool for the pre-therapy screening and risk stratification, as well as during therapy surveillance of cancer treatment-related cardiotoxicity.
Collapse
|
4
|
Predictive Value of Coronary Artery Calcium in Patients Receiving Computed Tomography Pulmonary Angiography for Suspected Pulmonary Embolism in the Emergency Department. J Thorac Imaging 2022; 37:279-284. [PMID: 35576536 DOI: 10.1097/rti.0000000000000654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Coronary artery calcium (CAC) is a frequent incidental finding on computed tomography pulmonary angiogram (CTPA) in the evaluation of pulmonary embolism (PE) in the emergency department (ED); however, its prognostic value is unclear. In this study, we interrogate the prognostic value of CAC identified on CTPA in predicting adverse outcomes in the evaluation of PE in the ED. MATERIALS AND METHODS In this retrospective cohort study, we identified 610 patients presenting to the ED in 2013 and evaluated with CTPA for suspected PE. Ordinal CAC scores were evaluated as absent (0), mild (1), moderate (2), or severe (3) in each of the 4 main coronary arteries. Composite CAC scores were subsequently compared against adverse clinical outcomes, defined as intensive care unit admission, hospital stay longer than 72 hours, or death during hospital course or at 6-month follow-up, using univariate and multivariate logistic regression analyses. Relevant exclusion criteria included a history of cardiovascular disease. RESULTS In all, 365 patients met the inclusion criteria (231 women, mean age 56±16 y) with 132 patients (36%) having some degree of CAC and 16 (4%) having severe CAC. Known malignancy was present in 151 (41%) patients and composite adverse clinical outcomes were observed in 98 patients (32%). Age, presence of acute PE, malignancy, and presence of CAC were significant predictors of adverse outcomes on both univariate and multivariate analyses. CAC was not an independent predictor of short-term adverse outcomes on multivariate analysis ( P =0.06) when all patients were considered. However, when patients with known malignancy were excluded, CAC was an independent predictor of short-term adverse outcomes (odds ratio=2.5, confidence interval=1.1-5.5, P =0.03) independent of age and presence of PE. CONCLUSION The presence of CAC on CT PA was predictive of adverse outcomes in patients without known cardiac disease presenting to the ED with suspected PE.
Collapse
|
5
|
Faubry C, Faure M, Toublanc AC, Veillon R, Lemaître AI, Vergnenègre C, Cochet H, Khan S, Raherison C, Dos Santos P, Zysman M. A Prospective Study to Detect Immune Checkpoint Inhibitors Associated With Myocarditis Among Patients Treated for Lung Cancer. Front Cardiovasc Med 2022; 9:878211. [PMID: 35734278 PMCID: PMC9207328 DOI: 10.3389/fcvm.2022.878211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/25/2022] [Indexed: 11/27/2022] Open
Abstract
Background Immune checkpoint inhibitors (ICIs) are widely used in lung cancer management. However, myocarditis, which is a rare, yet potentially severe adverse-related event associated with ICIs, could be under-reported. Objectives This study is aimed to prospectively evaluate the cumulative incidence rate of myocarditis, through systematic screening, among patients receiving ICIs for lung cancer. Methods All patients who received the first administration of ICIs for non-small cell (NSCLC) and small cell lung cancer (SCLC), between May and November 2020, in the pulmonary department of Bordeaux University Hospital, were included. Echocardiography (ECG), troponin-I, and natriuretic peptide dosages before ICIs' first administration and before each infusion were recorded. ECG and magnetic resonance imaging (MRI) were done additionally, in case of at least three times increase in troponin levels, ECG modifications, and the onset of cardiovascular symptoms. Second, if possible, coronarography than endomyocardial biopsy was assessed. The primary outcome was defined as ICIs related to myocarditis onset, while secondary outcomes included other cardiovascular events, disease-free, and overall survival. Results During the period of interest, 99 patients received their first infusion of ICIs for lung cancer (mean age 64 ± 9 years; 52 men, 67% with adenocarcinoma). Three cases of myocarditis without major adverse cardiac events (MACEs) occurred (two definite and one possible), and the mean duration between the first ICIs' administration and myocarditis onset was 144 ± 3 days. Median disease-free survival and overall survival were 169 [102; 233] days and 209 [147; 249] days, respectively. Conclusion In our study, systematic screening of myocarditis associated with ICIs leads to a more frequent incidence and a later onset than previously reported. None of them were severe. Additional prospective evidence is needed before we could adopt routine cardiac screening in unselected patients starting ICIs; however, these data shed new light on the risk of myocarditis associated with ICIs administration.
Collapse
Affiliation(s)
- Clara Faubry
- Pulmonary Department, Centre Hospitalier Universitaire (CHU) Haut-Lévèque, Bordeaux, France
| | - Maxime Faure
- Heart Failure Unit, Cardiology Department, Centre Hospitalier Universitaire (CHU) Haut-Lévèque, Bordeaux, France
| | - Anne-Claire Toublanc
- Pulmonary Department, Centre Hospitalier Universitaire (CHU) Haut-Lévèque, Bordeaux, France
| | - Rémi Veillon
- Pulmonary Department, Centre Hospitalier Universitaire (CHU) Haut-Lévèque, Bordeaux, France
| | - Anne-Iris Lemaître
- Heart Failure Unit, Cardiology Department, Centre Hospitalier Universitaire (CHU) Haut-Lévèque, Bordeaux, France
| | - Charlotte Vergnenègre
- Pulmonary Department, Centre Hospitalier Universitaire (CHU) Haut-Lévèque, Bordeaux, France
| | - Hubert Cochet
- Department Cardiology, Lyric Institute, Fondation Bordeaux Université, Bordeaux, France
- Department Medicine, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux, France
- Department of Cardiovascular Imaging, Centre Hospitalier Universitaire (CHU) Bordeaux, Bordeaux, France
| | - Sadia Khan
- Bordeaux University, Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux Population Health Research Center, Bordeaux, France
| | - Chantal Raherison
- Pulmonary Department, Centre Hospitalier Universitaire (CHU) Haut-Lévèque, Bordeaux, France
- Bordeaux University, Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux Population Health Research Center, Bordeaux, France
| | - Pierre Dos Santos
- Heart Failure Unit, Cardiology Department, Centre Hospitalier Universitaire (CHU) Haut-Lévèque, Bordeaux, France
- Department Cardiology, Lyric Institute, Fondation Bordeaux Université, Bordeaux, France
- Department Medicine, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux, France
| | - Maeva Zysman
- Pulmonary Department, Centre Hospitalier Universitaire (CHU) Haut-Lévèque, Bordeaux, France
- Centre de Recherche Cardio-Thoracique, Universitaire Bordeaux, Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux, France
- *Correspondence: Maeva Zysman
| |
Collapse
|
6
|
An S, Fan R, Zhao B, Yi Q, Yao S, Shi X, Zhu Y, Yi X, Liu S. Evaluating coronary artery calcification with low-dose chest CT reconstructed by different kernels. Clin Imaging 2022; 83:166-171. [DOI: 10.1016/j.clinimag.2021.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/22/2021] [Accepted: 12/29/2021] [Indexed: 11/25/2022]
|
7
|
Schreuder A, Jacobs C, Lessmann N, Broeders MJM, Silva M, Išgum I, de Jong PA, Sverzellati N, Prokop M, Pastorino U, Schaefer-Prokop CM, van Ginneken B. Combining pulmonary and cardiac computed tomography biomarkers for disease-specific risk modelling in lung cancer screening. Eur Respir J 2021; 58:13993003.03386-2020. [PMID: 33574075 DOI: 10.1183/13993003.03386-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/18/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Combined assessment of cardiovascular disease (CVD), COPD and lung cancer may improve the effectiveness of lung cancer screening in smokers. The aims were to derive and assess risk models for predicting lung cancer incidence, CVD mortality and COPD mortality by combining quantitative computed tomography (CT) measures from each disease, and to quantify the added predictive benefit of self-reported patient characteristics given the availability of a CT scan. METHODS A survey model (patient characteristics only), CT model (CT information only) and final model (all variables) were derived for each outcome using parsimonious Cox regression on a sample from the National Lung Screening Trial (n=15 000). Validation was performed using Multicentric Italian Lung Detection data (n=2287). Time-dependent measures of model discrimination and calibration are reported. RESULTS Age, mean lung density, emphysema score, bronchial wall thickness and aorta calcium volume are variables that contributed to all final models. Nodule features were crucial for lung cancer incidence predictions but did not contribute to CVD and COPD mortality prediction. In the derivation cohort, the lung cancer incidence CT model had a 5-year area under the receiver operating characteristic curve of 82.5% (95% CI 80.9-84.0%), significantly inferior to that of the final model (84.0%, 82.6-85.5%). However, the addition of patient characteristics did not improve the lung cancer incidence model performance in the validation cohort (CT model 80.1%, 74.2-86.0%; final model 79.9%, 73.9-85.8%). Similarly, the final CVD mortality model outperformed the other two models in the derivation cohort (survey model 74.9%, 72.7-77.1%; CT model 76.3%, 74.1-78.5%; final model 79.1%, 77.0-81.2%), but not the validation cohort (survey model 74.8%, 62.2-87.5%; CT model 72.1%, 61.1-83.2%; final model 72.2%, 60.4-84.0%). Combining patient characteristics and CT measures provided the largest increase in accuracy for the COPD mortality final model (92.3%, 90.1-94.5%) compared to either other model individually (survey model 87.5%, 84.3-90.6%; CT model 87.9%, 84.8-91.0%), but no external validation was performed due to a very low event frequency. CONCLUSIONS CT measures of CVD and COPD provides small but reproducible improvements to nodule-based lung cancer risk prediction accuracy from 3 years onwards. Self-reported patient characteristics may not be of added predictive value when CT information is available.
Collapse
Affiliation(s)
- Anton Schreuder
- Dept of Radiology, Nuclear Medicine, and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Colin Jacobs
- Dept of Radiology, Nuclear Medicine, and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands.,Fraunhofer MEVIS, Bremen, Germany
| | - Nikolas Lessmann
- Dept of Radiology, Nuclear Medicine, and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands.,Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mireille J M Broeders
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Dutch Expert Centre for Screening, Nijmegen, The Netherlands
| | - Mario Silva
- Unit of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Section of Radiology, Unit of Surgical Sciences, Dept of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Ivana Išgum
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pim A de Jong
- Dept of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nicola Sverzellati
- Section of Radiology, Unit of Surgical Sciences, Dept of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Mathias Prokop
- Dept of Radiology, Nuclear Medicine, and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Ugo Pastorino
- Unit of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cornelia M Schaefer-Prokop
- Dept of Radiology, Nuclear Medicine, and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands.,Dept of Radiology, Meander Medisch Centrum, Amersfoort, The Netherlands
| | - Bram van Ginneken
- Dept of Radiology, Nuclear Medicine, and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands.,Fraunhofer MEVIS, Bremen, Germany.,Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| |
Collapse
|
8
|
Rosmini S, Aggarwal A, Chen DH, Conibear J, Davies CL, Dey AK, Edwards P, Guha A, Ghosh AK. Cardiac computed tomography in cardio-oncology: an update on recent clinical applications. Eur Heart J Cardiovasc Imaging 2021; 22:397-405. [PMID: 33555007 DOI: 10.1093/ehjci/jeaa351] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/08/2020] [Indexed: 01/07/2023] Open
Abstract
Chemotherapy and radiotherapy have drastically improved cancer survival, but they can result in significant short- and long-term cardiovascular complications, most commonly heart failure from chemotherapy, whilst radiotherapy increases the risk of premature coronary artery disease (CAD), valve, and pericardial diseases. Cardiac computed tomography (CT) with calcium scoring has a role in screening asymptomatic patients for premature CAD, cardiac CT angiography (CTCA) allows the identification of significant CAD, also in the acute settings where concerns exist towards invasive angiography. CTCA integrates the diagnostic work-up and guides surgical/percutaneous management of valvular heart diseases and allows the assessment of pericardial conditions, including detection of effusion and pericardial calcification. It is a widely available and fast imaging modality that allows a one-step evaluation of CAD, myocardial, valvular, and pericardial disease. This review aims to provide an update on its current use and accompanying evidence-base for cardiac CT in the management of cardio-oncology patients.
Collapse
Affiliation(s)
- Stefania Rosmini
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London EC1A 7BE, UK
| | - Ankita Aggarwal
- Department of Internal Medicine, Wayne State University, Providence Hospital, Rochester, MI, USA
| | - Daniel H Chen
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London EC1A 7BE, UK.,Cardio-Oncology Service, University College London Hospital, London, UK.,Hatter Cardiovascular Institute, University College London, London, UK
| | - John Conibear
- Oncology Department, Barts Cancer Centre, St Bartholomew's Hospital London, UK
| | - Ceri L Davies
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London EC1A 7BE, UK
| | - Amit Kumar Dey
- National Heart, Lung and Blood Institute, Bethesda, USA.,Department of Internal Medicine, Georgetown University, Washington, DC, USA
| | - Paula Edwards
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Avirup Guha
- Harrington Heart and Vascular Institute, Cleveland, 11100 Euclid Ave, Cleveland, OH 44106, USA
| | - Arjun K Ghosh
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London EC1A 7BE, UK.,Cardio-Oncology Service, University College London Hospital, London, UK.,Hatter Cardiovascular Institute, University College London, London, UK
| |
Collapse
|
9
|
Homayounieh F, Yan P, Digumarthy SR, Kruger U, Wang G, Kalra MK. Prediction of Coronary Calcification and Stenosis: Role of Radiomics From Low-Dose CT. Acad Radiol 2021; 28:972-979. [PMID: 34217490 DOI: 10.1016/j.acra.2020.09.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/25/2020] [Accepted: 09/26/2020] [Indexed: 12/20/2022]
Abstract
RATIONALE AND OBJECTIVES We aimed to assess relationship between single-click, whole heart radiomics from low-dose computed tomography (LDCT) for lung cancer screening with coronary artery calcification and stenosis. MATERIALS AND METHODS The institutional review board-approved, retrospective study included all 106 patients (68 men, 38 women, mean age 64 ± 7 years) who underwent both LDCT for lung cancer screening and had calcium scoring and coronary computed tomography angiography in our institution. We recorded the clinical variables including patients' demographics, smoking history, family history, and lipid profiles. Coronary calcium scores and grading of coronary stenosis were recorded from the radiology information system. We calculated the multiethnic scores for atherosclerosis risk scores to obtain 10-year coronary heart disease (MESA 10-Y CHD) risk of cardiovascular disease for all patients. Deidentified LDCT exams were exported to a Radiomics prototype for automatic heart segmentation, and derivation of radiomics. Data were analyzed using multiple logistic regression and kernel Fisher discriminant analyses. RESULTS Whole heart radiomics were better than the clinical variables for differentiating subjects with different Agatston scores (≤400 and >400) (area under the curve [AUC] 0.92 vs 0.69). Prediction of coronary stenosis and MESA 10-Y CHD risk was better on whole heart radiomics (AUC:0.86-0.87) than with clinical variables (AUC:0.69-0.79). Addition of clinical variables or visual assessment of coronary calcification from LDCT to whole heart radiomics resulted in a modest change in the AUC. CONCLUSION Single-click, whole heart radiomics obtained from LDCT for lung cancer screening can differentiate patients with different Agatston and MESA risk scores for cardiovascular diseases.
Collapse
Affiliation(s)
- Fatemeh Homayounieh
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 75 Blossom Court, Room 248, Boston, MA 02114.
| | - Pingkun Yan
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Tory, New York
| | - Subba R Digumarthy
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 75 Blossom Court, Room 248, Boston, MA 02114
| | - Uwe Kruger
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Tory, New York
| | - Ge Wang
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Tory, New York
| | - Mannudeep K Kalra
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 75 Blossom Court, Room 248, Boston, MA 02114
| |
Collapse
|
10
|
Rankin NM, McWilliams A, Marshall HM. Lung cancer screening implementation: Complexities and priorities. Respirology 2021; 25 Suppl 2:5-23. [PMID: 33200529 DOI: 10.1111/resp.13963] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/17/2022]
Abstract
Lung cancer is the number one cause of cancer death worldwide. The benefits of lung cancer screening to reduce mortality and detect early-stage disease are no longer in any doubt based on the results of two landmark trials using LDCT. Lung cancer screening has been implemented in the US and South Korea and is under consideration by other communities. Successful translation of demonstrated research outcomes into the routine clinical setting requires careful implementation and co-ordinated input from multiple stakeholders. Implementation aspects may be specific to different healthcare settings. Important knowledge gaps remain, which must be addressed in order to optimize screening benefits and minimize screening harms. Lung cancer screening differs from all other cancer screening programmes as lung cancer risk is driven by smoking, a highly stigmatized behaviour. Stigma, along with other factors, can impact smokers' engagement with screening, meaning that smokers are generally 'hard to reach'. This review considers critical points along the patient journey. The first steps include selecting a risk threshold at which to screen, successfully engaging the target population and maximizing screening uptake. We review barriers to smoker engagement in lung and other cancer screening programmes. Recruitment strategies used in trials and real-world (clinical) programmes and associated screening uptake are reviewed. To aid cross-study comparisons, we propose a standardized nomenclature for recording and calculating recruitment outcomes. Once participants have engaged with the screening programme, we discuss programme components that are critical to maximize net benefit. A whole-of-programme approach is required including a standardized and multidisciplinary approach to pulmonary nodule management, incorporating probabilistic nodule risk assessment and longitudinal volumetric analysis, to reduce unnecessary downstream investigations and surgery; the integration of smoking cessation; and identification and intervention for other tobacco related diseases, such as coronary artery calcification and chronic obstructive pulmonary disease. National support, integrated with tobacco control programmes, and with appropriate funding, accreditation, data collection, quality assurance and reporting mechanisms will enhance lung cancer screening programme success and reduce the risks associated with opportunistic, ad hoc screening. Finally, implementation research must play a greater role in informing policy change about targeted LDCT screening programmes.
Collapse
Affiliation(s)
- Nicole M Rankin
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Annette McWilliams
- Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, WA, Australia.,Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia.,Thoracic Tumour Collaborative of Western Australia, Western Australia Cancer and Palliative Care Network, Perth, WA, Australia
| | - Henry M Marshall
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia.,The University of Queensland Thoracic Research Centre, Brisbane, QLD, Australia
| |
Collapse
|
11
|
Barta JA, Shusted CS, Ruane B, Pimpinelli M, McIntire RK, Zeigler-Johnson C, Myers RE, Evans NR, Kane GC, Juon HS. Racial Differences in Lung Cancer Screening Beliefs and Screening Adherence. Clin Lung Cancer 2021; 22:570-578. [PMID: 34257020 DOI: 10.1016/j.cllc.2021.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/05/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND One challenge in high-quality lung cancer screening (LCS) is maintaining adherence with annual and short-interval follow-up screens among high-risk individuals who have undergone baseline low-dose CT (LDCT). This study aimed to characterize attitudes and beliefs toward lung cancer and LCS and to identify factors associated with LCS adherence. METHODS We administered a questionnaire to 269 LCS participants to assess attitudes and beliefs toward lung cancer and LCS. Clinical data including sociodemographics and screening adherence were obtained from the LCS Program Registry. RESULTS African-American individuals had significantly greater lung cancer worries compared with Whites (6.10 vs. 4.66, P < .001). In making the decision to undergo LCS, African-American participants described screening convenience and cost as very important factors significantly more frequently than Whites (60% vs. 26.8%, P< .001 and 58.4% vs. 37.8%, P = .001; respectively). African-American individuals with greater than high school education had significantly higher odds of LCS adherence (aOR 2.55; 95% CI, 1.14-5.60) than Whites with less than high school education. Participants who described screening convenience and cost as "very important" had significantly lower odds of completing screening follow-up after adjusting for demographic and other factors (aOR 0.56; 95% CI, 0.33-0.97 and aOR 0.54; 95% CI, 0.33-0.91, respectively). CONCLUSION Racial differences in beliefs about lung cancer and LCS exist among African-American and White individuals enrolled in an LCS program. Cost, convenience, and low educational attainment may be barriers to LCS adherence, specifically among African-American individuals. IMPACT More research is needed on how barriers can be overcome to improve LCS adherence.
Collapse
Affiliation(s)
- Julie A Barta
- The Jane and Leonard Korman Respiratory Institute at Thomas Jefferson University, Division of Pulmonary and Critical Care Medicine, Philadelphia, PA
| | - Christine S Shusted
- The Jane and Leonard Korman Respiratory Institute at Thomas Jefferson University, Department of Medicine, Philadelphia, PA
| | - Brooke Ruane
- The Jane and Leonard Korman Respiratory Institute at Thomas Jefferson University, Division of Pulmonary and Critical Care Medicine, Philadelphia, PA
| | - Marcella Pimpinelli
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Russell K McIntire
- Thomas Jefferson University, Jefferson College of Population Health, Philadelphia, PA
| | - Charnita Zeigler-Johnson
- Thomas Jefferson University, Department of Medical Oncology, Division of Population Science, Philadelphia, PA
| | - Ronald E Myers
- Thomas Jefferson University, Department of Medical Oncology, Division of Population Science, Philadelphia, PA
| | - Nathaniel R Evans
- The Jane and Leonard Korman Respiratory Institute at Thomas Jefferson University, Division of Thoracic Surgery, Philadelphia, PA
| | - Gregory C Kane
- The Jane and Leonard Korman Respiratory Institute at Thomas Jefferson University, Department of Medicine, Philadelphia, PA
| | - Hee-Soon Juon
- Thomas Jefferson University, Department of Medical Oncology, Division of Population Science, Philadelphia, PA.
| |
Collapse
|
12
|
Snoeckx A, Franck C, Silva M, Prokop M, Schaefer-Prokop C, Revel MP. The radiologist's role in lung cancer screening. Transl Lung Cancer Res 2021; 10:2356-2367. [PMID: 34164283 PMCID: PMC8182709 DOI: 10.21037/tlcr-20-924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Lung cancer is still the deadliest cancer in men and women worldwide. This high mortality is related to diagnosis in advanced stages, when curative treatment is no longer an option. Large randomized controlled trials have shown that lung cancer screening (LCS) with low-dose computed tomography (CT) can detect lung cancers at earlier stages and reduce lung cancer-specific mortality. The recent publication of the significant reduction of cancer-related mortality by 26% in the Dutch-Belgian NELSON LCS trial has increased the likelihood that implementation of LCS in Europe will move forward. Radiologists are important stakeholders in numerous aspects of the LCS pathway. Their role goes beyond nodule detection and nodule management. Being part of a multidisciplinary team, radiologists are key players in numerous aspects of implementation of a high quality LCS program. In this non-systematic review we discuss the multifaceted role of radiologists in LCS.
Collapse
Affiliation(s)
- Annemiek Snoeckx
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Caro Franck
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Mario Silva
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Mathias Prokop
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Marie-Pierre Revel
- Department of Radiology, Cochin Hospital, APHP Centre, Université de Paris, Paris, France
| |
Collapse
|
13
|
Yoon YE, Yun BL, Kim KM, Suh JW. Breast Arterial Calcification: A Potential Biomarker for Atherosclerotic Cardiovascular Disease Risk? Curr Atheroscler Rep 2021; 23:21. [PMID: 33772359 DOI: 10.1007/s11883-021-00924-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 01/21/2023]
Abstract
PURPOSE OF REVIEW We aimed to summarize the current evidence regarding the association between breast arterial calcification (BAC) and atherosclerotic cardiovascular disease (ASCVD) in women and discuss the potential role of BAC in the risk stratification and preventive approaches for ASCVD. RECENT FINDINGS BAC has emerged as a potential women-specific risk marker for ASCVD. Although BAC presents as a medial calcification of the arteries, notably different from the intimal atherosclerotic process, current evidence supports a correlation between BAC and ASCVD risk factors or subclinical and clinical ASCVD, such as coronary artery disease or stroke. As millions of women undergo mammograms each year, the potential clinical application of BAC in enhanced ASCVD risk estimation, with no additional cost or radiation, has tremendous appeal. Although further research regarding optimal risk assessment and management in women with BAC is required, the presence of BAC should prompt healthy cardiovascular lifestyle modifications.
Collapse
Affiliation(s)
- Yeonyee E Yoon
- Department of Radiology, New York-Presbyterian Hospital, and Weill Cornell Medicine, New York, NY, USA.
- Department of Cardiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Bo La Yun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Min Kim
- Division of Endocrinology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Gyeonggi-do, Republic of Korea
| | - Jung-Won Suh
- Department of Cardiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
14
|
Chamberlin J, Kocher MR, Waltz J, Snoddy M, Stringer NFC, Stephenson J, Sahbaee P, Sharma P, Rapaka S, Schoepf UJ, Abadia AF, Sperl J, Hoelzer P, Mercer M, Somayaji N, Aquino G, Burt JR. Automated detection of lung nodules and coronary artery calcium using artificial intelligence on low-dose CT scans for lung cancer screening: accuracy and prognostic value. BMC Med 2021; 19:55. [PMID: 33658025 PMCID: PMC7931546 DOI: 10.1186/s12916-021-01928-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/26/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Artificial intelligence (AI) in diagnostic radiology is undergoing rapid development. Its potential utility to improve diagnostic performance for cardiopulmonary events is widely recognized, but the accuracy and precision have yet to be demonstrated in the context of current screening modalities. Here, we present findings on the performance of an AI convolutional neural network (CNN) prototype (AI-RAD Companion, Siemens Healthineers) that automatically detects pulmonary nodules and quantifies coronary artery calcium volume (CACV) on low-dose chest CT (LDCT), and compare results to expert radiologists. We also correlate AI findings with adverse cardiopulmonary outcomes in a retrospective cohort of 117 patients who underwent LDCT. METHODS A total of 117 patients were enrolled in this study. Two CNNs were used to identify lung nodules and CACV on LDCT scans. All subjects were used for lung nodule analysis, and 96 subjects met the criteria for coronary artery calcium volume analysis. Interobserver concordance was measured using ICC and Cohen's kappa. Multivariate logistic regression and partial least squares regression were used for outcomes analysis. RESULTS Agreement of the AI findings with experts was excellent (CACV ICC = 0.904, lung nodules Cohen's kappa = 0.846) with high sensitivity and specificity (CACV: sensitivity = .929, specificity = .960; lung nodules: sensitivity = 1, specificity = 0.708). The AI findings improved the prediction of major cardiopulmonary outcomes at 1-year follow-up including major adverse cardiac events and lung cancer (AUCMACE = 0.911, AUCLung Cancer = 0.942). CONCLUSION We conclude the AI prototype rapidly and accurately identifies significant risk factors for cardiopulmonary disease on standard screening low-dose chest CT. This information can be used to improve diagnostic ability, facilitate intervention, improve morbidity and mortality, and decrease healthcare costs. There is also potential application in countries with limited numbers of cardiothoracic radiologists.
Collapse
Affiliation(s)
- Jordan Chamberlin
- Department of Radiology, Medical University of South Carolina, Charleston, SC, 29403, USA
| | - Madison R Kocher
- Department of Radiology, Medical University of South Carolina, Charleston, SC, 29403, USA
| | - Jeffrey Waltz
- Department of Radiology, Medical University of South Carolina, Charleston, SC, 29403, USA
| | - Madalyn Snoddy
- Department of Radiology, Medical University of South Carolina, Charleston, SC, 29403, USA
| | - Natalie F C Stringer
- Department of Radiology, Medical University of South Carolina, Charleston, SC, 29403, USA
| | - Joseph Stephenson
- Department of Radiology, Medical University of South Carolina, Charleston, SC, 29403, USA
| | | | | | | | - U Joseph Schoepf
- Department of Radiology, Medical University of South Carolina, Charleston, SC, 29403, USA
| | - Andres F Abadia
- Department of Radiology, Medical University of South Carolina, Charleston, SC, 29403, USA
| | | | | | - Megan Mercer
- Department of Radiology, Medical University of South Carolina, Charleston, SC, 29403, USA
| | - Nayana Somayaji
- Department of Radiology, Medical University of South Carolina, Charleston, SC, 29403, USA
| | - Gilberto Aquino
- Department of Radiology, Medical University of South Carolina, Charleston, SC, 29403, USA
| | - Jeremy R Burt
- Department of Radiology, Medical University of South Carolina, Charleston, SC, 29403, USA.
- MUSC-ART, Cardiothoracic Imaging, 25 Courtenay Drive, MSC 226, 2nd Floor, Rm 2256, Charleston, SC, 29425, USA.
| |
Collapse
|
15
|
Kim D, Choi J, Lee D, Kim H, Jung J, Cho M, Lee KY. Motion correction for routine X-ray lung CT imaging. Sci Rep 2021; 11:3695. [PMID: 33580147 PMCID: PMC7880999 DOI: 10.1038/s41598-021-83403-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/29/2021] [Indexed: 11/30/2022] Open
Abstract
A novel motion correction algorithm for X-ray lung CT imaging has been developed recently. It was designed to perform for routine chest or thorax CT scans without gating, namely axial or helical scans with pitch around 1.0. The algorithm makes use of two conjugate partial angle reconstruction images for motion estimation via non-rigid registration which is followed by a motion compensated reconstruction. Differently from other conventional approaches, no segmentation is adopted in motion estimation. This makes motion estimation of various fine lung structures possible. The aim of this study is to explore the performance of the proposed method in correcting the lung motion artifacts which arise even under routine CT scans with breath-hold. The artifacts are known to mimic various lung diseases, so it is of great interest to address the problem. For that purpose, a moving phantom experiment and clinical study (seven cases) were conducted. We selected the entropy and positivity as figure of merits to compare the reconstructed images before and after the motion correction. Results of both phantom and clinical studies showed a statistically significant improvement by the proposed method, namely up to 53.6% (p < 0.05) and up to 35.5% (p < 0.05) improvement by means of the positivity measure, respectively. Images of the proposed method show significantly reduced motion artifacts of various lung structures such as lung parenchyma, pulmonary vessels, and airways which are prominent in FBP images. Results of two exemplary cases also showed great potential of the proposed method in correcting motion artifacts of the aorta which is known to mimic aortic dissection. Compared to other approaches, the proposed method provides an excellent performance and a fully automatic workflow. In addition, it has a great potential to handle motions in wide range of organs such as lung structures and the aorta. We expect that this would pave a way toward innovations in chest and thorax CT imaging.
Collapse
Affiliation(s)
- Doil Kim
- CT R&D Group, Health & Medical Equipment Business, Samsung Electronics Co., Ltd., Suwon, Republic of Korea
| | - Jiyoung Choi
- CT R&D Group, Health & Medical Equipment Business, Samsung Electronics Co., Ltd., Suwon, Republic of Korea
| | - Duhgoon Lee
- CT R&D Group, Health & Medical Equipment Business, Samsung Electronics Co., Ltd., Suwon, Republic of Korea
| | - Hyesun Kim
- CT R&D Group, Health & Medical Equipment Business, Samsung Electronics Co., Ltd., Suwon, Republic of Korea
| | - Jiyoung Jung
- CT R&D Group, Health & Medical Equipment Business, Samsung Electronics Co., Ltd., Suwon, Republic of Korea
| | - Minkook Cho
- CT R&D Group, Health & Medical Equipment Business, Samsung Electronics Co., Ltd., Suwon, Republic of Korea
| | - Kyoung-Yong Lee
- CT R&D Group, Health & Medical Equipment Business, Samsung Electronics Co., Ltd., Suwon, Republic of Korea.
| |
Collapse
|
16
|
Zeleznik R, Foldyna B, Eslami P, Weiss J, Alexander I, Taron J, Parmar C, Alvi RM, Banerji D, Uno M, Kikuchi Y, Karady J, Zhang L, Scholtz JE, Mayrhofer T, Lyass A, Mahoney TF, Massaro JM, Vasan RS, Douglas PS, Hoffmann U, Lu MT, Aerts HJWL. Deep convolutional neural networks to predict cardiovascular risk from computed tomography. Nat Commun 2021; 12:715. [PMID: 33514711 PMCID: PMC7846726 DOI: 10.1038/s41467-021-20966-2] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 01/05/2021] [Indexed: 11/30/2022] Open
Abstract
Coronary artery calcium is an accurate predictor of cardiovascular events. While it is visible on all computed tomography (CT) scans of the chest, this information is not routinely quantified as it requires expertise, time, and specialized equipment. Here, we show a robust and time-efficient deep learning system to automatically quantify coronary calcium on routine cardiac-gated and non-gated CT. As we evaluate in 20,084 individuals from distinct asymptomatic (Framingham Heart Study, NLST) and stable and acute chest pain (PROMISE, ROMICAT-II) cohorts, the automated score is a strong predictor of cardiovascular events, independent of risk factors (multivariable-adjusted hazard ratios up to 4.3), shows high correlation with manual quantification, and robust test-retest reliability. Our results demonstrate the clinical value of a deep learning system for the automated prediction of cardiovascular events. Implementation into clinical practice would address the unmet need of automating proven imaging biomarkers to guide management and improve population health.
Collapse
Affiliation(s)
- Roman Zeleznik
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Borek Foldyna
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Parastou Eslami
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jakob Weiss
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Ivanov Alexander
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jana Taron
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Chintan Parmar
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, USA
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Raza M Alvi
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Dahlia Banerji
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mio Uno
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yasuka Kikuchi
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Cause of Death Investigation, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Julia Karady
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Lili Zhang
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jan-Erik Scholtz
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas Mayrhofer
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany
| | - Asya Lyass
- Department of Mathematics and Statistics, Boston University, Boston, MA, USA
| | - Taylor F Mahoney
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Joseph M Massaro
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Ramachandran S Vasan
- National Heart, Lung, and Blood Institute and Boston University, Framingham Heart Study, Framingham, MA, USA
- Departments of Cardiology and Preventive Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Pamela S Douglas
- Department of Medicine, Division of Cardiology, Duke University School of Medicine, Duke Clinical Research Institute, Durham, NC, USA
| | - Udo Hoffmann
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael T Lu
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hugo J W L Aerts
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, USA.
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
- Department of Radiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
- Radiology and Nuclear Medicine, CARIM & GROW, Maastricht University, Maastricht, The Netherlands.
| |
Collapse
|
17
|
Management and Outcomes of Suspected Infectious and Inflammatory Lung Abnormalities Identified on Lung Cancer Screening CT. AJR Am J Roentgenol 2020; 217:1083-1092. [PMID: 33377416 DOI: 10.2214/ajr.20.25124] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background: Incidental findings are frequently encountered during lung cancer screening (LCS). Limited data describe the prevalence of suspected acute infectious and inflammatory lung processes on LCS and how they should be managed. Objective: To determine the prevalence, radiologic reporting and management, and outcome of suspected infectious and inflammatory lung processes identified incidentally during LCS, and to propose a management algorithm. Methods: This retrospective study included 6314 low dose CT (LDCT) examinations performed between June 2014 and April 2019 in 3800 patients as part of an established LCS program. Radiology reports were reviewed, and patients with potentially infectious or inflammatory lung abnormalities were identified and analyzed for descriptors of imaging findings, Lung-RADS designation, recommendations, and clinical outcomes. Based on the descriptors, outcomes and a >2% threshold risk of malignancy, a follow-up algorithm was developed to decrease additional imaging without affecting cancer detection. Results: A total of 331/3800 (8.7%) patients (178 men, 153 women; mean age: 66 ± 7 years) undergoing LCS had lung findings that were attributed to infection or inflammation. These abnormalities were reported as potentially significant findings using the "S" modifier in 149/331 (45.0%) and as the "dominant nodule" determining the Lung-RADS category in 96/331 (29.0%). Abnormalities were multiple or multifocal in 260/331 (78.5%). Common descriptors were ground-glass (155/331; 46.8%), tree-in-bud (56/331; 16.9%), consolidation (41/331; 12.4%), and clustered (67/331; 20.2%) opacities. A follow-up chest CT outside of screening was performed within 12 months or less in 264/331 (79.8%) and within 6 months or less in 286/331 (56.2%). A total of 260/331 (78.5%) opacities resolved on follow-up imaging. Two malignancies (2/331; 0.60%) were associated with these abnormalities, and both had consolidations. Theoretical adoption of a proposed management algorithm for suspected infectious and inflammatory findings reduced unnecessary follow-up imaging by 82.6% without missing a single malignancy. Conclusions: Presumed acute infectious or inflammatory lung abnormalities are frequently encountered in the setting of LCS. These opacities are commonly multifocal and resolve on follow-up. Less than 1% are associated with malignancy. Clinical impact: Adoption of a conservative management algorithm can standardize recommendations and reduce unnecessary imaging without increasing the risk of missing a malignancy.
Collapse
|
18
|
Chintanapakdee W, Mendoza DP, Zhang EW, Botwin A, Gilman MD, Gainor JF, Shepard JAO, Digumarthy SR. Detection of Extrapulmonary Malignancy During Lung Cancer Screening: 5-Year Analysis at a Tertiary Hospital. J Am Coll Radiol 2020; 17:1609-1620. [DOI: 10.1016/j.jacr.2020.09.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/02/2020] [Accepted: 09/09/2020] [Indexed: 12/18/2022]
|
19
|
Conventional Computed Tomographic Calcium Scoring vs full chest CTCS for lung cancer screening: a cost-effectiveness analysis. BMC Pulm Med 2020; 20:187. [PMID: 32631384 PMCID: PMC7336401 DOI: 10.1186/s12890-020-01221-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 06/22/2020] [Indexed: 11/12/2022] Open
Abstract
Background Conventional CTCS images the mid/lower chest for coronary artery disease (CAD). Because many CAD patients are also at risk for lung malignancy, CTCS often discovers incidental pulmonary nodules (IPN). CTCS excludes the upper chest, where malignancy is common. Full-chest CTCS (FCT) may be a cost-effective screening tool for IPN. Methods A decision tree was created to compare a FCT to CTCS in a hypothetical patient cohort with suspected CAD. (Figure) The design compares the effects of missed cancers on CTCS with the cost of working up non-malignant nodules on FCT. The model was informed by results of the National Lung Screening Trial and literature review, including the rate of malignancy among patients receiving CTCS and the rate of malignancy in upper vs lower portions of the lung. The analysis outcomes are Quality-Adjusted Life Year (QALY) and incremental cost-effectiveness ratio (ICER), which is generally considered beneficial when <$50,000/QALY. Results Literature review suggests that rate of IPNs in the upper portion of the lung varied from 47 to 76%. Our model assumed that IPNs occur in upper and lower portions of the lung with equal frequency. The model also assumes an equal malignancy potential in upper lung IPNs despite data that malignancy occurs 61–66% in upper lung fields. In the base case analysis, a FCT will lead to an increase of 0.03 QALYs comparing to conventional CTCS (14.54 vs 14.51 QALY, respectively), which translates into an QALY increase of 16 days. The associated incremental cost for FCT is $278 ($1027 vs $748, FCT vs CTCS respectively. The incremental cost-effectiveness ratio (ICER) is $10,289/QALY, suggesting significant benefit. Sensitivity analysis shows this benefit increases proportional to the rate of malignancy in upper lung fields. Conclusion Conventional CTCS may be a missed opportunity to screen for upper lung field cancers in high risk patients. The ICER of FCT is better than screening for breast cancer screening (mammograms $80 k/QALY) and colon cancer (colonoscopy $6 k/QALY). Prospective studies are appropriate to define protocols for FCT.
Collapse
|
20
|
Eijsvoogel NG, Hendriks BMF, Martens B, Gerretsen SC, Gommers S, van Kuijk SMJ, Mihl C, Wildberger JE, Das M. The performance of non-ECG gated chest CT for cardiac assessment - The cardiac pathologies in chest CT (CaPaCT) study. Eur J Radiol 2020; 130:109151. [PMID: 32650129 DOI: 10.1016/j.ejrad.2020.109151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/03/2020] [Accepted: 06/21/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Evaluating the prevalence of CAD on non-ECG gated chest CTs, image quality (IQ) and the clinical performance of the CAD-RADS classification for predicting cardiovascular events (CVE). METHODS 215 consecutive patients referred for chest CTs between May 2016 and March 2018 were included (3rd-generation DSCT) using non-ECG gated acquisitions with automated tube voltage selection (110kVqual.ref/40mAsqual.ref), pitch 2.65-3.0 and individualized contrast media injection protocols. Dedicated cardiac post-processing reconstructions (0.6 mm/0.4 mm/Kernel Bv36) were added to standard chest reconstructions. Two independent cardiac radiologists performed a 3-step analysis. In case of discrepancy, a third reader gave the final decision. Step 1: visual presence of calcifications; 2: scans with calcifications assessed for IQ using a 5-point Likert scale (poor/sufficient/moderate/good/excellent); 3: stenosis severity was analysed in detail (if Likert sufficient-excellent using CAD-RADS). Electronic patient files were checked to see if pathology was previously mentioned (incidental) and whether patients developed an CVE during follow-up. RESULTS 1: Calcifications were present in 156/215 cases (72.6 %), 74 of these were incidental. 2: In 68/156 (43.6 %) patients with calcifications IQ was rated sufficient-excellent. 3: CAD-RADS≥3 was seen in 39/68 patients (57.4 %), 12 times (30.8 %) findings were incidental. During follow-up (median 16 [0-35] months), 7/39 (18 %) patients with CAD-RADS≥3 developed a CVE. 17 patients died during follow-up. CONCLUSION Coronary calcification on non ECG-gated chest CTs was detected in 72.6 % of patients, cardiac assessment was feasible in nearly half of these patients. Only patients with a CAD-RADS≥3 developed CVE, therefore the CAD-RADS may help identify and guide patients at risk of future CVE.
Collapse
Affiliation(s)
- N G Eijsvoogel
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, the Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre+, Maastricht, the Netherlands.
| | - B M F Hendriks
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, the Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre+, Maastricht, the Netherlands.
| | - B Martens
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, the Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre+, Maastricht, the Netherlands.
| | - S C Gerretsen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, the Netherlands.
| | - S Gommers
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, the Netherlands.
| | - S M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, the Netherlands.
| | - C Mihl
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, the Netherlands.
| | - J E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre+, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, the Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre+, Maastricht, the Netherlands.
| | - M Das
- Department of Diagnostic and Interventional Radiology, Helios Kliniken Duisburg, An Der Abtei 7-11, 47166 Duisburg, Germany.
| |
Collapse
|
21
|
Yeo S, Moon JI, Shin J, Hwang JH, Cho I, Kim SH. Impacts of Coronary Artery Calcification on Intradialytic Blood Pressure Patterns in Patients Receiving Maintenance Hemodialysis. Chonnam Med J 2020; 56:27-35. [PMID: 32021839 PMCID: PMC6976763 DOI: 10.4068/cmj.2020.56.1.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/04/2019] [Accepted: 11/07/2019] [Indexed: 11/17/2022] Open
Abstract
Intradialytic blood pressure abnormalities are associated with adverse outcomes in patients with end-stage renal disease on dialysis. Vascular calcification is a common complicating feature, but whether this complication results in intradialytic blood pressure abnormalities remains uncertain. Therefore, this study investigated the relationship between coronary artery calcium score and intradialytic blood pressure abnormalities in patients with end-stage renal disease on maintenance hemodialysis. Thirty-six patients who received nongated chest computed tomography scans were included. Intradialytic hypotension was defined as a minimum intradialytic systolic blood pressure of <100 mmHg or a pre-dialysis blood pressure – minimum intradialytic systolic blood pressure >30 mmHg. Intradialytic hypertension was defined as >10 mmHg increase in systolic blood pressure (pre- to post-dialysis). Patients were classified as 22 (61.1%) with coronary artery calcium score <400 and 14 (38.9%) with coronary artery calcium score ≥400. Median systolic and diastolic blood pressures were equivalent, but median pulse pressure was higher in patients with coronary artery calcium score ≥400 than in those with scores <400. Coronary artery calcium score was comparable according to both intradialytic hypotension and hypertension, and had no correlation with systolic blood pressure fall and nadir systolic blood pressure. Coronary artery calcium score predicted the occurrence of cardiovascular events and all-cause mortality (hazard ratio 1.001 and 1.001; p=0.058 and 0.010). Coronary vascular calcification could be irrelevant to intradialytic blood pressure abnormalities in patients with end-stage renal disease on dialysis.
Collapse
Affiliation(s)
- Seongyup Yeo
- Division of Nephrology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Ji In Moon
- Division of Nephrology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jungho Shin
- Division of Nephrology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jin Ho Hwang
- Division of Nephrology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Iksung Cho
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Su Hyun Kim
- Division of Nephrology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| |
Collapse
|
22
|
Impact of Significant Coronary Artery Calcification Reported on Low-Dose Computed Tomography Lung Cancer Screening. J Thorac Imaging 2019; 35:129-135. [DOI: 10.1097/rti.0000000000000458] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
23
|
Puliti D, Mascalchi M, Carozzi FM, Carrozzi L, Falaschi F, Paci E, Lopes Pegna A, Aquilini F, Barchielli A, Bartolucci M, Grazzini M, Picozzi G, Pistelli F, Rosselli A, Zappa M. Decreased cardiovascular mortality in the ITALUNG lung cancer screening trial: Analysis of underlying factors. Lung Cancer 2019; 138:72-78. [PMID: 31654837 DOI: 10.1016/j.lungcan.2019.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/02/2019] [Accepted: 10/07/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES In the ITALUNG lung cancer screening trial after 9.3 years of follow-up we observed an unexpected significant decrease of cardiovascular (CV) mortality in subjects invited for low-dose CT (LDCT) screening as compared to controls undergoing usual care. Herein we extended the mortality follow-up and analyzed the potential factors underlying such a decrease. MATERIALS AND METHODS The following factors were assessed in screenes and controls: burden of CV disease at baseline, changes in smoking habits, use of CV drugs and frequency of planned vascular procedures after randomisation. Moreover, in the screenes we evaluated inclusion of presence of coronary artery calcification (CAC) in the LDCT report form that was transmitted to the participant and his/her General Practitioner. RESULTS The 2-years extension of follow-up confirmed a significant decrease of CV mortality in the subjects of the active group compared to control subjects (15.6 vs 34.0 per 10,000; p = 0.001) that was not observed in the drops-out of the active group. None of the explaining factors we considered significantly differed between active and control group. However, the subjects of the active group with reported CAC experienced a not significantly lower CV mortality and showed a significantly higher use of CV drugs and frequency of planned vascular procedures than the control group. CONCLUSIONS LDCT screening for lung cancer offers the opportunity for detection of CAC that is an important CV risk factor. Although the underlying mechanisms are not clear, our results suggest that the inclusion of information about CAC presence in the LDCT report may represent a candidate factor to explain the decreased CV mortality observed in screened subjects of the ITALUNG trial, possibly resulting in intervention for patient care to prevent CV deaths. Further studies investigating whether prospective reporting and rating of CAC have independent impact on such interventions and CV mortality are worthy.
Collapse
Affiliation(s)
- Donella Puliti
- Clinical Epidemiology Unit, ISPRO - Oncological Network, Prevention and Research Institute, Florence, Italy.
| | - Mario Mascalchi
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Italy.
| | - Francesca Maria Carozzi
- Regional Prevention Laboratory Unit, ISPRO - Oncological Network, Prevention and Research Institute, Florence, Italy.
| | - Laura Carrozzi
- Cardiothoracic and Vascular Department, University Hospital of Pisa, Italy; Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Italy.
| | - Fabio Falaschi
- Radiology Department, University Hospital of Pisa, Italy.
| | - Eugenio Paci
- Clinical Epidemiology Unit, ISPRO - Oncological Network, Prevention and Research Institute, Florence, Italy.
| | | | - Ferruccio Aquilini
- Cardiothoracic and Vascular Department, University Hospital of Pisa, Italy.
| | - Alessandro Barchielli
- Clinical Epidemiology Unit, ISPRO - Oncological Network, Prevention and Research Institute, Florence, Italy.
| | | | | | - Giulia Picozzi
- Radiodiagnostic Unit, ISPRO - Oncological Network, Prevention and Research Institute, Florence, Italy.
| | - Francesco Pistelli
- Cardiothoracic and Vascular Department, University Hospital of Pisa, Italy.
| | | | - Marco Zappa
- Clinical Epidemiology Unit, ISPRO - Oncological Network, Prevention and Research Institute, Florence, Italy.
| | | |
Collapse
|
24
|
Burch M, Kapur S, Starnes S. Lung Cancer Screening: Insights from a Thriving Clinical Practice. CURRENT PULMONOLOGY REPORTS 2019. [DOI: 10.1007/s13665-019-00231-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
25
|
Chiles C, Munden RF. Lung cancer screening: the path forward. Transl Lung Cancer Res 2018; 7:216-219. [PMID: 30050760 PMCID: PMC6037961 DOI: 10.21037/tlcr.2018.06.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Affiliation(s)
- Caroline Chiles
- Department of Radiology, Wake Forest Health Sciences Center, Winston-Salem, NC, USA
| | - Reginald F Munden
- Department of Radiology, Wake Forest Health Sciences Center, Winston-Salem, NC, USA
| |
Collapse
|