Lessons Learned from Peer Learning Conference in Cardiothoracic Radiology.

Medical errors may lead to patient harm and may also have a devastating effect on medical providers, who may suffer from guilt and the personal impact of a given error (second victim experience). While it is important to recognize and remedy errors, it should be done in a way that leads to long-standing practice improvement and focuses on systems-level opportunities rather than in a punitive fashion. Traditional peer review systems are score based and have some undesirable attributes.

Introducing First-Year Medical Students to Radiology: Implementation and Impact.

Rationale And Objectives: The aims of our study were (1) to describe a new educational intervention for first-year medical students that gave a substantial, early exposure to radiology and (2) to examine how this early exposure was received by the students.

Materials And Methods: Our new curriculum incorporated a new 2-week course very early in the M1 year entitled Foundations of Diagnostics and Therapeutics. Among other topics, the course included a substantial introduction to radiology primarily through small-group seminars and online materials, administered using a flipped-classroom approach.

Distinguishing acute from chronic aortic dissections using CT imaging features.

The aim was to compare computed tomography (CT) features in acute and chronic aortic dissections (AADs and CADs) and determine if a certain combination of imaging features was reliably predictive of the acute versus chronic nature of disease in individual patients. Consecutive patients with aortic dissection and a chest CT scan were identified, and 120 CT scans corresponding to 105 patients were reviewed for a variety of imaging features. Statistical tests assessed for differences in the frequency of these features.

Thoracic radiation-induced pleural effusion and risk factors in patients with lung cancer.

The risk factors and potential practice implications of radiation-induced pleural effusion (RIPE) are undefined. This study examined lung cancer patients treated with thoracic radiation therapy (TRT) having follow-up computed tomography (CT) or 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT. Increased volumes of pleural effusion after TRT without evidence of tumor progression was considered RIPE.

Pelvic artery aneurysm screening provides value in patients with thoracic aortic aneurysms.

Approximately ¼ of patients with thoracic aortic aneurysms (TAAs) have concomitant abdominal aortic aneurysms (AAAs), thereby justifying the addition of an abdominal CT scan to a chest CT scan in patients with a newly diagnosed or suspected TAA. However, the prevalence of pelvic artery aneurysms (PAAs) in these patients is unknown. The purpose of this study was to determine the prevalence of PAAs in patients with TAAs and to assess what patient specific factors were associated with PAAs, thereby providing insight into the usefulness of pelvic imaging in TAA patients.

Proximal thoracic aortic diameters: transesophageal-echocardiography- versus computed-tomography-derived measurements.

Purpose: The purpose of the study was to compare proximal aortic measurements from electrocardiogram-gated computed tomography (CT) to transesophageal echocardiography (TEE) and to evaluate differences in cusp-cusp and cusp-commissure CT measurements of sinus of Valsalva (SOV).

Methods: This retrospective study (n=25) compared aortic diameters from CT using manual double-oblique multiplanar reformats (MPRs) and semiautomatic centerline method to TEE.

Results: CT MPR and centerline measurements were higher than TEE for sinotubular junction and ascending aorta.

Evaluation for abdominal aortic aneurysms is justified in patients with thoracic aortic aneurysms.

Aortic aneurysms are a significant cause of mortality, and the presence of multiple aneurysms may affect treatment plans. The purpose of this study was to determine the frequency of abdominal aortic aneurysms (AAAs) in patients with thoracic aortic aneurysms (TAAs) and to establish whether patient specific factors, such as gender and comorbidities, influenced the frequency of AAAs, thereby indicating if and when abdominal aortic evaluation is justified. Electronic medical records were reviewed from 1000 patients with a computed tomography (CT) angiogram of the chest and abdomen and a clinical diagnosis of TAA from Cardiac Surgery clinic between 2008 and 2013.

Detection of fibroproliferation by chest high-resolution CT scan in resolving ARDS.

Background: In ARDS, the extent of fibroproliferative activity on chest high-resolution CT (HRCT) scan has been reported to correlate with poorer short-term outcomes and pulmonary-associated quality of life. However, clinical factors associated with HRCT scan fibroproliferation are incompletely characterized. We questioned if lung compliance assessed at the bedside would be associated with fibroproliferation on HRCT scans obtained during the resolution phase of ARDS.

Pulmonary artery invasion, high-dose radiation, and overall survival in patients with non-small cell lung cancer.

Purpose: To investigate whether high-dose radiation to the pulmonary artery (PA) affects overall survival (OS) in patients with non-small cell lung cancer (NSCLC).

Methods And Materials: Patients with medically inoperable/unresectable NSCLC treated with definitive radiation therapy in prospective studies were eligible for this study. Pulmonary artery involvement was defined on the basis of pretreatment chest CT and positron emission tomography/CT fusion.

Imaging in thoracic oncology: case studies from Multidisciplinary Thoracic Tumor Board (part 1 of 2 part series).

Multidisciplinary tumor board conferences foster collaboration among health care providers from a variety of specialties and help to facilitate optimal patient care. Typical cases from thoracic tumor board conferences include patients with known or suspected bronchogenic and esophageal carcinomas, as well as less common diseases such as thymomas and mesotheliomas. In most instances, the clinical questions revolve around the best options for establishing a diagnosis, staging the disease and directing treatment.

Imaging in thoracic oncology: case studies from Multidisciplinary Thoracic Tumor Board: (part 2 of 2 part series).

Multidisciplinary tumor board conferences foster collaboration among health care providers from a variety of specialties and help to facilitate optimal patient care. Generally, the clinical questions revolve around the best options for establishing a diagnosis, staging the disease and directing treatment. This article describes and illustrates the clinical scenarios of three patients who were presented at our thoracic Tumor Board, focusing on management issues and the role of imaging.

Incidental, subsolid pulmonary nodules at CT: etiology and management.

Pulmonary nodules, both solid and subsolid, are common incidental findings on computed tomography (CT) studies. Subsolid nodules (SSNs) may be further classified as either pure ground-glass nodules or part-solid nodules. The differential diagnosis for an SSN is broad, including infection, organizing pneumonia, inflammation, hemorrhage, focal fibrosis, and neoplasm.

Chest CT features are associated with poorer quality of life in acute lung injury survivors.

Objectives: Despite decreasing mortality rates in acute lung injury, studies of long-term physical function in acute lung injury survivors have consistently reported poorer quality of life persisting years into recovery for reasons that are not completely understood. We sought to determine if pulmonary dysfunction is independently associated with functional impairment among acute lung injury survivors and to determine if high-resolution computed tomography could be used to predict its development.

Design: Secondary analysis of data from a randomized controlled trial in acute lung injury.

Proximal thoracic aortic diameter measurements at CT: repeatability and reproducibility according to measurement method.

To determine the variability in CT measurements of proximal thoracic aortic diameters obtained using double-oblique short axis and semiautomatic centerline analysis techniques. Institutional review board approval, with waiver of informed consent, was obtained for this HIPAA-compliant, retrospective study. Cardiac gated thoracic aortic CT scans were evaluated in 25 patients.

Natural growth and disease progression of non-small cell lung cancer evaluated with 18F-fluorodeoxyglucose PET/CT.

Purpose: The aims of this study were to: (1) estimate the volumetric and metabolic growth rate of non-small cell lung cancer (NSCLC), (2) evaluate disease progression prior to treatment, and (3) explore the effects of tumor growth rate and time to treatment (TTT) on survival outcome.

Methods: Patients with inoperable stages I-III NSCLC with serial pre-treatment PET/CT scans were eligible for this study. PET-derived metabolic tumor volumes (PET-MTV) and CT-derived gross tumor volumes (CT-GTV) were contoured using PET/CT information.

Chest CT incidentalomas: thyroid lesions, enlarged mediastinal lymph nodes, and lung nodules.

A computed tomography (CT) incidentaloma is an incidentally detected and previously unsuspected finding or abnormality that is not related to the indication for obtaining the CT examination. The aim of this article is to review the frequency of incidentalomas on chest CT scans, discuss the potential clinical significance of the findings, and suggest guidelines for reporting, further evaluation, and follow-up, with particular focus on thyroid lesions, enlarged mediastinal lymph nodes and lung nodules.

"Sweet spot" for endoleak detection: optimizing contrast to noise using low keV reconstructions from fast-switch kVp dual-energy CT.

Objective: To assess endoleak detection and conspicuity using low-kiloelectron volt (keV) monochromatic reconstructions of single-source (fast-switch kilovolt [peak]) dual-energy data sets.

Methods: With approval of the institutional review board, multiphasic dual-energy computed tomographic (CT) scans for aortic endograft surveillance were retrospectively reviewed for 39 patients. Two abdominal radiologists each performed 2 separate reading sessions, at 55-keV and standard 75-keV reconstruction, respectively.

Aortic endograft surveillance: use of fast-switch kVp dual-energy computed tomography with virtual noncontrast imaging.

Objective: To assess endoleak detection and patients' radiation exposure using fast-switch peak kilovoltage (kVp) dual-energy computed tomography (DECT) with virtual noncontrast (VNC) imaging.

Methods: Institutional review board approved retrospective review of triphasic CTs for endograft follow-up: single-energy true noncontrast (TNC) and dual-energy arterial- and venous-phase postcontrast scans on GE HD-750 64-detector scanners. Iodine-subtracted VNC images generated from dual-energy data.

Incidental findings at chest CT: a needs assessment survey of radiologists' knowledge.

Rationale And Objectives: To assess practice patterns in evaluating incidental findings at chest computed tomography (CT) to determine the need for further education.

Materials And Methods: A survey was given to 1600 radiologists, presenting four clinical case questions regarding the evaluation/significance of the following incidental findings at chest CT: thyroid lesion; enlarged mediastinal lymph nodes; asymptomatic, small pulmonary embolus; and small lung nodule. The respondents' answers were compared with "truth," as defined by the best evidence available in the medical literature.

Embryology and imaging review of aortic arch anomalies.

Congenital malformations of the thoracic aorta can be discovered on chest radiographs when associated with symptoms or found incidentally. We review the imaging anatomy and associations of many of the aortic arch malformations that can be encountered in adults and highlight key points with regard to their treatment and prognoses. An understanding of the normal and abnormal embryologic development of the aortic arch, with knowledge of their imaging features, may be important for improving diagnostic accuracy and patient care.

The Lung Image Database Consortium (LIDC) and Image Database Resource Initiative (IDRI): a completed reference database of lung nodules on CT scans.

Purpose: The development of computer-aided diagnostic (CAD) methods for lung nodule detection, classification, and quantitative assessment can be facilitated through a well-characterized repository of computed tomography (CT) scans. The Lung Image Database Consortium (LIDC) and Image Database Resource Initiative (IDRI) completed such a database, establishing a publicly available reference for the medical imaging research community. Initiated by the National Cancer Institute (NCI), further advanced by the Foundation for the National Institutes of Health (FNIH), and accompanied by the Food and Drug Administration (FDA) through active participation, this public-private partnership demonstrates the success of a consortium founded on a consensus-based process.

Extra Z-axis coverage at CT imaging resulting in excess radiation dose: frequency, degree, and contributory factors.

Objective: To assess the degree of extra scanning beyond the prescribed anatomic boundaries for thoracic and body computed tomographic (CT) scans and to identify associated factors.

Methods: For 442 consecutive chest, abdomen, and/or pelvis CT examinations, the length of extra scanning beyond the prescribed anatomic boundaries was determined. Examinations were grouped according to the locations/types of the prescribed boundaries and compared with regard to length of extra scanning.

Traumatic aortic injury: computerized tomographic findings at presentation and after conservative therapy.

Objective: To determine the computerized tomographic (CT) findings in traumatic aortic injury (TAI) at presentation and after conservative management.

Methods: Institutional review board-approved retrospective review of trauma registry during a 6-year period identified class 1 or 2 trauma patients with TAI. The CT findings were correlated with patient outcome.