Implementation of an Institution-Wide Rules-Based Automated CT Protocoling System.

Examination protocoling is a noninterpretive task that increases radiologists' workload and can cause workflow inefficiencies. The purpose of this study was to evaluate effects of an automated CT protocoling system on examination process times and protocol error rates. This retrospective study included 317,597 CT examinations (mean age, 61.

Evaluation of an Artificial Intelligence Model for Detection of Pneumothorax and Tension Pneumothorax in Chest Radiographs.

Importance: Early detection of pneumothorax, most often via chest radiography, can help determine need for emergent clinical intervention. The ability to accurately detect and rapidly triage pneumothorax with an artificial intelligence (AI) model could assist with earlier identification and improve care.

Objective: To compare the accuracy of an AI model vs consensus thoracic radiologist interpretations in detecting any pneumothorax (incorporating both nontension and tension pneumothorax) and tension pneumothorax.

Management and Outcomes of Suspected Infectious and Inflammatory Lung Abnormalities Identified on Lung Cancer Screening CT.

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. The purpose of this study was 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.

Accessory and Incomplete Lung Fissures: Clinical and Histopathologic Implications.

Objective: This article reviews the anatomy, histology, and disease processes of pulmonary fissures, with emphasis on clinical implications of accessory and incomplete fissures.

Conclusion: Accessory and incomplete pulmonary fissures are often overlooked during routine imaging but can have profound clinical importance. Knowledge of fissure anatomy could improve diagnostic accuracy and inform prognosis for oncologists, interventional pulmonologists, and thoracic surgeons.

Non-Diagnostic CT-Guided Percutaneous Needle Biopsy of the Lung: Predictive Factors and Final Diagnoses.

Objective: To investigate the predictive factors for a non-diagnostic result and the final diagnosis of pulmonary lesions with an initial non-diagnostic result on CT-guided percutaneous transthoracic needle biopsy.

Materials And Methods: All percutaneous transthoracic needle biopsies performed over a 4-year period were retrospectively reviewed. The initial pathological results were classified into three categories-malignant, benign, and non-diagnostic.

Comparison of image quality and radiation doses between rapid kV-switching and dual-source DECT techniques in the chest.

Purpose: To compare image quality and radiation doses for chest DECT acquired with dual-source and rapid-kV switching techniques.

Materials And Methods: Our institutional Review Board approved retrospective study included 97 patients (54 men, 43 women; 63 ± 14 years) who underwent contrast-enhanced chest DECT with both single source, rapid kV-switching (SS-DECT) and dual source (DS-DECT) techniques per standard of care departmental protocols. Reconstructed images from both scanners had identical section thickness and section interval for virtual monoenergetic and material decomposition iodine (MDI) images.

Complications and Accuracy of Computed Tomography-guided Transthoracic Needle Biopsy in Patients Over 80 Years of Age.

Objectives: The purpose of this study was to evaluate the complications and diagnostic accuracy of computed tomography-guided percutaneous transthoracic needle biopsy (PTNB) in patients aged 80 years and older.

Materials And Methods: Consecutive PTNB procedures performed in an academic institution between July 2009 and June 2013 were reviewed. Procedures were performed according to a standard protocol using conscious sedation and rapid on-site pathology evaluation.

Missed Lung Cancer.

The chest radiograph is one of the most commonly used imaging studies and is the modality of choice for initial evaluation of many common clinical scenarios. Over the last two decades, chest computed tomography has been increasingly used for a wide variety of indications, including respiratory illnesses, trauma, oncologic staging, and more recently lung cancer screening. Diagnostic radiologists should be familiar with the common causes of missed lung cancers on imaging studies in order to avoid detection and interpretation errors.

Bedside Chest Radiographs in the Intensive care Setting: Wireless Direct Radiography Compared to Computed Radiography.

Objectives: To compare image quality, visibility of anatomic landmarks, tubes and lines, and other clinically significant findings on portable (bedside) chest radiographs acquired with wireless direct radiography (DRw) and computed radiography (CR).

Methods: In a prospective IRB-approved and HIPAA-compliant study, portable DRw (DRX-1C mobile retrofit portable wireless direct radiography, CareStream Inc., Rochester, NY) and portable CR (AGFA CR (DXG) version; NIM2103, AGFA Healthcare, Ridgefield Park, NJ) images of the chest were acquired within 24-hours in 80 patients in the intensive care unit (ICU).

Lung Cancer Screening: Why, When, and How?

This article explains the rationale of lung cancer screening with low-dose computed tomography and provides a practical approach to all relevant aspects of a lung cancer screening program. Imaging protocols, patient eligibility criteria, facility readiness, and reimbursement criteria are addressed step by step. Diagnostic criteria and Lung-RADS (Lung Computed Tomography Screening Reporting and Data System) nodule management pathways are illustrated with examples.

Imaging of Eosinophilic Lung Diseases.

Eosinophilic lung diseases encompass a broad range of conditions wherein patients present with pulmonary opacities and eosinophilia of the serum, pulmonary tissue, or bronchoalveolar lavage fluid. Many of these entities can be idiopathic or are secondary to parasitic infection, exposure to drugs, toxins, or radiation. These diseases exhibit a wide range of imaging findings, including consolidation, ground-glass opacities, nodules, and masses.

Pulmonary Artery Pseudoaneurysms: Clinical Features and CT Findings.

Objective: The purpose of this study was to analyze the clinical and CT features of pulmonary artery pseudoaneurysms (PAPs).

Materials And Methods: A database search of chest CT examinations performed from January 1, 2000 to December 31, 2014 identified 24 patients with findings consistent with PAPs. A CT finding consistent with a PAP was defined as a focal saccular outpouching of a pulmonary artery.

Radiologist Point-of-Care Clinical Decision Support and Adherence to Guidelines for Incidental Lung Nodules.

Purpose: To evaluate the effect of a workstation-integrated, point-of-care, clinical decision support (CDS) tool on radiologist adherence to radiology department guidelines for follow-up of incidental pulmonary nodules detected on abdominal CT.

Methods: The CDS tool was developed to facilitate adherence to department guidelines for managing pulmonary nodules seen on abdominal CT. In October 2012, the tool was deployed within the radiology department of an academic medical center and could be used for a given abdominal CT at the discretion of the interpreting radiologist.

The 10 Pillars of Lung Cancer Screening: Rationale and Logistics of a Lung Cancer Screening Program.

On the basis of the National Lung Screening Trial data released in 2011, the U.S. Preventive Services Task Force made lung cancer screening (LCS) with low-dose computed tomography (CT) a public health recommendation in 2013.

Diagnostic Yield of CT-Guided Percutaneous Transthoracic Needle Biopsy for Diagnosis of Anterior Mediastinal Masses.

Objective: The purpose of this study was to evaluate the diagnostic yield and accuracy of CT-guided percutaneous biopsy of anterior mediastinal masses and assess prebiopsy characteristics that may help to select patients with the highest diagnostic yield.

Materials And Methods: Retrospective review of all CT-guided percutaneous biopsies of the anterior mediastinum conducted at our institution from January 2003 through December 2012 was performed to collect data regarding patient demographics, imaging characteristics of biopsied masses, presence of complications, and subsequent surgical intervention or medical treatment (or both). Cytology, core biopsy pathology, and surgical pathology results were recorded.

Correlation of the Strength of Recommendations for Additional Imaging to Adherence Rate and Diagnostic Yield.

Purpose: The aim of this study was to evaluate the association between the wording of radiologist recommendations for chest CT with the likelihood of recommendation adherence and the diagnostic yield of the recommended follow-up CT imaging.

Methods: This HIPAA-compliant retrospective study had institutional review board approval, including waiver of the requirement for patient consent. All outpatient chest radiographic (CXR) studies performed at a tertiary care academic medical center in 2008 (n = 29,138) were searched to identify examinations with recommendations for chest CT.

Diagnostic yield of recommendations for chest CT examination prompted by outpatient chest radiographic findings.

Purpose: To evaluate the diagnostic yield of recommended chest computed tomography (CT) prompted by abnormalities detected on outpatient chest radiographic images.

Materials And Methods: This HIPAA-compliant study had institutional review board approval; informed consent was waived. Reports of all outpatient chest radiographic examinations performed at a large academic center during 2008 (n = 29 138) were queried to identify studies that included a recommendation for a chest CT imaging.

Clear vision through the haze: a practical approach to ground-glass opacity.

Ground-glass opacity (GGO) is a common, nonspecific imaging finding on chest computed tomography that may occur in a variety of pulmonary diseases. GGO may be the result of partial filling of alveolar spaces, thickening of the alveolar walls or septal interstitium, or a combination of partial filling of alveolar spaces and thickening of the alveolar walls and septal interstitium at the histopathologic level. Diseases that commonly manifest on chest computed tomography as GGO include pulmonary edema, alveolar hemorrhage, nonspecific interstitial pneumonia, hypersensitivity pneumonitis, and pulmonary alveolar proteinosis.

The imaging spectrum of bronchopulmonary sequestration.

Bronchopulmonary sequestration is a rare lesion characterized by abnormal lung tissue that lacks a normal bronchial communication and is supplied by an anomalous systemic artery. It has a variety of imaging appearances, including that of consolidation, a mass, or an air or fluid-filled cystic or multicystic lesion. This article reviews the imaging spectrum of bronchopulmonary sequestration, its important parenchymal mimics, and conditions that share the feature of anomalous systemic arterial supply to the lung.

Outcome of recommendations for radiographic follow-up of pneumonia on outpatient chest radiography.

Objective: Follow-up chest radiographs are frequently recommended by radiologists to document the clearing of radiographically suspected pneumonia. However, the clinical utility of follow-up radiography is not well understood. The purpose of this study was to examine the incidence of important pulmonary pathology revealed during follow-up imaging of suspected pneumonia on outpatient chest radiography.

Radiographic follow-up of suspected pneumonia: survey of Society of Thoracic Radiology membership.

Purpose: To examine the current radiographic follow-up recommendations of thoracic radiologists after detection of a new opacity, suspected to be "pneumonia," on chest radiography.

Materials And Methods: An anonymized, Institutional Review Board-approved, Internet-based survey was sent to the 735 members of the Society of Thoracic Radiology by e-mail. Questions focused on individual practices and institutional policies after radiographic detection of suspected pneumonia.