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In December 2013, the U.S. Preventive Services Task Force recommended screening for lung cancer with low-dose computed tomography (LDCT) for selected current and former smokers. The Task Force based the recommendation primarily on the results of the NLST (National Lung Screening Trial). In this trial, patients randomly assigned to LDCT screening for 3 years had lower rates of both lung cancer-specific mortality and all-cause mortality (relative risk reduction, 6.7% [95% Cl, 1.2% to 13.6%]; absolute risk reduction, 0.46% [Cl, 0% to 0.9%]). Clinicians and health systems confront questions and challenges as they begin to implement lung cancer screening. This paper summarizes a conference during which an internist and a radiologist discuss the application of the Task Force recommendation to an individual patient. [ABSTRACT FROM AUTHOR]

Morbid obesity may influence several aspects of airway function. However, the effect of morbid obesity on expiratory tracheal collapse in COPD patients is unknown. We thus prospectively studied 100 COPD patients who underwent full pulmonary function tests (PFTs), 6-minute walk test (6MWT), Saint George's Respiratory Questionnaire (SGRQ), and low-dose CT at total lung capacity and during dynamic exhalation with spirometric monitoring. We examined correlations between percentage dynamic expiratory tracheal collapse and body mass index (BMI). The association between tracheal collapse and BMI was compared to a control group of 53 volunteers without COPD. Patients included 48 women and 52 men with mean age 65 ± 7 years; BMI 30 ± 6; FEV1 64 ± 22% predicted and percentage expiratory collapse 59 ± 19%. Expiratory collapse was significantly associated with BMI (69 ± 12% tracheal collapse among 20 morbidly obese patients with BMI ≥35 compared to 57 ±19% in others, p = 0.002, t-test). In contrast, there was no significant difference in collapse between healthy volunteers with BMI ≥ 35 and < 35. COPD patients with BMI ≥ 35 also demonstrated shorter 6MWT distances (340 ± 139 m vs. 430 ± 139 m, p = 0.003) and higher (worse) total SGRQ scores (48 ± 19 vs. 36 ± 20, p = 0.013) compared to those with BMI < 35. In light of these results, clinicians should consider evaluating for excessive expiratory tracheal collapse when confronted with a morbidly obese COPD patient with greater quality of life impairment and worse exercise performance than expected based on functional measures. [ABSTRACT FROM AUTHOR]

The article focuses on a study to evaluate the use of chest x-rays and low-dose computed tomography (CT) in lung cancer screening and also describes the advantages and disadvantages of CT screening. It discusses a case of a 64-year-old woman with a medical history of hypertension, bilateral knee replacement and anxiety and also includes recommendations for the screening of lung cancer in the patient. The study reveals that chest radiographs have not prove beneficial for reducing mortality rates in lung cancer patients. It also discusses the risk associated with CT including anxiety, radiation exposure and overdiagnosis and also presents several tables regarding CT screening.

Background: COPD has been described as a risk factor for excessive expiratory tracheal collapse, but its prevalence and clinical correlates have not been fully determined. The purpose of this study is to prospectively determine the prevalence of excessive expiratory tracheal collapse among patients with COPD and to test the hypothesis that clinical and/or physiologic parameters will correlate with the presence of excessive tracheal collapse.Methods: We studied 100 adults meeting GOLD (Global Initiative for Obstructive Lung Disease) criteria for COPD, who underwent full pulmonary function tests (PFTs), 6-min walk test (6MWT), St. George's Respiratory Questionnaire (SGRQ), and low-dose CT scan at total lung capacity and during dynamic exhalation with spirometric monitoring. We examined correlations between percentage dynamic expiratory tracheal collapse and PFTs, 6MWT distance, and SGRQ scores.Results: Patients included 48 women and 52 men with mean age 65 ± 7 years, FEV₁ 64% ± 22% predicted, and percentage expiratory collapse 59% ± 19%. Twenty of 100 participants met study criteria for excessive expiratory collapse. There was no significant correlation between percentage expiratory tracheal collapse and any pulmonary function measure, total SGRQ score, or 6MWT distance. The SGRQ symptom subscale was weakly correlated with percentage collapse of the mid trachea (R = 0.215, P = .03).Conclusions: Excessive expiratory tracheal collapse is observed in a subset of patients with COPD, but the magnitude of collapse is independent of disease severity and does not correlate significantly with physiologic parameters. Thus, the incidental identification of excessive expiratory tracheal collapse in a general COPD population may not necessarily be clinically significant. [ABSTRACT FROM AUTHOR]

The article discusses a study on the prevalence of dynamic expiratory tracheal collapse in patients with chronic obstructive pulmonary disease (COPD). The study involved 100 adults who were subjected to pulmonary function tests (PFTs), 6-minute walk test (6MWT), St. George's Respiratory Questionnaire (SGRQ) and low-dose CT scan. The study found no significant correlation between percentage expiratory tracheal collapse and physiologic parameters.

The various techniques encompassed in the term ‘Thoracic Imaging’ have had a dramatic effect on the practice of respiratory medicine over the last 25 years. One of many examples is the increased precision with which lung cancer can be preoperatively staged using CT and PET imaging. The increasing sophistication of thoracic imaging tests brings many benefits, but there are caveats. This review considers a selection of techniques and contains state-of-the-art commentaries by distinguished experts on current challenges and likely future developments. [ABSTRACT FROM AUTHOR]

Purpose: To study the frequency and demographics of lung cancer on CT pulmonary angiography in patients with suspected pulmonary embolism referred from the Emergency Department. Materials and Methods: Retrospective review of the medical records and radiology reports, clinical and imaging follow-up studies and pathological reports revealed 1106 CT pulmonary angiography studies referred from our Emergency Department during the 15-month period between March 2003 and June 2004. Results: Five incidental lung cancer cases were found in 1106 studies from 1081 patients (0.47%). Pulmonary embolism was found in 95 patients (8.5%). Among the five incidental cases three patients were female and two were male (62-81 years old; mean 73 years, 17-130 packs year; mean 51 packs year). Tumor size ranged from 1.8 to 4.5 cm (mean 3.3 cm). The stagings of the lung cancers were IIIB in one patient and IV in four patients. Conclusion: Previously undiagnosed lung cancer was detected in 0.45% of patients among 1081 patients referred from Emergency Department, one of whom had coexistent pulmonary embolism. All five patients presented at advanced lung cancer stages of IIIB and IV. [ABSTRACT FROM AUTHOR]

The purpose of this article is to familiarize chest physicians with recent advances in airway imaging, with an emphasis on the emerging role of two-dimensional reformatted and three-dimensional CT reconstructed images in the assessment of central airway disorders. [ABSTRACT FROM AUTHOR]

A response by Diana Litmanovich, Phillip M. Boiselle, and Alexander A. Bankier, to a letter to the editor about their article, "CT of Pulmonary Emphysema: Current Status, Challenges, and Future Directions," which was published in a previous issue is presented.

Purpose: It has been suggested that assigned mentoring relationships are less successful than those that develop by free choice. This study evaluates radiology residents' overall experience with a mentoring program and compares the responses of those who self-selected mentors with those who were assigned mentors. Methods: A voluntary Web-based survey was sent to 27 radiology residents in postgraduate years 3-5. Data collected included the following: year in residency, method of mentor assignment, duration of relationship, frequency and types of communication, perceived value of mentoring, overall satisfaction with the program, and the perceived impact of mentoring. Results: Twenty-five of 27 residents (93%) responded, with 14 having self-selected mentors (56%) and 11 having assigned mentors (44%). Both groups unanimously agreed that mentoring is beneficial or critical to their training; however, those residents with self-selected mentors were significantly more satisfied with the mentoring program (4 vs 3,3; P = .04) and more likely to consider their mentor as their primary mentor compared with those with assigned mentors (11 [79%] vs 4 [36%]; P = .049). Although all residents perceived a benefit, residents with self-selected mentors rated almost all mentoring parameters more positively than those with assigned mentors, although most of these parameters did not reach statistical significance. Conclusion: Residents highly value the importance of mentoring. However, residents who self-select their mentors are more likely to be satisfied with a mentoring program. [ABSTRACT FROM AUTHOR]

The article presents a study which evaluated the prevalence and the characteristics of airway involvement in relapsing polychondritis (RP). Researchers examined data of RP patients presented in the Rheumatology Clinic and the Complex Airway Center at Beth Israel Deaconess Medical Center in Boston, Massachusetts from Janury 2004 to February 2008. The study concluded that symptotic airway involvement in RP is common and at times severe, while the nature of airway problems is diverse.

Integrity and trust are essential attributes of medical researchers. Research misconduct represents clear and present dangers to academic institutions and their faculty, residents, students, and staff. To achieve and maintain public trust, medical researchers must achieve and maintain research integrity. To do so requires synchronicity and collaboration between and within academic institutions. Substantial failures to maintain research integrity by institutional leadership will lead to increasing demands to do so from the funding organizations and the general public. This, in turn, will lead to avoidable consequences of substantial penalties, financial and otherwise, adverse publicity, and reputational damage. Researchers must self-regulate to avoid pitfalls, including those created by changes in the medical care delivery system that have decreased the influence of health care providers and increased the influence of outside legal and business interests. Our common goal should be to return public trust in our research enterprise that has done so much good for so many, but requires the establishment and maintenance of vigilance to establish and maintain research integrity. [ABSTRACT FROM AUTHOR]

BACKGROUND Low-dose computed tomography (LDCT) lung screening has been associated with a 20% reduction in lung cancer mortality. A major barrier to the adoption of lung screening is the potential negative psychological impact of a false-positive (FP) screen, occurring in 20% to 50% of those screened. The objective of this study was to assess the impact of abnormal findings on health-related quality of life (HRQoL) and anxiety in the American College of Radiology (ACRIN)/National Lung Screening Trial (NLST). METHODS The NLST was a randomized screening trial comparing LDCT with chest X-ray screening (CXR). This study was part of the original protocol. A total of 2812 participants at 16 of 23 ACRIN sites who had baseline HRQoL assessments were asked to complete the Short Form-36 and the State Trait Anxiety Inventory (form Y-1) questionnaires to assess short-term (1 month) and long-term (6 months) effects of screening. FP were lung cancer-free at 1 year, and true-positives (TP) were not. RESULTS Of the total participants, 1024 (36.4%) participants were FP, 63 (2.2%) were TP, 344 (12.2%) had significant incidental findings (SIFs), and 1381 (49.1%) had negative screens. Participants had been randomized to LDCT (n = 1947) and CXR (n = 865). Short-term and long-term HRQoL and state anxiety did not differ across participants with FP, SIF, or negative screens. Short-term and long-term HRQoL were lower and anxiety was higher for TP participants compared to participants with FP, SIF, and negative screens. CONCLUSIONS In a large multicenter lung screening trial, participants receiving a false-positive or SIF screen result experienced no significant difference in HRQoL or state anxiety at 1 or at 6 months after screening relative to those receiving a negative result. Cancer 2014;120:3401-3409. © 2014 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. [ABSTRACT FROM AUTHOR]

The article discusses a study on the use of multi-detector computed tomography (MDCT) to create two-dimensional (2-D) multiplanar (MPR) and three-dimensional (3-D) images from volumetric and isotropic axial computed tomography (CY) data. The potential diagnostic role of these images in the diagnosis of pulmonary vein stenosis in children is examined, with information on research of the diagnostic accuracy of these methods.

Continuing advances in multidetector computed tomography (MDCT) technology are revolutionizing the non-invasive evaluation of congenital and acquired large airway disorders in children. For example, the faster scanning time and increased anatomical coverage that are afforded by MDCT are especially beneficial to children. MDCT also provides high-quality multiplanar 2-dimensional (2-D), internal and external volume-rendering 3-dimensional (3-D), and dynamic 4-dimensional (4-D) imaging. These advances have enabled CT to become the primary non-invasive imaging modality of choice for the diagnosis, treatment planning, and follow-up evaluation of various large airway disorders in infants and children. It is thus essential for radiologists to be familiar with safe and effective techniques for performing MDCT and to be able to recognize the characteristic imaging appearances of large airway disorders affecting children. [ABSTRACT FROM AUTHOR]

Purpose: Evidence-based treatment guidelines for non-small-cell lung cancer (NSCLC) exist to improve the quality of care for patients with this disease. However, how often evidence-based decisions are used for care of NSCLC is poorly understood. Patients and Methods: We examined patterns of care and rate of adherence to evidence-based guidelines for 185 new NSCLC patients seen between 2007 and 2009. Evidence-based care status was determined for 150 patients. Results: Eighty-one percent of the patients were white, the mean age was 66 years, 49% were women, 11% were never smokers, 83% had Eastern Cooperative Oncology Group performance status 0 to 1, 49.7% of tumors were adenocarcinomas, 57.1% of never smokers had tumors genotyped (EGFR, ALK, KRAS), and 13.3% participated in clinical trials. The rate of evidence-based treatment adherence was 94.1% (16 of 17), 100% (21 of 21) and 100% (36 of 36) in patients with stages I, II, and III NSCLC, respectively. Stage IV disease, with adherence of 76.3% (58 of 76), was correlated with a higher rate of nonadherence when compared with stages I-III (odds ratio 16.33; 95% CI, 1.94 to 137.73). In patients with stage IV disease, the rate of evidence-based adherence was 95% (72 of 76) for first-line therapy, 95.2% (40 of 42) for second-line therapy, and only 33.3% (6 of 18) for third-line therapy (P < .001). There was no significant correlation between evidence-based adherence status and the patient's age, sex, performance status, smoking history, ethnicity, or the treating physician. Conclusion: These data point toward the need for improved evidence-based use of resources in the third-line setting of stage IV NSCLC. [ABSTRACT FROM AUTHOR]

Purpose: Evidence-based treatment guidelines for non-small-cell lung cancer (NSCLC) exist to improve the quality of care for patients with this disease. However, how often evidence-based decisions are used for care of NSCLC is poorly understood. Patients and Methods: We examined patterns of care and rate of adherence to evidence-based guidelines for 185 new NSCLC patients seen between 2007 and 2009. Evidence-based care status was determined for 150 patients. Results: Eighty-one percent of the patients were white, the mean age was 66 years, 49% were women, 11% were never smokers, 83% had Eastern Cooperative Oncology Group performance status 0 to 1, 49.7% of tumors were adenocarcinomas, 57.1% of never smokers had tumors genotyped (EGFR, ALK, KRAS), and 13.3% participated in clinical trials. The rate of evidence-based treatment adherence was 94.1% (16 of 17), 100% (21 of 21) and 100% (36 of 36) in patients with stages I, II, and III NSCLC, respectively. Stage IV disease, with adherence of 76.3% (58 of 76), was correlated with a higher rate of nonadherence when compared with stages I-III (odds ratio 16.33; 95% CI, 1.94 to 137.73). In patients with stage IV disease, the rate of evidence-based adherence was 95% (72 of 76) for first-line therapy, 95.2% (40 of 42) for second-line therapy, and only 33.3% (6 of 18) for third-line therapy (P < .001). There was no significant correlation between evidence-based adherence status and the patient's age, sex, performance status, smoking history, ethnicity, or the treating physician. Conclusion: These data point toward the need for improved evidence-based use of resources in the third-line setting of stage IV NSCLC. [ABSTRACT FROM AUTHOR]

Background: Prior studies in adults suggest that a wedge-shaped peripheral consolidation may be predictive of pulmonary embolism (PE). In contrast, a previous study in children provided no evidence of an association between this finding and PE, but it was limited by a small sample size and was not specifically designed to answer this question.Objective: To compare the frequencies of parenchymal and pleural abnormalities in children with and without PE at multidetector computed tomographic pulmonary angiography (CTPA).Materials and Methods: The study population included 22 consecutive pediatric patients (11 males, 11 females; mean age 13.2 +/- 5.8 years; range 4 months to 18 years) with PE diagnosed by CTPA from July 2004 to January 2009 and identified using our hospital database. The comparison group included 22 randomly selected pediatric patients (10 males, 12 females; mean age 15.2 +/- 3.3 years; range 5.6 to 18 years) who underwent CTPA studies without evidence of PE during the same study period. All CTPA studies were reviewed by consensus by two pediatric radiologists for the presence of parenchymal and pleural abnormalities including: wedge-shaped peripheral consolidation, other forms of consolidation, atelectasis, linear opacity, ground-glass opacity, mosaic attenuation pattern, nodule, mass, focal patchy increased attenuation, and pleural effusion. Differences in frequencies of parenchymal and pleural abnormalities between the two groups were analyzed by logistic regression to determine odds ratios for association with PE. The two groups were also compared with respect to risk factors for PE.Results: Wedge-shaped peripheral consolidation was seen in eight children (36%) with PE and in two children (9%) without PE [odds ratio = 5.7, 95% confidence interval (CI): 1.2 to 30, p = 0.03]. There were no significant differences in the frequency of other findings between the groups (all p-values > 0.10). Prior history of neoplasm was the only independent risk factor significantly associated with the presence of PE (p = 0.006).Conclusion: Wedge-shaped peripheral consolidation is significantly associated with PE on CTPA studies of children. The identification of a wedge-shaped peripheral consolidation in children should alert radiologists to carefully evaluate for concurrent PE. [ABSTRACT FROM AUTHOR]

Pulmonary emphysema is characterized by irreversible destruction of lung parenchyma. Emphysema is a major contributor to chronic obstructive pulmonary disease (COPD), which by itself is a major cause of morbidity and mortality in the western world. Computed tomography (CT) is an established method for the in-vivo analysis of emphysema. This review first details the pathological basis of emphysema and shows how the subtypes of emphysema can be characterized by CT. The review then shows how CT is used to quantify emphysema, and describes the requirements and foundations for quantification to be accurate. Finally, the review discusses new challenges and their potential solution, notably focused on multi-detector-row CT, and emphasizes the open questions that future research on CT of pulmonary emphysema will have to address. [ABSTRACT FROM AUTHOR]

Rationale: Central airway stabilization with silicone stents can improve respiratory symptoms in patients with severe symptomatic tracheobronchomalacia (TBM) but is associated with a relatively high rate of complications. Surgery with posterior tracheobronchial splinting using a polypropylene mesh has also been used for this condition but to date has not been evaluated prospectively and objectively for patient outcomes.Objectives: To evaluate the effect of surgical tracheobronchoplasty on symptoms, functional status, quality of life, lung function, and exercise capacity in patients with severe and symptomatic TBM.Methods: A prospective observational study in which baseline measurements were compared to those obtained 3 months after surgical tracheobronchoplasty.Measurements and Main Results: Of 104 referred patients to our complex airway center for severe TBM, 77 had baseline measurements. Of this group, 57 patients had severe malacia and underwent stent placement for central airway stabilization. Of those, 37 patients reported improvement in respiratory symptoms and 35 were considered for surgical tracheobronchoplasty. Two patients were excluded from surgery for medical reasons. Median age was 61 years (range, 39 to 83 years), 20 patients were men, 11 patients (31%) had COPD, 9 patients (26%) had asthma, and 4 patients (11%) had Mounier-Kuhn syndrome. Thirty-three patients (94%) presented with severe dyspnea, 26 patients (74%) with uncontrollable cough, and 18 patients (51%) reported recurrent pulmonary infections. Two patients (3%) presented with respiratory failure requiring mechanical ventilation. After surgery, quality of life scores improved in 25 of 31 patients (p < 0.0001), dyspnea scores improved in 19 of 26 patients (p = 0.007), functional status scores improved in 20 of 31 patients (p = 0.003), and mean exercise capacity improved in 10 patients (p = 0.012).Conclusions: In experienced hands, surgical central airway stabilization with posterior tracheobronchial splinting using a polypropylene mesh improves respiratory symptoms, health-related quality of life, and functional status in highly selected patients with severe symptomatic TBM. [ABSTRACT FROM AUTHOR]

The article presents a study concerning the efficacy of tracheobronchoplasty surgery for severe tracheobronchomalacia (TBM). It notes that central airway stabilization with silicon stents can improve respiratory symptoms in patients with symptomatic TBM but is prone to high rate of complications. The study shows that surgical central airway stabilization with posterior tracheobronchial splinting using a polypropylene mesh improves respiratory symptoms and health-related quality of life.

Background: Mediastinal aortic vascular anomalies are relatively common causes of extrinsic central airway narrowing in infants with respiratory symptoms. Surgical correction of mediastinal aortic vascular anomalies alone might not adequately treat airway symptoms if extrinsic narrowing is accompanied by intrinsic tracheomalacia (TM), a condition that escapes detection on routine end-inspiratory imaging. Paired inspiratory-expiratory multidetector CT (MDCT) has the potential to facilitate early diagnosis and timely management of TM in symptomatic infants with mediastinal aortic vascular anomalies.Objective: To assess the technical feasibility of paired inspiratory-expiratory MDCT for evaluating TM among symptomatic infants with mediastinal aortic vascular anomalies.Materials and Methods: The study group consisted of five consecutive symptomatic infants (four male, one female; mean age 4.1 months, age range 2 weeks to 6 months) with mediastinal aortic vascular anomalies who were referred for paired inspiratory-expiratory MDCT during a 22-month period. CT angiography was concurrently performed during the end-inspiration phase of the study. Two pediatric radiologists in consensus reviewed all CT images in a randomized and blinded fashion. The end-inspiration and end-expiration CT images were reviewed for the presence and severity of tracheal narrowing. TM was defined as > or =50% reduction in tracheal cross-sectional luminal area between end-inspiration and end-expiration. The presence of TM was compared to the bronchoscopy results when available (n = 4).Results: Paired inspiratory-expiratory MDCT was technically successful in all five patients. Mediastinal aortic vascular anomalies included a right aortic arch with an aberrant left subclavian artery (n = 2), innominate artery compression (n = 2), and a left aortic arch with an aberrant right subclavian artery (n = 1). Three (60%) of the five patients demonstrated focal TM at the level of mediastinal aortic vascular anomalies. The CT results were concordant with the results of bronchoscopy in all patients who underwent bronchoscopy (n = 4).Conclusion: Paired inspiratory-expiratory MDCT is technically feasible for evaluating TM in symptomatic infants with mediastinal aortic vascular anomalies and has the potential to facilitate prompt diagnosis and treatment. [ABSTRACT FROM AUTHOR]

The article focuses on a study which tries to analyze the effect of silicone stents on symptoms, quality of life, lung function, and exercise capacity in the patients with severe tracheobronchomalacia (TBM). It observed 75 patients and 58 of them had severe disease and underwent therapeutic rigid bronchoscopy with stent placement.

The article cites a study which aims to evaluate the accuracy of dynamic expiratory computerized axial tomography (CT) for detecting airway malacia using bronchoscopy as the diagnostic standard. The study is comprised of 29 cohort patients. Researchers of the study concluded that CT is a highly sensitive method for detecting airway malacia and has the possibility to be an effective, non-invasive test for diagnosing this condition.

An abstract of the article "Obesity Associated With Excessive Dynamic Expiratory Airway Collapse in COPD" by Gaetane Michaud and colleagues is presented.