Search

Progressive pulmonary fibrosis (PPF) and interstitial lung abnormalities (ILA) are relatively new concepts in interstitial lung disease (ILD) imaging and clinical management. Recognition of signs of PPF, as well as identification and classification of ILA, are important tasks during chest high-resolution CT interpretation, to optimize management of patients with ILD and those at risk of developing ILD. However, following professional society guidance, the role of imaging surveillance remains unclear in stable patients with ILD, asymptomatic patients with ILA who are at risk of progression, and asymptomatic patients at risk of developing ILD without imaging abnormalities. In this AJR Expert Panel Narrative Review, we summarize the current knowledge regarding PPF and ILA and describe the range of clinical practice with respect to imaging patients with ILD, those with ILA, and those at risk of developing ILD. In addition, we offer suggestions to help guide surveillance imaging in areas with an absence of published guidelines, where such decisions are currently driven primarily by local pulmonologists' preference.

In 2014, the American College of Radiology (ACR) created Lung-RADS 1.0. The system was updated to Lung-RADS 1.1 in 2019, and further updates are anticipated as additional data become available. Lung-RADS provides a common lexicon and standardized nodule follow-up management paradigm for use when reporting lung cancer screening (LCS) low-dose CT (LDCT) chest examinations and serves as a quality assurance and outcome monitoring tool. The use of Lung-RADS is intended to improve LCS performance and lead to better patient outcomes. To date, the ACR's Lung Cancer Screening Registry is the only LCS registry approved by the Centers for Medicare & Medicaid Services and requires the use of Lung-RADS categories for reimbursement. Numerous challenges have emerged regarding the use of Lung-RADS in clinical practice, including the timing of return to LCS after planned follow-up diagnostic evaluation; potential substitution of interval diagnostic CT for future LDCT; role of volumetric analysis in assessing nodule size; assessment of nodule growth; assessment of cavitary, subpleural, and category 4X nodules; and variability in reporting of the S modifier. This article highlights the major updates between versions 1.0 and 1.1 of Lung-RADS, describes the system's ongoing challenges, and summarizes current evidence and recommendations.

Objective: The objective of our study was to reduce variation in image quality of orthogonal reformatted images generated from long-z-axis CT angiography (CTA) studies of the upper and lower extremities., Subjects and Methods: Upper and lower extremity CTA studies were targeted at a single health care system. A correctly performed CTA examination was defined as one that met the following three criteria: Sagittal and coronal reformats were obtained, a high-resolution matrix greater than 512 × 512 was used, and reformatted images were available in a distance-measurable format. Baseline data were collected from February 1, 2014, through September 30, 2014. Corrective actions were implemented during three consecutive plan-do-check-act (PDCA) cycles from October 1, 2014, through July 31, 2015, that addressed human, technical, and systematic variations. A 3-month maintenance period followed in which no intervention was performed. Longitudinal data were analyzed monthly using a statistical process control chart (p-chart)., Results: The total number of long-z-axis extremity CTA studies analyzed was as follows: 351 CTA studies were analyzed at baseline, 94 at the first PDCA cycle, 92 at the second PDCA cycle, 114 at the third PDCA cycle, and 138 during the maintenance period. The monthly rate of correctly performed studies ranged from 7% to 51% (mean, 38% ± 13% [SD]) during the baseline period, 32-59% (mean, 46% ± 14%) during the first PDCA cycle, 40-81% (mean, 61% ± 21%) during the second PDCA cycle, and 80-82% (mean, 81% ± 0.9%) during the third PDCA cycle. The monthly rate improved to 90-91% (mean, 91% ± 0.5%) during the maintenance period. The upper and lower control limits of the p-chart were upshifted after the second and third PDCA cycles. Correcting systematic and technical variations led to the greatest improvements in reformat accuracy., Conclusion: Obtaining consistently and correctly reformatted images from long-z-axis CTA studies is achievable using iterative PDCA cycles.

Objective: The objective of the present study is to evaluate patient understanding of radiology and radiologists and to assess patient interest in direct consultation with a radiologist., Materials and Methods: A total of 1976 adult radiology outpatients at both a university and a nearby community hospital were surveyed. After an initial survey was administered, educational material with an attached follow-up survey was distributed to the patients. A McNemar test was used to assess the difference between patients who correctly chose the radiologist as the image interpreter before and after educational material was provided, whereas a paired t test was used to test the difference between patient levels of comfort with various image interpreters., Results: Of the respondents, 84% expressed interest in meeting with a radiologist, with 43% willing to pay $0, 37% willing to pay $10-$30, and 20% willing to pay $40 or more to do so. Small percentages of respondents incorrectly identified ultrasound (10%) and MRI (45%) examinations as using radiation, whereas larger percentages of respondents correctly identified radiography (87%), CT (63%), and nuclear medicine imaging (62%) examinations as using radiation. A total of 73% of respondents (1002/1369) initially chose the radiologist as the image interpreter; this percentage improved to 81% (1109/1369) after the respondents received educational material (p < 0.0001). Both before and after educational material was provided, respondents had a statistically significantly lower mean (± SD) comfort level score (scale, 1-10) when faced with the prospect of a nurse or physician assistant interpreting their examination versus a trained physician (i.e., a radiologist) (mean score, 5.2 ± 3.27 and 9.4 ± 1.47, respectively, before education [p < 0.0001] and 5.2 ± 2.94 and 9.56 ± 1.24, respectively, after education [p < 0.0001])., Conclusion: The level of comfort with radiologists as image interpreters was statistically significantly higher than the level of comfort with nonradiologist interpreters, and most patients were interested in meeting with radiologists. Educational material improved patient perception and knowledge of radiology.

Objective: The purpose of this article is to review both expected and unexpected thoracic CT manifestations of nonsurgical breast cancer treatment with multimodality imaging correlation. Specific topics include the spectrum of posttherapy changes attributed to chemotherapy and radiation therapy and the spread of breast cancer., Conclusion: Thoracic CT is an important tool commonly used for breast cancer staging and surveillance and for diagnostic indications such as shortness of breath and chest pain. Imaging findings can be related to progression of disease or to associated conditions, such as pulmonary embolism. The hallmarks of breast cancer spread in the thorax include pulmonary nodules, enlarged lymph nodes, pleural effusions, thickening or nodularity, and sclerotic or lytic skeletal lesions. Less common findings including pulmonary lymphangitic tumor spread and pericardial metastasis. The findings also may represent the sequelae of surgery, radiation therapy, or chemotherapy for breast cancer. Knowledge of various treatment methods and their expected and unexpected CT findings is important for recognizing treatment-related abnormalities to avoid confusion with breast cancer spread and thereby minimize the risk that unnecessary further diagnostic imaging will be performed.

Objective: The purpose of this article is to discuss the surgical treatment of breast cancer and its resultant thoracic CT and multimodality imaging manifestations., Conclusion: Many breast cancer patients undergo cross-sectional imaging at some point during or after treatment. Thoracic CT is an important modality performed for staging and surveillance. Thoracic CT examinations often show findings related to patients' surgical or adjuvant treatment. The postsurgical changes visible on thoracic CT may include those related to lumpectomy, mastectomy, breast reconstruction, and axillary surgery. Postsurgical complications may also be seen, including fluid collections, infection, fat necrosis, and lymphedema. Recognition and appropriate interpretation of the posttherapeutic spectrum of findings are important to avoid unnecessary diagnostic imaging and minimize patient anxiety.

Objective: The purpose of this study was to retrospectively determine CT-based normal reference values of left atrial volume, function, and diameter normalized by age, sex, and body surface area., Materials and Methods: The study group consisted of 74 subjects with normal findings at ECG-gated coronary CT angiography performed with retrospective gating. Analysis of left atrial volume (end-diastolic, end-systolic, and stroke volume) and function (ejection fraction) was performed with the Simpson method. Left atrial diameter was measured in the anteroposterior dimension. General linear model analysis was performed to model the data and assess statistical significance by age group after adjustment for sex and body surface area., Results: The reference range for left atrial volume, function, and diameter was normalized (indexed) to age, sex, and body surface area in healthy subjects. A statistically significant difference was noted between left atrial volume and age without adjustment for sex and body surface area, but no statistically significant difference was found after adjustment for these variables. Sex and body surface area had a significant influence on left atrial volume, function, and diameter., Conclusion: Left atrial volume, function, and diameter normalized to age, sex, and body surface area can be reported from CTA datasets and may provide information important for patient care.