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A variety of thoracic imaging modalities and techniques have been used to evaluate diseases of the trachea and central bronchi. This document evaluates evidence for the use of thoracic imaging in the evaluation of tracheobronchial disease, including clinically suspected tracheal or bronchial stenosis, tracheomalacia or bronchomalacia, and bronchiectasis. Appropriateness guidelines for initial imaging evaluation of tracheobronchial disease and for pretreatment planning or posttreatment evaluation are included. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. A search for the underlying cause of infection typically includes radiological imaging as part of this investigation. This document focuses on thoracic and abdominopelvic causes of sepsis. In 2017, the global incidence of sepsis was estimated to be 48.9 million cases, with 11 million sepsis-related deaths (accounting for nearly 20% of all global deaths); therefore, understanding which imaging modalities and types of studies are acceptable or not acceptable is imperative. The 5 variants provided include the most commonly encountered scenarios in the setting of sepsis along with recommendations and data for each imaging study. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the association between census tract–level measures of social vulnerability and residential segregation and incidental pulmonary nodule (IPN) follow-up. This retrospective cohort study included patients with IPNs ≥6 mm in size or multiple subsolid or ground-glass IPNs <6 mm (with nonoptional follow-up recommendations) diagnosed between January 1, 2018, and December 30, 2019, at a large urban tertiary center and followed for ≥2 years. Geographic sociodemographic context was characterized by the 2018 Centers for Disease Control and Prevention Social Vulnerability Index (SVI) and the index of concentration at the extremes (ICE), categorized in quartiles. Multivariable binomial regression models were used, with a primary outcome of inappropriate IPN follow-up (late or no follow-up). Models were also stratified by nodule risk. The study consisted of 2,492 patients (mean age, 65.6 ± 12.6 years; 1,361 women). Top-quartile SVI patients were more likely to have inappropriate follow-up (risk ratio [RR], 1.24; 95% confidence interval [CI], 1.12-1.36) compared with the bottom quartile; risk was also elevated in top-quartile SVI subcategories of socioeconomic status (RR, 1.23; 95% CI, 1.13-1.34), Minority status and language (RR, 1.24; 95% CI, 1.03-1.48), housing and transportation (RR, 1.13; 95% CI, 1.02-1.26), and ICE (RR, 1.20; 95% CI, 1.11-1.30). Furthermore, top-quartile ICE was associated with greater risk for inappropriate follow-up among high-risk versus lower risk IPNs (RR, 1.33 [95% CI, 1.18-1.50] versus 1.13 [95% CI, 1.02-1.25]), respectively; P for interaction =.017). Local social vulnerability and residential segregation are associated with inappropriate IPN follow-up and may inform policy or interventions tailored for neighborhoods. [ABSTRACT FROM AUTHOR]

Finding comparison to relevant prior studies is a requisite component of the radiology workflow. The purpose of this study was to evaluate the impact of a deep learning tool simplifying this time-consuming task by automatically identifying and displaying the finding in relevant prior studies. The algorithm pipeline used in this retrospective study, TimeLens (TL), is based on natural language processing and descriptor-based image-matching algorithms. The dataset used for testing comprised 3872 series of 246 radiology examinations from 75 patients (189 CTs, 95 MRIs). To ensure a comprehensive testing, five finding types frequently encountered in radiology practice were included: aortic aneurysm, intracranial aneurysm, kidney lesion, meningioma, and pulmonary nodule. After a standardized training session, nine radiologists from three university hospitals performed two reading sessions on a cloud-based evaluation platform resembling a standard RIS/PACS. The task was to measure the diameter of the finding-of-interest on two or more exams (a most recent and at least one prior exam): first without use of TL, and a second session at an interval of at least 21 days with the use of TL. All user actions were logged for each round, including time needed to measure the finding at all timepoints, number of mouse clicks, and mouse distance traveled. The effect of TL was evaluated in total, per finding type, per reader, per experience (resident vs. board-certified radiologist), and per modality. Mouse movement patterns were analyzed with heatmaps. To assess the effect of habituation to the cases, a third round of readings was performed without TL. Across scenarios, TL reduced the average time needed to assess a finding at all timepoints by 40.1% (107 vs. 65 seconds; p < 0.001). Largest accelerations were demonstrated for assessment of pulmonary nodules (−47.0%; p < 0.001). Less mouse clicks (−17.2%) were needed for finding evaluation with TL, and mouse distance traveled was reduced by 38.0%. Time needed to assess the findings increased from round 2 to round 3 (+27.6%; p < 0.001). Readers were able to measure a given finding in 94.4% of cases on the series initially proposed by TL as most relevant series for comparison. The heatmaps showed consistently simplified mouse movement patterns with TL. A deep learning tool significantly reduced both the amount of user interactions with the radiology image viewer and the time needed to assess findings of interest on cross-sectional imaging with relevant prior exams. [ABSTRACT FROM AUTHOR]

Routine chest imaging has been used to identify unknown or subclinical cardiothoracic abnormalities in the absence of symptoms. Various imaging modalities have been suggested for routine chest imaging. We review the evidence for or against the use of routine chest imaging in different clinical scenarios. This document aims to determine guidelines for the use of routine chest imaging as initial imaging for hospital admission, initial imaging prior to noncardiothoracic surgery, and surveillance imaging for chronic cardiopulmonary disease. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

To determine the performance of volumetric dual energy low kV and iodine radiomic features for the differentiation of intrathoracic lymph node histopathology, and influence of contrast protocol. Intrathoracic lymph nodes with histopathologic correlation (neoplastic, granulomatous sarcoid, benign) within 90 days of DECT chest imaging were volumetrically segmented. 1691 volumetric radiomic features were extracted from iodine maps and low-kV images, totaling 3382 features. Univariate analysis was performed using 2-sample t -test and filtered for false discoveries. Multivariable analysis was used to compute AUCs for lymph node classification tasks. 129 lymph nodes from 72 individuals (mean age 61 ± 15 years) were included, 52 neoplastic, 51 benign, and 26 granulomatous-sarcoid. Among all contrast enhanced DECT protocol exams (routine, PE and CTA), univariable analysis demonstrated no significant differences in iodine and low kV features between neoplastic and non-neoplastic lymph nodes; in the subset of neoplastic versus benign lymph nodes with routine DECT protocol, 199 features differed (p =.01- < 0.05). Multivariable analysis using both iodine and low kV features yielded AUCs >0.8 for differentiating neoplastic from non-neoplastic lymph nodes (AUC 0.86), including subsets of neoplastic from granulomatous (AUC 0.86) and neoplastic from benign (AUC 0.9) lymph nodes, among all contrast protocols. Volumetric DECT radiomic features demonstrate strong collective performance in differentiation of neoplastic from non-neoplastic intrathoracic lymph nodes, and are influenced by contrast protocol. • Iodine and low kV features on multivariable, but not univariable, analysis significantly differ between neoplastic and non-neoplastic intrathoracic lymph nodes. • Diagnostic performance is improved with the combined use of iodine and low kV features. • Contrast protocol influences classifying performance of iodine and low kV features. [ABSTRACT FROM AUTHOR]

Lung nodules are frequently encountered while interpreting chest CTs and are challenging to detect, characterize, and manage given they can represent both benign or malignant etiologies. An understanding of features associated with malignancy and causes of interpretive pitfalls is helpful to avoid misdiagnoses. This review addresses pertinent topics related to the etiologies for missed lung nodules on radiography and CT. Additionally, CT imaging technical pitfalls and challenges in addition to issues in the evaluation of nodule morphology, attenuation, and size will be discussed. Nodule management guidelines will be addressed as well as recent investigations that further our understanding of lung nodules. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of structured recommendations on follow-up completion for incidental lung nodules (ILNs).Methods: Patients with ILNs before and after implementation of structured Fleischner recommendations and electronic tracking were sampled randomly. The cohorts were compared for imaging follow-up. Multivariable logistic regression was used to assess appropriate follow-up and loss to follow-up, with independent variables including use of structured recommendations or tracking, age, sex, race, ethnicity, setting of the index test (inpatient, outpatient, emergency department), smoking history, and nodule features.Results: In all, 1,301 patients met final inclusion criteria, including 255 patients before and 1,046 patients after structured recommendations or tracking. Baseline differences were found in the pre- and postintervention groups, with smaller ILNs and younger age after implementing structured recommendations. Comparing pre- versus postintervention outcomes, 40.0% (100 of 250) versus 29.5% (309 of 1,046) of patients had no follow-up despite Fleischner indications for imaging (P = .002), and among the remaining patients, 56.6% (82 of 145) versus 75.0% (553 of 737) followed up on time (P < .001). Delayed follow-up was more frequent before intervention. Differences postintervention were mostly accounted for by nodules ≤8 mm in the outpatient setting (P < .001). In multivariable analysis, younger age, White race, outpatient setting, and larger nodule size showed significant association with appropriate follow-up completion (P < .015), but structured recommendations did not. Similar results applied for loss to follow-up.Discussion: Consistent use of structured reporting is likely key to mitigate selection bias when benchmarking rates of appropriate follow-up of ILN. Emergency department patients and inpatients are at high risk of missed or delayed follow-up despite structured recommendations. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the inter-observer consistency for subsolid pulmonary nodule radiomic features.Materials and Methods: Subsolid nodules were selected by reviewing radiology reports of CT examinations performed December 1, 2015 to April 1, 2016. Patients with CTs at two time points were included in this study. There were 55 patients with subsolid nodules, of whom 14 had two nodules. Of 69 subsolid nodules, 66 were persistent at the second time point, yielding 135 lesions for segmentation. Two thoracic radiologists and an imaging fellow segmented the lesions using a semi-automated volumetry algorithm (Syngo.via Vb20, Siemens). Coefficient of variation (CV) was used to assess consistency of 91 quantitative measures extracted from the subsolid nodule segmentations, including first and higher order texture features. The accuracy of segmentation was visually graded by an experienced thoracic radiologist. Influencing factors on radiomic feature consistency and segmentation accuracy were assessed using generalized estimating equation analyses and the Exact Mann-Whitney test.Results: Mean patient age was 71 (38-93 years), with 39 women and 16 men. Mean nodule volume was 1.39mL, range .03-48.2mL, for 135 nodules. Several radiomic features showed high inter-reader consistency (CV<5%), including entropy, uniformity, sphericity, and spherical disproportion. Descriptors such as surface area and energy had low consistency across inter-reader segmentations (CV>10%). Nodule percent solid component and attenuation influenced inter-reader variability of some radiomic features. The presence of contrast did not significantly affect the consistency of subsolid nodule radiomic features. Near perfect segmentation, within 5% of actual nodule size, was achieved in 68% of segmentations, and very good segmentation, within 25% of actual nodule size, in 94%. Morphologic features including nodule margin and shape (each p <0.01), and presence of air bronchograms (p = 0.004), bubble lucencies (p = 0.02) and broad pleural contact (p < 0.01) significantly affected the probability of near perfect segmentation. Stroke angle (p = 0.001) and length (p < 0.001) also significantly influenced probability of near perfect segmentation.Conclusions: The inter-observer consistency of radiomic features for subsolid pulmonary nodules varies, with high consistency for several features, including sphericity, spherical disproportion, and first and higher order entropy, and normalized non-uniformity. Nodule morphology influences the consistency of subsolid nodule radiomic features, and the accuracy of subsolid nodule segmentation. [ABSTRACT FROM AUTHOR]

Diffuse lung disease, frequently referred to as interstitial lung disease, encompasses numerous disorders affecting the lung parenchyma. The potential etiologies of diffuse lung disease are broad with several hundred established clinical syndromes and pathologies currently identified. Imaging plays a critical role in diagnosis and follow-up of many of these diseases, although multidisciplinary discussion is the current standard for diagnosis of several DLDs. This document aims to establish guidelines for evaluation of diffuse lung diseases for 1) initial imaging of suspected diffuse lung disease, 2) initial imaging of suspected acute exacerbation or acute deterioration in cases of confirmed diffuse lung disease, and 3) clinically indicated routine follow-up of confirmed diffuse lung disease without acute deterioration. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. [ABSTRACT FROM AUTHOR]

Chest pain is a common reason that patients may present for evaluation in both ambulatory and emergency department settings, and is often of musculoskeletal origin in the former. Chest wall syndrome collectively describes the various entities that can contribute to chest wall pain of musculoskeletal origin and may affect any chest wall structure. Various imaging modalities may be employed for the diagnosis of nontraumatic chest wall conditions, each with variable utility depending on the clinical scenario. We review the evidence for or against use of various imaging modalities for the diagnosis of nontraumatic chest wall pain. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. [ABSTRACT FROM AUTHOR]

Mediastinal masses can present with symptoms, signs, and syndromes or incidentally. Selecting the appropriate diagnostic imaging study for mediastinal mass evaluation requires awareness of the strengths and weaknesses of the various imaging modalities with regard to tissue characterization, soft tissue contrast, and surveillance. This publication expounds on the differences between chest radiography, CT, PET/CT, ultrasound, and MRI in terms of their ability to decipher and surveil mediastinal masses. Making the optimal imaging choice can yield diagnostic specificity, avert unnecessary biopsy and surgery, guide the interventionist when necessary, and serve as a means of surveillance for probably benign, but indeterminate mediastinal masses. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. [ABSTRACT FROM AUTHOR]

Purpose: To develop natural language processing (NLP) to identify incidental lung nodules (ILNs) in radiology reports for assessment of management recommendations.Methods and Materials: We searched the electronic health records for patients who underwent chest CT during 2014 and 2017, before and after implementation of a department-wide dictation macro of the Fleischner Society recommendations. We randomly selected 950 unstructured chest CT reports and reviewed manually for ILNs. An NLP tool was trained and validated against the manually reviewed set, for the task of automated detection of ILNs with exclusion of previously known or definitively benign nodules. For ILNs found in the training and validation sets, we assessed whether reported management recommendations agreed with Fleischner Society guidelines. The guideline concordance of management recommendations was compared between 2014 and 2017.Results: The NLP tool identified ILNs with sensitivity and specificity of 91.1% and 82.2%, respectively, in the validation set. Positive and negative predictive values were 59.7% and 97.0%. In reports of ILNs in the training and validation sets before versus after introduction of a Fleischner reporting macro, there was no difference in the proportion of reports with ILNs (108 of 500 [21.6%] versus 101 of 450 [22.4%]; P = .8), or in the proportion of reports with ILNs containing follow-up recommendations (75 of 108 [69.4%] versus 80 of 101 [79.2%]; P = .2]. Rates of recommendation guideline concordance were not significantly different before and after implementation of the standardized macro (52 of 75 [69.3%] versus 60 of 80 [75.0%]; P = .43).Conclusion: NLP reliably automates identification of ILNs in unstructured reports, pertinent to quality improvement efforts for ILN management. [ABSTRACT FROM AUTHOR]

Increased public and regulatory scrutiny of imaging-related radiation exposure requires familiarity with current dose-monitoring techniques and best practices. CT-related ionizing radiation exposure has been cited as the largest and fastest growing source of population-wide iatrogenic ionizing radiation exposure. Upcoming federal regulations require imaging centers to familiarize themselves with available dose-monitoring techniques and implement comprehensive strategies to track patient dose, with particular emphasis on CT. Because of institution-specific and vendor-specific technologies, there are significant barriers to adoption and implementation. In this article, the authors outline the core components of a universal dose-monitoring strategy and detail a few of the many available commercial platforms. In addition, the authors introduce a cloud-based hybrid model dose-tracking system with the goal of rapid implementation, multicenter scalability, real-time dose feedback for technologists, cumulative dose monitoring, and optional dose communication to patients and into the record; doing so results in improved patient loyalty, referring physician satisfaction, and opportunity for repeat business. [Copyright &y& Elsevier]

Background: Lobectomy is the standard therapy for patients with stage I non−small cell lung cancer (NSCLC). Recently, sublobar resections (SLR), radiofrequency ablation (RFA), and percutaneous cryablation therapy (PCT) for high-risk patients unfit for standard resection have been reported. This study compares all 3 modalities in stage I NSCLC. Study Design: Patients with biopsied stage I NSCLC determined by PET/CT deemed medically unfit for standard resection were reviewed by a tumor board according to American College of Surgeons Oncology Group/NIH inoperability criteria before being offered SLR, RFA, or PCT under anesthesia. Patients were followed with CT scans alternating with PET scans. The primary end points were overall survival, cancer-specific survival, and cancer-free survival. Kaplan-Meier analysis and log-rank tests were used. Results: Sixty-four patients underwent SLR (n = 25; 11 men, 13 women; median age 66 years, range 49 to 85 years), RFA (n = 12; 8 men, 4 women; median age 74 years, range 62 to 83 years), and PCT (n = 27; 16 men, 11 women; median age 74 years; range 59 to 88 years). The probability of 3-year survival for the SLR, RFA, and PCT groups was 87.1%, 87.5%, and 77%, respectively (p > 0.05). The 3-year cancer-specific and cancer-free survival for SLR, RFA, and PCT groups was 90.6% and 60.8% versus 87.5% and 50% versus 90.2% and 45.6%, respectively. Conclusions: This experience suggests comparable survival after sublobar resections and ablative therapies at 3 years. Ablative therapies appear to be a reasonable alternative in high-risk patients not fit for surgery. However, larger randomized studies with longer follow-up are needed to make recommendations for therapy. [Copyright &y& Elsevier]

Rationale and Objectives: To evaluate the potential use of gadolinium (Gd)-based contrast media, especially that of Gadovist, a 1-molar Gd medium, in computed tomography (CT) and compare our findings with standard iodinated contrast media. Material and Methods: Using a live rabbit and an acrylic CT body phantom for comparative CT imaging of Gd- and I-based media. The images were acquired at 80, 100, and 120 kVp, using fixed standard beam filtration. The phantom study used serial dilutions of the Magnevist and Ultravist 300 (2.4-molar I), whereas the animal study used different volumes of Gadovist, Magnevist (0.5 molar Gd), and Ultravist administered intravenously. Results: At 80 kVp for the same injection volumes of Gadovist and Ultravist, the image contrast enhancement of the aorta with Gadovist was 40% lower than that of Ultravist. In the phantom studies, however, for the same kVp settings the CT image contrast was up to fourfold higher for Gd compared with iodine when comparing the same molar concentrations of the two elements in the solutions. Conclusion: These results indicate a potential of Gd-based media for clinical CT angiography and provide incentive for further investigation of this subject. [Copyright &y& Elsevier]

Acute pulmonary embolism (PE) is a critical, potentially life-threatening finding on contrast-enhanced cross-sectional chest imaging. Timely and accurate diagnosis of thrombus acuity and extent directly influences patient management, and outcomes. Technical and interpretive pitfalls may present challenges to the radiologist, and by extension, pose nuance in the development and integration of artificial intelligence support tools. This review delineates imaging considerations for diagnosis of acute PE, and rationale, hurdles and applications of artificial intelligence for the PE task. • Technical standards and interpretive guidelines facilitate accurate diagnosis and characterization of pulmonary embolism (PE). • Spectral CT and MRI are emerging technologies for PE evaluation. • Rationale of AI for PE is based on morbidity and mortality risk, in the setting of potentially constrained resources. • AI may play a role in CTPA exam decision support, triage and computer-aided detection, and reporting of associated findings. [ABSTRACT FROM AUTHOR]

Purpose: For a successful bronchoscopic lung volume reduction coil treatment it is important to place the coils in the most emphysematous lobes. Therefore assessment of the lobe with greatest destruction is essential. Our aims were to investigate the level of agreement among expert reviewers of HRCT-scans in emphysema patients and the comparison with QCT (quantitative computed tomography) software.Method: Five experienced CT-assessors, conducted a visual assessment of the baseline HRCT-scans of emphysema patients who participated in the RENEW bronchoscopic lung volume reduction coil study. On the same HRCT-scans, a QCT analysis was performed.Results: In total 134 HRCT-scans were rated by all 5 experts. All 5 CT-assessors agreed on which was the most destructed lobe in 61 % of the left lungs (ƙ:0.459) and 60 % of the right lungs (ƙ:0.370). The consensus of the 5 assessors matched the QCT in the left lung for 77 % of the patients (ƙ:0.425) and in the right lung for 82 % (ƙ:0.524).Conclusions: Our results show that the interobserver agreement between five expert CT-assessors was only fair to moderate when evaluating the most destructed lobe. CT-assessor consensus improved matching with QCT determination of lobar destruction compared to individual assessor determinations. Because some CT-features are associated with treatment outcomes and important for optimal patient selection of bronchoscopic lung volume reduction treatment, we recommend including more than one CT-reviewer and supported by QCT measurements. [ABSTRACT FROM AUTHOR]

The right ventricular outflow tract (RVOT) velocity time integral (VTI), an echocardiographic measure of stroke distance, correlates with cardiac index. We sought to determine the prognostic significance of low RVOT VTI on clinical outcomes among patients with acute pulmonary embolism (PE). We conducted a retrospective review of echocardiograms on Pulmonary Embolism Response Team (PERT) activations at our institution. The main outcome was a composite of death, cardiac arrest, or hemodynamic deterioration. Of 188 patients, 30 met the combined outcome (16%) and had significantly lower RVOT VTI measurements (9.0 cm v 13.4 cm, p < 0.0001). The AUC for RVOT VTI at a cutoff of 10 cm was 0.78 (95% CI 0.67–0.90) with a sensitivity, specificity, negative predictive value, and positive predictive value of 0.72, 0.81, 0.94, and 0.42, respectively. Fifty-two patients of the cohort were classified as intermediate-high-risk PE and 21% of those met the combined outcome. RVOT VTI was lower among outcome positive patients (7.3 cm v 10.7 cm, p = 0.02). Low RVOT VTI is associated with poor clinical outcomes among patients with acute PE. • Right ventricular outflow tract velocity time integral (RVOT VTI) is a measure of stroke distance. • Low RVOT VTI is associated with death or hemodynamic deterioration in acute PE. • Low RVOT VTI is associated with poor clinical outcomes in intermediate-high-risk PE. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate detection and characterization of groundglass and fibrosis-like opacities imaged by non-contrast 0.55 Tesla MRI, and versus clinically-acquired chest CT images, in a cohort of post-Covid patients.Materials and Methods: 64 individuals (26 women, mean age 53 ± 14 years, range 19-85) with history of Covid-19 pneumonia were recruited through a survivorship registry, with 106 non-contrast low-field 0.55 T cardiopulmonary MRI exams acquired from 9/8/2020-9/28/2021. MRI exams were obtained at an average interval of 9.5 ± 4.5 months from initial symptom report (range 1-18 months). Of these, 20 participants with 22 MRI exams had corresponding clinically-acquired CT chest imaging obtained within 30 days of MRI (average interval 18 ± 9 days, range 0-30). MR and CT images were reviewed and scored by two thoracic radiologists, for presence and extent of lung opacity by quadrant, opacity distribution, and presence versus absence of fibrosis-like subpleural reticulation and subpleural lines. Scoring was performed for each of four lung quadrants: right upper and middle lobe, right lower lobe, left upper lobe and lingula, and left lower lobe. Agreement between readers and modalities was assessed with simple and linear weighted Cohen's kappa (k) coefficients.Results: Inter-reader concordance on CT for opacity presence, opacity extent, opacity distribution, and presence of subpleural lines and reticulation was 99%, 78%, 97%, 99%, and 94% (k 0.96, 0.86, 0.94, 0.97, 0.89), respectively. Inter-reader concordance on MR, among all 106 exams, for opacity presence, opacity extent, opacity distribution, and presence of subpleural lines and reticulation was 85%, 48%, 70%, 86%, and 76% (k 0.57, 0.32, 0.46, 0.47, 0.37), respectively. Inter-modality agreement between CT and MRI for opacity presence, opacity extent, opacity distribution, and presence subpleural lines and reticulation was 86%, 52%, 79%, 93%, and 76% (k 0.43, 0.63, 0.65, 0.80, 0.52).Conclusion: Low-field 0.55 T non-contrast MRI demonstrates fair to moderate inter-reader concordance, and moderate to substantial inter-modality agreement with CT, for detection and characterization of groundglass and fibrosis-like opacities. [ABSTRACT FROM AUTHOR]

Purpose: Surgical resection remains the standard of care for operable early-stage non–small-cell lung cancer (NSCLC). However, some patients are not fit for surgery because of comorbidites such as chronic obstructive pulmonary disease (COPD) and other medical conditions. We aimed to evaluate pulmonary function and tumor volume before and after stereotactic body radiotherapy (SBRT) for patients with and without COPD in early-stage lung cancer. Methods and Materials: A review of prospectively collected data of Stage I and II lung cancers, all treated with SBRT, was performed. The total SBRT treatment was 60 Gy administered in three 20 Gy fractions. The patients were analyzed based on their COPD status, using their pretreatment pulmonary function test cutoffs as established by the American Thoracic Society guidelines (forced expiratory volume [FEV]% ≤50% predicted, FEV%/forced vital capacity [FVC]% ≤70%). Changes in tumor volume were also assessed by computed tomography. Results: Of a total of 30 patients with Stage I and II lung cancer, there were 7 patients in the COPD group (4 men, 3 women), and 23 in t he No-COPD group (9 men, 14 women). At a mean follow-up time of 4 months, for the COPD and No-COPD patients, pretreatment and posttreatment FEV% was similar: 39 ± 5 vs. 40 ± 9 (p = 0.4) and 77 ± 0.5 vs. 73 ± 24 (p = 0.9), respectively. The diffusing capacity of the lungs for carbon monoxide (DLCO) did significantly increase for the No-COPD group after SBRT treatment: 60 ± 24 vs. 69 ± 22 (p = 0.022); however, DLCO was unchanged for the COPD group: 49 ± 13 vs. 50 ± 14 (p = 0.8). Although pretreatment tumor volume was comparable for both groups, tumor volume significantly shrank in the No-COPD group from 19 ± 24 to 9 ± 16 (p < 0.001), and there was a trend in the COPD patients from 12 ± 9 to 6 ± 5 (p = 0.06). Conclusion: SBRT did not seem to have an effect on FEV1 and FVC, but it shrank tumor volume and improved DLCO for patients without COPD. [ABSTRACT FROM AUTHOR]