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Computer-aided diagnosis has been under development for more than 3 decades. The rate of progress appears exponential, with either recent approval or pending approval for devices focusing on mammography, chest radiographs, and chest CT. Related technologies improve diagnosis for many other types of medical images including virtual colonography, vascular imaging, as well as automated quantitation of image-derived metrics. A variety of techniques are currently employed with success, likely reflecting the variety of imagery used, as well as the variety of tasks. Most areas of medical imaging have had efforts at computer assistance, and some have even received FDA approval and can be reimbursed. We anticipate that the rapid advance of these technologies will continue, and that application will broaden to cover much of medical imaging. Acceptance of, and integration of computer-aided diagnosis technology with the electronic radiology practice is a current challenge. These challenges will be overcome, and we expect that computer-aided diagnosis will be routinely applied to medical images. [ABSTRACT FROM AUTHOR]

Abstract Background Early diagnosis of pulmonary hypertension (PH) in idiopathic pulmonary fibrosis (IPF) has potential prognostic and therapeutic implications but can be difficult due to the lack of specific clinical manifestations or accurate non-invasive tests. Histopathologic parameters correlating with PH in IPF are also not known. Remodeling of postcapillary pulmonary vessels has been reported in the nonfibrotic areas of explanted lungs from IPF patients. We hypothesized that iron deposition and increased alveolar capillaries, the findings often seen in postcapillary PH, might predict the presence of clinical PH, independent of the severity of fibrosis or ventilatory dysfunction in IPF patients. To test this hypothesis, we examined the association between these histologic parameters and the degree of PH, with consideration of the severity of disease in IPF. Methods Iron deposition and alveolar septal capillary density (ASCD) were evaluated on histologic sections with hematoxylin-eosin, iron, elastin and CD34 stainings. Percentage of predicted forced vital capacity (FVC%) was used for grading pulmonary function status. Fibrosis score assessed on high resolution computed tomography (HRCT) was used for evaluating overall degree of fibrosis in whole lungs. Right ventricular systolic pressure (RVSP) by transthoracic echocardiography was used for the estimation of PH. Univariate and multivariate regression analyses were performed. Results A cohort of 154 patients was studied who had the clinicopathological diagnosis of IPF with surgical lung biopsies or explants during the period of 1997 to 2006 at Mayo Clinic Rochester. In univariate analysis, RVSP in our IPF cases was associated with both iron deposition and ASCD (p < 0.001). In multivariate analysis with FVC% and HRCT fibrosis score included, iron deposition (p = 0.02), but not ASCD (p = 0.076), maintained statistically significant association with RVSP. FVC% was associated with RVSP on univariate analysis but not on multivariate analysis, while fibrosis score lacked any association with RVSP by either univariate or multivariate analyses. Conclusions Iron deposition and ASCD in non fibrotic lung tissue showed an association with RVSP, suggesting that these features are possible morphologic predictors of PH in IPF.

Background: Effective detection of early lung disease in cystic fibrosis (CF) is critical to understanding early pathogenesis and evaluating early intervention strategies. We aimed to compare ability of several proposed sensitive functional tools to detect early CF lung disease as defined by CT structural disease in school aged children., Methods: 50 CF subjects (mean±SD 11.2 ± 3.5y, range 5-18y) with early lung disease (FEV 1 ≥70 % predicted: 95.7 ± 11.8 %) performed spirometry, Multiple breath washout (MBW, including trapped gas assessment), oscillometry, cardiopulmonary exercise testing (CPET) and simultaneous spirometer-directed low-dose CT imaging. CT data were analysed using well-evaluated fully quantitative software for bronchiectasis and air trapping (AT)., Results: CT bronchiectasis and AT occurred in 24 % and 58 % of patients, respectively. Of the functional tools, MBW detected the highest rates of abnormality: S cond 82 %, MBW TG RV 78 %, LCI 74 %, MBW TG IC 68 % and S acin 51 %. CPET VO 2 peak detected slightly higher rates of abnormality (9 %) than spirometry-based FEV 1 (2 %). For oscillometry AX (14 %) performed better than Rrs (2 %) whereas Xrs and R5-19 failed to detect any abnormality. LCI and S cond correlated with bronchiectasis (r = 0.55-0.64, p < 0.001) and AT (r = 0.73-0.74, p < 0.001). MBW-assessed trapped gas was detectable in 92 % of subjects and concordant with CT-assessed AT in 74 %., Conclusions: Significant structural and functional deficits occur in early CF lung disease, as detected by CT and MBW. For MBW, additional utility, beyond that offered by LCI, was suggested for S cond and MBW-assessed gas trapping. Our study reinforces the complementary nature of these tools and the limited utility of conventional oscillometry and CPET in this setting., Competing Interests: Declaration of competing interest The authors have no conflict of interests to declare, (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

While CT lung cancer screening reduces lung cancer-specific mortality, there are remaining challenges. Radiomic tools promiss to address these challenges, however, they are subject to interobserver variability if semi-automated segmentation techniques are used. Herein we report interobserver variability for two validated radiomic tools, BRODERS (Benign versus aggRessive nODule Evaluation using Radiomic Stratification) and CANARY (Computer-Aided Nodule Assessment and Risk Yield). We retrospectively analyzed the CT images of 95 malignant lung nodules of the adenocarcinoma spectrum using BRODERS and CANARY. Cases were identified at Mayo Clinic (n = 45) and Vanderbilt University Medical Center and Nashville/Veteran Administration Tennessee Valley Health Care System (n = 50). Three observers with different training levels (medical student, internal medicine resident and thoracic radiology fellow) each performed lung nodule segmentation. All methods were carried out in accordance with relevant guidelines and regulations. Interclass correlation coefficients (ICC) of 0.77, 0.98 and 0.97 for the average nodule volume, BRODERS cancer probability and Score Indicative of Lesion Aggression (SILA) which summarizes the distribution of the CANARY exemplars indicated good to excellent reliability, respectively. The dice similarity coefficient was 0.79 and 0.81 for the data sets from the two institutions. BRODERS and CANARY are robust radiomics tools with excellent interobserver variability. These tools are simple and reliable regardless the observer/operator's level of training., (© 2023. The Author(s).)

Idiopathic pulmonary fibrosis (IPF) is characterised by progressive fibrosing interstitial pneumonia with an associated irreversible decline in lung function and quality of life. IPF prevalence increases with age, appearing most frequently in patients aged > 50 years. Pulmonary vessel-like volume (PVV) has been found to be an independent predictor of mortality in IPF and other interstitial lung diseases, however its estimation can be impacted by artefacts associated with image segmentation methods and can be confounded by adjacent fibrosis. This study compares PVV in IPF patients (N = 21) with PVV from a healthy cohort aged > 50 years (N = 59). The analysis includes a connected graph-based approach that aims to minimise artefacts contributing to calculation of PVV. We show that despite a relatively low extent of fibrosis in the IPF cohort (20% of the lung volume), PVV is 2-3 times higher than in controls. This suggests that a standardised method to calculate PVV that accounts for tree connectivity could provide a promising tool to provide early diagnostic or prognostic information in IPF patients and other interstitial lung disease., (© 2023. The Author(s).)

Purpose: To investigate the correlations between densitometric and Computer Aided Lung Informatics for Pathology Evaluation and Rating (CALIPER)-derived indices of pulmonary emphysema and their change in the short-term period for groups of patients with different smoking habits., Method: This retrospective study included 284 subjects from the ITALUNG trial (198 men and 86 women; mean±sd age 60±4 years) who underwent low-dose chest computed tomography at baseline and 2-year follow-up. Subjects were divided into four groups (persistent smokers, restarters, quitters and former smokers) according to their smoking habit at baseline and follow-up. Densitometric and texture analyses were performed, using CALIPER software. A correlation analysis was conducted between CALIPER-derived low-attenuation areas (LAAs) and densitometric indices, including the 15th percentile of the whole-lung attenuation histogram (Perc 15 ) and the relative areas with density ≤-950 HU (RA 950 ). Densitometric indices and LAAs were evaluated at baseline and variation assessed longitudinally with comparisons between groups with different smoking habit. Further analysis of parenchymal changes per pulmonary zone was performed., Results: LAAs were strongly correlated with Perc 15 (r s =0.81; p<0.001) and RA 950 (r s =0.905; p<0.001). At baseline, the group of smokers showed higher Perc 15 , lower RA 950 , lower LAAs (particularly mild sub-class of LAAs) than the group of ex-smokers (p<0.001). At 2-year follow-up, densitometric indices and LAAs increased in persistent smokers, former smokers and quitters (p<0.05). The progression was larger and statistically more significant in quitters (p<0.001)., Conclusion: CALIPER texture analysis provides an objective measure comparable to traditional density/histogram features to assess the lung parenchymal changes in relation to different smoking habits., Competing Interests: Conflict of interest: B. Bartholmai declares personal fees from Promedior, LLC, and from Imbio, LLC, outside the submitted work. Mayo Clinic has received grants from NIH/NHLBI, fees from Imbio, LLC, and Boehringer Ingelheim outside the submitted work. In addition, B. Bartholmai has a patent for Systems and Methods For Analyzing In Vivo Tissue Volumes Using Medical Imaging pending to Mayo Clinic. R.A. Karwoski declares personal fees from LLC, and from Imbio, LLC, outside the submitted work. The other authors of this manuscript declare no conflict of interest; the authors received no financial support for the research, authorship, and/or publication of this article., (Copyright ©The authors 2022. For reproduction rights and permissions contact permissions@ersnet.org.)

Purpose: To perform a semiquantitative and quantitative analysis of interstitial lung disease (ILD), through computed tomography (CT), in different serological subgroups of idiopathic inflammatory myopathies (IIM) patients, to find radiologic and clinical differences of disease related to serology., Materials and Methods: This was a prospective study, which included 98 IIM patients, divided into serological subgroups: anti-aminoacyl-transfer-RNA-synthetases (anti-ARS) positive and myositis-specific autoantibodies (MSA) negative.For each baseline CT the total semiquantitative score of Warrick (WS) and the automated software (Computer-Aided Lung Informatics for Pathology Evaluation and Rating) quantitative scores interstitial lung disease % (ILD%) and vascular-related structure % (VRS%) were calculated. Pulmonary function tests included total lung capacity % (TLC%), forced vital capacity % (FVC%), and diffusing capacity of the lung for carbon monoxide % (DLCO%)., Results: Inverse correlations ( P <0.001) between the radiologic scores and the functional scores DLCO% and TLC% were found, the most relevant being between ILD% and DLCO% (ρ=-0.590), VRS% and DLCO% (ρ=-0.549), and WS and DLCO% (ρ=-0.471).Positive correlations between ILD% and VRS% (ρ=0.916; P <0.001), WS and ILD% (ρ=0.663; ρ<0.001), and WS and VRS% (ρ=0.637; P <0.001) were obtained.Statistically significant higher values of WS, ILD%, and VRS% were found in the anti-ARS group (WS=15; ILD%=11; VRS%=3.5) compared with the MSA negative one (WS=2.5; ILD%=0.84; VRS%=2.2).The nonspecific interstitial pneumonia pattern was dominant. No statistically significant differences emerged at pulmonary function tests., Conclusions: In this study, ILD in anti-ARS-positive and MSA-negative groups was defined through semiquantitative and quantitative analysis of lung CT. The inverse correlations between the radiologic scores and TLC% and DLCO% ( P <0.001) confirm the role of lung CT in the evaluation of ILD in IIM., Competing Interests: B.B. declares personal fees from Promedior, LLC, and from Imbio, LLC, outside the submitted work. Mayo Clinic has received grants from NIH/NHLBI, fees from Imbio, LLC, and Boehringer Ingelheim outside the submitted work. In addition, B.B. has a patent for SYSTEMS AND METHODS FOR ANALYZING IN VIVO TISSUE VOLUMES USING MEDICAL IMAGING pending to Mayo Clinic. The remaining authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Aim: To compare the machine learning computed tomography (CT) quantification tool, Computer-Aided Lung Informatics for Pathology Evaluation and Ratings (CALIPER) to pulmonary function testing (PFT) in assessing idiopathic pulmonary fibrosis (IPF) for patients undergoing treatment and determine the effects of limited (LD) and ultra-low dose (ULD) CT on CALIPER performance., Materials and Methods: Thirty-eight IPF patients underwent PFT and standard, LD, and ULD CT. CALIPER classified each CT voxel into either vessel-related structures (VRS), normal, reticular (R), honeycomb (HC) or ground-glass (GG) features. CALIPER-derived interstitial lung disease (ILD) extent represented the sum of GG, R and HC values. Repeated-measures correlation coefficient (ρ rm ) and 95% confidence interval (CI) evaluated CALIPER features correlation with PFT. Lin's concordance correlation coefficient (CCC) assessed concordance of CALIPER parameters across different CT dosages., Results: Twenty patients completed 12 months of follow-up. CALIPER ILD correlated significantly with percent predicted (%) forced vital capacity (FVC) and forced expiratory volume in 1 second (%FEV1; p=0.004, ρ rm -0.343, 95% CI [-0.547, -0.108] and 0.008, -0.321, [-0.518, -0.07], respectively). VRS significantly correlated with %FVC and %FEV1 (p=0.000, ρ rm -0.491, 95% CI [-0.685, -0.251] and -0.478, 0.000, [-0.653, -0.231], respectively). There was near perfect LD and moderate ULD concordance with standard dose CT for both ILD (CCC 0.995, 95% CI 0.988-0.999 and 0.9, 0.795-0.983, respectively) and VRS (CCC 0.989, 95% CI 0.963-0.997 and 0.915, 0.806-0.956, respectively)., Conclusions: CALIPER parameters correlate well with PFTs for evaluation of IPF in patients undergoing anti-fibrotic treatment without being influenced by dose variation. CALIPER may serve as a robust, objective adjunct to PFTs in assessing anti-fibrotic treatment related changes., (Copyright © 2021 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Differentiating the invasiveness of ground-glass nodules (GGN) is clinically important, and several institutions have attempted to develop their own solutions by using computed tomography images. The purpose of this study is to evaluate Computer-Aided Analysis of Risk Yield (CANARY), a validated virtual biopsy and risk-stratification machine-learning tool for lung adenocarcinomas, in a Korean patient population. To this end, a total of 380 GGNs from 360 patients who underwent pulmonary resection in a single institution were reviewed. Based on the Score Indicative of Lung Cancer Aggression (SILA), a quantitative indicator of CANARY analysis results, all of the GGNs were classified as "indolent" (atypical adenomatous hyperplasia, adenocarcinomas in situ, or minimally invasive adenocarcinoma) or "invasive" (invasive adenocarcinoma) and compared with the pathology reports. By considering the possibility of uneven class distribution, statistical analysis was performed on the 1) entire cohort and 2) randomly extracted six sets of class-balanced samples. For each trial, the optimal cutoff SILA was obtained from the receiver operating characteristic curve. The classification results were evaluated using several binary classification metrics. Of a total of 380 GGNs, the mean SILA for 65 (17.1%) indolent and 315 (82.9%) invasive lesions were 0.195±0.124 and 0.391±0.208 (p < 0.0001). The area under the curve (AUC) of each trial was 0.814 and 0.809, with an optimal threshold SILA of 0.229 for both. The macro F1-score and geometric mean were found to be 0.675 and 0.745 for the entire cohort, while both scored 0.741 in the class-equalized dataset. From these results, CANARY could be confirmed acceptable in classifying GGN for Korean patients after the cutoff SILA was calibrated. We found that adjusting the cutoff SILA is needed to use CANARY in other countries or races, and geometric mean could be more objective than F1-score or AUC in the binary classification of imbalanced data., Competing Interests: The authors have declared that no competing interests exist.

Background: Combined pulmonary fibrosis and emphysema (CPFE) is a heterogeneous clinico-radiological syndrome without a consensus definition. There are limited data on the relation between the amount of parenchymal fibrosis and prognosis. In this study, we assessed the prognostic implications of the extent of fibrosis assessed by an automated quantitative computed tomography (CT) technique and the radiological and functional change over time in patients with a broad spectrum of fibrotic interstitial lung diseases (ILDs) encountered in a real-world setting., Methods: We conducted a single-centre, retrospective study of 228 consecutive patients with CPFE, encountered from 2007 to 2015 at Kameda Medical Center, Chiba, Japan. We investigated the prognostic value of automated CT fibrosis quantification and the subsequent course of CPFE., Results: Among 228 patients with CPFE, 89 had fibrosis affecting < 5% of their lungs, 54 had 5 to < 10% fibrosis, and 85 had ≥ 10% fibrosis at the time of diagnosis. Lower volume of fibrosis correlated with lower rates of mortality and acute exacerbation (p < 0.001). In particular, among those with < 5% fibrosis, only 4.5% died and none experienced acute exacerbation during follow-up, whereas 57.6% and 29.4% of those with ≥ 10% fibrosis experienced death and acute exacerbation, respectively. Although, the ≥ 10% fibrosis group had the poorest overall survival as well as the highest incidence of acute exacerbation, the incidence of decline in pulmonary function tests, change per year in total lung volume, and progression of fibrosis on chest CT was highest in the 5 to < 10% fibrosis group. The Cox proportional hazard model for CPFE progression (defined by composite criteria of death, acute exacerbation, and decline in forced vital capacity or diffusing capacity) showed fibrosis proportion was a risk factor independent of age, sex, smoking pack-years, the Charlson Comorbidity Index, lung cancer, connective tissue disease, and idiopathic pulmonary fibrosis., Conclusions: Less severe (< 5%) fibrosis at baseline was associated with disease stability and better prognosis compared to more severe fibrosis in CPFE occurring with fibrotic ILDs. Further studies including a validation cohort will be needed. Trial Registration Retrospectively registered.

Objective: Our goal is to translate lung ultrasound surface wave elastography (LUSWE) for assessing patients with interstitial lung disease (ILD) and various connective tissue diseases including systemic sclerosis (SSc)., Methods: LUSWE was used to measure the surface wave speed of lung at 100, 150, and 200 Hz through six intercostal lung spaces for 91 patients with ILD and 30 healthy control subjects. In addition, skin viscoelasticity was measured on both forearms and upper arms for patients and controls., Results: The surface wave speeds of patients' lungs were significantly higher than those of control subjects. Patient skin elasticity and viscosity were significantly higher than those of control subjects. In dividing ILD patients into two groups, ILD with SSc patients and ILD without SSc patients, significant differences between each patient group with the control group were found for both the lung and skin. No significant differences were found between the two patient groups, although there were some differences at a few locations and at 100 Hz for skin viscoelasticity., Conclusion: Significant differences of surface wave speed were found between ILD patients and healthy control subjects for both the lung and skin., Significance: LUSWE may be useful for assessing ILD and SSc and screening early stage patients.

Lung ultrasound surface wave elastography (LUSWE) is a novel non-invasive technique for measuring superficial lung tissue stiffness. The purpose of the study described here was to develop LUSWE for assessment of progression in patients with interstitial lung disease (ILD). In this study, LUSWE was used to measure changes in lung surface wave speeds at 100, 150 and 200 Hz through six intercostal lung spaces for 52 patients with ILD. The mean age was 63.1 ± 12.0 y (range: 20-85, 23 male and 29 female). The follow-up interval was 9.2 ± 3.5 mo depending on each patient's return appointment and availability. For each patient, disease progression between the baseline and follow-up tests was evaluated clinically using a 7-point Likert scale comprising three grades of improvement (mild, moderate, marked), unchanged status and three grades of worsening (mild, moderate, marked). Clinical assessments were based on changes in pulmonary function tests together with high-resolution computed tomography, echocardiography and clinical evaluations. This study illustrates the correlations between changes in lung surface wave speed and clinical assessments. Correlations of changes in lung surface wave speed at lower lateral and posterior portions of the lung portions with clinical assessments were good. LUSWE provides quantitative global and regional changes in lung surface wave speed that may be useful for quantitative assessment of progression of ILD., (Copyright © 2018 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)

Visualizing process metrics can help identify targets for improvement initiatives. Dashboards and scorecards are tools to visualize important metrics in an easily interpretable manner. We describe the development of two visualization systems: a dashboard to provide real-time situational awareness to frontline coordinators, and a scorecard to display aggregate monthly performance metrics for strategic process improvement efforts. Both systems were designed by a multidisciplinary team of physicians, allied health staff, engineers and information technology specialists. We describe the process of defining important metrics, gathering and cleaning data, and designing the visualization interfaces. We also describe some improvement initiatives that stemmed. These systems were implemented in our hospital and improved the availability of data to our staff and leadership, making performance gaps visible and generating new targets for quality improvement projects.

Importance: Idiopathic pulmonary fibrosis (IPF) is a progressive fibrotic lung disease with poor prognosis. Approved therapies do not halt disease progression., Objective: To determine the effect of recombinant human pentraxin 2 vs placebo on change from baseline to week 28 in mean forced vital capacity (FVC) percentage of predicted value., Design, Setting, and Participants: Phase 2, randomized, double-blind, placebo-controlled trial conducted at 18 sites in 7 countries of eligible patients with IPF (N = 117; aged 40-80 years; FVC ≥50% and ≤90% predicted; ratio of forced expiratory volume in the first second/FVC >0.70; diffusing capacity for carbon monoxide [Dlco] ≥25% and ≤90% predicted; and distance of ≥150 m on the 6-minute walk test). Study period was August 2015-May 2017., Interventions: Patients were randomized to receive either recombinant human pentraxin 2 (10 mg/kg intravenous every 4 weeks, n = 77) or placebo (n = 39) for 24 weeks, and stratified by concurrent IPF treatment status., Main Outcomes and Measures: The primary end point was the least-squares mean change in FVC percentage of predicted value from baseline to week 28 (minimal clinically important difference, decline of 2%-6%). Secondary end points included mean change in lung volumes (total, normal, and interstitial lung abnormalities) on high-resolution computed tomography (HRCT) and 6-minute walk distance (minimal clinically important difference, 24-45 m)., Results: Of 117 randomized patients, 116 received at least 1 dose of study drug (mean age, 68.6 years; 81.0% men; mean time since IPF diagnosis, 3.8 years), and 111 (95.7%) completed the study. The least-squares mean change in FVC percentage of predicted value from baseline to week 28 in patients treated with recombinant human pentraxin 2 was -2.5 vs -4.8 for those in the placebo group (difference, +2.3 [90% CI, 1.1 to 3.5]; P = .001). No significant treatment differences were observed in total lung volume (difference, 93.5 mL [90% CI, -27.7 to 214.7]), quantitative parenchymal features on HRCT (normal lung volume difference, -1.2% [90% CI, -4.4 to 1.9]; interstitial lung abnormalities difference, 1.1% [90% CI, -2.2 to 4.3]), or measurement of Dlco (difference, -0.4 [90% CI, -2.6 to 1.7]). The change in 6-minute walk distance was -0.5 m for patients treated with recombinant human pentraxin 2 vs -31.8 m for those in the placebo group (difference, +31.3 m [90% CI, 17.4 to 45.1]; P < .001). The most common adverse events in the recombinant human pentraxin 2 vs placebo group were cough (18% vs 5%), fatigue (17% vs 10%), and nasopharyngitis (16% vs 23%)., Conclusions and Relevance: In this preliminary study, recombinant human pentraxin 2 vs placebo resulted in a slower decline in lung function over 28 weeks for patients with idiopathic pulmonary fibrosis. Further research should more fully assess efficacy and safety., Trial Registration: clinicaltrials.gov Identifier: NCT02550873.

The majority of incidentally and screen-detected lung cancers are adenocarcinomas. Optimal management of these tumors is clinically challenging due to variability in tumor histopathology and behavior. Invasive adenocarcinoma (IA) is generally aggressive while adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) may be extremely indolent. Computer Aided Nodule Analysis and Risk Yield (CANARY) is a quantitative computed tomography (CT) analysis tool that allows non-invasive assessment of tumor characteristics. This analysis may obviate the need for tissue biopsy and facilitate the risk stratification of adenocarcinoma of the lung. CANARY was developed by unsupervised machine learning techniques using CT data of histopathologically-characterized adenocarcinomas of the lung. This technique identified 9 distinct exemplars that constitute the spectrum of CT features found in adenocarcinoma of the lung. The distributions of these features in a nodule correlate with histopathology. Further automated clustering of CANARY nodules defined three distinct groups that have distinctly different post-resection disease free survival (DFS). CANARY has been validated within the NLST cohort and multiple other cohorts. Using semi-automated segmentation as input to CANARY, there is excellent repeatability and interoperator correlation of results. Confirmation and longitudinal tracking of indolent adenocarcinoma with CANARY may ultimately add decision support in nuanced cases where surgery may not be in the best interest of the patient due to competing comorbidity. Currently under investigation is CANARY's role in detecting differing driver mutations and tumor response to targeted chemotherapeutics. Combining the results from CANARY analysis with clinical information and other quantitative techniques such as analysis of the tumor-free surrounding lung may aid in building more powerful predictive models. The next step in CANARY investigation will be its prospective application, both in selecting low-risk stage 1 adenocarcinoma for active surveillance and investigation in selecting high-risk early stage adenocarcinoma for adjuvant therapy., Competing Interests: Conflicts of Interest: CANARY software is currently licensed to Imbio LLC (annual royalties <$5,000). This COI applies to Mayo Clinic and B Bartholmai, F Maldonado, R Karwoski, T Peikert and S Rajagopalan. R Clay has no conflicts of interest to declare.

Systemic sclerosis (SSc) is a multi-organ connective tissue disease characterized by immune dysregulation and organ fibrosis. Severe organ involvement, especially of the skin and lung, is the cause of morbidity and mortality in SSc. Interstitial lung disease (ILD) includes multiple lung disorders in which the lung tissue is fibrotic and stiffened. The purpose of this study was to translate ultrasound surface wave elastography (USWE) for assessing patients with SSc and/or ILD via measuring surface wave speeds of both skin and superficial lung tissue. Forty-one patients with both SSc and ILD and 30 healthy patients were enrolled in this study. An external harmonic vibration was used to generate the wave propagation on the skin or lung. Three excitation frequencies of 100, 150 and 200 Hz were used. An ultrasound probe was used to measure the wave propagation in the tissue non-invasively. Surface wave speeds were measured on the forearm and upper arm of both left and right arm, as well as the upper and lower lungs, through six intercostal spaces of patients and healthy patients. Viscoelasticity of the skin was calculated by the wave speed dispersion with frequency using the Voigt model. The magnitudes of surface wave speed and viscoelasticity of patients' skin were significantly higher than those of healthy patients (p <0.0001) for each location and each frequency. The surface wave speeds of patients' lung were significantly higher than those of healthy patients (p <0.0001) for each location and each frequency. USWE is a non-invasive and non-ionizing technique for measuring both skin and lung surface wave speed and may be useful for quantitative assessment of SSc and/or ILD., (Copyright © 2018 World Federation for Ultrasound in Medicine and Biology. Published by Elsevier Inc. All rights reserved.)

A lung ultrasound surface wave elastography (LUSWE) technique is developed to measure superficial lung tissue elastic properties. The purpose of this paper was to translate LUSWE into clinical studies for assessing patients with interstitial lung disease (ILD) and present the pilot data from lung measurements on 10 healthy subjects and 10 patients with ILD. ILD includes multiple lung disorders in which the lung tissue is distorted and stiffened by tissue fibrosis. Chest radiography and computed tomography are the most commonly used techniques for assessing lung disease, but they are associated with radiation and cannot directly measure lung elastic properties. LUSWE provides a noninvasive and nonionizing technique to measure the elastic properties of superficial lung tissue. LUSWE was used to measure regions of both lungs through six intercostal spaces for patients and healthy subjects. The data are presented as wave speed at 100, 150, and 200 Hz at the six intercostal spaces. As an example, the surface wave speeds are, respectively, 1.88 ± 0.11 m/s at 100 Hz, 2.74 ± 0.26 m/s at 150 Hz, and 3.62 ± 0.13 m/s at 200 Hz for a healthy subject in the upper right lung; this is in comparison to measurements from an ILD patient of 3.3 ± 0.37 m/s at 100 Hz, 4.38 ± 0.33 m/s at 150 Hz, and 5.24 ± 0.44 m/s at 200 Hz in the same lung space. Significant differences in wave speed between healthy subjects and ILD patients were found. LUSWE is a safe and noninvasive technique which may be useful for assessing ILD.

Background and Purpose: Cement PE represents a potentially serious complication following vertebroplasty. To determine the frequency and extent of cement PE during percutaneous vertebroplasty, we performed a retrospective review of chest CT scans obtained in patients who had previously undergone ≥1 vertebroplasty procedure., Materials and Methods: After approval by our local institutional review board, we retrospectively evaluated 244 patients who had undergone vertebroplasty at 465 levels and subsequently underwent chest CT. A thoracic radiologist evaluated the presence, number, size, and location of discrete cement PEs. We catalogued the following data: age, sex, number of treated vertebrae, cement volume per vertebra, operator, presence of cement leakage noted by the operator during the procedure, and clinical presentation at postvertebroplasty CT., Results: At least 1 cement PE was detected in 23 (9.4%; 95% CI, 6%-13%) of 244 patients; 1 patient was symptomatic from a cement PE. The mean number of discrete cement PEs was 3.2 ± 3.4 (median, 2; range, 1-12). There was no correlation among the total number of treatment sessions, number of levels treated per session, cement volume per level, operator, or time between vertebroplasty and chest CT in the detection of cement PE. Those with PE were significantly younger (P=.0229) and had significantly more total levels treated (P=.0260). Cement PE was recognized by the operator during the vertebroplasty in 2 (8.7%) of 23 patients found to have it on CT., Conclusions: Small asymptomatic cement PEs are common during vertebroplasty and usually are not recognized by the operator during the procedure.

Multi-site imaging research has several specialized needs that are substantially different from what is commonly available in clinical imaging systems. An attempt to address these concerns is being led by several institutes including the National Institutes of Health and the National Cancer Institute. With the exception of results reporting (which has an infrastructure for standard reports, albeit with several competing lexicons), medical imaging has been largely standardized by the efforts of DICOM, HL7, and IHE. What are not well developed in this area are the tools required for multi-site imaging collaboration and data mining. The goal of this paper is to identify existing clinical interoperability methods that can be used to harmonize the research and clinical worlds, and identify gaps where they exist. To do so, we will detail the approaches of a specific multi-site trial, point out the current deficiencies and workarounds developed in that trial, and finally point to work that seeks to address multi-site imaging challenges.

Background: Recently, it has been shown that emphysematous destruction of the lung is associated with a decrease in the total number of terminal bronchioles. It is unknown whether a similar decrease is visible in the more proximal airways. We aimed to assess the relationships between proximal airway count, CT imaging measures of emphysema, and clinical prognostic factors in smokers, and to determine whether airway count predicts the BMI, airflow obstruction, dyspnea, and exercise capacity (BODE) index., Methods: In 50 smokers, emphysema was measured on CT scans and airway branches from the third to eighth generations of the right upper lobe apical bronchus were counted manually. The sum of airway branches from the sixth to eighth generations represented the total airway count (TAC). For each subject, the BODE index was determined. We used logistic regression to assess the ability of TAC to predict a high BODE index (≥ 7 points)., Results: TAC was inversely associated with emphysema (r = -0.54, P < .0001). TAC correlated with the modified Medical Research Council dyspnea score (r = -0.42, P = .004), FEV(1)% predicted (r = 0.52, P = .0003), 6-min walk distance (r = 0.36, P = .012), and BODE index (r = -0.55, P < .0001). The C-statistics, which correspond to the area under the receiver operating characteristic curve, for the ability of TAC alone and TAC, emphysema, and age to predict a high BODE index were 0.84 and 0.92, respectively., Conclusions: TAC is lower in subjects with greater emphysematous destruction and is a predictor of a high BODE index. These results suggest that CT imaging-based TAC may be a unique COPD-related phenotype in smokers.