Korean Clinical Imaging Guidelines for Justification of Diagnostic Imaging Study for COVID-19

To develop Korean coronavirus disease (COVID-19) chest imaging justification guidelines, eight key questions were selected and the following recommendations were made with the evidence-based clinical imaging guideline adaptation methodology. It is appropriate not to use chest imaging tests (chest radiograph or CT) for the diagnosis of COVID-19 in asymptomatic patients. If reverse transcription-polymerase chain reaction testing is not available or if results are delayed or are initially negative in the presence of symptoms suggestive of COVID-19, chest imaging tests may be considered. In addition to clinical evaluations and laboratory tests, chest imaging may be contemplated to determine hospital admission for asymptomatic or mildly symptomatic unhospitalized patients with confirmed COVID-19. In hospitalized patients with confirmed COVID-19, chest imaging may be advised to determine or modify treatment alternatives. CT angiography may be considered if hemoptysis or pulmonary embolism is clinically suspected in a patient with confirmed COVID-19. For COVID-19 patients with improved symptoms, chest imaging is not recommended to make decisions regarding hospital discharge. For patients with functional impairment after recovery from COVID-19, chest imaging may be considered to distinguish a potentially treatable disease.

Infections in Lung Transplant Recipients during and after Prophylaxis / 감염과화학요법

Background@#The timeline of infections after lung transplantation has been changed with the introduction of new immunosuppressants and prophylaxis strategies. The study aimed to investigate the epidemiological characteristics of infectious diseases after lung transplantation in the current era. @*Materials and Methods@#All patients who underwent lung or heart–lung transplantation at our institution between October 29, 2008 and April 3, 2019 were enrolled. We retrospectively reviewed the patients' medical records till April 2, 2020. @*Results@#In total, 100 consecutive lung transplant recipients were enrolled. The median follow-up period was 28 months after lung transplantation. A total of 127 post–lung transplantation bacterial infections occurred. Catheter-related bloodstream infection (25/84, 29.8%) was the most common within 6 months and pneumonia (23/43, 53.5%) was the most common after 6 months. Most episodes (35/40, 87.5%) of respiratory viral infections occurred after 6 months, mainly as upper respiratory infections. The remaining episodes (5/40, 12.5%) mostly manifested as lower respiratory tract infections. Seventy cytomegalovirus infections observed in 43 patients were divided into 23 episodes occurring before and 47 episodes occurring after discontinuing prophylaxis. Of 10 episodes of cytomegalovirus disease, four occurred during prophylaxis and six occurred after prophylaxis.Of 23 episodes of post–lung transplantation fungal infection, 7 were aspergillosis and all occurred after the discontinuation of prophylaxis. @*Conclusion@#Lung transplant recipients experienced a high burden of infection even after 6 months, especially after the end of the prophylaxis period. Therefore, these patients should be continued to be monitored long-term for infectious disease.

Infections in Lung Transplant Recipients during and after Prophylaxis / 감염과화학요법

Background@#The timeline of infections after lung transplantation has been changed with the introduction of new immunosuppressants and prophylaxis strategies. The study aimed to investigate the epidemiological characteristics of infectious diseases after lung transplantation in the current era. @*Materials and Methods@#All patients who underwent lung or heart–lung transplantation at our institution between October 29, 2008 and April 3, 2019 were enrolled. We retrospectively reviewed the patients' medical records till April 2, 2020. @*Results@#In total, 100 consecutive lung transplant recipients were enrolled. The median follow-up period was 28 months after lung transplantation. A total of 127 post–lung transplantation bacterial infections occurred. Catheter-related bloodstream infection (25/84, 29.8%) was the most common within 6 months and pneumonia (23/43, 53.5%) was the most common after 6 months. Most episodes (35/40, 87.5%) of respiratory viral infections occurred after 6 months, mainly as upper respiratory infections. The remaining episodes (5/40, 12.5%) mostly manifested as lower respiratory tract infections. Seventy cytomegalovirus infections observed in 43 patients were divided into 23 episodes occurring before and 47 episodes occurring after discontinuing prophylaxis. Of 10 episodes of cytomegalovirus disease, four occurred during prophylaxis and six occurred after prophylaxis.Of 23 episodes of post–lung transplantation fungal infection, 7 were aspergillosis and all occurred after the discontinuation of prophylaxis. @*Conclusion@#Lung transplant recipients experienced a high burden of infection even after 6 months, especially after the end of the prophylaxis period. Therefore, these patients should be continued to be monitored long-term for infectious disease.

Association of Chest CT-Based Quantitative Measures of Muscle and Fat with Post-Lung Transplant Survival and Morbidity: A Single Institutional Retrospective Cohort Study in Korean Population

OBJECTIVE: Abnormal body composition is an important modifiable risk factor in lung transplantation. Therefore, precise quantification of different body components, including muscle and fat, may play an important role in optimizing outcomes in lung transplant patients. The purpose of the study was to investigate the prognostic significance of muscle and subcutaneous fat mass measured on chest CT with regard to lung transplantation survival and other post-transplant outcomes. MATERIALS AND METHODS: The study population included 45 consecutive adult lung transplant recipients (mean age of 47.9 ± 12.1 years; 31 males and 14 females) between 2011 and 2017. Preoperative cross-sectional areas of muscle and subcutaneous fat were semi-automatically measured on axial CT images at the level of the 12th thoracic vertebra (T12). Additional normalized indexed parameters, adjusted for either height or weight, were obtained. Associations of quantitative parameters with survival and various other post-transplant outcomes were evaluated. RESULTS: Of the 45 patients included in the present study, 10 mortalities were observed during the follow-up period. Patients with relative sarcopenia (RS) classified based on height-adjusted muscle area with a cut-off value of 28.07 cm²/m² demonstrated worse postoperative survival (log-rank test, p = 0.007; hazard ratio [HR], 6.39:1) despite being adjusted for age, sex, and body mass index (HR, 8.58:1; p = 0.022). Weight-adjusted parameters of muscle area were negatively correlated with duration of ventilator support (R = −0.54, p < 0.001) and intensive care unit (ICU) stay (R = −0.33, p = 0.021). CONCLUSION: Patients with RS demonstrate worse survival after lung transplantation that those without RS. Additionally, quantitative parameters of muscles measured at the T12 level on chest CT were associated with the duration of post-lung transplant ventilator support and duration of stay in the ICU.

CT Image Conversion among Different Reconstruction Kernels without a Sinogram by Using a Convolutional Neural Network

OBJECTIVE: The aim of our study was to develop and validate a convolutional neural network (CNN) architecture to convert CT images reconstructed with one kernel to images with different reconstruction kernels without using a sinogram. MATERIALS AND METHODS: This retrospective study was approved by the Institutional Review Board. Ten chest CT scans were performed and reconstructed with the B10f, B30f, B50f, and B70f kernels. The dataset was divided into six, two, and two examinations for training, validation, and testing, respectively. We constructed a CNN architecture consisting of six convolutional layers, each with a 3 × 3 kernel with 64 filter banks. Quantitative performance was evaluated using root mean square error (RMSE) values. To validate clinical use, image conversion was conducted on 30 additional chest CT scans reconstructed with the B30f and B50f kernels. The influence of image conversion on emphysema quantification was assessed with Bland–Altman plots. RESULTS: Our scheme rapidly generated conversion results at the rate of 0.065 s/slice. Substantial reduction in RMSE was observed in the converted images in comparison with the original images with different kernels (mean reduction, 65.7%; range, 29.5–82.2%). The mean emphysema indices for B30f, B50f, converted B30f, and converted B50f were 5.4 ± 7.2%, 15.3 ± 7.2%, 5.9 ± 7.3%, and 16.8 ± 7.5%, respectively. The 95% limits of agreement between B30f and other kernels (B50f and converted B30f) ranged from −14.1% to −2.6% (mean, −8.3%) and −2.3% to 0.7% (mean, −0.8%), respectively. CONCLUSION: CNN-based CT kernel conversion shows adequate performance with high accuracy and speed, indicating its potential clinical use.

CT Evaluation for Clinical Lung Cancer Staging: Do Multiplanar Measurements Better Reflect Pathologic T-Stage than Axial Measurements?

OBJECTIVE: To retrospectively investigate whether tumor size assessment on multiplanar reconstruction (MPR) CT images better reflects pathologic T-stage than evaluation on axial images and evaluate the additional value of measurement in three-dimensional (3D) space. MATERIALS AND METHODS: From 1661 patients who had undergone surgical resection for primary lung cancer between June 2013 and November 2016, 210 patients (145 men; mean age, 64.4 years) were randomly selected and 30 were assigned to each pathologic T-stage. Two readers independently measured the maximal lesion diameters on MPR CT. The longest diameters on 3D were obtained using volume segmentation. T-stages determined on CT images were compared with pathologic T-stages (overall and subgroup—Group 1, T1a/b; Group 2, T1c or higher), with differences in accuracy evaluated using McNemar's test. Agreement between readers was evaluated with intraclass correlation coefficients (ICC). RESULTS: The diagnostic accuracy of MPR measurements for determining T-stage was significantly higher than that of axial measurement alone for both reader 1 (74.3% [156/210] vs. 63.8% [134/210]; p = 0.001) and reader 2 (68.1% [143/210] vs. 61.9% [130/210]; p = 0.049). In the subgroup analysis, diagnostic accuracy with MPR diameter was significantly higher than that with axial diameter in only Group 2 (p < 0.05). Inter-reader agreements for the ICCs on axial and MPR measurements were 0.98 and 0.98. The longest diameter on 3D images showed a significantly lower performance than MPR, with an accuracy of 54.8% (115/210) (p < 0.05). CONCLUSION: Size measurement on MPR CT better reflected the pathological T-stage, specifically for T1c or higher stage lung cancer. Measurements in a 3D plane showed no added value.

Human Bocavirus Infection in Adults: Clinical Features and Radiological Findings

OBJECTIVE: Human bocavirus (HBoV) is a newly identified pathogen that can cause upper and lower respiratory infections usually in children; however, its clinical characteristics and significance in respiratory infections in adults have not been well known. Our objective was to evaluate the clinical features of respiratory HBoV infection and to describe the CT findings of HBoV pneumonia in adults. MATERIALS AND METHODS: A total of 185 adult patients diagnosed with HBoV infection at a tertiary referral center between January 2010 and December 2017 were retrospectively evaluated with respect to the clinical characteristics of HBoV infection and its risk factors for pneumonia. Chest CT findings for 34 patients with HBoV pneumonia without co-infection were analyzed and compared between immunocompetent (n = 18) and immunocompromised (n = 16) patients. RESULTS: HBoV infections were predominantly noted between February and June. Among the 185 patients with HBoV infection, 119 (64.3%) had community-acquired infections and 110 (59.5%) had pneumonia. In multivariable analysis, older age (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.00–1.04; p = 0.045) and nosocomial infection (OR, 2.07; 95% CI, 1.05–4.10; p = 0.037) were associated with HBoV pneumonia. The main CT findings were bilateral consolidation (70.6%) and/or ground-glass opacities (64.7%); centrilobular nodules (14.7%) were found less frequently. The pattern of CT findings were not significantly different between immunocompetent and immunocompromised patients (all, p > 0.05). CONCLUSION: HBoV infection can be a potential respiratory tract infection in adults. The most frequent CT findings of HBoV pneumonia were bilateral consolidation and/or ground-glass opacities.

Deep Learning Algorithm for Reducing CT Slice Thickness: Effect on Reproducibility of Radiomic Features in Lung Cancer

OBJECTIVE: To retrospectively assess the effect of CT slice thickness on the reproducibility of radiomic features (RFs) of lung cancer, and to investigate whether convolutional neural network (CNN)-based super-resolution (SR) algorithms can improve the reproducibility of RFs obtained from images with different slice thicknesses. MATERIALS AND METHODS: CT images with 1-, 3-, and 5-mm slice thicknesses obtained from 100 pathologically proven lung cancers between July 2017 and December 2017 were evaluated. CNN-based SR algorithms using residual learning were developed to convert thick-slice images into 1-mm slices. Lung cancers were semi-automatically segmented and a total of 702 RFs (tumor intensity, texture, and wavelet features) were extracted from 1-, 3-, and 5-mm slices, as well as the 1-mm slices generated from the 3- and 5-mm images. The stabilities of the RFs were evaluated using concordance correlation coefficients (CCCs). RESULTS: The mean CCCs for the comparisons of original 1 mm vs. 3 mm, 1 mm vs. 5 mm, and 3 mm vs. 5 mm images were 0.41, 0.27, and 0.65, respectively (p < 0.001 for all comparisons). Tumor intensity features showed the best reproducibility while wavelets showed the lowest reproducibility. The majority of RFs failed to achieve reproducibility (CCC ≥ 0.85; 3.6%, 1.0%, and 21.5%, respectively). After applying the CNN-based SR algorithms, the reproducibility significantly improved in all three pairings (mean CCCs: 0.58, 0.45, and 0.72; p < 0.001 for all comparisons). The reproducible RFs also increased (36.3%, 17.4%, and 36.9%, respectively). CONCLUSION: The reproducibility of RFs in lung cancer is significantly influenced by CT slice thickness, which can be improved by the CNN-based SR algorithms.

Long-Term Outcomes of Adult Lung Transplantation Recipients: A Single-Center Experience in South Korea / 결핵

BACKGROUND: Recently, the number of lung transplants in South Korea has increased. However, the long-term outcome data is limited. In this study, we aimed to investigate the long-term outcomes of adult lung transplantation recipients. METHODS: Among the patients that underwent lung transplantation at a tertiary referral center in South Korea between 2008 and 2017, adults patient who underwent deceased-donor lung transplantation with available follow-up data were enrolled. Their medical records were retrospectively reviewed. RESULTS: Through eligibility screening, we identified 60 adult patients that underwent lung (n=51) or heart-lung transplantation (n=9) during the observation period. Idiopathic pulmonary fibrosis (46.7%, 28/60) was the most frequent cause of lung transplantation. For all the 60 patients, the median follow-up duration for post-transplantation was 2.6 years (range, 0.01–7.6). During the post-transplantation follow-up period, 19 patients (31.7%) died at a median duration of 194 days. The survival rates were 75.5%, 67.6%, and 61.8% at 1 year, 3 years, and 5 years, respectively. Out of the 60 patients, 8 (13.3%) were diagnosed with chronic lung allograft dysfunction (CLAD), after a mean duration of 3.3±2.8 years post-transplantation. The CLAD development rate was 0%, 17.7%, and 25.8% at 1 year, 3 years, and 5 years, respectively. The most common newly developed post-transplantation comorbidity was the chronic kidney disease (CKD; 54.0%), followed by diabetes mellitus (25.9%). CONCLUSION: Among the adult lung transplantation recipients at a South Korea tertiary referral center, the long-term survival rates were favorable. The proportion of patients who developed CLAD was not substantial. CKD was the most common post-transplantation comorbidity.

Added Value of Bone Suppression Image in the Detection of Subtle Lung Lesions on Chest Radiographs with Regard to Reader's Expertise

BACKGROUND: Chest radiographs (CXR) are the most commonly used imaging techniques by various clinicians and radiologists. However, detecting lung lesions on CXR depends largely on the reader's experience level, so there have been several trials to overcome this problem using post-processing of CXR. We investigated the added value of bone suppression image (BSI) in detecting various subtle lung lesions on CXR with regard to reader's expertise. METHODS: We applied a software program to generate BSI in 1,600 patients in the emergency department. Of them, 80 patients with subtle lung lesions and 80 patients with negative finding on CXR were retrospectively selected based on the subtlety scores on CXR and CT findings. Ten readers independently rated their confidence in deciding the presence or absence of a lung lesion at each of 960 lung regions on the two separated imaging sessions: CXR alone vs. CXR with BSI. RESULTS: The additional use of BSI for all readers significantly increased the mean area under the curve (AUC) in detecting subtle lung lesions (0.663 vs. 0.706; P < 0.001). The less experienced readers were, the more AUC differences increased: 0.067 (P < 0.001) for junior radiology residents; 0.064 (P < 0.001) for non-radiology clinicians; 0.044 (P < 0.001) for senior radiology residents; and 0.019 (P = 0.041) for chest radiologists. The additional use of BSI significantly increased the mean confidence regarding the presence or absence of lung lesions for 213 positive lung regions (2.083 vs. 2.357; P < 0.001) and for 747 negative regions (1.217 vs. 1.195; P = 0.008). CONCLUSION: The use of BSI increases diagnostic performance and confidence, regardless of reader's expertise, reduces the impact of reader's expertise and can be helpful for less experienced clinicians and residents in the detection of subtle lung lesions.

The Pathological Findings of Chloromethylisothiazolinone and Methylisothiazolinone-associated Lung Injury

No abstract available.

What should medical students know about artificial intelligence in medicine? / 보건의료교육평가

Artificial intelligence (AI) is expected to affect various fields of medicine substantially and has the potential to improve many aspects of healthcare. However, AI has been creating much hype, too. In applying AI technology to patients, medical professionals should be able to resolve any anxiety, confusion, and questions that patients and the public may have. Also, they are responsible for ensuring that AI becomes a technology beneficial for patient care. These make the acquisition of sound knowledge and experience about AI a task of high importance for medical students. Preparing for AI does not merely mean learning information technology such as computer programming. One should acquire sufficient knowledge of basic and clinical medicines, data science, biostatistics, and evidence-based medicine. As a medical student, one should not passively accept stories related to AI in medicine in the media and on the Internet. Medical students should try to develop abilities to distinguish correct information from hype and spin and even capabilities to create thoroughly validated, trustworthy information for patients and the public.

Long-Term Outcomes of Adult Lung Transplantation Recipients: A Single-Center Experience in South Korea / 결핵및호흡기질환

BACKGROUND@#Recently, the number of lung transplants in South Korea has increased. However, the long-term outcome data is limited. In this study, we aimed to investigate the long-term outcomes of adult lung transplantation recipients.@*METHODS@#Among the patients that underwent lung transplantation at a tertiary referral center in South Korea between 2008 and 2017, adults patient who underwent deceased-donor lung transplantation with available follow-up data were enrolled. Their medical records were retrospectively reviewed.@*RESULTS@#Through eligibility screening, we identified 60 adult patients that underwent lung (n=51) or heart-lung transplantation (n=9) during the observation period. Idiopathic pulmonary fibrosis (46.7%, 28/60) was the most frequent cause of lung transplantation. For all the 60 patients, the median follow-up duration for post-transplantation was 2.6 years (range, 0.01–7.6). During the post-transplantation follow-up period, 19 patients (31.7%) died at a median duration of 194 days. The survival rates were 75.5%, 67.6%, and 61.8% at 1 year, 3 years, and 5 years, respectively. Out of the 60 patients, 8 (13.3%) were diagnosed with chronic lung allograft dysfunction (CLAD), after a mean duration of 3.3±2.8 years post-transplantation. The CLAD development rate was 0%, 17.7%, and 25.8% at 1 year, 3 years, and 5 years, respectively. The most common newly developed post-transplantation comorbidity was the chronic kidney disease (CKD; 54.0%), followed by diabetes mellitus (25.9%).@*CONCLUSION@#Among the adult lung transplantation recipients at a South Korea tertiary referral center, the long-term survival rates were favorable. The proportion of patients who developed CLAD was not substantial. CKD was the most common post-transplantation comorbidity.

Two Cases of Chloromethylisothiazolinone and Methylisothiazolinone-associated Toxic Lung Injury

Previous animal studies have not conclusively determined the association between exposure to humidifier disinfectants (HDs) containing 5-chloro-2-methyl-4-isothiazolin-3-one (CMIT) and/or 2-methyl-4-isothiazolin-3-one (MIT) and development of HD-associated lung injuries. Nonetheless, patients exposed to HDs containing only CMIT and/or MIT showed clinically similar lung injuries to those exposed to HDs containing polyhexamethylene guanidine (PHMG) or oligo (2-[2-ethoxy]ethoxyethyl) guanidinium chloride (PGH). Here, we report twin sisters with lung injuries associated with exposure to CMIT/MIT-containing HDs. At 6 months of age, a younger twin sister presented with the 3-day history of cough, sputum, and respiratory difficulty. Chest radiography revealed multiple patchy consolidation and ground-glass opacities with pneumothorax and pneumomediastinum. Thoracostomy was performed due to pneumothorax at admission and she was discharged at 11 days of hospitalization. At 5 years of age, multiple tiny nodules and faint centrilobular ground-glass opacities were observed with the small pneumatocele. The elder sister visited a tertiary hospital due to dyspnea at 12 months of age. Chest radiography showed consolidation, pneumomediastinum, and pulmonary interstitial emphysema. There was no response to the administration of immunosuppressant drugs and antifibrotic agents. At 5 years of age, chest CT revealed ground-glass opacity and multiple tiny centrilobular ground-glass opacities nodules in both lungs with exercise intolerance.

Primary Imaging Test and Appropriate Biopsy Methods for Thyroid Nodules: Guidelines by Korean Society of Radiology and National Evidence-Based Healthcare Collaborating Agency

The Korean Society of Radiology and the National Evidence-based Healthcare Collaborating Agency developed guidelines for primary imaging tests and appropriate biopsy methods for thyroid nodules. These guidelines were developed using an adaptation process by collaboration between the development committee and the working group. The development committee, composed of research methodology experts, established the overall plan and provided support about methodological strategies. The working group, composed of radiologist experts in thyroid imaging, wrote the proposals. The guidelines recommend neck ultrasound (US) as a first-line imaging modality for the diagnosis of thyroid nodules in patients with suspected nodules, and US-guided fine-needle aspiration as a primary method for histologic examination of thyroid nodules.

2018 Korean Clinical Imaging Guideline for Hemoptysis

In 2014, the American College of Radiology (ACR) announced the guideline for the appropriate diagnostic approach and treatment of patients according to the severity of hemoptysis and risk for lung cancer. However, the application of the ACR guideline in Korea may not be appropriate, because many patients in Korea have active tuberculosis or pulmonary fibrosis due to previous tuberculosis. The Korean Society of Radiology and Korean Society of Thoracic Radiology have proposed a new guideline suitable for Korean practice. This new guideline was prepared through the consensus of a development committee, working party, and an advisory committee. The guideline proposal process was based on an evidence-based clinical imaging guideline proposed by the development committee. Clinical imaging guideline for adult patients with hemoptysis is as follows: Chest radiography is an initial imaging modality to evaluate hemoptysis. Contrast-enhanced chest CT is recommended in patients with two risk factors for lung cancer (> 40 years old and > 30 pack-year smoking history), moderate hemoptysis (> 30 mL/24 hours) or recurrent hemoptysis. Contrast-enhanced chest CT is also recommended in patients with massive hemoptysis (> 400 mL/24 hours) without cardiopulmonary compromise.

The First Living-Donor Lobar Lung Transplantation in Korea: a Case Report

Lung transplantation is the only treatment for end-stage lung disease, but the problem of donor shortage is unresolved issue. Herein, we report the first case of living-donor lobar lung transplantation (LDLLT) in Korea. A 19-year-old woman patient with idiopathic pulmonary artery hypertension received her father's right lower lobe and her mother's left lower lobe after pneumonectomy of both lungs in 2017. The patient has recovered well and is enjoying normal social activity. We think that LDLLT could be an alternative approach to deceased donor lung transplantation to overcome the shortage of lung donors.

Principles for evaluating the clinical implementation of novel digital healthcare devices

With growing interest in novel digital healthcare devices, such as artificial intelligence (AI) software for medical diagnosis and prediction, and their potential impacts on healthcare, discussions have taken place regarding the regulatory approval, coverage, and clinical implementation of these devices. Despite their potential, ‘digital exceptionalism’ (i.e., skipping the rigorous clinical validation of such digital tools) is creating significant concerns for patients and healthcare stakeholders. This white paper presents the positions of the Korean Society of Radiology, a leader in medical imaging and digital medicine, on the clinical validation, regulatory approval, coverage decisions, and clinical implementation of novel digital healthcare devices, especially AI software for medical diagnosis and prediction, and explains the scientific principles underlying those positions. Mere regulatory approval by the Food and Drug Administration of Korea, the United States, or other countries should be distinguished from coverage decisions and widespread clinical implementation, as regulatory approval only indicates that a digital tool is allowed for use in patients, not that the device is beneficial or recommended for patient care. Coverage or widespread clinical adoption of AI software tools should require a thorough clinical validation of safety, high accuracy proven by robust external validation, documented benefits for patient outcomes, and cost-effectiveness. The Korean Society of Radiology puts patients first when considering novel digital healthcare tools, and as an impartial professional organization that follows scientific principles and evidence, strives to provide correct information to the public, make reasonable policy suggestions, and build collaborative partnerships with industry and government for the good of our patients.

Guidelines for Primary Imaging Test and Biopsy Methods in the Diagnosis of Thyroid Nodules: Joint Report by the Korean Society of Radiology and National Evidence-Based Healthcare Collaborating Agency

The Korean Society of Radiology and the National Evidence-based Healthcare Collaborating Agency developed the guideline for primary imaging and biopsy methods in the diagnosis of thyroid nodules. The development committee, the working committee, and the advisory committee were formed to develop the recommendation. The development committee mainly plays a role of methodological consulting and overall planning and management of the advisory development stage. The working committee was composed of experts recommended by the Korean Society of Thyroid Radiology and conducted a practical adaptation process from the selection of core questions to the final recommendation. The Advisory Committee consisted of clinical experts recommended by the Korean Thyroid Association and reviewed core questions and draft recommendations and participated in the Expert Panel Survey. This guideline recommends cervical ultrasound as the first imaging modality for diagnosis of suspected thyroid nodules and recommends ultrasound-guided fine needle aspiration for histologic diagnosis of thyroid nodules. This guideline is expected to be of significant benefit to clinicians treating thyroid nodules.

Korean Clinical Imaging Guideline for Hemoptysis

In 2014, the American College of Radiology announced a guideline for appropriate diagnostic approach and treatment in patients with hemoptysis, according to severity of hemoptysis and risk of lung cancer. However, in Korea many patients have pulmonary fibrosis due to previous tuberculosis or have active tuberculosis. Therefore, application of this guideline is not appropriate. The Korean Society of Radiology and Korean Society of Thoracic Radiology proposed a guideline more closely matching the real state of diagnostic approach and treatment of patients with hemoptysis in Korea. The guideline was prepared in consensus by a development committee, working party, and an advisory committee. The process of the guideline proposal was based on methodology for developing evidence-based clinical imaging guidelines: joint recommendations by the Korean Society of Radiology and National Evidence-Based Healthcare Collaborating Agency. The clinical imaging guideline for adult patients with hemoptysis is as follows. Chest radiography is an initial imaging modality to evaluate hemoptysis. Contrast enhanced chest CT is recommended in patients with two lung cancer risks (> 40 years old and > 30 packs per year smoking history), moderate hemoptysis (> 30 cc/24 hours) or recurrent hemoptysis. Contrast enhanced chest CT is also recommended for patients with massive hemoptysis (> 400 mL/24 hours) without cardiopulmonary compromise.