Acceptability of adding a non-contrast abdominal CT scan to screen for kidney cancer and other abdominal pathology within a community-based CT screening programme for lung cancer: A qualitative study.

OBJECTIVES: The Yorkshire Kidney Screening Trial (YKST) is a feasibility study of adding non-contrast abdominal CT scanning to screen for kidney cancer and other abdominal malignancies to community-based CT screening for lung cancer within the Yorkshire Lung Screening Trial (YLST). This study explored the acceptability of the combined screening approach to participants and healthcare professionals (HCPs) involved in the trial. METHODS: We conducted semi-structured interviews with eight HCPs and 25 participants returning for the second round of scanning within YLST, 20 who had taken up the offer of the additional abdominal CT scan and five who had declined. Transcripts were analysed using thematic analysis, guided by the Theoretical Framework of Acceptability. RESULTS: Overall, combining the offer of a non-contrast abdominal CT scan alongside the low-dose thoracic CT was considered acceptable to participants, including those who had declined the abdominal scan. The offer of the additional scan made sense and fitted well within the process, and participants could see benefits in terms of efficiency, cost and convenience both for themselves as individuals and also more widely for the NHS. Almost all participants made an instant decision at the point of initial invitation based more on trust and emotions than the information provided. Despite this, there was a clear desire for more time to decide whether to accept the scan or not. HCPs also raised concerns about the burden on the study team and wider healthcare system arising from additional workload both within the screening process and downstream following findings on the abdominal CT scan. CONCLUSIONS: Adding a non-contrast abdominal CT scan to community-based CT screening for lung cancer is acceptable to both participants and healthcare professionals. Giving potential participants prior notice and having clear pathways for downstream management of findings will be important if it is to be offered more widely.

Short-term psychosocial outcomes of adding a non-contrast abdominal computed tomography (CT) scan to the thoracic CT within lung cancer screening.

OBJECTIVES: To evaluate psychological, social, and financial outcomes amongst individuals undergoing a non-contrast abdominal computed tomography (CT) scan to screen for kidney cancer and other abdominal malignancies alongside the thoracic CT within lung cancer screening. SUBJECTS AND METHODS: The Yorkshire Kidney Screening Trial (YKST) is a feasibility study of adding a non-contrast abdominal CT scan to the thoracic CT within lung cancer screening. A total of 500 participants within the YKST, comprising all who had an abnormal CT scan and a random sample of one-third of those with a normal scan between 14/03/2022 and 24/08/2022 were sent a questionnaire at 3 and 6 months. Outcomes included the Psychological Consequences Questionnaire (PCQ), the short-form of the Spielberger State-Trait Anxiety Inventory, and the EuroQoL five Dimensions five Levels scale (EQ-5D-5L). Data were analysed using regression adjusting for participant age, sex, socioeconomic status, education, baseline quality of life (EQ-5D-5L), and ethnicity. RESULTS: A total of 380 (76%) participants returned questionnaires at 3 months and 328 (66%) at 6 months. There was no difference in any outcomes between participants with a normal scan and those with abnormal scans requiring no further action. Individuals requiring initial further investigations or referral had higher scores on the negative PCQ than those with normal scans at 3 months (standardised mean difference 0.28 sd, 95% confidence interval 0.01-0.54; P = 0.044). The difference was greater in those with anxiety or depression at baseline. No differences were seen at 6 months. CONCLUSION: Screening for kidney cancer and other abdominal malignancies using abdominal CT alongside the thoracic CT within lung cancer screening is unlikely to cause significant lasting psychosocial or financial harm to participants with incidental findings.

Short-term relation between air pollutants and hospitalizations for respiratory diseases: analysis by temporal association rules.

This study investigates the relation between exposure to critical air pollution events with multipollutant (CO, PM10, PM2.5, NO2, O3, and SO2) and hospitalizations for respiratory diseases in the metropolitan area of São Paulo (RMSP) and in the countryside and coastline, from 2017 to 2021. Data mining analysis by temporal association rules searched for frequent patterns of respiratory diseases and multipollutants associated with time intervals. In the results, pollutants PM10, PM2.5, and O3 showed high concentration values in the three regions, SO2 on the coast, and NO2 in the RMSP. Seasonality was similar between pollutants and between cities and concentrations significantly higher in winter, except for O3, which was present in warm seasons. Hospitalizations were recurrent during the transition from summer to colder periods. In approximately 35% of the total days with hospitalization greater than the annual average, one or more pollutants had a high concentration. The rules showed that PM2.5, PM10, and O3 pollutants are strongly associated with increased hospitalizations in the RMSP (PM2.5 and PM10 with 38.5% support and 77% confidence) and in Campinas (PM2.5 with 66.1% support and 94% confidence) and the pollutant O3 with maximum support of 17.5%. On the coast, SO2 was related to high hospitalizations (43.85% support and 80% confidence). The pollutants CO and NO2 were not associated with the increase in hospitalizations. The ratio delay indicates the pollutants that were associated with hospitalizations, having concentration remained above the limit for three days, oscillating in smaller hospitalizations on the 1st day and again higher on the 2nd and 3rd days of delay, in a decreasing way. In conclusion, high pollutant exposure is significantly associated with daily hospitalization for respiratory problems. The cumulative effect of air pollutants increased hospitalization in the following days, in addition to identifying the pollutants and which pollutant combinations are most harmful to health in each region.

Spatial patterns and temporal variations of pollutants at 56 air quality monitoring stations in the state of São Paulo, Brazil.

This study applied two data mining tasks: clustering and association rules to a dataset of pollutants in the state of São Paulo. The clustering task was applied to temporal patterns and geospatial distributions of pollutants, and the association rules were used to identify prevailing meteorological conditions when there were high concentrations of pollutants from 2017 to 2019. The results indicated good adequacy of the cluster, indicating different pollution levels per group, with a silhouette coefficient from 0.26 to 0.72. In the spatial evaluation, the groups severely polluted were located in the metropolitan region, on the coast and, some inland cities, by industrial, vehicular, burning, agriculture, and other emissions. The cluster identified a strong presence of O3 and PM2.5 in 65% and 72% of the monitored stations in several areas of the state. As for the distance between the sources of pollution, the groups of PM10 and NO2 were geographically distant, while PM2.5, CO, SO2, and O3 were closer, suggesting a spatial relationship of exposure. Seasonality was similar between groups, with significantly higher concentrations in winter, except for O3, for which higher concentrations occurred in summer. Meteorological conditions contributed to critical episodes of pollution (support and confidence greater than 80%), with low temperature and humidity, low rainfall, and milder wind associated with increased pollutants. In conclusion, investigating spatial representativeness allows revealing spatial and temporal patterns of pollutants and unfavorable meteorological conditions to diffusion. Thus, ideal and effective measures can be taken to avoid critical periods of exposure based on the behavior of pollutants in different regions and related climate changes.

The Yorkshire Kidney Screening Trial (YKST): protocol for a feasibility study of adding non-contrast abdominal CT scanning to screen for kidney cancer and other abdominal pathology within a trial of community-based CT screening for lung cancer.

INTRODUCTION: Kidney cancer (renal cell cancer (RCC)) is the seventh most common cancer in the UK. As RCC is largely curable if detected at an early stage and most patients have no symptoms, there is international interest in evaluating a screening programme for RCC. The Yorkshire Kidney Screening Trial (YKST) will assess the feasibility of adding non-contrast abdominal CT scanning to screen for RCC and other abdominal pathology within the Yorkshire Lung Screening Trial (YLST), a randomised trial of community-based CT screening for lung cancer. METHODS AND ANALYSIS: In YLST, ever-smokers aged 55-80 years registered with a general practice in Leeds have been randomised to a Lung Health Check assessment, including a thoracic low-dose CT (LDCT) for those at high risk of lung cancer, or routine care. YLST participants randomised to the Lung Health Check arm who attend for the second round of screening at 2 years without a history of RCC or abdominal CT scan within the previous 6 months will be invited to take part in YKST. We anticipate inviting 4700 participants. Those who consent will have an abdominal CT immediately following their YLST thoracic LDCT. A subset of participants and the healthcare workers involved will be invited to take part in a qualitative interview. Primary objectives are to quantify the uptake of the abdominal CT, assess the acceptability of the combined screening approach and pilot the majority of procedures for a subsequent randomised controlled trial of RCC screening within lung cancer screening. ETHICS AND DISSEMINATION: YKST was approved by the North West-Preston Research Ethics Committee (21/NW/0021), and the Health Research Authority on 3 February 2021. Trial results will be disseminated at clinical meetings, in peer-reviewed journals and to policy-makers. Findings will be made available to participants via the study website (www.YKST.org). TRIAL REGISTRATION NUMBERS: NCT05005195 and ISRCTN18055040.

Comparación de la reproducibilidad en las mediciones angulares entre trazado manual y computarizado / A comparison of angle measure reproducibility between manual and computerized tracing

INTRODUCCIÓN: las cefalometrías digitales permiten controlar los errores que se generan en el trazo manual, por eso el propósito de este estudio fue evaluar la reproducibilidad y precisión de las medidas angulares entre un trazo manual y el obtenido con el programa Cephapoint en una radiografía digital. MÉTODOS: se utilizaron 11 radiografías digitales directas tomadas a estudiantes de ortodoncia, las cuales se introdujeron en el programa Cephapoint. Se hizo la medición de 9 ángulos, cada uno medido en la radiográfia digital de manera manual y en el programa Cephapoint. Todas las medidas fueron hechas por 3 operadores con intervalo de 1 semana. Se halló el promedio de error interobservador para medir la reproducibilidad de cada medida angular, y el promedio de error intraobservador para determinar la precisión de cada observador. RESULTADOS: : el ángulo FH/N/Pg tuvo la menor diferencia en el error interobservador (0,10°) en ambos métodos, favoreciendo el trazado manual. Mientras que los ángulos con menor diferencia de error interobservador en el trazado computarizado fueron: II-NB (0,11°) y N-A/Pg (0,11°). La reproducibilidad intraobservador mostró un Coeficiente de Correlación Intraclase (CCI), excelente para ambos métodos. CONCLUSIONES: la reproducibilidad de las medidas angulares con el trazado manual y computarizado no presentó diferencias significativas. De acuerdo a los hallazgos de este estudio, los métodos evaluados brindan igual validez diagnóstica.

INTRODUCTION: digital cephalometry allows handling errors produced during manual tracing; the purpose of this study was therefore to evaluate the reproducibility and precision of angle measures between manual tracing and that obtained with Cephapoint in digital radiography. METHODS: 11 direct digital radiographs taken to orthodontics students were introduced in the Cephapoint computer program. 9 angles were measured in both hand-tracing digital radiography and Cephapoint. All measurements were made by 3 operators with 1-week interval. We calculated the average interobserver error to find the reproducibility of each angle measure, and the average intra-observer error to determine the accuracy of each observer. RESULTS: : the FH/N/Pg angle showed the smallest interobserver error difference (0.10°) in both methods, favoring manual tracing. On the other hand, the angles with the smallest inter-observer error difference in computerized tracing were LI-NB (0.11°) and N-A/Pg (0.11°). Intraobserver reproducibility showed excellent Intraclass Correlation Coefficient (ICC) in both methods. CONCLUSIONS: reproducibility of angular measurements did not show significant differences between manual and computerized tracing. According to the findings of this study, the methods under evaluation offer equal diagnostic validity.

Reproducibilidad en la ubicación de puntos cefalométricos de tejidos blandos en radiografías convencionales y digitales directas / Reproducibility of soft tissue cephalometric landmark identification by conventional and digital direct radiography

Introducción: es escasa la información sobre la reproducibilidad de puntos cefalométricos de tejidos blandos, el propósito de este estudio fue evaluar la reproducibilidad y precisión de la ubicación de los puntos cefalométricos de tejidos blandos en una radiografía digital directa y una radiografía convencional. Método: se utilizaron 11 pares de radiografías convencionales y radiografías digitales directas las cuales se introdujeron en el programa Cephapoint. Se ubicaron 10 puntos cefalométricos en un plano cartesiano (X y Y) en las imágenes convencional y digital. Las medidas fueron hechas dos veces por 3 operadores con intervalo de 1 semana. Se halló el promedio de error interobservador para medir la reproducibilidad de cada punto y el error intraobservador para determinar la precisión. Resultados: el error interobservador en la ubicación de puntos cefalométricos en tejidos blandos fue menor a 1 mm para la mayoría de los puntos en ambas imágenes, excepto para mentón y pogonion, sin diferencias estadísticamente significativas. Se encontraron diferencias estadísticamente significativas entre las varianzas en el eje X, con menor variabilidad para la radiografía digital en los puntos labrale superior (p = 0,043), subnasal (p = 0, 013), columnella (p = 0,038), stomion superior (p = 0,029) y stomion inferior (p = 0,015). En el eje y no se presentaron diferencias estadísticamente significativas entre los dos métodos. La evaluación de la reproducibilidad intraobservador mostró coeficiente de correlación intraclase (CCI) excelente (0,935) en ambos métodos. Conclusión: de acuerdo con los hallazgos de este estudio las radiografías y los métodos evaluados brindan igual validez diagnóstica.

Introduction: there is little information on the reproducibility of soft tissue cephalometric points; the purpose of this study was then to evaluate the reproducibility and accuracy of soft tissue cephalometric landmark identification in direct digital radiography and conventional radiography. Methods: 11 pairs of conventional and direct digital radiographs were introduced in the Cephapoint program. 10 cephalometric points were located on a Cartesian plane (X and Y) in conventional and digital images. The measurements were taken twice by 3 operators with 1 week interval. Interobserver average error was calculated in order to assess reproducibility in each point, and intraobserver error was used to determine accuracy. Results: interobserver error in soft tissue cephalometric points was less than 1 mm for most points in both images, except in chin and pogonion, with no statistically significant differences. Statistically significant differences were found between the variances in the X axis, with less variability in the case of digital radiography in these points: labrale superius (p = 0.043), subnasale (p = 0, 013), columella (p = 0.038), stomion superius (p = 0.029), and stomion inferius (p = 0.015). The Y axis did not show statistically significant differences between the two methods. The assessment of intraobserver reproducibility showed an excellent Intraclass Correlation Coefficient (ICC) (0.935) in both methods. Conclusion: according to the findings of this study, the evaluated radiographs and methods offer similar diagnostic accuracy.

Child-parent screening for familial hypercholesterolemia.

A pilot study of child-parent screening for familial hypercholesterolemia was undertaken in children aged 1 to 2 years coming for immunization. Of 214 parents asked, 200 agreed to screening (94%). Simultaneous immunization-cholesterol measurement was successful in all children. Population child-parent screening is feasible and acceptable when combined with pediatric immunization.