ACR Appropriateness Criteria hemoptysis.

Hemoptysis is defined as the expectoration of blood originating from the tracheobronchial tree or pulmonary parenchyma, ranging from 100 mL to 1 L in volume over a 24-hour period. This article reviews the literature on the indications and usefulness of radiologic studies for the evaluation of hemoptysis. The following recommendations are the result of evidence-based consensus by the American College of Radiology Appropriateness Criteria Expert Panel on Thoracic Radiology: (1) Initial evaluation of patients with hemoptysis should include a chest radiograph; (2) Patients at high risk for malignancy (>40 y old, >40 pack-year smoking history) with negative chest radiograph, computed tomography (CT) scan, and bronchoscopy can be followed with observation for the following 3 years. Radiography and CT are recommended imaging modalities for follow-up. Bronchoscopy may complement imaging during the period of observation; (3) In patients who are at high risk for malignancy and have suspicious chest radiograph findings, CT is suggested for initial evaluation; CT should also be considered in patients who are active or exsmokers, despite a negative chest radiograph; and (4) Massive hemoptysis can be effectively treated with either surgery or percutaneous embolization. Contrast-enhanced multidetector CT before embolization or surgery can define the source of hemoptysis as bronchial systemic, nonbronchial systemic, and/or pulmonary arterial. Percutaneous embolization may be used initially to halt the hemorrhage before definitive surgery.

Workers with Libby amphibole exposure: retrospective identification and progression of radiographic changes.

PURPOSE: To assess how early pleural and/or parenchymal abnormalities consistent with asbestos exposure could be ascertained and to identify factors associated with progression. MATERIALS AND METHODS: Informed consent was obtained under an institutional review board-approved protocol. Multiple sequential chest radiographs obtained between 1955 and 2004 in 84 workers exposed to amphiboles associated with vermiculite in the town of Libby, Montana, were studied. A panel of three NIOSH B readers reviewed each worker's longitudinal chest radiograph series in reverse chronologic order and achieved a consensus reading for each radiograph. Measures of exposure were compared between workers with and those without progression of parenchymal and pleural abnormalities. RESULTS: Because of the way the study was designed, all subjects had pleural (n = 84) and/or parenchymal (n = 26) abnormalities on the most recent chest radiograph. Compared with other investigations that used different methods, this investigation revealed shorter latency periods (defined as the interval between date of hire and date of earliest radiographic detection) for circumscribed pleural plaque (median latency, 8.6 years) and pleural calcification (median latency, 17.5 years). Pleural abnormalities progressed in 64 workers, while parenchymal abnormalities progressed in 14. No significant differences were found with regard to measures of exposure between workers with and those without progression. CONCLUSION: The latency period for the development of pleural plaques may be shorter than previously reported. Early plaques are subtle and may not be detectable except at retrospective review.

ACR Appropriateness Criteria on chronic dyspnea: suspected pulmonary origin.

Chronic dyspnea of pulmonary origin raises concern for chronic obstructive pulmonary disease or interstitial lung disease. A chest radiograph is recommended as the initial imaging study. When chest radiography is nonrevealing or provides no definitive diagnosis, a high-resolution chest computed tomography is indicated. The high-resolution chest computed tomography should include expiratory imaging in patients with known or suspected air trapping.

ACR Appropriateness Criteria on acute respiratory illness.

In a patient with acute respiratory illness (cough, sputum production, chest pain, and/or dyspnea), the need for chest imaging depends on the severity of illness, age of the patient, clinical history, physical and laboratory findings, and other risk factors. Chest radiographs seem warranted when one or more of the following are present: age > or = 40; dementia; a positive physical examination; hemoptysis; associated abnormalities (leukocytosis, hypoxemia); or other risk factors, including coronary artery disease, congestive heart failure, or drug-induced acute respiratory failure. Chest CT may be warranted in complicated cases of severe pneumonia and in febrile neutropenic patients with normal or nonspecific chest radiographic findings. Literature on the indications and usefulness of radiologic studies for acute respiratory illness in different clinical settings is reviewed.

Vanishing lung syndrome (giant bullous emphysema): CT findings in 7 patients and a literature review.

PURPOSE: we reviewed the imaging findings in 7 patients with idiopathic giant bullous emphysema. This is a chronic, progressive condition usually affecting young male smokers and is characterized by giant emphysematous bullae, which commonly develop in the upper lobes. Extensive paraseptal emphysema coalesces to form giant bullae, compressing the normal lung parenchyma and often displacing it centrally. These bullae occupy at least one-third of a hemithorax. MATERIALS AND METHODS: Seven patients with chest radiographic evidence of a bulla or bullae occupying at least one-third of a hemithorax, who had also been examined with high-resolution computed tomography (HRCT), were included in this retrospective study. On HRCT scans, the size, location, and distribution of the bullae were documented and categorized as either subpleural or central. RESULTS: The HRCT scan findings in all 7 study patients included numerous bullae ranging in size from a few centimeters in diameter to giant bullae nearly filling an entire hemithorax, mimicking a pneumothorax. Five of the 7 patients had extensive upper lobe predominant bullae, 4 of the 7 patients showed severe bilateral disease with asymmetric involvement, 2 of the 7 patients demonstrated left lung predominance and whereas 1 patient showed right lung predominant disease. All of our patients had subpleural bullae, had parenchymal fibrosis, another had extensive subcutaneous emphysema, and 1 had accompanying bronchiectasis. CONCLUSIONS: The predominant findings on HRCT scans are extensive paraseptal emphysema coalescing into giant bullae. HRCT is helpful in confirming the diagnosis of VLS, assessing the degree of the disease, and providing information to guide treatment.

Linking information on the World Wide Web.

The uniform resource locator (URL) is the key element of the World Wide Web, connecting widely separate sources of information. Logically constructed URLs are important in helping users find desired information. URLs can deceive users. Cyber squatting and other practices that manipulate URLs often lead the user to unwanted information. Critical to future scholarship and education is access to full text articles online. This will require consistent and well-constructed URLs.

DICOM to print, 35-mm slides, web, and video projector: tutorial using Adobe Photoshop.

Preparing images for publication has dealt with film and the photographic process. With picture archiving and communications systems, many departments will no longer produce film. This will change how images are produced for publication. DICOM, the file format for radiographic images, has to be converted and then prepared for traditional publication, 35-mm slides, the newest techniques of video projection, and the World Wide Web. Tagged image file format is the common format for traditional print publication, whereas joint photographic expert group is the current file format for the World Wide Web. Each medium has specific requirements that can be met with a common image-editing program such as Adobe Photoshop (Adobe Systems, San Jose, CA). High-resolution images are required for print, a process that requires interpolation. However, the Internet requires images with a small file size for rapid transmission. The resolution of each output differs and the image resolution must be optimized to match the output of the publishing medium.

Creating a Web-based bibliography database: AJR volumes 1-95.

OBJECTIVE: The purpose of this study was to index the contents of the pre-MEDLINE American Journal of Roentgenology into a database that could then be accessed over the World Wide Web. CONCLUSION: The database is composed of more than 8,000 citations from the years 1914 (volume 1) to 1965 (volume 95). Using a Web browser, a user can search the database by year, volume, title word, page, or author. Results are returned sorted by year and page number in a bibliographic format. The database is accessed approximately 200 times per month.