ABSTRACT
Lung cancer is the leading cause of cancer-related mortality in the U.S. TNM staging of lung cancer is implemented to define the extent of disease and consequently assign prognosis and guide treatment. The newest edition of TNM staging of lung cancer has been released recently. In this article, we present the TNM staging of lung cancer in a concise, yet comprehensive, visual format.
Subject(s)
Lung Neoplasms/classification , Lung Neoplasms/pathology , Neoplasm Staging , Humans , PrognosisABSTRACT
Pneumothorax can be a critical medical condition. The radiographic curvilinear appearance of pneumothorax can be mimicked by a skinfold artifact. Radiographic differentiation of the two entities is achieved in most cases by careful analysis of the characteristics of the linear shadow and its course. A thin, sharply defined opaque density representing the visceral pleura is the hallmark of pneumothorax. The added density of a skinfold presents as a broad opacity, which is outlined laterally by a sharply defined lucent line as a result of the Mach band effect and adjacent air. Unlike pneumothorax, a skinfold produces a line that does not follow the expected course of visceral pleura. Additional features, such as the absence of increased lucency laterally and the projection of lung markings across the curvilinear shadow, can help in the correct identification of skinfolds. Repeating the chest radiograph or using other imaging modalities can be considered in difficult cases.
Subject(s)
Artifacts , Pleura/diagnostic imaging , Pneumothorax/diagnosis , Radiography, Thoracic/methods , Diagnosis, Differential , HumansABSTRACT
PURPOSE: There are few computer-aided detection (CAD) systems that are available for the detection of nodules on chest radiographs. We evaluated the performance of a Food and Drug Administration-approved system and 3 of its subsequent versions to determine their potential to improve readers' accuracy. MATERIALS AND METHODS: We tested the performance of 4 generations of CAD software programs, RapidScreen 1.1 and OnGuard 3.0, 4.0, and 5.0 (Riverain Medical), for their ability to detect lung cancer on a sample of 100 patients with and 100 patients without nodules. Each proven nodule (computed tomography scan and/or pathology) was evaluated for its overall difficulty, size, density, shape, contour, and location. The sensitivity and number of false-positive (FP) marks were compared between the different versions; reasons for FP and false-negative marks were analyzed and compared. RESULTS: The newer versions have significantly improved overall sensitivity [62.5% (OnGuard 3.0), 62.5% (4.0), and 64.4% (5.0)] compared with the first version (44.2%). OnGuard 5.0 demonstrated sensitivity of 73.3% for moderately subtle lesions compared with very subtle lesions (20.0%). There was a significant reduction in the average number of FPs per image for each version (3.9 for 1.1, 3.3 for 3.0, 2.6 for 4.0, and 2.0 for 5.0). Rib and vessel crossings were the most common reasons for FPs. CONCLUSION: The latest version of CAD demonstrates good detection of moderately subtle lesions with a relatively low FP rate.
Subject(s)
Diagnosis, Computer-Assisted/methods , Lung Neoplasms/diagnostic imaging , Radiography, Thoracic/methods , Solitary Pulmonary Nodule/diagnostic imaging , Aged , Case-Control Studies , Chi-Square Distribution , Female , Humans , Logistic Models , Male , Middle Aged , Predictive Value of Tests , Sensitivity and Specificity , Software , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: The primary objective of our study was to compare the effect of a chest radiography computer-aided detection (CAD) system on the follow-up recommendations of chest radiologists, general radiologists, and pulmonologists. MATERIALS AND METHODS: A chest radiography CAD system (RapidScreen 1.1) that has been approved by the U.S. Food and Drug Administration (FDA) and a second-generation version of the system (OnGuard 3.0) not yet approved by the FDA were applied to single frontal radiographs of 200 patients at high risk for lung cancer. One hundred patients had actionable nodules (mean size, 16.9 mm) and 100 patients did not. Six chest radiologists, six general radiologists, and six pulmonologists independently interpreted each image first without CAD and then with CAD during blinded reading sessions. The frequency with which readers correctly referred patients for follow-up tests was measured. Differential effects based on nodule size, shape, location, density, and subtlety were tested with multiplevariable logistic regression. RESULTS: For patients without actionable lesions, pulmonologists showed an increase in their recommendations for follow-up from 0.46 unaided to 0.52 with CAD (p = 0.001), whereas chest and general radiologists had much lower average rates and were not affected by CAD's false marks (0.26 without CAD vs 0.25 with RapidScreen 1.1 and 0.26 with OnGuard 3.0, p ≥ 0.734). CAD improved all readers' detection of moderately subtle lesions (p = 0.013) but did not significantly increase follow-up rates overall for patients with actionable nodules (0.63 unaided vs 0.63 with RapidScreen 1.1, p = 0.795; and 0.63 unaided vs 0.64 with OnGuard 3.0, p = 0.187). CONCLUSION: The effect of CAD on readers' clinical decisions varies depending on the training of the reader. CAD did not improve the performance of chest or general radiologists. Nonradiologists are particularly vulnerable to CAD's false-positive marks.
Subject(s)
Image Processing, Computer-Assisted , Lung Neoplasms/diagnostic imaging , Pulmonary Medicine , Radiology , Solitary Pulmonary Nodule/diagnostic imaging , Specialization , Aged , Decision Support Techniques , Female , Follow-Up Studies , Humans , Male , Middle Aged , Patient Selection , Practice Patterns, Physicians' , Radiography , Retrospective StudiesABSTRACT
Lung cancer remains the most common cause of cancer-related death in the United States. TNM staging, which is an important guide to the prognosis and treatment of lung cancer, has been revised recently. In this article, we propose a quick reference chart and diagrams that consolidate TNM staging information in a simple format. The current classification of lymph node stations and zones is illustrated as well.
Subject(s)
Lung Neoplasms/pathology , Manuals as Topic , Neoplasm Staging/methods , Humans , Lung Neoplasms/classificationABSTRACT
Paget-Schroetter syndrome is an uncommon cause of pulmonary thromboembolic disease that should be suspected in young patients in whom effort-related subclavian vein thrombosis should be investigated. Our case illustrates the pivotal role of imaging and the different modalities available to establish such a diagnosis.
Subject(s)
Pulmonary Embolism/etiology , Upper Extremity Deep Vein Thrombosis/complications , Adult , Axillary Vein/diagnostic imaging , Contrast Media , Diagnosis, Differential , Dyspnea/etiology , Humans , Male , Pulmonary Artery/diagnostic imaging , Pulmonary Embolism/drug therapy , Radiographic Image Enhancement/methods , Subclavian Vein/diagnostic imaging , Thrombolytic Therapy/methods , Tomography, X-Ray Computed/methods , Ultrasonography , Upper Extremity Deep Vein Thrombosis/drug therapy , Urokinase-Type Plasminogen Activator/therapeutic use , Venous Thrombosis/complications , Venous Thrombosis/diagnostic imaging , Young AdultSubject(s)
Bone Neoplasms/pathology , Diagnostic Imaging/methods , Neurilemmoma/pathology , Thoracic Wall/pathology , Biopsy, Needle , Bone Neoplasms/diagnostic imaging , Bone Neoplasms/surgery , Contrast Media , Female , Follow-Up Studies , Humans , Immunohistochemistry , Magnetic Resonance Imaging , Middle Aged , Neurilemmoma/diagnostic imaging , Neurilemmoma/surgery , Radiography, Thoracic , Risk Assessment , Thoracotomy , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
OBJECTIVE: The newer versions of PowerPoint (Microsoft) have drawing tools that can be used to draw medical illustrations for presentations and publications. Our purpose is to review the concept and elements of vector computer graphics, explain the toolbar setup, introduce the basic techniques of drawing with PowerPoint tools, and describe manipulation of a drawing by changing the types of anchor points and lines. The advantages of illustration with PowerPoint tools are viewed from three perspectives: drawing on a do-it-yourself basis, using computers, and using PowerPoint tools. CONCLUSIONS: The drawing tools of the newer versions of PowerPoint can be useful in enhancing the visual component of presentations. Advanced presentations can be developed with simple steps and tools. By learning the drawing techniques of PowerPoint, radiologists can improve their ability to communicate and deliver their messages eloquently.
Subject(s)
Computer Graphics , Medical Illustration , Radiography , SoftwareABSTRACT
OBJECTIVE: Our purpose is to present a step-by-step example of how to use PowerPoint (Microsoft) drawing techniques to make a medical illustration. CONCLUSION: The newer versions of PowerPoint have useful drawing tools that can enhance radiologic presentations. Using a simplified approach and with practice, users should be able to draw high-quality medical illustrations.
Subject(s)
Computer Graphics , Medical Illustration , Radiography , SoftwareABSTRACT
OBJECTIVE: This article, the first in a two-part series, reviews the manipulation commands of PowerPoint and briefly describes their advantages and limitations. CONCLUSION: The 2002 version of PowerPoint has many useful image-manipulation features. The second article will discuss some practical applications of these features.
Subject(s)
Computer Graphics , Radiographic Image Enhancement/methodsABSTRACT
OBJECTIVE: This article, the second of two parts, suggests some practical applications for image manipulation using the 2002 version of PowerPoint. CONCLUSION: Applications include enhancing previously manipulated images and manipulating unedited images. The user can develop his or her preferred techniques of image editing.
