Early Results From the Implementation of a Lung Cancer Screening Program: The Beaumont Health System Experience.

PURPOSE: In 2010, a new study published by the National Lung Screening Trial showed a 20% reduction in mortality for those patients screened with low-dose computed topography (CT) versus x-ray. Recently, the Centers of Medicare and Medicaid have agreed to cover this service for those patients who meet the screening criteria. We compare the outcomes and costs associated with developing and implementing a lung cancer screening program. MATERIALS AND METHODS: One thousand sixty-five patients were screened from January 2014 to December 2014. These patients were screened on a low-dose CT screening protocol throughout Beaumont Health System. The American College of Radiology Lung Imaging Reporting and Data System (Lung-RADS) were used to assign the score for each patient. Screening eligibility criteria were based on the National Comprehensive Cancer Network guidelines. Downstream activity and revenue was determined after initial low-dose CT screening. RESULTS: At 1 year, 20 patients (1.6%) were diagnosed with lung cancer and another 15 patients were diagnosed with another form of cancer after screening. The median age, packs per day, and pack years smoked for all patients was 63, 1.0, and 39.0 years, respectively. Lung-RADS scores for all patients was 18% (1), 24.1% (2), 6.3% (3), and 5.4% (4). The net revenue for all activity after screening was $3.2 million. CONCLUSIONS: The establishment of a low-dose CT lung cancer screening program improved the ability to screen patients as demonstrated by the number of patients screened and those diagnosed with a malignancy. These findings were also consistent with the findings from the National Lung Screening Trial study.

Intractable Hiccups Due to Posterior Inferior Cerebellar Artery Aneurysm.

This is the third reported case of a posterior inferior cerebellar artery (PICA) aneurysm presenting as intractable hiccups (IH). A previously healthy 29-year-old woman was admitted with a 2-week history of hiccups occurring >100 times per minute. Symptoms persisted despite numerous noninvasive therapies. Magnetic resonance imaging and magnetic resonance angiogram of the brain showed a left PICA aneurysm that was confirmed by catheter angiography. Symptoms resolved following suboccipital craniotomy and resection. Although rare, PICA aneurysm is a potentially curable cause of IH.

ABR Core examination preparation: results of a survey of fourth-year radiology residents who took the 2013 examination.

RATIONALE AND OBJECTIVES: A survey was administered to fourth-year radiology residents after receiving their results from the first American Board of Radiology (ABR) Core examination in 2013. The purpose was to gather information regarding resources and study strategies to share with program directors and future resident classes. MATERIALS AND METHODS: An online survey was distributed to examinees nationwide. The survey included free-response and multiple choice questions that covered examination results, perceived value of enumerated study resources, case-based and didactic teaching conferences, board reviews, study materials for noninterpretive skills, multidisciplinary conference attendance, and free-form comments. RESULTS: Two hundred sixty-six of 1186 residents who took the Core examination responded to the survey. Some resources demonstrated a significant difference in perceived value between residents who passed the examination and residents who failed, including internal board reviews (1.10, P < .01), daily didactic conferences (1.51, P < .01), and daily case conferences (1.43, P < .01). Residents who passed reported that conferences and review sessions at their institutions were modified with multiple choice questions, audience response, and integration of clinical physics and patient safety topics compared to residents who failed. CONCLUSIONS: Radiology residents and residency programs have adapted their preparations for the ABR Core examination in a variety of ways. Certain practices and study tools, including daily conferences and internal board reviews, had greater perceived value by residents who passed the examination than by residents who failed. This survey provides insights that can be used to assess and modify current preparation strategies for the ABR Core examination.

Shielding artificially increases the attenuation of water: study of CT gradient attenuation induced by shielding (CT GAINS).

RATIONALE AND OBJECTIVES: Quantitatively analyze the computed tomography (CT) attenuation effects caused by bismuth shields, which are used to reduce superficial organ dose. MATERIALS AND METHODS: The solid water uniformity section of the American College of Radiology CT phantom was scanned with a modified chest CT protocol. Scans were performed with a bismuth breast shield in multiple configurations, emphasizing three clinically relevant orientations. Attenuation effects were measured as changes in mean Hounsfield unit (HU) values of equal midsagittal regions of interest (ROI). Multiple statistical techniques were used in regression analysis. RESULTS: Bismuth shielding resulted in significant positive shifts of the expected Hounsfield unit values. The mean nonshielded CT attenuation was -0.16 ± 0.75 HU. Based on the clinically relevant ROI distance from the shield (~3-16 cm), the shielded values ranged from 43.8-4 HU, 45.8-10.1 HU, and 50.6-4.5 HU for shields 1, 2, and 3, respectively. All shield configurations displayed a statistically significant shift (P < .0001) at all distance ranges. The best fitting regression model was a quadratic function of distance versus logarithmic function of HU. A prediction table of the approximate shift in water HU values as a function of ROI distance from the shield was generated per shield type from their respective close-fitting regressions. CONCLUSIONS: The data support the claim that bismuth shields increase the attenuation of water, which can cause inaccurate characterization of simple fluid, giving the appearance of complex fluid or even solid density. However, there is potential for anticipation of the attenuation effects to validate continued use of these shields for dose reduction.

The American Board of Radiology Holman Research Pathway: 10-year retrospective review of the program and participant performance.

INTRODUCTION: In 1999, the American Board of Radiology (ABR) implemented an innovative training program track in diagnostic radiology (DR) and radiation oncology (RO) designed to stimulate development of a cadre of future academic researchers and educators in the 2 disciplines. The program was designated the Holman Research Pathway (HRP). An in-depth retrospective review of initial certification examination performance, post-training career choices, and academic productivity has not been written. This report represents a 10-year retrospective review of post-training performance of a cohort of trainees who have had sufficient time to complete their training and initial certification process and to enter practice. METHODS AND MATERIALS: All pertinent proceedings of the ABR and Accreditation Council for Graduate Medical Education (ACGME) Residency Review Committees for DR and RO between 1997 and May 2011 were reviewed. Thirty-four HRP candidates who fulfilled the established evaluation criteria were identified, and their ABR data files were analyzed regarding performance on the qualifying and certifying examinations. All candidates were contacted directly to obtain a current curriculum vitae. RESULTS: Twenty candidates in RO and 14 candidates in DR were identifiable for review. All candidates attained initial certification. At the time of analysis, 23 of 33 (66.6%) candidates were employed in full-time academic practice (1 DR candidate remained in a fellowship and was not evaluated regarding employment status). Fifteen of 20 (75%) RO candidates were in faculty positions compared with 7 of 13 (53.8%) DR trainees. Additional academic productivity metrics are reported. CONCLUSIONS: A high percentage of HRP trainees remained in academic practice and demonstrated significant academic productivity as measured by manuscript authorship and research support. Additional time and observation will be needed to determine whether these findings will be sustained by past, current, and future HRP trainees.

A comprehensive approach to CT radiation dose reduction: one institution's experience.

OBJECTIVE: The purpose of this article is to review the process of creating and implementing a comprehensive plan to reduce diagnostic radiation exposure at our institution. CONCLUSION: This process, which was initiated by forming a radiation dose reduction committee, addressed several different issues to improve patient safety. These include avoidance of unnecessary CT examinations, adjusting individual scanning parameters, revising protocols, use of shielding and dose monitoring, and implementing computer-based dose modulation software as well as educating referring physicians and radiologic technologists.