UK Lung Cancer RCT Pilot Screening Trial: baseline findings from the screening arm provide evidence for the potential implementation of lung cancer screening.

BACKGROUND: Lung cancer screening using low-dose CT (LDCT) was shown to reduce lung cancer mortality by 20% in the National Lung Screening Trial. METHODS: The pilot UK Lung Cancer Screening (UKLS) is a randomised controlled trial of LDCT screening for lung cancer versus usual care. A population-based questionnaire was used to identify high-risk individuals. CT screen-detected nodules were managed by a pre-specified protocol. Cost effectiveness was modelled with reference to the National Lung Cancer Screening Trial mortality reduction. RESULTS: 247 354 individuals aged 50-75 years were approached; 30.7% expressed an interest, 8729 (11.5%) were eligible and 4055 were randomised, 2028 into the CT arm (1994 underwent a CT). Forty-two participants (2.1%) had confirmed lung cancer, 34 (1.7%) at baseline and 8 (0.4%) at the 12-month scan. 28/42 (66.7%) had stage I disease, 36/42 (85.7%) had stage I or II disease. 35/42 (83.3%) had surgical resection. 536 subjects had nodules greater than 50 mm(3) or 5 mm diameter and 41/536 were found to have lung cancer. One further cancer was detected by follow-up of nodules between 15 and 50 mm(3) at 12 months. The baseline estimate for the incremental cost-effectiveness ratio of once-only CT screening, under the UKLS protocol, was £8466 per quality adjusted life year gained (CI £5542 to £12 569). CONCLUSIONS: The UKLS pilot trial demonstrated that it is possible to detect lung cancer at an early stage and deliver potentially curative treatment in over 80% of cases. Health economic analysis suggests that the intervention would be cost effective-this needs to be confirmed using data on observed lung cancer mortality reduction. TRIAL REGISTRATION: ISRCTN 78513845.

Evaluation of head examinations produced with a mobile CT unit.

Recent years have seen the development of mobile CT units, designed for use in operating theatres, intensive care units and accident and emergency departments. One such unit is the Tomoscan M (Philips, Utrecht, The Netherlands). It operates with a maximum tube voltage of 130 kV, and a maximum tube current of only 50 mA. This study tested whether acceptable quality CT images of the brain could be produced on the mobile unit with these parameters. 44 consecutive normal head examinations performed on the mobile scanner were compared with 35 examinations from two conventional CT units. Two independent readers scored the examinations for noise and artefact. CT dose index (CTDI) values for the three CT units were obtained in free air as an estimate of patient dose. Differences in artefact score between CT units were generally small, but noise scores were worse when using the Tomoscan M with a 2 s slice time. The lowest CTDI values were obtained with the Somatom DRH (Siemens, Erlangen, Germany) unit and the highest with the SR 7000 (Philips, Utrecht, The Netherlands), with values from Tomoscan M, in all except one case, falling between these values for the protocols used in the study. The measured scattered radiation doses from the Tomoscan M are presented.

Imaging the thoracic manifestations of AIDS.

Pulmonary complications occur in over half of patients with AIDS at some point in their illness. A chest X-ray is a valuable first-line investigation. The plain film and computed tomographic features of these complications are described and several examples illustrated. The role of computed tomography, including high resolution scanning techniques in further investigation and management, is discussed.

A comparison of air, CO2 and an air/CO2 mixture as insufflation agents for double contrast barium enema.

Using CO2 for DCBE is recommended as it may decrease pain afterwards but recent studies suggest it produces inferior distension. This prospective double blind study was designed to evaluate the use of an air/CO2 mixture. We randomised 105 patients to receive air, CO2 or a 50/50 mixture as the insufflation agent in DCBE. Gases were administered from prefilled bags. Those requiring additional insufflations before over couch films were recorded. Post procedure symptoms were evaluated by questionnaire. Distension and mucosal coating were assessed independently. There was no difference in mucosal coating. Those given CO2 had significantly less immediate and delayed pain compared to air and less delayed pain compared to the 50/50 mixture. Distension with air was graded better than with the other two agents but the difference did not reach statistical significance. However 50 % of patients receiving CO2 and 40 % of those receiving the mixture required additional insufflation before over couch films as distension was considered suboptimal, compared to 17 % of those given air, which was statistically significant. Our results indicate that using CO2 causes less pain than using air or the mixture although top up insufflations are often required to maintain adequate quality distension.

Case report: the role of arteriography in patients with isolated neurological deficit following a penetrating upper limb injury.

Two cases are described of patients who presented with isolated neurological deficit following penetrating injury to the upper limb. Arteriography demonstrated brachial artery false aneurysm formation in each case. There are accepted indications for emergency angiography following stab wounds including pulse deficit, vascular bruit, expanding haematoma and hypotension with no obvious cause. Indirect indicators of vascular damage include proximity of the injury to an artery with no physical signs or isolated neurological deficit. These indications do have a significant association with concurrent arterial injury and should be investigated by elective angiography if the patient is haemodynamically stable.

Case report: oesophageal duplication cyst causing left lung collapse and hypoperfusion.

Oesophageal duplication cysts are very rare congenital abnormalities. We report a case of one sited in the middle third of the oesophagus causing stenoses of both pulmonary arteries, with collapse of the left lung due to left main bronchus obstruction.