It Is Time to Inform Patients of Medical Imaging Risks

Guidance for chest-CT in children and adults with cystic fibrosis: A European perspective

The European Cystic Fibrosis Society-Clinical Trials Network (ECFS-CTN) herein proposes guidance for the use of chest CT-scans for the regular monitoring of lung disease in CF. Statements were completed in a 3-step process: the questions were identified via an anonymous online survey, followed by a comprehensive literature search, and a final Delphi process. The guidance recommends the use of ultra-low dose CT scans (effective radiation dose, 0.08 mSv; equivalent to 2 to 4 chest X-rays), tracking of patients' cumulative radiation and effective communication strategies using "de-medicalized" information for shared decision making. Chest CT scans (with lung volume monitoring) are not recommended systematically in both children and adults. Ultimate responsibility for justifying a chest CT scan lies with the individual professionals directly involved, the final decision being influenced by indications, costs, expertise, available material, resources and/or the patient's values, as well as possible impact on treatment modalities.

The Correlation between Plasma Circulating Tumor DNA and Radiographic Tumor Burden

Conventional blood-based biomarkers and radiographic imaging are excellent for use in monitoring different aspects of malignant disease, but given their specific shortcomings, their integration with other, complementary markers such as plasma circulating tumor DNA (ctDNA) will be beneficial toward a precision medicine-driven future. Plasma ctDNA analysis utilizes the measurement of cancer-specific molecular alterations in a variety of bodily fluids released by dying tumor cells to monitor and profile response to therapy, and is being employed in several clinical scenarios. Plasma concentrations of ctDNA have been reported to correlate with tumor burden. However, the strength of this association is generally poor and highly variable, confounding the interpretation of longitudinal plasma ctDNA measurements in conjunction with routine radiographic assessments. Herein is discussed what is currently understood with respect to the fundamental characteristics of tumor growth that dictate plasma ctDNA concentrations, with a perspective on its interpretation in conjunction with radiographically determined tumor burden assessments.

Racial difference in receiving computed tomography for head injury patients in emergency departments

STUDY OBJECTIVE

Prior studies have suggested potential racial differences in receiving imaging tests in emergency departments (EDs), but the results remain inconclusive. In addition, most prior studies may only have limited racial groups for minority patients. This study aimed to investigate racial differences in head computed tomography (CT) administration rates in EDs among patients with head injuries.

METHODS

Patients with head injuries who visited EDs were examined. The primary outcome was patients receiving head CT during ED visits, and the primary exposure was patient race/ethnicity, including Asian, Hispanic, Non-Hispanic Black (Black), and Non-Hispanic White (White). Multivariable logistic regression analyses were performed using the National Hospital Ambulatory Medical Care Survey database, adjusting for patients and hospital characteristics.

RESULTS

Among 6130 patients, 51.9% received a head CT scan. Asian head injury patients were more likely to receive head CT than White patients (59.1% versus 54.0%, difference 5.1%, p < 0.001). This difference persisted in adjusted results (odds ratio, 1.52; 95% CI, 1.06-2.16, p = 0.022). In contrast, Black and Hispanic patients have no significant difference in receiving head CT than White patients after the adjustment.

CONCLUSIONS

Asian head injury patients were more likely to receive head CT than White patients. This difference may be attributed to the limited English proficiency among Asian individuals and the fact that there is a wide variety of different languages spoken by Asian patients. Future studies should examine rates of receiving other diagnostic imaging modalities among different racial groups and possible interventions to address this difference.

Turning radiology reports into epidemiological data to track seasonal pulmonary infections and the COVID-19 pandemic

OBJECTIVES

To automatically label chest radiographs and chest CTs regarding the detection of pulmonary infection in the report text, to calculate the number needed to image (NNI) and to investigate if these labels correlate with regional epidemiological infection data.

MATERIALS AND METHODS

All chest imaging reports performed in the emergency room between 01/2012 and 06/2022 were included (64,046 radiographs; 27,705 CTs). Using a regular expression-based text search algorithm, reports were labeled positive/negative for pulmonary infection if described. Data for regional weekly influenza-like illness (ILI) consultations (10/2013-3/2022), COVID-19 cases, and hospitalization (2/2020-6/2022) were matched with report labels based on calendar date. Positive rate for pulmonary infection detection, NNI, and the correlation with influenza/COVID-19 data were calculated.

RESULTS

Between 1/2012 and 2/2020, a 10.8-16.8% per year positive rate for detecting pulmonary infections on chest radiographs was found (NNI 6.0-9.3). A clear and significant seasonal change in mean monthly detection counts (102.3 winter; 61.5 summer; p < .001) correlated moderately with regional ILI consultations (weekly data r = 0.45; p < .001). For 2020-2021, monthly pulmonary infection counts detected by chest CT increased to 64-234 (23.0-26.7% per year positive rate, NNI 3.7-4.3) compared with 14-94 (22.4-26.7% positive rate, NNI 3.7-4.4) for 2012-2019. Regional COVID-19 epidemic waves correlated moderately with the positive pulmonary infection CT curve for 2020-2022 (weekly new cases: r = 0.53; hospitalizations: r = 0.65; p < .001).

CONCLUSION

Text mining of radiology reports allows to automatically extract diagnoses. It provides a metric to calculate the number needed to image and to track the trend of diagnoses in real time, i.e., seasonality and epidemic course of pulmonary infections.

CLINICAL RELEVANCE

Digitally labeling radiology reports represent previously neglected data and may assist in automated disease tracking, in the assessment of physicians' clinical reasoning for ordering radiology examinations and serve as actionable data for hospital workflow optimization.

KEY POINTS

• Radiology reports, commonly not machine readable, can be automatically labeled with the contained diagnoses using a regular-expression based text search algorithm. • Chest radiograph reports positive for pulmonary infection moderately correlated with regional influenza-like illness consultations (weekly data; r = 0.45; p < .001) and chest CT reports with the course of the regional COVID-19 pandemic (new cases: r = 0.53; hospitalizations: r = 0.65; p < 0.001). • Rendering radiology reports into data labels provides a metric for automated disease tracking, the assessment of ordering physicians clinical reasoning and can serve as actionable data for workflow optimization.

Radiation Exposure to Low-Dose Computed Tomography for Lung Cancer Screening: Should We Be Concerned?

Lung cancer screening (LCS) programs through low-dose Computed Tomography (LDCT) are being implemented in several countries worldwide. Radiation exposure of healthy individuals due to prolonged CT screening rounds and, eventually, the additional examinations required in case of suspicious findings may represent a concern, thus eventually reducing the participation in an LCS program. Therefore, the present review aims to assess the potential radiation risk from LDCT in this setting, providing estimates of cumulative dose and radiation-related risk in LCS in order to improve awareness for an informed and complete attendance to the program. After summarizing the results of the international trials on LCS to introduce the benefits coming from the implementation of a dedicated program, the screening-related and participant-related factors determining the radiation risk will be introduced and their burden assessed. Finally, future directions for a personalized screening program as well as technical improvements to reduce the delivered dose will be presented.