[Show abstract][Hide abstract] ABSTRACT: Between 2004 and 2012, US funding for the biomedical sciences decreased to historic lows. Health-related research was crippled by receiving only 1/20th of overall federal scientific funding. Despite the current funding climate, there is increased pressure on academic radiology programs to establish productive research programs. Whereas larger programs have resources that can be utilized at their institutions, small to medium-sized programs often struggle with lack of infrastructure and support. To address these concerns, the Association of University Radiologists' Radiology Research Alliance developed a task force to explore any untapped research productivity potential in these smaller radiology departments. We conducted an online survey of faculty at smaller clinically funded programs and found that while they were interested in doing research and felt it was important to the success of the field, barriers such as lack of resources and time were proving difficult to overcome. One potential solution proposed by this task force is a collaborative structured research model in which multiple participants from multiple institutions come together in well-defined roles that allow for an equitable distribution of research tasks and pooling of resources and expertise. Under this model, smaller programs will have an opportunity to share their unique perspective on how to address research topics and make a measureable impact on the field of radiology as a whole. Through a health services focus, projects are more likely to succeed in the context of limited funding and infrastructure while simultaneously providing value to the field.
Full-text · Article · Nov 2015 · Academic radiology
[Show abstract][Hide abstract] ABSTRACT: Artificial airway devices are commonly used to provide adequate ventilation and/or oxygenation in multiple clinical settings, both emergent and nonemergent. These frequently used devices include laryngeal mask airway, esophageal-tracheal combitube, endotracheal tube, and tracheostomy tube and are associated with various acute and late complications. Clinically, this may vary from mild discomfort to a potentially life-threatening situation. Radiologically, these devices and their acute and late complications have characteristic imaging findings which can be detected primarily on radiographs and computed tomography. We review appropriate positioning of these artificial airway devices and illustrate associated complications including inadequate positioning of the endotracheal tube, pulmonary aspiration, tracheal laceration or perforation, paranasal sinusitis, vocal cord paralysis, post-intubation tracheal stenosis, cuff overinflation with vascular compression, and others. Radiologists must recognize and understand the potential complications of intubation to promptly guide management and avoid long-term or even deadly consequences.
No preview · Article · Sep 2014 · Emergency Radiology
[Show abstract][Hide abstract] ABSTRACT: Aspiration is a common but underrecognized clinicopathologic entity, with varied radiographic manifestations. Aspiration represents a spectrum of diseases, including diffuse aspiration bronchiolitis, aspiration pneumonitis, airway obstruction by foreign body, exogenous lipoid pneumonia, interstitial fibrosis, and aspiration pneumonia with or without lung abscess formation. Many patients who aspirate do not present with disease, suggesting that pathophysiology is related to a variety of factors, including decreased levels of consciousness, dysphagia, impaired mucociliary clearance, composition of aspirate, and impaired host defenses. In this pictorial essay, we will review the different types of aspiration lung diseases, focusing on their imaging features and differential diagnosis.
No preview · Article · Jun 2014 · Journal of Thoracic Imaging
[Show abstract][Hide abstract] ABSTRACT: A 52 year-old African American female with a past medical history of symptomatic uterine fibroids and increasing abdominal circumference underwent abdominal computed tomography (CT) as part of her workup. Because of an abnormality in the left lower lobe, CT of the chest was subsequently performed and showed a focal region of discontinuous crescentic consolidation with central ground glass opacification in the right lower lobe, suggestive of the reversed halo sign. The patient underwent percutaneous CT-guided core biopsy of the lesion, which demonstrated lymphocytic interstitial pneumonia, a benign lymphoproliferative disease characterized histologically by small lymphocytes and plasma cells. This case report describes the first histologically confirmed presentation of lymphocytic interstitial pneumonia with the reversed halo sign on CT.
Full-text · Article · Oct 2013 · Journal of Radiology Case Reports
[Show abstract][Hide abstract] ABSTRACT: As the most common type of malignancy, lung cancer is regularly encountered by primary care physicians, pulmonologists, as well as radiologists during their routine practice. Many lung cancers are detected incidentally or when patients present with symptoms related to either local or systemic effects of a tumor. Imaging plays an important role in lung cancer staging through the characterization of the primary tumor, evaluation of nodal disease, and the detection of distant metastases. Imaging guidance can also provide a means for obtaining tissue diagnosis, both for the primary or metastatic lesions.
[Show abstract][Hide abstract] ABSTRACT: A 56-year-old male presented to our institution with shortness of breath, heart palpitations, left-sided chest dis-comfort, chills, nausea, and vomiting. He had a prior medi-cal history of rheumatic fever, subacute bacterial endocar-ditis, and a successful aortic valve replacement 17 years ago. His physical exam revealed normal respirations, sinus tachycardia, no audible murmurs, and normal pedal pulses without peripheral edema. A transesophageal echocardiogram (TEE) revealed severe mitral regurgitation, a dilated ascending aortic root with a perivalvular leak, and a normally functioning prosthetic aortic valve. Coronary angiography showed moderate stenosis of the left anterior descending coronary artery. Subsequently, the patient underwent complex mitral-valve repair with reconstruction of the artificial chordae, a sliding plasty of posterior mitral-valve leaflet, and an annuloplasty using a 28-mm Cosgrove ring. He also had aortic root re-placement with reimplantation of the coronariesm, using a 27-mm freestyle aortic prosthesis. The ascending aortic aneurysm was also repaired without any complications, and the patient was discharged seven days after admission. The patient returned to the hospital five months later with complaints of palpitation and chest pain a few days after an accidental electrical shock at work. He was diag-nosed with atrial flutter and successfully cardioverted to sinus rhythm. According to the patient, TEE was per-formed at an outside hospital, and he raised the possibility of an intracardiac "shunt." However, the patient did not have specific details/diagnosis of the underlying defect or records of the echocardiogram. To define the surgically altered cardiac anatomy and to evaluate for a possible in-tracardiac defect, a cardiac CTA imaging study was requested. CTA of the chest was performed using a 64-slice CT scanner (Philips Brilliance-64) (Fig. 1). A bolus-tracking technique was used, with the region of interest placed in the aortic arch. The threshold for contrast triggering was set at 120 HU. 100ml of ioversol (Optiray 350,Mallinck-rodt, Inc) was administered intravenously at a rate of 5 ml/ sec, followed by 40ml of a saline chaser. Scan parameters were as follows: collimation, 64 x 0.625mm; voltage, 120 kVp; current, 800 mAs. ECG gating was used, and multi-phase retrospective reconstruction was performed for image interpretation. The CTA demonstrated a postsurgical appearance com-patible with the prior ascending thoracic aortic aneurysm repair, and aortic and mitral valve replacement. However, RCR Radiology Case Reports | radiology.casereports.net
Full-text · Article · May 2011 · Radiology Case Reports
[Show abstract][Hide abstract] ABSTRACT: The survival for patients with locally advanced, unresectable non-small cell lung cancer receiving standard of care concomitant chemoradiation remains disappointingly low. A reduction in both local and distant recurrence is needed to improve patients' outcome. Performing molecular studies on serially collected tumor specimens may result in a better selection of therapeutic options.
We conducted a phase II single-institution trial of two cycles of induction chemotherapy with gemcitabine and carboplatin followed by high-dose conformal radiation concomitant with weekly paclitaxel and carboplatin in 39 patients. The trial required a dedicated tumor biopsy before treatment initiation. In addition, tumor biopsies were requested, if safely feasible, before initiation of chemoradiation and 2 months after completion all therapy.
Induction chemotherapy was well tolerated, and 38 patients proceeded with chemoradiation. The mean delivered radiation dose was 70.2 Gy, 23 patients received the full dose of 74 Gy, and 19 patients completed all treatment on schedule without dose reductions or delays. Median overall and progression-free survivals were 22.7 and 14.3 months, respectively. A total of 82 procedures, including 46 transthoracic core needle biopsies, were performed. Thirteen patients had all three serial tumor biopsies. Three of these procedures resulted in complications that required an intervention; all for the treatment of a biopsy-induced pneumothorax.
We conclude that induction gemcitabine/carboplatin followed by concurrent paclitaxel/carboplatin with conformal radiation to 74 Gy is safe and tolerable with promising efficacy. We demonstrated that dedicated and serial tumor collections are safe, feasible, and acceptable for patients with non-small cell lung cancer.
No preview · Article · Mar 2011 · Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer
[Show abstract][Hide abstract] ABSTRACT: Traumatic pericardial rupture, with complicating cardiac herniation, is an extremely uncommon condition with a high mortality rate. We are reporting our experience with a case of blunt trauma to the chest, secondary to high-impact motor vehicle collision. The preoperative diagnosis of ascending aortic transection was made on subsequent imaging studies for which surgical repair was elected. Upon thoracotomy, a posterior pericardial tear was found to be associated with laterally displaced cardiac axis. Delayed levorotation of the cardiac axis in traumatic pericardial rupture is an uncommon finding and needs to be recognized in a timely manner.
No preview · Article · Dec 2010 · Emergency Radiology
[Show abstract][Hide abstract] ABSTRACT: The treatment of patients with advanced non-small-cell lung cancer (NSCLC) is based on clinical trials experience. Molecular characteristics that impact metabolism and efficacy of chemotherapeutic agents are not used for decision making. Ribonucleotide reductase subunit 1 (RRM1) is crucial for nucleotide metabolism, and it is the dominant molecular determinant of gemcitabine efficacy. Excision repair cross-complementing group 1 gene (ERCC1), a component of the nucleotide excision repair complex, is important for platinum-induced DNA adduct repair. We hypothesized that selection of double-agent chemotherapy based on tumoral RRM1 and ERCC1 expression would be feasible and beneficial for patients with advanced NSCLC.
We conducted a prospective phase II clinical trial in patients with advanced NSCLC. Patients were required to have a dedicated tumor biopsy for determination of RRM1 and ERCC1 gene expression by real-time quantitative reverse transcriptase polymerase chain reaction. Double-agent chemotherapy consisting of carboplatin, gemcitabine, docetaxel, and vinorelbine was selected based on gene expression. Disease response and patient survival were monitored.
Eighty-five patients were registered, 75 had the required biopsy without significant complications, 60 fulfilled all eligibility criteria, and gene expression analysis was not feasible in five patients. RRM1 expression ranged from 0 to 1,637, ERCC1 expression ranged from 1 to 8,103, and their expression was correlated (Spearman's rho = 0.46; P < .01). Disease response was 44%. Overall survival was 59% and progression-free survival was 14% at 12 months, with a median of 13.3 and 6.6 months, respectively.
Therapeutic decision making based on RRM1 and ERCC1 gene expression for patients with advanced NSCLC is feasible and promising for improvement in patient outcome
[Show abstract][Hide abstract] ABSTRACT: The heart is an exceedingly rare site of metastatic involvement in carcinoid tumors. Only nineteen cases have been described in the literature over the past 30 years. We report here on a patient who presented with progressive carcinoid syndrome despite surgical resection of her liver metastases. She was found to have cardiac metastases on inidium-111-pentetreotide scintigraphy and subsequently underwent external beam radiation to the heart resulting in symptomatic palliation of her syndrome and objective radiographic response. To our knowledge, this is the first reported case of metastatic cardiac carcinoid treated with external beam irradiation.
Full-text · Article · Feb 2007 · Journal of Medical Case Reports
[Show abstract][Hide abstract] ABSTRACT: Diagnostic imaging plays an important role in the monitoring of tumor response during lung cancer restaging to evaluate the efficacy of chemotherapy and/or radiation therapy during treatment, and in the detection of recurrent or metastatic neoplasm after treatment has been completed. While CT represents the primary imaging modality for lesion evaluation during restaging and for surveillance imaging once therapy has been completed, studies evaluating the role of 18-fluoro-2 deoxyglucose positron emission tomography (FDG-PET) in lung cancer restaging have shown promise regarding the detection of residual and recurrent neoplasm, and in evaluating for early response to first line therapy. With both CT and FDG-PET, residual or recurrent disease should, when possible, be differentiated from therapy-related changes in the lungs. We review the role of imaging in lung cancer restaging with attention to CT and FDG-PET for treatment assessment and the detection of recurrent or metastatic disease.
No preview · Article · May 2005 · Seminars in Roentgenology
[Show abstract][Hide abstract] ABSTRACT: LEARNING OBJECTIVES
To demonstrate that the previously reported CT reversed halo sign of cryptogenic organizing pneumonia is non-specific and can also be seen in other etiologies, including fungal infections and neoplasm.
The reversed halo sign has previously been defined by Voloudaki et al.(Acta Radiol:37;1996) as a central ground-glass opacity surrounded by a more dense cresentric or ring shaped consolidation at least 2mm thick. This CT sign has previously been reported by Kim et al.(AJR:180; 2003) as being relatively specific for cryptogenic organizing pneumonia. Our cases demonstrate other etiologies, including both fungal and neoplastic, may produce this sign. A series of follow up high resolution CT scans of the thorax demonstrate progression of peripheral nodules to a large reversed halo in a pancytopenic patient with biopsy proven zygomycete fungi. Neoplastic etiology is demonstrated by a case of a patient with a prior pneumonectomy for non-small cell carcinoma with a reversed halo in the contralateral lung, which represented metastatic disease. These cases establish that the reversed halo sign is a non-specific finding that can be seen in inflammatory, infectious, and neoplastic etiologies.
[Show abstract][Hide abstract] ABSTRACT: The management of patients with suspected or known lung cancer is becoming increasingly complex. State-of-the-art care often requires input from many sources, including pulmonology, thoracic surgery, medical oncology, radiation oncology, pathology, and radiology. Valuable contributions to care also come from nursing, social work, psychology, psychiatry, pastoral care, and palliative care, among others. As a result, multidisciplinary input into care is vital. Patients with suspected lung cancer should be expeditiously evaluated and referred for management. Clear and understandable information on the diagnosis, treatment options, and possible outcomes should be provided. Treatment recommendations should be based on locally agreed-on adaptations of clinical practice guidelines. Provisions for ongoing care should be apparent to all concerned
[Show abstract][Hide abstract] ABSTRACT: To appraise the potential cost-effectiveness of lung cancer screening with CT.
Incremental cost-effectiveness ratios are estimated for two hypothetical cohorts followed up over time. One cohort was screened over the first 5 years of the study period; the other cohort received usual care. Cost streams are projected for each cohort under alternative sets of parameters/ assumptions and from the perspective of national payer groups. Cohort cost differentials arise as a result of screening and variations in stage-specific treatment. Cohort life expectancies are also projected, and they too differ as a consequence of variations in the stage distribution at diagnosis. The ratios of these cost and life-expectancy differences are used to judge the expected economic value of screening.
Results are analyzed for a "worst-case" scenario, ie, with the highest cost and lowest yield assumptions. Under these conditions, screening with CT costs approximately $48,000 per life-year gained, if screening results in 50% of lung cancers detected at localized stage. Smaller proportions of cancer detected at a localized stage result in higher cost-effectiveness ratios, and vice versa.
If screening for lung cancer is effective, it is likely to be cost-effective if the screening process can detect > 50% of cancers at localized stage.