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JTI Blog
Current events in cardiopulmonary radiology, updates about the journal’s web site features, and links to other web sites of interest to cardiopulmonary radiologists.
Monday, December 22, 2014

The January 2015 issue of JTI has been published online and in print. 2015 marks the 30th anniversary of the journal, and this issue features “30-on-30” in which 30 international cardiothoracic radiologists reflect on the most influential articles published in JTI in the past 30 years. Additionally, former Editor-in-Chief of JTI, Dr. Jeff Klein, has provided us with his reflections on JTI’s past 30 years.

This issue also includes a perspective article by Dr. Mark Parker and colleagues that focuses on the April 2014 decision by the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) to recommend against Medicare coverage for lung cancer screening. This thoughtful piece addresses MEDCAC’s concerns on a point-by-point basis. Since MEDCAC’s decision and the acceptance of this article, the Centers for Medicare & Medicaid Services has subsequently issued draft recommendations for lung cancer screening, although they differ somewhat from the U.S. Preventive Services Task Force (USPSTF) and have rather stringent requirements. Dr. Parker’s article is followed by a response from Diana Zuckerman, PhD, of the National Center for Health Research. These two articles together should encourage the reader to think more about lung cancer screening and how we as a society should consider screening in this changing era of healthcare reform and emphasis on population health.

Also in this issue of JTI is a review article entitled “Developmental Lung Malformations in Children: Recent Advances in Imaging Techniques, Classification System, and Imaging Findings”. This article by Dr. Paul Thacker and colleagues is available for 1.0 self-assessment CME (SA-CME) credits, which can be applied to the American Board of Radiology’s Maintenance of Certification program as well as local licensure requirements. Complementing Dr. Thacker’s article is a review article by Dr. Beatrice Trotman-Dickenson entitled “Congenital Lung Disease in the Adult: Guide to the Evaluation and Management”

Original research articles in this issue include two previously published ahead-of-print articles: “Detection of Pulmonary Embolism on Computed Tomography: Improvement Using a Model-based Iterative Reconstruction Algorithm Compared With Filtered Back Projection and Iterative Reconstruction Algorithms” by Dr. Seth Kligerman and colleagues and “70 kVp Computed Tomography Pulmonary Angiography: Potential for Reduction of Iodine Load and Radiation Dose” by Dr. Julian L. Wichmann, both of which were detailed in previous blog entries.

Thursday, December 11, 2014

Whenever I go to RSNA, I always come back home with a renewed appreciation for how much better many people dress than I do. I used to cite economics (poor resident/fellow excuse) as a point of rationalization, but even now, I still see a discrepancy between what I wear and those who are most fashionable. As I was getting ready for my first day of work after RSNA, this got me thinking--what is appropriate work attire? A typical outfit for me is a button down shirt with rolled up sleeves, dress pants or khakis, and non-sneaker shoes; no white coat. My impression is that they would send me home to change on the east coast while being practically over-dressed in the Pacific Northwest. This is sort of assessment is completely speculative, however.

Really, the question is how does one define “appropriate?” If one is concerned about reducing the spread of infection in the hospital, ties should be banned, white coats should be abolished, and you should not wear anything below the elbows (1). Unfortunately, even I know that the short-sleeved shirt look in the hospital setting is somehow not quite right. This look would clearly not fly in most medical centers of the world. Perhaps we should cater to what patients want? Studies have show that they tend to want formal attire (shirt and tie) and white coats but do not base their level of satisfaction on these things (1) . Moreover, they are amenable to less formal attire from their physicians if they are educated on the rationale behind not wearing ties or white coats. Items universally deemed inappropriate by patients include jeans, shorts, and open-toe shoes. I would include t-shirts, cargo pants, and sneakers; but this is coming from someone who spent his whole residency in scrubs, khakis, a pullover, and clogs.

In the end, what one wears might be most important to his/her own state of mind. In a previous blog, I discussed the idea of enclothed cognition (“Dressing for Success”), essentially, this theory states that what one wears can actually affect performance through influence of psychological processes. If wearing a white coat (disease infested as it may be), can actually improve clinical performance, then it makes sense to wear it. If wearing a suit makes one more confident, decisive, and a better leader for his/her clinical team, then this should be the apparel of choice. For what it’s worth, I wore a blazer to work (no tie; they are disgusting fomites) the last couple days. I don’t know if it made me a better doctor, but it did get me a few compliments, which is better than nothing.

1. Bearman G, Bryant K, Leekha S, Mayer J, Munoz-Price LS, Murthy R, Palmore T, Rupp ME, White J. Healthcare personnel attire in non-operating-room settings. Infect Control Hosp Epidemiol. 2014 Feb;35(2):107-21

Sunday, November 30, 2014

Published ahead-of-print in JTI are two new original research articles focused on CT pulmonary angiography.

The first article, entitled "70 kVp Computed Tomography Pulmonary Angiography: Potential for Reduction of Iodine Load and Radiation Dose" by J. Wichmann et al. reports on the results of 120 patients who under went CT pulmonary angiography using single source vs. dual source technique. Subjects were divided into three groups:

  1. Group A - standard single-source 100 kVp, 120 mAs, 400 mg iodine/mL
  2. Group B - single-source 70 kVp, 208 mAs, 400 mg iodine/mL
  3. Group C - dual-source 70 kVp CTPA, 416 mAs, 300 mg iodine/mL

The authors conclude that single-source 70 kVp CTPA provides significant radiation dose savings with comparable signal-to-noise ration and contrast-to-noise ratios. Dual-source 70 kVp CTPA provides superior objective image quality with reduction of iodine concentration.

The second article, entitled "Detection of Pulmonary Embolism on Computed Tomography: Improvement Using a Model-based Iterative Reconstruction Algorithm Compared With Filtered Back Projection and Iterative Reconstruction Algorithms" by S. Kligerman et al. Twenty-two consecutive patients with CT pulmonary angiograms positive for pulmonary embolism (PE) were included in the study. All scans were reconstructed with filtered back project (FBP), hybrid iterative reconstruction (HIR), and model-based iterative reconstruction (MBIR). Five thoracic radiologists and two thoracic radiology fellows reviewed reconstructed scans who recorded features related to quality as well the presence or absence of PE. The authors conclude that MBIR led to significant increase in PE detection (82.5% pooled sensitivity) compared to HIR and FBP (78.6% and 76% pooled sensitivity, respectively). Furthermore, readers reported improved diagnostic confidence, perceived noise, and perceived enhancement with MBIR compared with FBP and HIR.

Tuesday, November 11, 2014
The US Center for Medicare Services (CMS) has announced a favorable draft coverage decision for lung cancer screening. Click here for full details about the draft decision.
As noted in a recent JTI editorial, this decision is an important step toward narrowing the coverage gap for select seniors in the US at high risk for lung cancer. Click here to see a recent perspective on this topic by Dr. Mark Parker and colleagues.

Thursday, October 23, 2014

The November 2014 issue of JTI has been published in print and on-line. This issue contains several original scientific articles as well as other features.

This issue's Expert Opinion installment is entitled "SubmilliSievert Cardiothoracic CT Imaging in Daily Practice". Participants describe what can be achieved in low dose chest CT and briefly state how technology can aid in lowering dose.

V. Sharma and colleagues have written a review article entitled "Myocardial Tissue Characterization with Magnetic Resonance Imaging". This article first discusses the different signal characteristics and then reviews tissue characterization based on myocardial pathology. A variety of images nicely illustrate the various findings and patterns.

This issue's original articles have been highlighted in recent blog entries (10/15/2014 and 10/7/2014). The articles include:

  • "Cardiac Magnetic Resonance Imaging Findings Predict Major Adverse Events in Apical Hypertrophic Cardiomyopathy" by K Hangman et al.
  • "Computed Tomography Fluoroscopy Versus Conventional Computed Tomography Guidance for Biopsy of Intrathoracic Lesions: A Retrospective Review of 1143 Consecutive Procedures" by J. Mammarappallil et al.
  • "Computed Tomography–guided Percutaneous Lung Biopsy: Impact of Lesion Proximity to Diaphragm on Biopsy Yield and Pneumothorax Rate" by C. Hague et al.
  • "Correlation Between EGFR Mutation Status and Computed Tomography Features in Patients With Advanced Pulmonary Adenocarcinoma" by J-S. Hsu et al.

The ACR Appropriateness Criteria for rib fractures have been updated by T. Henry and colleagues.

Web Exclusive content for this issue includes:

The next installment of the popular Signs in Cardiopulmonary Imaging series: the beak sign by P. Moullet and H. Mann.

Meeting notes from the Japanese Society of Thoracic Radiology. These case reports include:

  • Extranodal Marginal Zone Lymphoma of Mucosa-associated Lymphoid Tissue of the Central Bronchi by M. Ujita et al.
  • Familial Interstitial Pneumonia Complicated by Lung Cancer in 2 Sisters by A. Terada et al.
  • Cystic Tumor of the Atrioventricular Node: Computed Tomography and Magnetic Resonance Imaging Findings by K. Suzuki et al.

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Journal of Thoracic Imaging
Current events in cardiopulmonary radiology, updates about the journal?s web site features, and links to other web sites of interest to cardiopulmonary radiologists.