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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.
Wednesday, August 27, 2014
The September 2014 issue of JTI has been published in print and online. This issue features a symposium on quality and safety in cardiothoracic imaging, guest edited by Dr. Jeffrey P. Kanne of the University of Wisconsin School of Medicine and Public Health. The symposium consists of four review articles on topics readers should find relevant to their professional practices.

First Dr. Daniel Ocazionez and colleagues from the University of Washington have authored a review article focused on MRI safety in cardiothoracic imaging. Their article addresses implanted devices, pharmacologic agents, gadolinium contrast agents, external equipment, and anesthesia and sedation.

Second, Dr. Kanne reviews peer review in a broad context as well as addresses specific challenges in cardiothoracic imaging. This article discusses the various types of peer review with their respective advantages and disadvantages. This article is available for self-assessment CME (SA-CME) and counts toward the life-long learning requirements for Maintenance of Certification for the American Board of Radiology.

Third, Drs. Jacobo Kirsch and Daniel Vargas, from Cleveland Clinic Florida and the University of Colorado, respectively, write on cardiothoracic imaging guidelines in quality improvement. Appropriateness criteria, decision support tools, and physician certification are reviewed in the context of subspecialty cardiothoracic imaging.

Finally, Dr. Anne Leung of Stanford University concludes this symposium with a review of professionalism in radiology. One major theme in Dr. Leung’s review article is the importance of radiologists serving as stewards of medical imaging: acting as consultants to ensure that appropriate imaging is performed for appropriate indications. Dr. Leung’s article is also available for SA-CME credit.

Also included in this is of JTI is an expert opinion poll on challenges in peer review in cardiothoracic imaging, relevant to the topics in this symposium.

Previously mentioned published ahead-of-print articles are now in print including results of a survey of the membership of the Society of Thoracic Radiology on CT lung cancer screening. Furthermore, a joint practice parameter sponsored by the American College of Radiology and the Society of Thoracic Radiology on Performance and Reporting of Lung Cancer Screening Thoracic Computed Tomography is included in this issue.

An original research article on HRCT findings of microaspiration is published in this issue and is complemented by a pictorial essay on aspiration-related lung diseases.

Finally, web-exclusive content in this issue includes updated American College of Radiology Appropriateness Criteria on nontraumatic aortic disease and the latest installment of “Signs in Cardiopulmonary Imaging”: the Hammock Sign by Drs. Moore and Agarwal from the University of Michigan.

Sunday, August 10, 2014
Published ahead-of-print in JTI are two new original articles and one symposium review article.

Heusch and colleagues report on their study investigating the use of high-concentration iodine delivery using reduced tube current for CT pulmonary angiography. The authors analyzed scans on 119 consecutive patients imaged on a 128-slice scanner, performed with 4 different techniques, and concluded that 100 kVp, 90 mAs, and 5 mL/sec of 400 mg iodine / mL of iomeprol resulted in excellent image quality and an estimated 33% dose savings.

Eberth and colleagues report the results of their survey of the membership of the Society of Thoracic Radiology regarding lung cancer screening. Nearly 60% of responding intuitions were engaged in low-dose computed tomography screening for lung cancer. Of the responding institutions not offering screening CT at the time of the survey, 89% reported that they were considering having a screening program in the future. Forty-four percent of responding institutions engaged in screening were self-pay only with prices ranging from $200 to $500.

Kirsch and Vargas’ review article “Cardiothoracic Imaging Guidelines in Quality Improvement” is part of the upcoming symposium on Quality and Safety in Cardiopulmonary Imaging.

Thursday, July 10, 2014

Part III. Elements of  good scan protocols: Building blocks of a good practice

 

There is no dearth of good scanning protocols on the web and in the journals, and yet one of my favorite place for a great protocol template lies in the public domain at the American Association of Physicists in Medicine website (http://www.aapm.org/pubs/CTProtocols/documents/AdultRoutineChestCT.pdf). The outstanding Working Group on Standardization of CT Nomenclature and Protocols has comprehensively described the nuances of a few common protocols for all major CT vendors.  Even if one might not completely agree with the actual scan parameters, I find it hard to argue against the exquisitely structured protocols, which start at the level of clinical indication and then address patient positioning, contrast injection details, breathing instructions, and scan range. If you are in the business of making CT protocols, the site is a must visit!

 

In a good CT protocol, the header should state body region, protocol title, scanner details (name, vendor, slice profile) and version date. I am fond of stating to our technologists “With some luck I can fix noise and some artifacts, but I have no chance against chest CT compromised by motion artifacts.” This brings me to the amazing why, what, and how manual on respiratory instructions for CT of the lungs by Bankier and colleagues (1). For a chest CT, the best conversation a CT technologist can have with the patient pertains to breathing during scanning. No scan parameter is as important as clear, concise, correct breathing instructions for chest CT. 

 

Once these crucial elements of scanning are addressed, you can then begin to populate specific scan parameters for planning radiographs (scout images), which serve several purposes beyond just planning the scan range. Parameters for transverse CT images should include specific values for scanning mode, kV, mA (or automatic exposure control descriptors), rotation time, detector configuration, table feed per rotation, pitch, reconstruction approach (filtered back projection or iterative reconstruction), reconstruction filter, field of view kernel or algorithm, section thickness, as well as section interval. Specifications for additional thin sections, coronal and sagittal multiplanar reformats and maximum intensity projection images should be clearly stated.  We will discuss each of these items in separate blogs, I promise.

 

I personally prefer Excel, Spreadsheet or Worksheets to create and archive our protocols. Separate files are created for individual clinical indication based protocols. Each spreadsheet can have different pages or tabs for different CT scanners. I never use identical scan protocols for identical clinical indications for different CT scanner types.  This ensures that one capitalizes upon individual strengths of different scanners.

 

Reference:

1. BankierAA, O’Donnell CR, Boiselle PM. Respiratory instructions for CT examinations of the lungs: a hands-on guide. RadioGraphics 2008; 28: 919–931


Tuesday, June 24, 2014
The July 2014 issue of JTI has been published in print and on-line. This issue includes a review article by Y. J. Cho and colleagues entitled “Iterative Image Reconstruction Techniques: Cardiothoracic Computed Tomography Applications.” The authors of this article review the types of iterative reconstruction, discuss applications in cardiothoracic CT, and address radiation exposure issues.

A number of original research articles are also included in this issue of JTI. One of the original research articles is a systematic review performed by A. Raymakers and colleagues, evaluating cost-effectiveness analyses for CT pulmonary angiography for pulmonary embolism.

Dr. J Ackman and colleagues report on their survey of members of the Society of Thoracic Radiology regarding the current state of nonvascular thoracic MRI. Their results show that nonvascular thoracic MRI is still in its early phase, with surveyed cardiothoracic radiologists reporting overall limited experience with and unclear recognition of value of nonvascular thoracic MRI yet an eagerness to increase knowledge and utilization.

Web-only content in this issue includes the ACR Appropriateness Criteria® for nonischemic myocardial disease with clinical manifestations (ischemic cardiomyopathy already excluded).

The next installment of the popular Signs in Cardiopulmonary Imaging feature is the “Incomplete Border Sign” by C. Hsu and colleagues.

Finally, Society of Thoracic Radiology (STR) announcements include the 2014 Gold Medal Award of the STR winner, Dr. Sanford Rubin; the 2014 STR Inspiration Award given to Dr. Ella Kazerooni, and published abstracts from the 2014 Society of Thoracic Radiology annual meeting and postgraduate course.

Wednesday, June 18, 2014
Published ahead-of-print in JTI is the next installment of Expert Opinion, addressing the U.S. Preventive Services Task Force (USPSTF) recommendation on screening for lung cancer. The USPSTF issued a grade B recommendation for low-dose CT screening for lung cancer in December 2013 for smokers age 55-80 years old with at least a 30 pack-year smoking history or former smokers in the same age range who quit within 15 years. Under the Affordable Care Act, private insurers will be required to cover screening for these patients beginning in 2015.

The JTI editorial staff asked this group of experts, “if you were given the opportunity to make one modification to the recent lung cancer screening recommendations from the [USPSTF], what would it be and why?” To find out what our experts had to say, you can find the article here.
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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.