Using quantitative CT (QCT) can help providers pinpoint the small changes in airways that begin to pop up in smokers who have not yet exhibited any substantial symptoms or effects.

In studies looking at emphysema, expiratory airflow obstructive, and airway wall thickening, QCT, as a minimally invasive technique, is considered the gold standard for evaluating the minimal morphologic changes that are linked to smoking. But, until now, there has been relatively little research on smokers who do not yet have findings that show up on CT.

Using a normalization scheme with QCT to evaluate airway parameters, though, can help providers investigate structural airway changes that exist even if a smoker has a normal-looking CT, said a multi-institutional team of researchers in a study published this week in the 

“This study indicates that QCT could help identify minimal changes in airways and could help in understanding pathophysiological airway changes induced by smoking,” said the team led by Eric A. Hoffman, Ph.D., professor of radiology, medicine, and biomedical engineering at the University of Iowa.

Overall, their analysis showed a diffuse luminal narrowing of airways over all generations, no change in wall thickness of proximal bronchi between the first and third generations, and thinned distal airway walls for fourth and later generations.

To reach these conclusions and evaluate airway parameters using QCT, the team conducted a retrospective analysis, examining CT scans conducted between January 2014 to December 2016 from 222 non-smokers and 69 smokers who averaged 22.8 pack years. The images were captured with a 128 multi-detector CT without iterative reconstruction, and the team performed multiple linear regressions of tracheal wall thickness, diameter, luminal area, adjusting for age, sex, and height.

Specifically, the team said, smokers tended to have smaller airway diameters, but only 8 of 22 regional airways selected (36.4 percent) were statistically significant. In addition, the wall area of 83.4 percent of selected airways was also significantly decreased in smokers. While the mechanism behind the distal airway wall thinning seen in smokers was unclear, the team said it could be a result of increased mucus secretion and inflammatory cell infiltration into the wall tissue of the proximal airways due to the accumulation of toxic particles.

Based on these results, the team said, using a normalization scheme could have both research and clinical benefits, enabling providers to evaluate airway narrowing to determine how far it is out of the normal range.

“We believe with a normalized scheme, it may be easier to identify early-stage alterations of a smoker’s airways and eventually prevent disease development and initiate early treatment,” the team said. “With further multi-center studies with larger cohorts, this normalization scheme can be modified and strengthened to apply in various clinical situations where different CT parameters are used.”

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Articles

QCT can pick up on small airway changes in smokers that are not yet visible on CT scans.

Quantitative CT Identifies Airway Changes in Smokers Without Symptoms

People who smoke marijuana face increased rates of emphysema compared to individuals who choose tobacco-only cigarettes.

In a scientific e-poster that will be presented during the 2021 ARRS Virtual Annual Meeting, researchers from Ottawa Hospital in Canada show that smoking marijuana not only elevates the emphysema rate overall, but the increase is even greater when patients are age-matched. In addition, the team saw greater rates of paraseptal emphysema.

To make this determination, the team, led by first author Luke Murtha, M.D., a diagnostic radiologist at Ottawa Hospital examined imaging reports from the facilities PACS system. They concentrated on three groups, matching them for age and sex: marijuana smokers (56 patients), non-smokers/non-marijuana users (57 patients), and tobacco-only smokers (33 patients).

A review by two board-certified, fellowship-trained radiologists who were blinded to smoking or marijuana-use history, completed consensus reading of chest CTs for the study group.

Based on their analysis, they determined 75 percent of main-group marijuana smoking patients had greatly elevated rates of emphysema compared with 5 percent of main-group control patients. Rates were even higher among the age-matched subgroup where 93 percent of marijuana smokers and 66 percent of tobacco-only smokers experienced significant increases in emphysema.

The team also identified a much higher proportion of paraseptal emphysema – compared to other types – in marijuana smokers. Of those individuals, 53 percent demonstrated paraseptal emphysema, while only 24 percent of tobacco-only smokers and 7 percent of non-smokers experienced it.

In addition to these findings, Murtha said, marijuana use was also linked to other conditions.

“Marijuana smoking is also associated with airways disease, including bronchial wall thickening, bronchiectasis, and bronchiolar mucoid impaction, in comparison to both the control group and tobacco-only group,” he said.

These findings can be significant, the team said, because legalization of and use of marijuana is changing.

“Given that marijuana use is increasing, particularly within nations, such as Canada, that have legalized the substance, it is important for us, as radiologists, to define specific findings associated with its consumption,” the team concluded.

Images show greater rates of emphysema in individuals who smoke marijuana than in those who smoke tobacco-only cigarettes or non-smokers.

Chest CT Shows More Emphysema in Marijuana Smokers

Welcome to Diagnostic Imaging’s Weekly Scan. I’m senior editor Whitney Palmer.

Before we get out our featured interview with Dr. Diana Miglioretti about a risk-based model designed to help providers prioritize which women to bring in for mammograms during a crisis, such as the COVID-19 pandemic, here are the top stories of the week.

Fetal cardiovascular MRI can be useful in providing information about congenital heart defects when echocardiography results are unclear, said a group of researchers in 

Although echocardiography is typically the tool of choice to catch these defects in utero, sometimes the acoustic window isn’t sufficient, leading to indeterminate images. In these cases, fetal CMR can provide useful details in 84 percent of cases, potentially impacting choices for mode of delivery, early postnatal care planning, and parental counseling. To determine how well fetal CMR performs, the team examined results from 31 fetuses with an average gestational age of 36 weeks between January 2017 and June 2020. Alongside that additional diagnostic information, the team determined the extra data bolstered parental counseling in 68 percent of cases.

Being a new radiologist can be difficult. You have to learn the ropes of your new practice, get to know your colleagues, and figure out how to handle the daily workload. It can be overwhelming – and, frankly, residency doesn’t necessary give you the skills you need navigate it all successfully. In an attempt to help you, a group of radiology experts from The Netherlands published a list of 10 survival tips this week in the 

Journal of the American College of Radiology

 They touched on finances, insurance, continuing medical education, setting boundaries, avoiding burnout, and more. Not only can these tips help the new radiologist, but they can also be good suggestions for how residency programs can improve how they prepare providers for the realities of clinical practice.

spoke with Dr. Diana Miglioretti, chief of biostatistics at the University of California-Davis School of Medicine, about the risk-based model she and her colleagues created. It is designed to help providers prioritize which women to bring in for screening mammography during times of crisis when resources and capacity are limited, such as during the COVID-19 pandemic. Here’s what she had to say about the impact of using such as model.

Videos

Fetal cardiac MRI and congenital heart defects; Survival tips for early radiology practice; Plus, Risk-based prioritization models for mammography during crises.

Diagnostic Imaging's Weekly Scan: April 2, 2021

Improvements in technology are fundamental to providing the highest level of patient care in radiology. To meet that goal, industry vendors are constantly developing new tools and equipment that provide better image quality, greater diagnostic potential, and significant improvements in comfort for both provider and patient.

 brings you the latest product offerings released each quarter, including details about product specifications and their potential impacts and benefits. This quarter, we bring you new products from Hologic, Fujifilm, Canon Medical Systems, Siemens Healthineers, Carestream, Philips Healthcare Solutions, and GE Healthcare.

Diagnostic Imaging's Radiology Product Showcase: Quarter 1 2021

Slideshows

The latest products released on the market for Quarter 1 2021.

A 35-year-old man presents with intermittent painful inflamed, swollen joints, that worsen during sleep. What does the hand X-ray show?

 Multiple well defined punched out erosive lesions with sclerotic changes in a juxta-articular pattern are visualized via X-ray. Over-hanging edges, sometimes known as rate-bite erosions, are seen at these locations. 

Surrounding soft tissues may demonstrate pathogomonic tophi which appear as opacities adjacent to the joint spaces on radiograph. Joint effusions can be seen. The joint space is intact in earlier stages of disease, but, in late-stage disease, there is joint space narrowing.

What is your diagnosis from this hand X-ray?

Image IQ Quiz: Patient Presents with Swollen Joints

Taking those first steps into actual radiology practice after finishing up residency or a fellowship can be daunting. There are plenty of challenges ahead and being able to manage the workload is only one of them.

But, it is possible for you, as a new radiologist, to set yourself up for success. In an opinion article published March 31, in the 

four veteran providers offered up 10 tips that can make the transition easier. Their goal was providing guidance not routinely found in residency programs.

“Residents may not be well prepared for their first job as a radiologist,” said the group led by Thomas C. Kwee, M.D., Ph.D., from the University of Groningen in The Netherlands. “We composed a top 10 list…our purpose was to fill in some important practical knowledge gaps that are typically not addressed in traditional residency programs.”

Kwee was joined by Ömer Kasalak, M.D., Ph.D., Derya Yakar, M.D., Ph.D., all from the University of Groningen, and Robert M. Kwee, M.D., Ph.D., from Zuyderland Medical Center in The Netherlands.

For a smoother move into practice, here’s what they suggested:

Be sure a new work environment is a good fit for your competencies and interests, as well as your future career goals for advancement. Inquire about it during interviews and expect interviewers to ask you about your preferences.

“Matching realistic expectations is the key for success and satisfaction from both sides,” they said.

 It can feel awkward to go over your contract with a fine-tooth comb before signing, but it’s critical that you do. Remember, oral agreements are not legally binding. Even if the job market is tight, check the contract and be willing to enter into negotiations – it can help you sidestep future regrets. If the contract is complex, consider engaging help from a legal or financial advisor.

 Although you hope to never have to use it, it is vital to have appropriate medical liability insurance. Research medical malpractice policies before choosing one, and be sure whatever policy you select offers clear parameters around the local medico-legal and compensation culture and the risk you have of becoming a defendant. In addition, the group said, new radiologists should also consider occupational disability and term life insurance policies.

 Unfortunately, most radiology residency programs do not offer any guidance in financial competency even though 76 percent of medical school students carry significant debt upon graduation. To help mitigate this stress, consider hiring a financial advisor. It would also be helpful, they said, for radiology residents to consider optional financial literacy courses prior to graduation.

 New employees are always more closely watched to see if they’re performing well and fitting in. It’s normal, so expect it. Your new colleagues will be analyzing how well you can carry the workload, whether you fit in with the culture of the office, and whether you can positively contribute to the practice.

“Being under the magnifying glass may introduce additional stress,” they said, “but, it can be considered an inevitable process one has to go through, for which one needs to be mentally prepared.”

 As with other professions, new radiologists frequently work overtime to manage workloads and learn processes that are critical to the job. Consequently, it’s no surprise that the earlier years as a practicing provider – typically the under-40 crowd – are fraught with burnout. Stay aware – know the symptoms, self-reflect, and look for solutions quickly when you see or feel evidence of problems.

 Mistakes are inevitable, but knowing where you might be vulnerable can help. If you’re nervous about becoming the “final read,” improve your knowledge about error prevention. It can also be helpful for relatively new supervising radiologists to conduct independent reviews before evaluating a resident’s interpretation, potentially reducing any erroneous agreements.

 New radiologists are frequently tasked with teaching residents, but residency programs do not offer teaching courses. This makes it harder for you to handle instances where residents don’t perform well.

“It is highly recommended for newly starting radiologists who have a residency program in their department to pursue dedicated teaching courses early on in their career,” the group suggested.

 Keep an eye out for co-workers who will readily exploit your unfamiliarity with your new work environment. They might make unreasonable work requests or ask for a disproportionate amount of favors. Do your best not to give in, the group said.

“The best tactic is to avoid toxic personalities and to clearly indicate boundaries, non-engagement, and intolerance to unjust behavior,” they said. “Unprofessional behaviors need to be reported to leadership or human resources.”

 Re-accreditation is required to maintain your license, but finding time to work it into your schedule can be difficult. Do your due diligence – research what you must do to fulfill these requirements, confirm how long they will take, and mark off time on your calendar. Be sure to do this in a timely manner to avoid any problems.

In addition to being a guide for new graduates, the group said, these tips can also be of value to senior radiologists who serve as mentors, as well as to residency programs looking to augment their training.

“Most of these survival tips can be addressed well in advance before embarking on a new job as a radiologist,” they said, “and the others can be applied on the job.”

What residency doesn’t teach you, but that you need to know for your practice.

For the New Rad: 10 Survival Tips

Nines Radiology announced Tuesday it has received 510(k) clearance from the U.S. Food & Drug Administration (FDA) for its new lung nodule measurement tool, NinesMeasure™.

Built using artificial intelligence (AI), this tool is designed to facilitate rapid diagnosis of respiratory conditions. Its development is also unique, said company officials.

“To our knowledge, NinesMeasure is the only lung nodule measurement tool cleared by the FDA that was developed by a combined team of radiologists and engineers collaborating every day,” said Michael Kelleher, M.D., Nines Radiology president, noting that radiologists are paired with house engineers for development. “This advanced tool can significantly reduce the amount of time our radiologists spend measuring pulmonary nodules, improving time to diagnosis for patients without rushing our radiologists.”

This marks the Silicon Valley-based company’s second FDA clearance in 10 months, following its AI-based technology that triages mass effect conditions and intracranial hemorrhages.

According to company data, NinesMeasure is designed to help radiologists measure nodules along the long and short axes quickly and with high accuracy. It can also help providers address inter-study consistency throughout a patient’s treatment.

With this clearance, Nines also augmented its product offerings that have led to significant improvements in non-diagnostic workflow and fewer distractions by administrative tasks, the company said. On average, they said, the company’s focus on improving clinical workflow has led to a 40-percent gain in efficiency for radiology customers.

510(k) clearance has been awarded to artificial intelligence-based tool designed to accelerate respiratory disease diagnosis.

FDA Clears Lung Nodule Measurement Tool from Nines Radiology

Pediatric Patient Presents with Foot Finding

- The adult counterpart is termed Mueller-Weiss Syndrome.

- This disease typically affects between ages 4 and 6. It is self-limited and heals spontaneously,    often with navicular re-ossification and reconstitution.

- The etiology thought to be due to a vascular insult.

What is your diagnosis for a pediatric patient who presents with findings on a foot radiograph?

Image IQ Quiz: Pediatric Patient Presents with Foot Finding

Leading radiology practice Radiology Partners (RP) announced Tuesday it has created an Office of the Chief Medical Officer and has named 13 providers to serve.

The launch of the office is an opportunity for these leaders within the practice to further promote the organization’s mission to transform the specialty through improvements in operations, integrations, communications and health policy, artificial intelligence, technology and data, provider experience, research and education, recruitment, and growth.

“Establishing a radiologist-led Office of the Chief Medical Officer is an exciting step that will further amplify the voices of radiologist leaders both internally and externally,” said Rich Whitney, RP chair and chief executive officer. “This step-function increase in investment in radiologist leadership is reflective of our core values and represents continued progress on our journey building a transformative radiology practice that is delivering clinical value to our patients and the healthcare system overall.”

The intent of the office, according to a practice statement, is in line with RP’s mission of being physician-led. The CMO office will include:

Frank Castellano, M.D.,James Lyons, M.D.

 will serve as the associate CMOs for clinical operations for the Midwest, West and Southeast Regions, respectively.

) will serve as associate CMOs for integration.

) will serve as the associate CMO for communications and health policy.

) will serve as associate CMO for clinical artificial intelligence.

will serve as associate CMO of clinical technology and data.

) will serve as associate CMO for radiologist experience.

) will serve as associate CMO for clinical value.

) will serve as associate CMO for research and education.

will serve as associate CMO for recruitment.

 will serve as associate CMO for growth.

Move underscores practice’s foundation of being physician-led.

Radiology Partners Unveils New CMO Office, Names 13 Leaders

Throughout the COVID-19 pandemic, chest CT has gotten the most attention as the imaging option for detection, but a new study shows that, when paired with artificial intelligence (AI), chest X-ray can provide near-perfect identification, potentially leading to clinical benefits in the future.

 researchers from Brazil revealed that using an automatic detection method to identify features extracted from chest X-rays can detect the virus with 95.6 percent-to-98.5 percent accuracy.

“Our results show that the use of convolutional neural networks to extract features, applying the transfer learning concept, and, then, classifying these features with consolidated machine learning methods is an effective way to classify X-ray images as in normal conditions or positive for COVID-19,” said the team led by Victor Hugo C. de Albuquerque, a researcher in the Laboratory of Image Processing, Signals, and Applied Computing with the Universidade de Fortaleza, noting that early detection is critical for preventing the spread of disease.

Samples from the dataset used in this study (a) X-ray with PA view of a patient with COVID-19; (b) X-ray with AP view of a patient with COVID-19; (c) X-ray of a healthy patient from Dataset A; (d) X-ray of a healthy patient from Dataset B.

Being able to provide an alternative to detection via chest CT is critical, Albuquerque said, because the modality isn’t always available in some medical facilities. In addition, test supply and processing can also be inadequate, making X-ray, which is readily available in every hospital, an attractive option.

But, to determine how effective AI-fueled chest X-rays are at detection, the team only had 194 publicly available COVID-19 X-rays and 194 X-rays from healthy individuals. To compensate for the small amount, they used a model previously trained on a large dataset of other X-rays and trained it to use strategies to identify which lungs were infected with the virus. The top two machine learning methods provided those levels of near-perfect accuracy.

“Since X-rays are very fast and cheap, they can help to triage patients in places where the healthcare system has collapsed or in places that are far from major centers with access to more complex technologies,” Albuquerque said. “This approach to detect and classify medical images automatically can assist doctors in identifying, measuring the severity and classifying the disease.”

The team did note, however, that this proposed method has yet to go under clinical study and requires a more thorough investigation with a larger dataset. Consequently, while it cannot replace a medical diagnosis, it does contribute to the push toward using chest X-rays for faster, automatic, accurate COVID-19 diagnosis.

The ultimate goal, they said, is to develop a free online platform for medical image classification.

Pairing machine learning methods with chest X-rays can potentially improve viral detection in areas where access to swab testing and chest CT scans is inadequate.

AI-Fueled Chest X-ray Can Provide Near-Perfect COVID-19 Identification

Fewer than 40 percent of American Indian women adhere to regular screening mammography, a proportion vastly lower than the U.S. population of women from all races.

In a poster presentation during the Society of Breast Imaging/American College of Radiology 2021 Virtual Annual Meeting, Nicole Honey, a medical student from the University of Michigan Medical School revealed that only 38.7 percent of American Indian women were mammography adherent. And, reaching even this level could be difficult without the use of mobile mammography units.

For other Society of Breast Imaging conference coverage, click 

“This American Indian population is far below recommended rates of screening at recommended intervals,” she said in her poster, noting that, existing data shows 72.8 percent of women of all races have undergone screening mammography within the last two years. “Without mobile mammography, screening may be less.”

Honey based her research on the performance of an Indian Health Service mobile mammography unit that traveled more than 4,500 miles to provide screening services to 22 predominantly rural Indian Health Services clinics across four states between 2013 and 2017. She compared the adherence of American Indian women to screening data from the American College of Radiology National Mammography Database (NMD).

She defined adherence for both groups as a previous mammogram within 9 months to 27 months before the mobile mammography visit. Non-adherence was no previous mammogram or a prior scan from more than 27 months.

For the study, she included 1,616 American Indian women between ages 42 and 87, as well as 2,509,826 women between ages 42 and 80 from the NMD. According to her analysis, 625 American Indian women (38.7 percent) were adherent compared to the 1,481,021 women (59 percent) included in the NMD. Consequently, the non-adherence rate among American Indian women was 1.5 times that of NMD patients – 61.3 percent versus 41 percent, respectively.

In addition, she found that, among non-adherent women, more American Indian women than NMD women – 43.7 percent and 21.7 percent, respectively – had a prior mammogram more than 27 months before the study. Baseline mammogram rates were similar for both groups – 34.5 percent and 32.1 percent.

The screening mammography non-adherence rate among American Indian women is 1.5 times that of the overall population.

Mobile Mammography May Be Critical for Screenings in American Indian Women

Ten years after Connecticut passed the first breast density notification law, approximately three-quarters of women with dense breasts now opt to undergo supplemental whole-breast ultrasound screening.

In a poster presentation during the Society of Breast Imaging/American College of Radiology 2021 Virtual Annual Meeting, Liane Philpotts, M.D., FACR, professor of radiology and biomedical imaging at Yale School of Medicine, outlined her department’s experience with breast density laws.

For more Society of Breast Imaging conference coverage, click 

Currently 38 states have breast density notification laws, and a federal law is anticipated soon. Her department started offering screening whole-breast ultrasound (WBUS) in 2009 with the state first passed the law.

“Our policy has been to inform women of density (as per Connecticut law) and offer, but not explicitly recommend WBUS, leaving it to the patient and provider to decide,” said Philpotts, who is also section chief of breast imaging.

To help practices in the early stages of adopting supplemental screening, her team assessed the percentage of women with dense breasts who have opted to undergo supplemental WBUS.

By searching an electronic breast imaging database, Philpotts team identified women with dense breast tissue who had screening mammography performed at either a main academic tertiary hospital or three outpatient satellite offices. They also identified women who underwent bilateral WBUS after a normal, same-day screening mammogram. They compared the number of patients from July 1 to July 31 of each year between 2010 and 2019.

Based on her team’s analysis, screening mammography volume increased 3.5 times across practice sites over the decade. The first year, only 18 percent of women underwent WBUS, but the increase was steady on a year-by-year basis, growing to 28 percent by year two and climbing all the way to 75 percent each year of the past few years, she said.

These results show that the dense breast notification laws could be having some positive impact, she said.

“While initial uptake was low, after a few years, the majority of women with dense breasts undergoing mammography also undergo WBUS,” she said. “This suggest the acceptance of the supplemental screening test is high among both providers and women.”

After a decade, roughly 75 percent of women with dense breasts seen in one department now undergo screening whole-breast ultrasound as a supplemental imaging service.

10 Years Later: Dense Breast Notification Letters Result in Higher Supplemental Ultrasound Screening

Ultrasound should not be offered up for pediatric patients who experience breast pain without an accompanying palpable mass, new research indicates.

In a poster presentation during the Society of Breast Imaging/American College of Radiology 2021 Virtual Annual Meeting, Lauren K. Hinojosa, M.D., a diagnostic radiology resident at the University of Texas Southwestern Medical Center provided evidence that pointed to a minimized role for ultrasound.

“Pediatricians should be advised to offer reassurance rather than imaging in cases of breast pain without a palpable mass,” she said. “Pediatric breast pain should not contribute to a recommendation for biopsy following breast ultrasound.”

In a retrospective study, she examined radiology reports and medical records from 310 patients under age 18 – 271 females and 39 males – who underwent breast ultrasound for breast pain between Jan. 2, 1010, and Dec. 31, 2017. The average age was 13, and 41 percent reported right-sided pain, 39 percent presented with left-sided pain, and 19 percent had bilateral discomfort.

Most patients – 65 percent – reported focal pain, and the duration of pain varied. Roughly 23 percent had experienced pain for less than a week, 13 percent between one-to-three weeks, 21 percent between one-to-six months, and 6 percent reporting between one-to-three years.

What to Know About Pediatric Breast Ultrasound

While 196 patients (63 percent) had a palpable mass, 146 cases (47 percent) showed no sonographic correlate to the symptoms. In addition, 146 cases had benign correlates with the most common being asymmetric breast bud and benign-appearing mass. However, 18 cases (6 percent) did have a sonographic mass that could not be categorized as benign, six of which went to biopsy which revealed benign pathology, she said.

Based on these results, Hinojosa said, ultrasound did not uncover any malignancy, and biopsies in the 2 percent of cases sent for further evaluation yielded the same results.

It is important to note, she said, that no formal guidelines for managing imaging findings on pediatric breast ultrasound exist, and BI-RADS classifications are likely to over-state malignancy risk in this population. Consequently, she reiterated the need for reassurance with patients over pursuing imaging.



Pediatric breast ultrasound use should be minimized for patients with breast pain but not a palpable mass.



For Pediatric Breast Pain -- Choose Reassurance, Not Imaging

Using pre-operative MRI can help providers identify which patients could be at increased risk for post-operative ischemic complications following nipple-sparing mastectomy (NSM), according to newly presented research.

During the Society of Breast Imaging/American College of Radiology 2021 Virtual Annual Meeting, Natalie Ultey, a medical student from Georgetown University School of Medicine, shared details of how using these images can help with patient counseling and surgical planning.

“Nipple sparing mastectomy is a growing surgical option for patients undergoing mastectomy in both the oncologic and prophylactic setting,” she said. “Nipple sparing mastectomy is associated with improved patient satisfaction and has a similar low recurrence rate compared to skin-sparing mastectomy.”

However, between 5.9 percent and 15 percent of patients who undergo NSM experience ischemia and nipple necrosis. To determine whether pre-operative imaging could alert providers to which patients might develop these problems, Utley conducted a retrospective review on women who underwent pre-operative breast MRI and mammography before NSM between 2015 and 2020. Most of the patients included – 68.8 percent – were white, and 16.8 percent were African American.

For the study, she reviewed records from 125 patients who underwent 220 mastectomies – 33.2 percent for invasive cancer, 30 for ductal carcinoma in situ, and 53.2 percent for prophylactic reasons. Within this group, 10 cases of nipple necrosis (4.5 percent) developed in eight patients. In addition, 21 patients experienced 28 cases of post-operative ischemia (12.7 percent) with 19 cases (8.6 percent that occurred in 14 patients being considered major ischemia that required surgical intervention.

Most cases of ischemic complications were identified in patients who had a mild background of parenchymal enhancement (23.9 percent) – and additional 20 percent with minimal background parenchymal enhancement also experienced the complication. Patients with marked background parenchymal enhancement experienced major ischemia. Additionally, 80 percent of nipple necrosis cases occurred in patients with mild background parenchymal enhancement.

Her analysis also showed that all nipple necrosis and major ischemia presented in patients with scattered and hetereogenous fibroglandular tissue. Necrosis cases also developed in patients with minimal and mild nipple enhancement compared to the ipsilateral background parenchymal enhancement of MRI.

The record review also showed that African American women were disproportionately affected by these problems – they accounted for 50 percent of nipple necrosis cases, as well as 36.8 percent of major ischemic complications.

“There is a correlation between the pre-operative breast MRI imaging features of background parenchymal enhancement and the fibroglandular tissue and both post-operative major ischemic changes and nipple necrosis,” Utley concluded.

Images can pinpoint which women are at risk for ischemia and nipple necrosis.  

Pre-Operative Breast MRI Can Help Identify Patients Likely to Experience Nipple-Sparing Mastectomy Risks

Recent research has shed light on the low utilization rate for low-dose CT lung cancer screening, but there’s been little investigation into what might drive adherence to annual screening and what might keep people away.

 on March 30, investigators from the University of Colorado Anschutz Medical Campus took a deep dive into insurance claims and found that age, geographic location, and type of insurance coverage can keep at-risk patients from getting screened on a yearly basis.

“The State of Lung Cancer”: Single-Digit Low-Dose CT Screening and Significant Outcomes Disparities

“Quantifying population-based adherence rates and understanding factors associated with annual adherence is a critical first step in improving screening adherence and ultimately reducing lung cancer death,” said the team led by Stephen P. Malkoski, M.D., Ph.D., associate clinical professor of medicine, pulmonary sciences, and critical care.

Even though current data shows that survival rates for lung cancer detected at earlier stages is 55 percent, reports of real-world screening compliance outside of clinical trials show between 37 percent and 66 percent adherence, the team said. This is the first study to examine insurance claims data to identify factors that influence adherence rates.

For retrospective their study, Malkoski’s team evaluated 9,056 claims records from the Colorado All Payer Claims Dataset of people who had undergone screening with low-dose CT. Of the group 3,072 were adherent patients, 3,570 were non-adherent patients, and 2,414 patients couldn’t be classified. The team defined adherence as a second screening claim filed within 10 months-to-18 months of the initial claim.

Overall, when using the 18-month definition, they found 46-percent adherence. It increased to 53 percent if any second claim timeframe was considered adherence. Of the patients who came in for a second screening, 50 percent continued their adherence.

More specifically, the team determined that patients between ages 55 and 64, as well as those between ages 75 and 79 had a 20-percent adherence reduction.

USPSTF Updates Recommendation for LDCT Lung Cancer Screening

“Reduced adherence among older individuals is likely explained by multiple recommendations to stop [lung cancer screening] as individuals reach their mid-70s, and an increasing proportion of patients who may have a shorter life expectancy and hence derive less screening benefit,” they said. “Younger individuals are less likely to receive preventive services than individuals over 65 and may have competing time priorities and misperceptions about screening cost.”

If patients lived in rural areas, Malkoski’s team found they had a 44-percent drop in adherence compared to urban residents, despite having higher rates of smoking. In addition, individuals with Medicare fee-for-service and Medicaid had a 45-percent adherence reduction over those with Medicare Advantage.

The team also found that outpatients who had no co-morbidities were slightly more likely to adhere to annual screening.

“That the association between adherence and healthcare utilization was most pronounced in individuals with no co-morbidities may suggest that healthcare utilization alone is associated with higher adherence to preventive services,” they explained.

No association was found between adherence and gender.

These results could be used to pinpoint populations that could benefit from specific interventions designed to increase adherence and maximize the benefit of lung cancer screening efforts. These interventions, which have been successful with breast, colon, cervical, and prostate cancer screening adherence, could include dedicated program coordinators, patient reminders, and mobile screening for rural residents.

Results show screening adherence is low among patients who could benefit most from scans.