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pulmonary nodule guidelines

Yaron B Gesthalter, Elisa Koppelman, Rendelle Bolton, Christopher G Slatore, Sue H Yoon, Hilary C Cain, Nichole T Tanner, David H Au, Jack A Clark, Renda Soylemez Wiener
BACKGROUND: Guidelines recommend lung cancer screening and it is currently being adopted nationwide. The American College of Chest Physicians advises inclusion of specific programmatic components to ensure high-quality screening. However, little is known about how lung cancer screening has been implemented in practice. We sought to evaluate the experience of early-adopting programs, characterize barriers faced, and identify strategies to achieve successful implementation. METHODS: We performed qualitative evaluations of lung cancer screening implementation at three Veterans Health Administration facilities, conducting semi-structured interviews with key staff (n=29)...
February 18, 2017: Chest
Shengyu Hao, Fei Long, Fenglan Sun, Teng Liu, Daowei Li, Shujuan Jiang
BACKGROUND: The Birt-Hogg-Dubé (BHD) syndrome is a very rare autosomal dominant form of genodermatosis caused by germline mutations in the folliculin (FLCN) gene, which is mapped to the p11.2 region in chromosome 17. BHD commonly presents cutaneous fibrofolliculomas, pulmonary cysts, renal cell carcinoma, and recurrent pneumothoraxes. The disease is easily ignored or misdiagnosed as pneumothorax, pulmonary lymphangiomyomatosis (LAM), or emphysema. Follow-up and guidelines for managing recurrent pneumothoraxes in these patients are lacking...
February 21, 2017: BMC Pulmonary Medicine
Linda S Kinsinger, Charles Anderson, Jane Kim, Martha Larson, Stephanie H Chan, Heather A King, Kathryn L Rice, Christopher G Slatore, Nichole T Tanner, Kathleen Pittman, Robert J Monte, Rebecca B McNeil, Janet M Grubber, Michael J Kelley, Dawn Provenzale, Santanu K Datta, Nina S Sperber, Lottie K Barnes, David H Abbott, Kellie J Sims, Richard L Whitley, R Ryanne Wu, George L Jackson
Importance: The US Preventive Services Task Force recommends annual lung cancer screening (LCS) with low-dose computed tomography for current and former heavy smokers aged 55 to 80 years. There is little published experience regarding implementing this recommendation in clinical practice. Objectives: To describe organizational- and patient-level experiences with implementing an LCS program in selected Veterans Health Administration (VHA) hospitals and to estimate the number of VHA patients who may be candidates for LCS...
January 30, 2017: JAMA Internal Medicine
Nichole T Tanner, Alexander Porter, Michael Gould, Xiao-Jun Li, Anil Vachani, Gerard A Silvestri
BACKGROUND: The annual incidence of pulmonary nodules is estimated at 1.57 million. Guidelines recommend utilizing an initial assessment of nodule probability for malignancy (pCA). A previous study found that despite this recommendation, physicians did not follow guidelines. METHODS: Physician (n= 337) and two previously validated risk model assessment of cancer pre-test probability were evaluated for performance in 337 patients with pulmonary nodules based on final diagnosis and compared...
January 20, 2017: Chest
Uroosa Ibrahim, Amina Saqib, Farhan Mohammad, Terenig Terjanian
Nocardiosis is a rare cause of opportunistic infection post hematopoietic stem cell transplant (HSCT) occurring in about 0.3% of patients. The risk factors include delayed immune reconstitution, prolonged neutropenia, and graft-versus-host disease. The most common site of infection is the lung, followed by the brain and the skin. Concomitant pulmonary and central nervous system (CNS) nocardiosis is an extremely rare entity as presented in our case. We present the case of a 72-year-old male at 137 days post transplant presenting with complaints of headache and slurred speech...
October 17, 2016: Curēus
Jennifer S McDonald, Chi Wan Koo, Darin White, Thomas E Hartman, Claire E Bender, Anne-Marie G Sykes
RATIONALE AND OBJECTIVES: The study aimed to determine whether the addition of the Fleischner Society guidelines to chest computed tomography (CT) reports identifying incidental pulmonary nodules affects follow-up care. PATIENTS AND METHODS: Beginning in 2008, a template containing the Fleischner Society guidelines was added at the interpreting radiologist's discretion to chest CT reports describing incidental solid pulmonary nodules at our institution. The records of all medical centers in Olmsted county were used to capture the complete medical history of local patients >35 years old diagnosed with a pulmonary nodule from April 1, 2008 to October 1, 2011...
March 2017: Academic Radiology
Thomas Ebenhan, Isabel Schoeman, Daniel D Rossouw, Anne Grobler, Biljana Marjanovic-Painter, Judith Wagener, Hendrik G Kruger, Mike M Sathekge, Jan Rijn Zeevaart
PURPOSE: Radiopharmaceuticals containing the motive tripeptide arginyl-glycyl-asparatic acid (RGD) are known to target ανβ3 integrins during tumor angiogenesis. A more generic kit radiolabeling procedure accommodating Ga-68 from different generators was developed for NOTA-RGD and evaluated for its versatile use and safety in subsequent in vivo applications. The [(68)Ga]NOTA-RGD kit was further verified for its expected biodistribution and pharmacokinetics in nonhuman primates and its clinical sensitivity to detect solitary pulmonary nodules (SPN) in cancer patients...
October 14, 2016: Molecular Imaging and Biology: MIB: the Official Publication of the Academy of Molecular Imaging
Simone Perandini, G A Soardi, A R Larici, A Del Ciello, G Rizzardi, A Solazzo, L Mancino, F Zeraj, M Bernhart, M Signorini, M Motton, S Montemezzi
OBJECTIVES: To achieve multicentre external validation of the Herder and Bayesian Inference Malignancy Calculator (BIMC) models. METHODS: Two hundred and fifty-nine solitary pulmonary nodules (SPNs) collected from four major hospitals which underwent 18-FDG-PET characterization were included in this multicentre retrospective study. The Herder model was tested on all available lesions (group A). A subgroup of 180 SPNs (group B) was used to provide unbiased comparison between the Herder and BIMC models...
September 15, 2016: European Radiology
Alissa S Marr, Chi Zhang, Apar Kishor Ganti
Small cell lung cancer (SCLC) often presents with either regional or systemic metastases, but approximately 4% of patients present with a solitary pulmonary nodule. Surgical resection can be an option for these patients and is endorsed by the National Comprehensive Cancer Network (NCCN) guidelines. There are no prospective randomized clinical trials evaluating the role of adjuvant systemic therapy in these resected SCLC patients. A recent National Cancer Database analysis found that the receipt of adjuvant chemotherapy alone [hazard ratio (HR), 0...
August 2016: Journal of Thoracic Disease
Sonali Sethi, Scott Parrish
Indeterminate pulmonary nodules are commonly encountered and often result in costly and invasive procedures that eventually turn out to be unnecessary. Current prediction models can help to estimate the pretest probability of cancer and assist in determining a strategy of observation with serial imaging for a low pretest probability of cancer, and a more aggressive approach for those patients with a high pretest probability. However, the majority of patients will have an intermediate pretest probability which becomes complex...
July 2016: Journal of Thoracic Disease
James T Dobbins, H Page McAdams, John M Sabol, Dev P Chakraborty, Ella A Kazerooni, Gautham P Reddy, Jenny Vikgren, Magnus Båth
Purpose To conduct a multi-institutional, multireader study to compare the performance of digital tomosynthesis, dual-energy (DE) imaging, and conventional chest radiography for pulmonary nodule detection and management. Materials and Methods In this binational, institutional review board-approved, HIPAA-compliant prospective study, 158 subjects (43 subjects with normal findings) were enrolled at four institutions. Informed consent was obtained prior to enrollment. Subjects underwent chest computed tomography (CT) and imaging with conventional chest radiography (posteroanterior and lateral), DE imaging, and tomosynthesis with a flat-panel imaging device...
January 2017: Radiology
N Ose, H Maeda, Y Takeuchi, Y Susaki, Y Kobori, S Taniguchi, R Maekura
BACKGROUND: In some patients, non-tuberculous mycobacteria (NTM) infections manifest in solitary nodules (solitary nodular [SN] type) generally caused by Mycobacterium avium complex (MAC). In patients treated using surgical resection, the American Thoracic Society guidelines state that postoperative chemotherapy is not necessary in the absence of lesions, although there have been a few reports of such cases. METHODS: Twenty-eight patients diagnosed with NTM who underwent solitary pulmonary nodule resection at Toneyama Hospital, Osaka, Japan, between January 2000 and October 2012 were enrolled...
August 2016: International Journal of Tuberculosis and Lung Disease
Moulay Ali Nassiri, Manon Rouleau, Philippe Després
Many studies have shown a statistically significant increase of life-time risk of radiation-induced cancer from CT examinations. In this context, in Canada, the Quebec's provincial clinical center of expertise in radiation safety (CECR) has led a province-wide tour of 180 CT installations in order to: (i) evaluate the technical and functional performance of CT scanners, (ii) evaluate and improve radiation safety practices and (iii) initiate, with local teams, a CT dose optimization process. The CT tour consisted of a two day visit of CT installations by a CECR multidisciplinary team of medical physicists, engineers and medical imaging technologists (MITs) carried out in close collaboration with local teams composed of MITs, radiologists, physicists, engineers and managers...
June 6, 2016: Journal of Radiological Protection: Official Journal of the Society for Radiological Protection
David Seidenwurm, Frank James Lexa
Bundled or episode payments are among the most heavily emphasized approaches to aligning incentives and promoting care coordination, efficiency, and accountability in health care redesign. Bundled or episode payments price a market basket of services for an entire episode of care with both a clearly defined trigger and termination. Because the radiologist is "ancillary" in many bundles, the specialty is often unaware of the phenomenon. This is likely to change rapidly. Radiology is pivotal in high-prevalence, high-impact care areas such as low back pain and stroke that are focuses of widely used system performance metrics...
September 2016: Journal of the American College of Radiology: JACR
Lars Henning Schmidt, Benedikt Vietmeier, Gerrit Kaleschke, Christoph Schülke, Dennis Görlich, Christoph Schliemann, Torsten Kessler, Arik Bernard Schulze, Boris Buerke, Andreas Kuemmel, Michael Thrull, Rainer Wiewrodt, Helmut Baumgartner, Wolfgang E Berdel, Michael Mohr
BACKGROUND: Transcatheter aortic valve implantation (TAVI) has become the treatment of choice in patients with severe aortic valve stenosis who are not eligible for operative replacement and an alternative for those with high surgical risk. Due to high age and smoking history in a high proportion of TAVI patients, suspicious findings are frequently observed in pre-procedural chest computer tomography (CCT). METHODS: CCT scans of 484 consecutive patients undergoing TAVI were evaluated for incidentally discovered solitary pulmonary nodules (SPN)...
2016: PloS One
Chee K Phua, Wen Y Sim, Kuan Sen Tee, Sennen J W Lew, Albert Y H Lim, Dessmon Y H Tai, Soon Keng Goh, Ai Ching Kor, Alan W K Ng, John Abisheganaden, Akash Verma
BACKGROUND: American College of Chest Physicians (ACCP) provides guidelines to manage pulmonary nodules. Pulmonary nodules however can be malignant or benign. Similar incidence of tuberculosis (TB) and lung cancer in Asian countries raises concern over the relevance of suggested guidelines in Asian population. There is little data on the pattern of clinical practice in the management of pulmonary nodules in Asian country (Singapore). Our study describes the current pattern of clinical practice in this area highlighting the variation in practice and discussing the potential reasons...
May 2016: Journal of Thoracic Disease
Erika M Moseson, Renda Soylemez Wiener, Sara E Golden, David H Au, John D Gorman, Amber D Laing, Mark E Deffebach, Christopher G Slatore
RATIONALE: Many patients are diagnosed with small pulmonary nodules for which professional societies recommend subsequent imaging surveillance. Adherence to these guidelines involves many steps from both clinicians and patients but has not been well studied. OBJECTIVES: In a health care setting with a nodule tracking system, we evaluated the association of communication processes and distress with patient and clinician adherence to recommended follow up and Fleischner Society guidelines, respectively...
May 2016: Annals of the American Thoracic Society
David R Baldwin
The British Thoracic Society guideline on the investigation and management of pulmonary nodules is based on a comprehensive and systematic review of the literature on pulmonary nodules. Recent evidence has suggested that significant changes to existing guidelines are necessary. The use of 2 malignancy prediction calculators to better characterize the risk of malignancy was firmly supported by evidence, as were the recommendations for a higher nodule size threshold for follow‑up (≥5 mm or ≥80 mm3) and a reduction of the follow‑up period to 1 year for solid pulmonary nodules...
April 26, 2016: Polskie Archiwum Medycyny Wewnętrznej
Onno M Mets, Pim A de Jong, Kaman Chung, Jan-Willem J Lammers, Bram van Ginneken, Cornelia M Schaefer-Prokop
OBJECTIVES: The aim of this study was to assess awareness and conformance to the Fleischner society recommendations for the management of subsolid pulmonary nodules (SSN) in clinical practice. METHODS: An online questionnaire with four imaging cases was sent to 1579 associates from the European Respiratory Society and 757 from the European Society of Thoracic Imaging. Each respondent was asked to choose from several options which one they thought was the indicated management for the nodule presented...
November 2016: European Radiology
Chunxue Bai, Chang-Min Choi, Chung Ming Chu, Devanand Anantham, James Chung-Man Ho, Ali Zamir Khan, Jang-Ming Lee, Shi Yue Li, Sawang Saenghirunvattana, Anthony Yim
BACKGROUND: American College of Chest Physicians (CHEST) clinical practice guidelines on the evaluation of pulmonary nodules may have low adoption among clinicians in Asian countries. Unique patient characteristics of Asian patients affect the diagnostic evaluation of pulmonary nodules. The objective of these clinical practice guidelines was to adapt those of CHEST to provide consensus-based recommendations relevant to practitioners in Asia. METHODS: A modified ADAPTE process was used by a multidisciplinary group of pulmonologists and thoracic surgeons in Asia...
October 2016: Chest
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