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Abstract Purpose To assess the feasibility of using CT to correct specific uptake values (SUVs) for fluorodeoxyglucose (FDG) in patients with nonsolid nodules. Methods Patients with FDG-PET/CT and thin-section CT were included in this pilot study. Thirty-five adenocarcinomas manifesting as nonsolid nodules were classified into two groups; 90–100% and 1–89% lepidic component. SUVmax was corrected based on the CT determination of the proportion of soft tissue component within the cancer (SUVatt). Results Both SUVmax and SUVatt increased as the percentage of the lepidic component decreased. SUVmax and SUVatt were significantly different between the groups. Conclusion Extent of invasiveness of nonsolid cancers (as a marker of aggressiveness) can potentially be quantified by PET/CT using a correction method that accounts for the proportion of soft tissue within the tumor. Highlights • SUVatt is the ratio of SUVmax to the proportion of soft tissue within the tumor. • SUVatt reflected tumor activity without being diluted by remaining air in the alveoli. • SUVmax and SUVatt increased as the percentage of the lepidic component decreased. • SUVatt fell within range of expected values for relatively indolent adenocarcinoma. • Aggressiveness of nonsolid cancers can be quantified by PET-CT after correction. [ABSTRACT FROM AUTHOR]

Detection of small pulmonary nodules has markedly increased as computed tomography (CT) technology has advanced and interpretation evolved from viewing small CT images on film to magnified images on large, high-resolution computer monitors. Despite these advances, determining the etiology of a lung nodule short of major surgery remains problematic. Initial nodule size is a major criterion in evaluating the risk for malignancy, and the majority of CT detected nodules are <10 mm in diameter. Also, the likelihood that the nodule is a lung cancer increases with increasing age and smoking history, and such clinical information needs to be integrated into algorithms that guide the workup of such nodules. Baseline and annual repeat screening results are also very helpful in developing and assessing the usefulness of such algorithms. Based on CT morphology, subtypes of nodules have been identified; today nodules are routinely classified as being solid, part-solid, or nonsolid. It has been shown that part-solid nodules have a higher frequency of being malignant than solid or nonsolid ones. Other nodule characteristics such as spiculation are useful, although granulomas and fibrosis also have such features, so these characteristics have not been as useful as nodule-growth assessment. Depending on the aggressiveness of the lung cancer and the size of the nodule when it is initially seen, a follow-up CT scan 1-3 months after the first CT scan can identify those nodules with growth at a malignant rate. Software has been developed by all CT scanner manufacturers for such growth assessment, but the inherent variability of such assessments needs further development. Nodule-growth assessment based on 2-dimensional approaches is limited; therefore, software has been developed for the 3-dimensional assessment of growth. Different approaches for such growth assessment have been developed, either using automated computer segmentation techniques or hybrid methods that allow the radiologist to adjust such segmentation. There are, however, inherent reasons for variability in such measurements that need to be carefully considered, and this, together with continued technologic advances and integration of the relevant clinical information, will allow for individualization of the algorithms for the workup of small pulmonary nodules. Mt Sinai J Med 78:882-893, 2011. © 2011 Mount Sinai School of Medicine [ABSTRACT FROM AUTHOR]

Abstract: Tube and line interpretation in portable chest radiographs was assessed using a new visualization method. When using the new method, radiologists'' interpretation time was reduced by 30% vs. standard modality processing and window and level (23 vs. 33 s). For pulmonary ICU physicians, reading time was essentially unchanged. There was more than a 50% reduction in the use of inferential language in the dictation for both reader groups when using the new method, suggesting greater interpretation confidence. [Copyright &y& Elsevier]

Abstract: Purpose: To assess the vascular component of small lung cancers. Material and methods: We identified 105 resected non-small-cell lung carcinomas without pathologic evidence of vascular, lymphatic, bronchial, or pleural invasion. The percentage of BAC (% BAC) of all adenocarcinomas was determined by a pulmonary pathologist. A representative histology slide of each carcinoma was digitally scanned and the number of blood vessels (#V) with at least a diameter of 200μm was identified as well as the area of these blood vessels (VA) and of the tumor (TA) was obtained. The CT consistency of the cancers was also recorded as non-solid (NS), part-solid (PS) and solid. Results: The number of blood vessels per cm2 of tumor area (#V/TA) was higher for adenocarcinoma (7.3±4.7) as compared with large- and squamous-cell carcinoma (3.6±2.1, 2.3±1.1, respectively, P <0.0001). For adenocarcinoma, #V/TA decreased with decreasing % BAC from 10.3 vessels per cm2 of tumor area for 100% BAC to 5.1 vessels per cm2 of tumor area for 0% BAC. The ratio of the total vascular area to tumor area (VA/TA), however, did not differ significantly by cell type nor for the adenocarcinoma by % BAC (P =0.87). While #V/TA decreased from 9.6 for non-solid nodules, to 7.5 for part-solid nodules and to 5.1 for solid nodules, there was no significant difference (P =0.27) in the VA/TA ratio by nodule consistency. Overall, VA comprised 2.7% of the total tumor area (TA) for 105 cancers. Conclusions: These results suggest that tumor vessels experience a continuous temporal and spatial remodeling as tumors grow and that bigger tumors tend to have fewer but larger blood vessels. It also suggests that, on average, squamous- or large-cell carcinomas have a larger average vessel diameter as compared with adenocarcinomas and that the vasculature of an adenocarcinoma might remodel as the % BAC decreases. The overall proportion of tumor volume comprised of vessels 200μm or larger is small and unlikely to influence overall tumor volume and doubling time estimates. [Copyright &y& Elsevier]

Discusses a study to assess the relationship between tumor size and disease stage at the time of diagnosis in non-small cell lung cancer. Identification of all cases of primary non-small cell lung cancer diagnosed prior to autopsy from the Surveillance, Epidemiology and End Results registry; Study's focus on 84,152 cases diagnosed in 1988 or later and documented as to tumor size and disease stage at diagnosis; Use of low-dose computed tomography as a way to diagnose early stage lung cancers; Distribution of disease stage within categories of tumor size; Indication that the smaller the tumor was, the more likely the disease was stage I; Conclusion that tumor size has substantial bearing on disease stage in non-small cell lung cancer.

Examines the merits of the articles by a group led by E.F. Patz Jr. and P.C. Goodman, concerning the fundamental presumption about low-dose computed tomography (CT) screening and the stage of lung cancer in relation to its size. Indication that small 5 to 10 millimeter lesions observed on CT have not metastasized, and that these lesions are very different from the 1 to 3 centimeter lesions detectable on chest radiographs; Suggestion that smaller lesions should have a very different, earlier stage distribution profile compared with larger lesions, which are presumed to have a more advanced stage distribution; Use of registry data; Type of registry used; Putative requirement; Implications and credibility; Group's failure to present evidence indicating that a relationship between tumor size and disease stage does not exist.

The purpose of this study was to characterize the diagnostic performance of a regimen of CT screening for lung cancer.Using a common protocol/regimen of screening, 2968 asymptomatic persons at high risk for lung cancer were enrolled in two studies [Early Lung Cancer Action Projects (ELCAP) I and II] for baseline and annual repeat screening. A total of 4538 annual repeat screenings were performed. The regimen''s diagnostic performance was characterized in terms of frequency of positive result of the initial CT as well as of screen-diagnosis and Stage I screen-diagnosis among all diagnoses (interim-diagnoses included), all separately for baseline and annual repeat screenings.The proportions with positive result of the initial CT were 12% and 6% in the baseline and repeat screenings, respectively. The proportions of screen-diagnoses among all diagnoses (interim-diagnoses included) were 97% and 99% in the baseline and repeat cycles, respectively. The corresponding proportions of pre-surgical Stage I screen-diagnoses were 95% and 93%.The performance of the ELCAP regimen is quite satisfactory in avoiding over many positive results of the initial CT, and it produces highly promising diagnostic results as for the attainment of cure by early intervention. [Copyright &y& Elsevier]

Objective: The objective of this study was to determine the relationship between tumor size and curability of stage I non-small cell lung cancer. Methods: From the Surveillance, Epidemiology, and End Results registry 2003, we identified all primary non-small cell lung cancer cases that were diagnosed prior to autopsy. Among these cases, we narrowed the focus to those diagnosed in 1988 or later, and to 7,620 patients who had undergone curative surgical resection. Kaplan-Meier survival curves were obtained for these stage I malignancies for five tumor size categories (ie, 5 to 15 mm, 16 to 25 mm, 26 to 35 mm, 36 to 45 mm, and > 45 mm). The 12-year Kaplan-Meier estimator of survival was used as a measure of lung cancer cure rate. Results: Among 7,620 stage I cancers, cure rates decreased with increasing tumor size. The 12-year survival rates for patients with tumors 5 to 15 mm in diameter was 69% (95% confidence interval [CI], 64 to 74%), 63% for those with tumors 16 to 25 mm in diameter (95% CI, 60 to 67%), 58% for those with tumors 26 to 35 mm in diameter (95% CI, 54 to 61%), 53% for those with tumors 36 to 45 mm in diameter (95% CI, 48 to 57%), and 43% for those with tumors > 45 mm in diameter (95% CI, 39 to 48%). Cure rates were statistically significantly different for all tumor size categories (p < 0.05) except for the groups with tumors 26 to 35 mm and 36 to 45 mm in diameter (p _ 0.10). Conclusions: Smaller tumor size at diagnosis is associated with improved curability within stage I non-small cell lung cancers. These results suggest that further subclassification by size within stage I may be important. [ABSTRACT FROM AUTHOR]

Abstract Even non-scientific people are generally aware of, and commonly also personally affected by, the confusion and debates that arose from two recent systematic reviews and their associated meta-analyses of the published randomized controlled trials (RCTs) that had been designed to assess the usefulness of screening for breast cancer. With nothing about the principles of research on cancer screening learned from this debacle, an RCT on screening for lung cancer has just been launched in the same ‘gold standard’ framework; and so in about 10 years, and upon expenditure of hundreds of millions of dollars, we are said to be able to learn whether the screening saves lives and whether it thereby is justifiable as a matter of public policy. We here examine the core tenets and precepts in this ‘gold standard’ line of thinking, and we argue that they are matters of belief at variance with the dictates of reason. [ABSTRACT FROM AUTHOR]

The author argues that lung cancer screening by chest computed tomography (CT) scan should be covered by health care insurance benefits in the U.S. He discusses the provisions of the law for lung cancer screening insurance coverage, the source of error in the interpretation of the results of the National Lung Screening Trial (NLST) and the need for the U.S. Centers for Medicare and Medicaid Services (CMS) to pay attention to the misinterpretation of NLST results in formulating policies.

Objectives: To determine the frequency of adrenal enlargement of participants in a CT-screening program for lung cancer and demonstrate the progression during follow-up, separately for baseline and annual repeat rounds.Materials and Methods: HIPAA-compliant informed consent was obtained in 4,776 participants. The adrenal gland was defined as enlarged if it measured ≥6 mm at its largest diameter. Logistic regression analyses were performed.Results: At baseline, 202 (4 %) of 4,776 participants had adrenal enlargement. Significant factors were age (OR = 1.4, 95 % CI: 1.2-1.7) and current smoker (OR = 1.8, 95 % CI: 1.3-2.4). Follow-up 7-18 months after baseline for 133 cases with adrenal enlargement <40 mm showed it decreased or was stable in 85 (64 %), and increased by <10 mm in 48 (36 %). Five (0.04 %) cases of adrenal enlargement were newly identified, none increased beyond 40 mm on follow-up. Adrenal enlargement was a significant predictor of a subsequent diagnosis of lung cancer (OR = 2.0, 95 % CI: 1.2-3.4).Conclusion: Participants with adrenal enlargement <40 mm identified at baseline and on repeat screening could be reasonably assessed on subsequent annual screening. Adrenal enlargement increased with increasing pack-years of smoking. Adrenal enlargement was an independent predictor of a subsequent diagnosis of lung cancer.Key Points: • Adrenal enlargement was seen in 4 % of participants at baseline screening. • Age and currently smoking were significantly associated with adrenal enlargement. • 0.04 % of participants were newly identified with adrenal enlargement. • Annual follow-up for adrenal enlargement <40 mm was appropriate. • Adrenal enlargement was an independent predictor of a diagnosis of lung cancer. [ABSTRACT FROM AUTHOR]

The American College of Radiology created the Lung CT Screening Reporting and Data System (Lung-RADS) in 2014 to standardize the reporting and management of screen-detected pulmonary nodules. Lung-RADS was updated to version 1.1 in 2019 and revised size thresholds for nonsolid nodules, added classification criteria for perifissural nodules, and allowed for short-interval follow-up of rapidly enlarging nodules that may be infectious in etiology. Lung-RADS v2022, released in November 2022, provides several updates including guidance on the classification and management of atypical pulmonary cysts, juxtapleural nodules, airway-centered nodules, and potentially infectious findings. This new release also provides clarification for determining nodule growth and introduces stepped management for nodules that are stable or decreasing in size. This article summarizes the current evidence and expert consensus supporting Lung-RADS v2022. [ABSTRACT FROM AUTHOR]

The author asserts that the harms associated with computed tomography (CT) scanning for lung cancer have been overstated, while its benefits have been underestimated. He argues that technological progress has made CT scanning safer and that the implementation of National Lung Screen Trial (NLST) in community settings should be considered, given improvements in quality standards. He adds that NLST has demonstrated that smaller cancers found by CT scan have demonstrated increased curability.

The article presents an obituary for educator and clinician Joseph P. Whalen.

The article explores the National Lung Screening Trial (NLST), which core result revealed 247 deaths caused by lung cancer per 100,00 person-years in the low-dose computed tomographic (CT) group. While practice guidelines developers interpreted the result as 4 out of 5 people will die from lung cancer, the author argues that it is wrong interpretation. As the NLST was not designed to quantify their comparative effectiveness, its result is quantitatively specific to the trail's design.

Background: To assess the relationship between lung cancer and emphysema subtypes. Objective: Airflow obstruction and emphysema predispose to lung cancer. Little is known, however, about the lung cancer risk associated with different emphysema phenotypes. We assessed the risk of lung cancer based on the presence, type and severity of emphysema, using visual assessment. Methods: Seventy-two consecutive lung cancer cases were selected from a prospective cohort of 3,477 participants enrolled in the Clínica Universidad de Navarra’s lung cancer screening program. Each case was matched to three control subjects using age, sex, smoking history and body mass index as key variables. Visual assessment of emphysema and spirometry were performed. Logistic regression and interaction model analysis were used in order to investigate associations between lung cancer and emphysema subtypes. Results: Airflow obstruction and visual emphysema were significantly associated with lung cancer (OR = 2.8, 95%CI: 1.6 to 5.2; OR = 5.9, 95%CI: 2.9 to 12.2; respectively). Emphysema severity and centrilobular subtype were associated with greater risk when adjusted for confounders (OR = 12.6, 95%CI: 1.6 to 99.9; OR = 34.3, 95%CI: 25.5 to 99.3, respectively). The risk of lung cancer decreases with the added presence of paraseptal emphysema (OR = 4.0, 95%CI: 3.6 to 34.9), losing this increased risk of lung cancer when it occurs alone (OR = 0.7, 95%CI: 0.5 to 2.6). Conclusions: Visual scoring of emphysema predicts lung cancer risk. The centrilobular phenotype is associated with the greatest risk. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Computed tomography screening and lung cancer outcomes," by P.B. Bach, J.R. Jett and colleagues.

Lung cancer screening is widely underutilized. Organizational factors, such as readiness for change and belief in the value of change (change valence), may contribute to underutilization. The aim of this study was to evaluate the association between healthcare organizations' preparedness and lung cancer screening utilization. Investigators cross-sectionally surveyed clinicians, staff, and leaders at10 Veterans Affairs from November 2018 to February 2021 to assess organizational readiness to implement change. In 2022, investigators used simple and multivariable linear regression to evaluate the associations between facility-level organizational readiness to implement change and change valence with lung cancer screening utilization. Organizational readiness to implement change and change valence were calculated from individual surveys. The primary outcome was the proportion of eligible Veterans screened using low-dose computed tomography. Secondary analyses assessed scores by healthcare role. The overall response rate was 27.4% (n =1,049), with 956 complete surveys analyzed: median age of 49 years, 70.3% female, 67.6% White, 34.6% clinicians, 61.1% staff, and 4.3% leaders. For each 1-point increase in median organizational readiness to implement change and change valence, there was an associated 8.4-percentage point (95% CI=0.2, 16.6) and a 6.3-percentage point increase in utilization (95% CI= −3.9, 16.5), respectively. Higher clinician and staff median scores were associated with increased utilization, whereas leader scores were associated with decreased utilization after adjusting for other roles. Healthcare organizations with higher readiness and change valence utilized more lung cancer screening. These results are hypothesis generating. Future interventions to increase organizations' preparedness, especially among clinicians and staff, may increase lung cancer screening utilization. [ABSTRACT FROM AUTHOR]

The article presents a letter to the editor concerning unreported financial disclosures in the article "Women's susceptibility to tobacco carcinogens and survival after diagnosis of lung cancer," published in the July 12, 2006 issue of the journal.

A letter to the editor is presented in response to the article "Screening for Lung Cancer," by E.F. Patz Jr, P.C. Goodman and colleagues in the November 30, 2000 issue.

In addition to lung cancer, other thoracic abnormalities, such as emphysema, can be visualized within low-dose CT scans that were initially obtained in cancer screening programs, and thus, opportunistic evaluation of these diseases may be highly valuable. However, manual assessment for each scan is tedious and often subjective, thus we have developed an automatic, rapid computer-aided diagnosis system for emphysema using attention-based multiple instance deep learning and 865 LDCTs. In the task of determining if a CT scan presented with emphysema or not, our novel Transfer AMIL approach yielded an area under the ROC curve of 0.94 ± 0.04, which was a statistically significant improvement compared to other methods evaluated in our study following the Delong Test with correction for multiple comparisons. Further, from our novel attention weight curves, we found that the upper lung demonstrated a stronger influence in all scan classes, indicating that the model prioritized upper lobe information. Overall, our novel Transfer AMIL method yielded high performance and provided interpretable information by identifying slices that were most influential to the classification decision, thus demonstrating strong potential for clinical implementation. [ABSTRACT FROM AUTHOR]

• Never smokers had significantly lower SUVmax and longer VDT compared to smokers. • No difference in SUVmax and VDT by smoking status after adjusting for histology. • Management and screening intervals should be identical, regardless of smoking history. To determine whether radiographic measures of tumor aggressiveness differ by smoking status. All patients diagnosed with non-small-cell lung cancer(NSCLC) ≤ 30 mm in maximum diameter, without clinical evidence of metastasis who had both pre-treatment PET scans and two CT scans at least 90 days apart in a prospective cohort, the Initiative for Early Lung Cancer Research on Treatment(IELCART) at Mount Sinai between 2016 and 2020 were identified. Comparison of two measures of tumor aggressiveness, positron emission tomography(PET) SUVmax and tumor volume doubling time(VDT) by smoking status was performed. Of 417 patients identified, 158 patients had pre-treatment PET scans and at least two CT scans available. The two measures of tumor aggressiveness, SUVmax and VDT values were significantly different between patients who had never smoked and those who smoked: patients who never smoked had lower median SUVmax[2.5(IQR: 1.1–4.8) vs. 4.2(IQR:2.1–9.2),p = 0.002] and longer median VDT[(372.6 days vs. 225.6 days,p = 0.001)] compared to those who smoked. Using multivariable analyses, when adjusting for age and sex alone, SUVmax(p = 0.004) and VDT(p = 0.0001) remained significantly different by smoking status. The final multivariable analysis, adjusted for all three co-variates(sex, age and tumor histology) showed no significant difference in SUVmax and VDT by smoking status [SUVmax(p = 0.25) and VDT(p = 0.06)]. Smoking history does not influence VDT or PET SUVmax measures of lung cancer aggressiveness. [ABSTRACT FROM AUTHOR]

Because incidental thyroid nodules (ITNs) are common extrapulmonary findings in low-dose computed tomography (LDCT) scans for lung cancer screening, we aimed to investigate the frequency of ITNs on LDCT scans separately on baseline and annual repeat scans, the frequency of malignancy among the ITNs, and any association with demographic, clinical, CT characteristics. Retrospective case series of all 2309 participants having baseline and annual repeat screening in an Early Lung and Cardiac Action Program (MS-ELCAP) LDCT lung screening program from January 2010 to December 2016 was performed. Frequency of ITNs in baseline and annual repeat rounds were determined. Multivariable regression analysis was performed to identify significant predictors. Dominant ITNs were seen in 2.5 % of 2309 participants on baseline and in 0.15 % of participants among 4792 annual repeat LDCTs. The low incidence of new ITNs suggests slow growth as it would take approximately an average of 16.8 years for a new ITN to be detected on annual rounds of screening. Newly detected ITNs on annual repeat LDCT were all smaller than 15 mm. Regression analysis showed that the increasing of age, coronary artery calcifications score and breast density grade were significant predictors for females having an ITN. No significant predictors were found for ITNs in males. ITNs are detected at LDCT however, no malignancy was found. Certain predictors for ITNs in females have been identified including breast density, which may point towards a common causal pathway. • Prevalence of incidental thyroid nodules at low-dose CT scans for lung cancer screening is 2.5 %. • Incidental thyroid nodules grow slowly approximately at an average of 16.8 years before being detected on low-dose CT scans. • Increasing age, coronary artery calcifications, and breast density are predictors for incidental thyroid nodules in females. [ABSTRACT FROM AUTHOR]

Background: Low-dose computed tomography screening for lung cancer can reduce mortality among high-risk persons, but "false-positive" findings may result in unnecessary evaluations with attendant risks. The effect of alternative thresholds for defining a positive result on the rates of positive results and cancer diagnoses is unknown. Objective: To assess the frequency of positive results and potential delays in diagnosis in the baseline round of screening by using more restrictive thresholds. Design: Prospective cohort study. Setting: Multi-institutional International Early Lung Cancer Action Program. Patients: 21 136 participants with baseline computed tomography performed between 2006 and 2010. Measurements: The frequency of solid and part-solid pulmonary nodules and the rate of lung cancer diagnosis by using current (5 mm) and more restrictive thresholds of nodule diameter. Results: The frequency of positive results in the baseline round by using the current definition of positive result (any parenchymal, solid or part-solid, noncalcified nodule ≥5.0 mm) was 16% (3396/21 136). When alternative threshold values of 6.0, 7.0, 8.0 and 9.0 mm were used, the frequencies of positive results were 10.2% (95% CI, 9.8% to 10.6%), 7.1% (CI, 6.7% to 7.4%), 5.1% (CI, 4.8% to 5.4%), and 4.0% (CI, 3.7% to 4.2%), respectively. Use of these alternative definitions would have reduced the work-up by 36%, 56%, 68%, and 75%, respectively. Concomitantly, lung cancer diagnostics would have been delayed by at most 9 months for 0%, 5.0% (CI, 1.1% to 9.0%), 5.9% (CI, 1.7 to 10.1%), and 6.7% (CI, 2.2% to 11.2%) of the cases of cancer, respectively. Limitation: This was a retrospective analysis and thus whether delays in diagnosis would have altered outcomes cannot be determined. Conclusion: These findings suggest that using a threshold of 7 or 8 mm to define positive results in the baseline round of computed tomography screening for lung cancer should be prospectively evaluated to determine whether the benefits of decreasing further work-up outweigh the consequent delay in diagnosis in some patients. [ABSTRACT FROM AUTHOR]

Background: Low-dose computed tomography screening for lung cancer can reduce mortality among high-risk persons, but "false-positive" findings may result in unnecessary evaluations with atten-dant risks. The effect of alternative thresholds for defining a positive result on the rates of positive results and cancer diagnoses is unknown. Objective: To assess the frequency of positive results and potential delays in diagnosis in the baseline round of screening by using more restrictive thresholds. Design: Prospective cohort study. Setting: Multi-institutional International Early Lung Cancer Action Program. Patients: 21 136 participants with baseline computed tomography performed between 2006 and 2010. Measurements: The frequency of solid and part-solid pulmonary nodules and the rate of lung cancer diagnosis by using current (5 mm) and more restrictive thresholds of nodule diameter. Results: The frequency of positive results in the baseline round by using the current definition of positive result (any parenchymal, solid or part-solid, noncalcified nodule s5.0 mm) was 16% (3396/ 21 136). When alternative threshold values of 6.0, 7.0, 8.0 and 9.0 mm were used, the frequencies of positive results were 10.2% (95% CI, 9.8% to 10.6%), 7.1% (CI, 6.7% to 7.4%), 5.1% (CI, 4.8% to 5.4%), and 4.0% (CI, 3.7% to 4.2%), respectively. Use of these alternative definitions would have reduced the work-up by 36%, 56%, 68%, and 75%, respectively. Concomitantly, lung cancer diagnostics would have been delayed by at most 9 months for 0%, 5.0% (CI, 1.1% to 9.0%), 5.9% (CI, 1.7 to 10.1%), and 6.7% (CI, 2.2% to 11.2%) of the cases of cancer, respectively. Limitation: This was a retrospective analysis and thus whether delays in diagnosis would have altered outcomes cannot be determined. Conclusion: These findings suggest that using a threshold of 7 or 8 mm to define positive results in the baseline round of computed tomography screening for lung cancer should be prospectively eval-uated to determine whether the benefits of decreasing further work-up outweigh the consequent delay in diagnosis in some patients. Primary Funding Source: The Flight Attendant Medical Research Institute and the American Legacy Foundation. [ABSTRACT FROM AUTHOR]

The pulmonary nodule is the most common manifestation of lung cancer, the most deadly of all cancers. Most small pulmonary nodules are benign, however, and currently the growth rate of the nodule provides for one of the most accurate noninvasive methods of determining malignancy. In this paper, we present methods for measuring the change in nodule size from two computed tomography image scans recorded at different times; from this size change the growth rate may be established. The impact of partial voxels for small nodules is evaluated and isotropic re- sampling is shown to improve measurement accuracy. Methods for nodule location and sizing, pleural segmentation, adaptive thresholding, image registration, and knowledge-based shape matching are presented. The latter three techniques provide for a significant improvement in volume change measurement accuracy by considering both image scans simultaneously. Improvements in segmentation are evaluated by measuring volume changes in benign or slow growing nodules. In the analysis of 50 nodules, the variance in percent volume change was reduced from 11.54% to 9.35% (p = 0.03) through the use of registration, adaptive thresholding, and knowledge-based shape matching. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The aim of this study was to assess the significance of Stage I diagnoses of lung cancer in the baseline cycle of screening for this disease, with special reference to the potential for overdiagnosis. Methods: We reviewed all 69 cases of Stage I lung cancer diagnosis resulting from our baseline CT screening. Among these 69 cases of lung cancer, 24 presented as solid, 30 as part-solid, and 15 as nonsolid nodules. The extent to which these represented genuine malignancy was assessed by a panel of experts on lung pathology, and the “aggressiveness” of these cases was addressed by the criterion of the tumor''s volume doubling time being less than 400 days. Results: The expert panel confirmed all 69 cases as representing genuine malignancy. Among the 69 cases without evidence of metastases, the proportion that satisfied the aggressiveness criterion was 60/69=87%. The corresponding proportions by presentation as solid, part-solid, and nonsolid nodule were 23/24 (96%), 27/30 (90%), and 10/15 (67%), respectively. Conclusions: In baseline CT screening for lung cancer, overdiagnosis of the disease is uncommon, with cases presenting as a nonsolid nodule a possible exception to this. [Copyright &y& Elsevier]

A method to estimate the population variability in tumour growth rate using incomplete data was developed. We assume exponential growth and lognormal distribution for the parameter of the growth curve. Estimates of growth rate obtained based on the cases with two measurements, one of which is obtained retrospectively, are biased towards lower growth rate. For the data sets where two measurements are available for some tumours and only one measurement for others (which means that no tumour was seen in retrospect for those cases), several approaches were developed that can eliminate or substantially reduce the bias. The relative error of the best estimates, as assessed by simulation, rarely exceeds 20 per cent. We found that the results of application of our estimation procedures to chest X-ray screening data agree well with the expectations. Copyright © 2004 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Osteoporotic fractures are a major contributor to late life morbidity and mortality, and impose a substantial societal cost, yet osteoporosis remains substantially underdiagnosed and undertreated. The purpose of this meta-analysis was to assess the pooled diagnostic sensitivity and specificity of computed tomography (CT) images for diagnosing osteoporosis in patients who meet WHO dual X-ray absorptiometry (DXA) osteoporosis criteria using specific Hounsfield unit (HU) values as a threshold. Systematic literature searches in PubMed, Embase, Web of Science and Google Scholar were performed from the earliest available date through 1 July 2018, restricted to publications in English. Participants in all studies underwent CT scans that included the lumbar and/or thoracic spine for different indications and HU measurements were used to identify osteoporosis. DXA scans served as the reference standard. Ten eligible studies were identified. The mean area under the hierarchical summary receiver operating characteristic (ROC) curve for diagnosis osteoporosis was 0.84 (95% CI: 0.81, 0.87). The pooled diagnostic sensitivity and specificity of CT images to identify osteoporosis were 0.83 (95% CI: 0.73, 0.90) and 0.74 (95% CI: 0.69, 0.79). The positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio were 3.4 (95% CI: 2.7, 4.5), 0.21 (95% CI: 0.12, 0.36), and 16.4 (95% CI: 7.8, 34.3), respectively. The bias-adjusted sensitivity and specificity of CT were 0.73 and 0.71. Meta-regression demonstrated that country of study, DXA criteria and scanner manufacturer were significant factors associated with the sensitivity of CT in detecting osteoporosis while scanner manufacturer was the only factor associated with specificity of CT. This meta-analysis showed reasonable pooled sensitivity and specificity for using threshold values measured on CT scans to identify osteoporosis opportunistically. • Mean area under the hierarchical SROC curve for diagnosis osteoporosis was 0.84. • The pooled diagnostic sensitivity of CT images to identify osteoporosis were 0.83. • The pooled diagnostic specificity of CT images to identify osteoporosis were 0.74. [ABSTRACT FROM AUTHOR]

Small pulmonary nodules are a common radiographic finding that presents an important diagnostic challenge in contemporary medicine. While pulmonary nodules are the major radiographic indicator of lung cancer, they may also be signs of a variety of benign conditions. Measurement of nodule growth rate over time has been shown to be the most promising tool in distinguishing malignant from nonmalignant pulmonary nodules. In this paper, we describe three-dimensional (3-D) methods for the segmentation, analysis, and characterization of small pulmonary nodules imaged using computed tomography (CT). Methods for the isotropic resampling of anisotropic CT data are discussed. 3-D intensity and morphology-based segmentation algorithms are discussed for several classes of nodules. New models and methods for volumetric growth characterization based on longitudinal CT studies are developed. The results of segmentation and growth characterization methods based on in vivo studies are described. The methods presented are promising in their ability to distinguish malignant from nonmalignant pulmonary nodules and represent the first such system in clinical use. [ABSTRACT FROM AUTHOR]

Purpose: To assess the genuineness and curability of diagnosed cases of Stage IA non-small-cell lung cancer of diameter 6–15 mm, with a view to screen-diagnosed asymptomatic cases. Methods: We identified all cases of diagnosed Stage IA (T1N0M0) primary non-small-cell lung cancer documented in the Surveillance, Epidemiology, and End Results (SEER) registry in 1988–1994. There were 885 such cases of diameter 6–15 mm, 33 of them unresected, 1659 of diameter 16–25 mm, and 782 of diameter 26–30 mm. We determined the 8-year cumulative lung-cancer death rates adjusted for competing causes of death, separately for untreated and fully resected cases. Given the relative underdetection of lymph node metastases of the untreated cases, we also documented the case-fatality rates for the resected with inclusion of those with detected intra-pulmonary, hilar or ipsilateral mediastinal lymph node metastases. Results: The 8-year fatality rate for the diagnosed but untreated cases of lung cancer 6–15 mm in diameter was 87%, for 16–25 mm it was 94%, and for 26–30 mm it was 88%. The corresponding estimates of cure rates with resection were 71, 67, and 55%, respectively. The cure rate estimate for the smallest cancers was 66% when adding those with detected lymph node metastases to the resected series, for those 16–25 mm in diameter it was 65%, and for those 26–30 mm in diameter it was 51%. Conclusion: Almost all diagnosed cases of Stage IA lung cancer as small as 10 mm in diameter have a malignant natural course, fatal if not treated, thus representing genuine cancer. Most of these cases are curable by resection. [Copyright &y& Elsevier]

Objective: As bronchioloalveolar carcinoma (BAC) is noninvasive but, in its later stages, has a worse prognosis than adenocarcinoma with bronchioloalveolar features (ACB), early identification and differentiation is important for therapeutic and prognostic purposes. We wanted to identify features of BAC, which differentiated it from ACB when both presented as ground-glass opacities (GGOs) on CT. Materials and methods: We reviewed all pathologic specimens of patients who were diagnosed with BAC and ACB in the lung from 1991 to 1999 in our institution and whose malignancy presented as a GGO on CT. This yielded 29 patients, 15 with BAC and 14 with ACB with GGOs on CT. Both univariate frequency table and multivariate logistic regression approaches were used to analyze the CT characteristics of these GGOs (location, GGO pattern, size, shape, margin, presence and type of air bronchogram and pseudocavitation). Results: BAC most frequently had a “GGO halo” around a solid opacity, often was a GGO “mixed with consolidation” with the smallest BACs being “pure GGO.” Air bronchograms were frequently present in the largest GGOs. Pseudocavitations were rare. ACB, on the other hand, most frequently presented as a GGO “mixed with consolidation,” less frequently with a “GGO halo” and rarely with “superimposed lymphangitis.” The air bronchograms, frequently present, were usually tortuous and ectatic. Pseudocavitation was present in about one-third of the cases. The most useful CT features of GGO in separating those due to BAC from those due to ACB were pure (uniform) ground-glass attenuation and absence of lymphangitis. Conclusion: The CT features of BAC and ACB presenting as GGO reflect the histologic descriptions of these carcinomas. [Copyright &y& Elsevier]

• Among subsolid NSCLCs ≤ 30 mm or typical carcinoids, none had MLN metastases. • CT and SUVmax had low sensitivity but high specificity for predicting MLN metastases. • Clinical Stage IA NSCLCs ≤ 30 mm should be based on CT tumor size and MLN ≤ 20 mm. Computed tomography (CT) and fluorodeoxyglucose-positron-emission-tomography (FDG-PET) measurements of mediastinal lymph nodes (MLNs) of patients with non-small-cell-lung-cancers (NSCLCs) ≤ 30 mm in maximum diameter are recommended for pre-surgical prediction of MLN metastases. We reviewed all patients at Mount Sinai Health System enrolled in the Initiative for Early Lung Cancer Research on Treatment (IELCART), prospective cohort between 2016 and 2020, who had pre-surgical FDG-PET and underwent surgery with MLN resection and/or pre-operative endobronchial ultrasound (EBUS) for a first primary NSCLC ≤ 30 mm in maximum diameter on pre-surgical CT. Among 470 patients, none with part-solid (n = 63) or nonsolid (n = 23) NSCLCs had MLN metastases. Solid NSCLCs were identified in 384 patients, none in typical carcinoid (n = 48) or NSCLC ≤ 10 mm in maximum diameter (n = 47, including 8 typical carcinoids) had MLN metastases. Among the remaining 297 patients with solid NSCLCs 10.1–30.0 mm, 7 (2.4%) had MLN metastases. Area-under-the-curve (AUC) for predicting MLN metastases in solid NSCLCs 10.1–30.0 mm, using the CT maximum short-axis MLN diameter was 0.62 (95% CI:0.44–0.81, p = 0.18) and using the highest SUVmax of any MLN, AUC was 0.58 (95% CI:0.39–0.78,p = 0.41). Neither AUCs were significantly different from chance alone. Optimal cutoff for prediction of MLN metastases was ≥ 18.9 mm for CT maximum short-axis diameter [sensitivity 14.3% (95%CI:0.0%–57.9%); specificity 100.0% (95%CI:98.9%-100.0%)] and for highest SUVmax was ≥ 11.7 [sensitivity 14.3% (95%CI:0.0%-57.9%) and specificity 99.7% (95%CI:98.3%-100.0%)]. CT and SUVmax had low sensitivity but high specificity for predicting MLN metastases in solid NSCLCs 10.1–30.0 mm. Clinical Stage IA NSCLCs ≤ 30 mm should be based on CT maximum tumor diameter and MLN maximum short-axis diameter ≤ 20 mm. [ABSTRACT FROM AUTHOR]

Chronic Obstructive Pulmonary Disease (COPD) includes chronic bronchitis, small airways disease, and emphysema. Diagnosis of COPD requires spirometric evidence and may be normal even when small airways disease or emphysema is present. Emphysema increases the risk of exacerbations, and is associated with all-cause mortality and increased risk of lung cancer. We evaluated the prevalence of emphysema in participants with and without a prior history of COPD. We reviewed a prospective cohort of 52,726 subjects who underwent baseline low dose CT screening for lung cancer from 2003 to 2016 in the International Early Lung Cancer Action Program. Of 52,726 participants, 23.8%(12,542) had CT evidence of emphysema. Of these 12,542 participants with emphysema, 76.5%(9595/12,542) had no prior COPD diagnosis even though 23.6% (2258/9595) had moderate or severe emphysema. Among 12,542 participants, significant predictors of no prior COPD diagnosis were: male (OR = 1.47, p < 0.0001), younger age (OR age10 = 0.72, p < 0.0001), lower pack-years of smoking (OR 10pack-years = 0.90, p < 0.0001), completed college or higher (OR = 1.54, p < 0.0001), no family history of lung cancer (OR = 1.12, p = 0.04), no self-reported cardiac disease (OR = 0.76, p = 0.0003) or hypertension (OR = 0.74, p < 0.0001). The severity of emphysema was significantly lower among the 9595 participants with no prior COPD diagnosis, the OR for moderate emphysema was OR moderate = 0.58(p = 0.0007) and for severe emphysema, it was OR severe = 0.23(p < 0.0001). Emphysema was identified in 23.8% participants undergoing LDCT and was unsuspected in 76.5%. LDCT provides an opportunity to identify emphysema, and recommend smoking cessation. • Emphysema was identified in 23.8% participants and was unsuspected in 76.5%. • 23.6% of participants with unsuspected COPD had moderate or severe emphysema on LDCT. • COPD is underdiagnosed in patients undergoing LDCT. • LDCT provides an opportunity to identify emphysema, reduce morbidity and mortality. [ABSTRACT FROM AUTHOR]

To evaluate whether the extent of COVID-19 pneumonia on CT scans using quantitative CT imaging obtained early in the illness can predict its future severity. We conducted a retrospective single-center study on confirmed COVID-19 patients between January 18, 2020 and March 5, 2020. A quantitative AI algorithm was used to evaluate each patient's CT scan to determine the proportion of the lungs with pneumonia (VR) and the rate of change (RAR) in VR from scan to scan. Patients were classified as being in the severe or non-severe group based on their final symptoms. Penalized B-splines regression modeling was used to examine the relationship between mean VR and days from onset of symptoms in the two groups, with 95% and 99% confidence intervals. Median VR max was 18.6% (IQR 9.1–32.7%) in 21 patients in the severe group, significantly higher (P < 0.0001) than in the 53 patients in non-severe group (1.8% (IQR 0.4–5.7%)). RAR was increasing with a median RAR of 2.1% (IQR 0.4–5.5%) in severe and 0.4% (IQR 0.1–0.9%) in non-severe group, which was significantly different (P < 0.0001). Penalized B-spline analyses showed positive relationships between VR and days from onset of symptom. The 95% confidence limits of the predicted means for the two groups diverged 5 days after the onset of initial symptoms with a threshold of 11.9%. Five days after the initial onset of symptoms, CT could predict the patients who later developed severe symptoms with 95% confidence. • Maximum volume ratio was 18.6% in 21 severe patients, significantly higher (P<0.0001) than in the 53 non-severe patients • Median number of days from the onset symptoms to D max was not significantly different in both severe and non-severe groups • Using VR threshold of 11.9%, CT performed 5 days after the first symptoms could predict severe symptoms with 95% confidence [ABSTRACT FROM AUTHOR]

As the COVID-19 pandemic impacts global populations, computed tomography (CT) lung imaging is being used in many countries to help manage patient care as well as to rapidly identify potentially useful quantitative COVID-19 CT imaging biomarkers. Quantitative COVID-19 CT imaging applications, typically based on computer vision modeling and artificial intelligence algorithms, include the potential for better methods to assess COVID-19 extent and severity, assist with differential diagnosis of COVID-19 versus other respiratory conditions, and predict disease trajectory. To help accelerate the development of robust quantitative imaging algorithms and tools, it is critical that CT imaging is obtained following best practices of the quantitative lung CT imaging community. Toward this end, the Radiological Society of North America's (RSNA) Quantitative Imaging Biomarkers Alliance (QIBA) CT Lung Density Profile Committee and CT Small Lung Nodule Profile Committee developed a set of best practices to guide clinical sites using quantitative imaging solutions and to accelerate the international development of quantitative CT algorithms for COVID-19. This guidance document provides quantitative CT lung imaging recommendations for COVID-19 CT imaging, including recommended CT image acquisition settings for contemporary CT scanners. Additional best practice guidance is provided on scientific publication reporting of quantitative CT imaging methods and the importance of contributing COVID-19 CT imaging datasets to open science research databases. • Collecting CT data for quantitative COVID-19 research requires careful control of image acquisition settings. • Elevated pitch scans will improve imaging of patients with respiratory conditions. • It is important to keep respiratory level and CT image acquisition settings consistent over time. • Publication methods sections need to support image acquisition reproducibility. • Open COVID-19 CT imaging databases will accelerate the development of improved quantitative biomarkers. [ABSTRACT FROM AUTHOR]

Presents a study by the Early Lung Cancer Action Project (ELCAP) to evaluate baseline and annual repeat screening by low-radiation-dose computed tomography (low-dose CT) in people at high risk of lung cancer. Methods; Findings; Interpretation that low-dose CT can improve the likelihood of detection of small non-calcified nodules.

The risk factors for lung cancer screening eligibility, age as well as smoking history, are also present for osteoporosis. This study aims to develop a visual scoring system to identify osteoporosis that can be applied to low-dose CT scans obtained for lung cancer screening. We retrospectively reviewed 1000 prospectively enrolled participants in the lung cancer screening program at the Mount Sinai Hospital. Optimal window width and level settings for the visual assessment were chosen based on a previously described approach. Visual scoring of osteoporosis and automated measurement using dedicated software were compared. Inter-reader agreement was conducted using six readers with different levels of experience who independently visually assessed 30 CT scans. Based on previously validated formulas for choosing window and level settings, we chose osteoporosis settings of Width = 230 and Level = 80. Of the 1000 participants, automated measurement was successfully performed on 774 (77.4 %). Among these, 138 (17.8 %) had osteoporosis. There was a significant correlation between the automated measurement and the visual score categories for osteoporosis (Kendall's Tau = −0.64, p < 0.0001; Spearman's rho = −0.77, p < 0.0001). We also found substantial to excellent inter-reader agreement on the osteoporosis classification among the 6 radiologists (Fleiss κ = 0.91). Our study shows that a simple approach of applying specific window width and level settings to already reconstructed sagittal images obtained in the context of low-dose CT screening for lung cancer is highly feasible and useful in identifying osteoporosis. • The population eligible for lung cancer screening, aging as well as smoking history, are also at high risk for osteoporosis. • Visual score has a significant correlation with automated measurement, and a substantial to excellent inter-reader agreement. • Visual score would provide an feasible opportunity to identify possible osteoporosis in lung cancer screening participants. [ABSTRACT FROM AUTHOR]

The Veterans Affairs Partnership to increase Access to Lung Screening (VA-PALS) is an enterprise-wide initiative to implement lung cancer screening programs at VA medical centers (VAMCs). VA-PALS will be using implementation strategies that include program navigators to coordinate screening activities, trainings for navigators and radiologists, an open-source software management system, tools to standardize low-dose computed tomography image quality, and access to a support network. VAMCs can utilize strategies according to their local needs. In this protocol, we describe the planned program evaluation for the initial 10 VAMCs participating in VA-PALS. The implementation of programs will be evaluated using the Consolidated Framework for Implementation Research to ensure broad contextual guidance. Program evaluation measures have been developed using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. Adaptations of screening processes will be assessed using the Framework for Reporting Adaptations and Modifications to Evidence Based Interventions. Measures collected will reflect the inner settings, estimate and describe the population reached, adoption by providers, implementation of the programs, report clinical outcomes and maintenance of programs. Analyses will include descriptive statistics and regression to evaluate predictors and assess implementation over time. This theory-based protocol will evaluate the implementation of lung cancer screening programs across the Veterans Health Administration using scientific frameworks. The findings will inform plans to expand the VA-PALS initiative beyond the original sites and can guide implementation of lung cancer screening programs more broadly. • Veterans Affairs is implementing lung cancer screening programs nationally. • Programs are provided a navigator, trainings, tools, and support network. • Scientific frameworks inform the design of this program evaluation. • Local environments and adaptations will be assessed through interviews and surveys. • Implementation and clinical outcomes will be measured using a retrospective cohort. [ABSTRACT FROM AUTHOR]

To determine the relationship between two documented indicators of tumor aggressiveness, SUV and volume doubling time (VDT) for stage I non-small cell lung cancer (NSCLC). 116 pathology proven solid NSCLC patients with 2 pretreatment CT and 1 PET/CT scan were retrospectively identified. The 2 CT scans were at least 85 days apart. SUV values were collected from PET/CT reports and CT derived VDT's were calculated assuming an exponential growth rate. Corrected SUV values were also obtained for all cases. Median VDT, SUV and corrected SUV values were reported according to cancer histology. Relationships between VDT, SUV and corrected SUV were examined. 91 Adenocarcinomas and 25 squamous-cell carcinomas had median VDT values of 150.6 and 110.0 days respectively. Median SUV values were 5.1 and 12.3 for adenocarcinoma and squamous-cell carcinoma, respectively (p = 0.0003); median corrected SUV values were 16.8 and 31.7 respectively (p = 0.003). A statistically significant monotonic relationship was observed between increased SUV uptake and faster VDT (p = 0.05) and corrected SUV and VDT (P = 0.0002). When stratified by cancer histology, the relationship between VDT and either SUV or corrected SUV was statistically significant for adenocarcinomas (p = 0.02 and p = 0.0001, respectively), but not for squamous-cell carcinoma (p = 0.85 and p = 0.37, respectively). We demonstrated an overall significant relationship between VDT, SUV and corrected SUV. The relationship, however, was stronger for adenocarcinomas than for squamous-cell carcinomas. This implies that the primary determinant for these relationships is histology and within each cell type, there are other factors that have strong influences. • There was an overall significant relationship between VDT and SUVmax with and without correcting for tumor size. • The relationship between VDT and SUVmax was stronger for adenocarcinomas than for squamous-cell carcinomas. • Different mechanisms that influence on the relationship between VDT and SUVmax may exist within histologic subtypes. [ABSTRACT FROM AUTHOR]

Evaluation of sensitivity and specificity of CT and fluorodeoxyglucose-positron emission tomography for pre-surgical staging of mediastinal lymph node metastases (N2/N3) of non-small-cell-lung-cancers ≤30 mm. We reviewed a total of 263 patients from a prospective cohort study, who underwent resection including mediastinal lymph nodes, for first primary non-small-cell-lung-cancer ≤30 mm in maximum diameter on pre-surgical CT. Cutoff criteria for short-axis diameter on CT of the largest N2/N3 node of 10, 15, and 20 mm and positron emission uptake of 2.5, 3.0, and 4.0 were evaluated using Area-Under-the-Curve (AUC) assessment. Accuracy criterion was used to determine the optimal cutoffs. Of 263 patients, 9 had nonsolid, 42 part-solid, and 212 solid non-small-cell-lung-cancers. Post-surgically, none of the 51 patients with nonsolid or part-solid cancers had mediastinal lymph node metastases. Among the 212 patients with solid cancers, 23 had N2 node metastases. For the 212 patients with solid cancers, the AUC for CT lymph node measurements was 0.67 (95% CI: 0.57–0.77), significantly higher (p = 0.001) than chance alone, while the AUC for SUVmax measurements, 0.56 (95% CI: 0.48–0.65), was not (p = 0.13). Optimal CT cutoff was >20 mm had low sensitivity of 30.4% (95% CI: 11.6%–49.2%) but high specificity of 99.5% (95% CI: 98.4%–100.0%). Based on these results, clinical Stage IA for non-small-cell-lung-cancers with nonsolid, part-solid, or solid consistency should be based on pre-surgical CT maximum tumor diameter and lymph node short-axis measurements on CT ≤20 mm. Further prospective evaluation of these clinical Stage IA staging criteria is needed. • None of the patients with nonsolid or part-solid NSCLCs had N1-N3 metastases. • FDG-PET has low sensitivity but high specificity for MLN metastases. • CT short axis of MLN > 20 mm was a better predictor of N2/N3 metastases than FDG-PET. • Further prospective evaluation of clinical Stage IA staging criteria is needed. [ABSTRACT FROM AUTHOR]

Objectives: Smoking is a major risk factor for both cardiovascular disease (CVD) and lung cancer. Aortic valve calcification (AVC) and coronary artery calcification (CAC) are both due to atherosclerotic disease. We aim to investigate whether AVC on low-dose CT (LDCT) predicts death from CVD in smokers beyond that provided by CAC. Methods: We reviewed a prospective cohort of 8618 smokers enrolled in LDCT screening for lung cancer in New York State between June 2000 and December 2005. As of December 2009, 169 of the 643 deaths were due to CVD; median follow-up time was 96.4 months. Visual AVC was assessed as being absent (AVC = 0) or present (AVC > 0). CAC ordinal scores of 0–12 were categorized into three validated prognostic categories (0, 1–3, and 4–12). Cox proportional hazards regression analysis was used to assess whether AVC > 0 increased the risk of CVD death, after adjustment for CAC categories and other risk factors. Results: The prevalence of AVC significantly increased (p < 0.0001) with the increasing severity of the CAC categories; Pearson, Spearman, and Kendall's correlation coefficients showed a significant correlation between AVC and CAC with r = 0.29, ρ = 0.32, and τB = 0.28 (all p values < 0.0001), respectively. CAC and AVC were significant predictors of CVD death when considered alone using multivariable Cox regression analysis (adjusted HR of CAC = 1.57, p = 0.04; adjusted HR of AVC = 1.39, p = 0.045). When AVC > 0 and CAC ≥ 4, the hazard ratio was 2.35 (95%CI 1.57–3.50) compared with the reference group of AVC = 0 and CAC < 4, when adjusted for other risk factors. Conclusions: The presence of AVC identified on LDCT is a significant predictor of future CVD death, particularly for those with ordinal CAC score ≥ 4. Key Points: • Aortic valve calcification (AVC) and coronary artery calcification (CAC) are both due to atherosclerotic disease. The prevalence of AVC in lung cancer screening cohort significantly increased with the increasing severity of CAC. • CAC and AVC were significant predictors of cardiovascular disease (CVD) death when considered alone. Participants who underwent lung cancer screening with AVC > 0 and CAC ≥ 4 had more than a 2-fold increased risk of CVD death than the group with AVC = 0 and CAC < 4, when adjusted for other risk factors. [ABSTRACT FROM AUTHOR]

• No relationship between lung cancer risk and tumor stage and VDT. • VDT was not significantly different by age or pack-years of smoking. • Tumor stage was not significantly different by age and pack-years. As low-dose CT screening is gaining acceptance, focus is on increasing the efficiency of screening. One major consideration is to reduce the total number of annual rounds by increasing the interval between screening rounds. It has been suggested that longer intervals could be used for individuals who are at lower risk of lung cancer. In this study, we explored whether eligible participants in a program of LDCT screening who are at lower risk of lung cancer have less aggressive cancers than those at higher risk. We retrospectively identified 118 participants in I-ELCAP database between 1992–2019 who had been screened using HIPAA-compliant protocols and had solid lung cancers diagnosed on an annual round of screening, 7–18 months after the prior round. Volume doubling time (VDT) for each cancer was calculated. Estimated risk of developing lung cancer was calculated using PLCO M2012 model. The strength of the relationship between VDT and individual PLCO M2012 scores was assessed by Pearson(r) and Spearman (ρ) correlation coefficients. VDTs were significantly different by cell-type (p < 0.0001); median VDT for small cell was 34.0 days, followed by other cell-types (61.8 days), squamous-cell (73.3 days), and adenocarcinoma (135.7 days). The median VDT for the 78 (66.1 %) Stage I lung cancers was significantly longer than the 40 Stage II + lung cancers (101.4 days vs. 45.5 days, p < 0.0001). None of the established lung cancer risk indicators (age, pack-years of smoking, or PLCO M2012 scores) were significant predictors of VDT or lung cancer stage. No significant relationship was demonstrated between risk of developing lung cancer (measured by risk models, age or smoking history) and lung cancer aggressiveness (measured by VDT, cell-type and Stage). This suggests that there is no evidence for determining intervals between repeat screenings using risk-based characteristics. It does not, however, exclude the possibility that future models may establish such a relationship. [ABSTRACT FROM AUTHOR]

The goal of this work is to determine the optimal projection to detect breast masses on Chest CT. Institutional Review Board (HIPPA compliant) approval was obtained with a waiver of consent. 10 image pairs of Chest CT images containing breast masses were selected for review by 10 chest radiologists: the pairs consisted of axial, sagittal, coronal and axial MIP images (MIP images) with each projection compared to a MIP and with one another. For each pair, the image where the mass was most conspicuous was recorded. MIPs were preferred to any cross sectional projection 82% of the time; sagittal (63%) or coronal (63%) images were preferred to the axial projection. When sagittal and coronal images were compared there was no preference. MIP images should be obtained and reviewed for breast pathology; sagittal or coronal projections may provide additional information. • Denser breast mass is more conspicuous on the MIP images. • Radiologists preferred the MIP images for breast mass detection. • Sagittal and coronal images were found to be equally preferable to axial. [ABSTRACT FROM AUTHOR]

Pulmonary hypertension (PH) is a progressive, potentially fatal disease, difficult to diagnose early due to non-specific nature of symptoms. PH is associated with increased morbidity and death in many respiratory and cardiac disorders, and with all-cause mortality, independent of age and cardiopulmonary disease. The main pulmonary artery diameter (MPA), and ratio of MPA to adjacent ascending aorta (AA), MPA:AA, on Chest CT are strong indicators of suspected PH. Our goal was to determine the prevalence of abnormally high values of these indicators of PH in asymptomatic low-dose CT (LDCT) screening participants at risk of lung cancer, and determine the associated risk factors. We reviewed consecutive baseline LDCT scans of 1949 smokers in an IRB-approved study. We measured the MPA and AA diameter and calculated MPA:AA ratio. We defined abnormally high values as being more than two standard deviations above the average (MPA ≥ 34 mm and MPA:AA ≥ 1.0). Regression analyses were used to identify risk factors and CT findings of participants associated with high values. The prevalence of MPA ≥ 34 mm and MPA:AA ≥ 1.0 was 4.2% and 6.9%, respectively. Multivariable regression demonstrated that BMI was a significant risk factor, both for MPA ≥ 34 mm (OR = 1.07, p < 0.0001) and MPA:AA ≥ 1.0 (OR = 1.04, p = 0.003). Emphysema was significant in the univariate but not in the multivariate analysis. We determined that the possible prevalence of PH as defined by abnormally high values of MPA and of MPA:AA was greater than previously described in the general population and that pulmonary consultation be recommended for these participants, in view of the significance of PH. • The prevalence of MPA ≥ 34 mm and MPA:AA ≥ 1.0 was 4.2% and 6.9%, respectively. • BMI was significantly associated with both having MPA ≥ 34 mm (OR = 1.07, p < 0.0001) and MPA:AA ≥ 1.0 (OR = 1.04, p = 0.003) after adjusting for other covariates. • No significant association between emphysema on CT and an increase in MPA or MPA:AA was found in this study. • When the MPA ≥ 34 mm or MPA:AA ≥ 1.0, further evaluation for possible PH is recommended. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate risk factors for prevalence and progression of aortic valve calcification (AVC) in lung cancer screening participants and also to assess the sensitivity and reliability of visual AVCs on low-dose CT (LDCT) for predicting aortic stenosis (AS) in high-risk smokers.Methods: We reviewed 1225 consecutive participants in annual LDCT screening for lung cancer at the Mount Sinai Hospital between 2010 and 2017. Sensitivity and specificity of moderate/severe AVC score on LDCT to identify AS on echocardiogram were calculated for 126 participants who had both within 12 months. Using regression analyses, risk factors for AVC at baseline, for progression, and for new AVC on annual rounds of screening were identified. Reliability of AVC assessment on LDCT was assessed by comparing visual AVC scores (1) with standard-dose, electrocardiography (ECG)-gated CT for 31 participants who had both within 12 months and (2) with Agatston scores of 1225 participants and by determining (3) the intra-reader agreement of 1225 participants.Results: Visual AVC scores on LDCT had substantial agreement with the severity of AS on echocardiography and substantial inter-observer and excellent intra-observer agreement. Sensitivity and specificity of moderate/severe visual AVC scores for moderate/severe AS on echocardiogram were 100% and 94%, respectively. Significant predictors for baseline AVC were male sex (OR = 2.52), age (OR10 years = 2.87), and coronary artery calcification score (OR = 1.18), the significant predictor for AVC progression after baseline was pack-years of smoking (HR10 packyears = 1.14), and significant predictors for new AVC on annual LDCT were male sex (HR = 1.51), age (HR10 years = 2.17), CAC (HR = 1.09)  and BMI (HR = 1.06).Conclusions: AVC scores on LDCT should be documented, especially in lung cancer screening program.Key Points: • LDCT screening for lung cancer provides an opportunity to identify lung cancer and cardiovascular disease in asymptomatic smokers. • Visual aortic valve calcification scores could be reliably evaluated on LDCT and had substantial agreement with the severity of aortic valve stenosis on echocardiography. • Sensitivity and specificity of moderate/severe visual AVC scores on LDCT for moderate/severe AS on echocardiogram were 100% and 94%, respectively. [ABSTRACT FROM AUTHOR]

To determine the prevalence of moderate-to-severe hepatic steatosis (HS) and associated risk factors in members of the World Trade Center (WTC) General Responder Cohort (GRC) who qualify for low-dose non-contrast computed tomography for lung cancer screening and compare them to non-WTC participants in the same screening program. All participants gave written informed consent before participating in this IRB-approved study. Clinical variables and laboratory values were recorded. Hepatic attenuation measurement (Hounsfield unit; HU) was measured on low-dose computed tomography (LDCT) and a threshold attenuation value <40HU indicated moderate-to-severe HS. Bivariate and multivariable linear and logistic regression analyses were performed. Propensity scores (PS) were calculated and inverse probability weighting (IPW) was used to adjust for potential confounders when comparing the WTC with non-WTC participants. The prevalence of moderate-to-severe HS was 16.2% among 154 WTC participants compared to 5.3% among 170 non-WTC participants. In WTC members, moderate-to-severe HS was associated with higher BMI, higher laboratory liver function tests, and former smoking status. Using PS analysis and IPW to account for potential confounders, the odds ratio for moderate-to-severe HS was 3.4-fold higher (95% confidence interval: 1.7–6.7) in the WTC participants compared with non-WTC participants. Moderate-to-severe HS was also associated with higher BMI and former smoker status. Prevalence of moderate-to-severe HS was >3-fold higher in the WTC-GRC group than in other participants. • LDCT images can provide important information about hepatic steatosis non-invasively and at no additional cost. • Individuals with liver attenuation < 40HU on LDCT should be advised of the high likelihood of having excess liver fat. • Patients with liver attenuation < 40HU should contact their referring physician or a liver specialist for further work up. [ABSTRACT FROM AUTHOR]