Establishing a computed tomography screening clinic

Since the publication of the National Lung Screening Trial results, there has been increasing interest among radiologists to establish computed tomography (CT) screening centers. During the past 10 years, we have operated a CT screening center in suburban Boston, MA. The purpose of this paper is to describe our process for performing self-referred CT lung screening exams, including our organizational structure, marketing, patient selection process, and standardized workflow. Direct communication between the patient and radiologist, both before and after the CT scan, in our opinion, is critical to a successful screening program. In many ways, CT screening offers radiologists a wonderful opportunity to interact directly with patients. Showing abnormal lung findings to patients on their CT scans may help create a unique teachable moment for current smokers and may help motivate patients to quit smoking

Reviewing imaging examination results with a radiologist immediately after study completion: patient preferences and assessment of feasibility in an academic department

OBJECTIVE: The purpose of this study was to assess patient preferences about receiving radiology results and reviewing the images and findings directly with a radiologist after completion of an examination. SUBJECTS AND METHODS: A prospective survey of English-speaking outpatients undergoing either nononcologic CT of the chest, abdomen, and pelvis or nonobstetric ultrasound examinations was completed between December 2010 and June 2011. Responses to survey items such as preferences regarding communication of results, knowledge of a radiologist, and anxiety level before and after radiologist-patient consultation were recorded. The average wait time between the end of the imaging examination and the consultation and the duration of consultation were documented. RESULTS: Eighty-six patients (43 men, 43 women; mean age, 52 years) underwent 37 CT and 49 ultrasound examinations). Forty-eight patients (56%) identified a radiologist as a physician who interprets images. Before imaging, 70 patients (81%) preferred hearing results from both the ordering provider and the radiologist. This percentage increased to 78 (91%) after consultation (p=0.03). Before consultation, 84 of the 86 patients (98%) indicated they would be comfortable hearing normal results or abnormal results from the person interpreting the examination; the number increased to 85 (99%) after consultation. Eighty-five patients (99%) agreed or strongly agreed that reviewing their examination findings with a radiologist was helpful. Eighty-four patients (98%) indicated they wanted the option of reviewing or always wanted to review future examination findings with a radiologist. After consultation, anxiety decreased in 41 patients (48%), increased in 13 (15%), and was unchanged in 32 (37%) (p=0.0001). The average wait for consultation and the duration of consultation were 9.9 and 10.4 minutes for CT and 1.2 and 7.1 minutes for ultrasound. CONCLUSION: Patients prefer hearing examination results from both their ordering provider and the interpreting radiologist. Most patients find radiologist consultation beneficial. Patients are comfortable hearing results from the radiologist, with most displaying decreased anxiety after consultation

Buchbesprechungen

Buchbesprechunge

CT Imaging Findings after Stereotactic Radiotherapy for Liver Tumors

Purpose. To study radiological response to stereotactic radiotherapy for focal liver tumors. Materials and Methods. In this IRB-approved, HIPAA-compliant study CTs of 68 consecutive patients who underwent stereotactic radiotherapy for liver tumors between 01/2006 and 01/2010 were retrospectively reviewed. Two independent reviewers evaluated lesion volume and enhancement pattern of the lesion and of juxtaposed liver parenchyma. Results. 36 subjects with hepatocellular carcinoma (HCC), 25 with liver metastases, and seven with cholangiocarcinoma (CCC) were included in study. Mean follow-up time was 5.6 ± 7.1 months for HCC, 6.4 ± 5.1 months for metastases, and 10.1 ± 4.8 months for the CCC. Complete response was seen in 4/36 (11.1%) HCCs and 1/25 (4%) metastases. Partial response (>30% decrease in long diameter) was seen in 25/36 (69%) HCCs, 14/25 (58%) metastases, and 7/7 (100%) of CCCs. Partial response followed by local recurrence (>20% increase in long diameter from nadir) occurred in 2/36 (6%) HCCs and 4/25 (17%) metastases. Liver parenchyma adjacent to the lesion demonstrated a prominent halo of delayed enhancement in 27/36 (78%) of HCCs, 19/21 (91%) of metastases, and 7/7 (100%) of CCCs. Conclusion. Sustainable radiological partial response to stereotactic radiotherapy is most frequent outcome seen in liver lesions. Prominent halo of delayed enhancement of the adjacent liver is frequent finding