Faculty Bibliography

Purpose: To compare 5-year survival of lung transplant (LTx) recipients in donation after circulatory death (DCD) versus donation after brain-death (

This pictorial essay presents cases of congenital coronary artery anomalies, including congenital anomalies of origin, course, and termination. Familiarity with atypical coronary anatomy and clinical presentation may facilitate appropriate diagnosis and management, particularly as cardiac and thoracic computed tomographic utilization increases.

OBJECTIVE: This study aims to provide the first description of the computed tomographic (CT) appearances of intracardiac embolized brachytherapy seeds in patients undergoing electrocardiogram (ECG)-gated cardiac CT. METHODS: The institutional Picture Archive and Communication System was searched for male patients who underwent enhanced ECG-gated cardiac CT, and reports were searched for the key words "metallic," "prostate," "brachytherapy," "radiation," "embolized," and "radioactive." Each study was identified and examined for an intracardiac metallic object conforming to the size of a prostate seed. RESULTS: Between January 01, 2005, and June 30, 2014, a total of 3206 male patients underwent ECG-gated cardiac CT. Five patients (0.15%) had a history of prostate cancer and an intracardiac metallic object with CT imaging characteristics consistent with an embolized prostate seed. In all 5 patients, the seeds were embedded in the trabeculations of the inferior aspect of the basal right ventricular free wall. CONCLUSIONS: Intracardiac embolized brachytherapy seeds appear as small objects with surrounding metallic artifact characteristically embedded in the inferior aspect of the basal right ventricular free wall.

Purpose: Lung transplantation (LTx) from donors after circulatory death (DCD) has become routine with reported similar survival outcomes compared to brain-dead donor (BDD). However, it remains unknown whether possible differences in donor and recipient characteristics between various DCD categories affect outcome. Methods: Between 01/2003 and 07/2015, 516 LTx from 12 participating institutions were reported to the ISHLT DCD Registry. No uncontrolled DCDs (I and II) have yet been recorded. Ten cases after euthanasia (DCD-V) were excluded from analysis, leaving 486 DCD-III (withdrawal from life support) and 20 DCD-IV (unexpected cardiac arrest in BDD) LTx recipients. Results: Donor age tended to be higher in DCD-III. Ante-mortem heparin was administered more frequently while steroids were given less often in DCD-IV. Time interval from cardiac arrest to cold flush was longer in DCD-III. DCD-III recipients were younger with more bilateral LTx. Indication for LTx varied significantly. Total ischemic time and length of hospital stay were similar. 1, 3, and 5-year survival was 89.2%, 71.2%, 60.3% vs 94.7%, 73.7%, 49.1% in DCD-III and DCD-IV recipients, respectively (p= 0.95, log rank). Conclusion: DCD-III is the most frequent category (94%) in the Registry. Despite older donor age, less heparinization, and longer warm ischemic time interval from arrest to flush in DCD-III, early and late outcome were comparable. DCD-III do not carry an increased risk for successful LTx compared to DCD-IV. (Table presented)

PURPOSE: The aim of this report is to describe our early experience with radiologist-led direct public education about imaging-based cancer screening examinations, with a focus on the level of satisfaction and the educational impact reported by session participants. METHODS: Subspecialty radiologists provided 1-hour educational sessions to small lay public audiences covering breast, prostate, and lung cancer screening, focusing on key radiologic screening tests. Subsequently, session participants completed a survey pertaining to their levels of satisfaction and the perceived impact of the sessions on knowledge of the diseases and relevant screening tests; results from all topic sessions were pooled for analysis. RESULTS: One hundred nineteen participants attended a total of 144 sessions. The large majority of respondents agreed or strongly agreed that the sessions increased their understanding (95.4%), they gained information not obtained from clinic visit (88.1%), seeing radiology images helped their understanding (92.6%), they felt more involved in their own care (85.8%), they felt more prepared to undergo screening tests (87.4%), they were satisfied with the sessions' format (93.3%) and content (96.2%), their main questions were answered (88.3%), they would be interested in similar future radiologist-led sessions (88.5%), and they would recommend the sessions to friends (93.9%). The provided information (43.1%) and images (34.7%) were identified as the most helpful aspects of the sessions. CONCLUSION: Radiologist-led direct public education sessions about imaging-based cancer screening examinations yield high levels of audience satisfaction and add value to the public's understanding of the role of radiology and radiologists. Our experience may provide an encouraging model for other radiology practices in pursuing similar endeavors.

PURPOSE: The aim of this report is to describe our early experience with radiologist-led direct public education about imaging-based cancer screening examinations, with a focus on the level of satisfaction and the educational impact reported by session participants. METHODS: Subspecialty radiologists provided 1-hour educational sessions to small lay public audiences covering breast, prostate, and lung cancer screening, focusing on key radiologic screening tests. Subsequently, session participants completed a survey pertaining to their levels of satisfaction and the perceived impact of the sessions on knowledge of the diseases and relevant screening tests; results from all topic sessions were pooled for analysis. RESULTS: One hundred nineteen participants attended a total of 144 sessions. The large majority of respondents agreed or strongly agreed that the sessions increased their understanding (95.4%), they gained information not obtained from clinic visit (88.1%), seeing radiology images helped their understanding (92.6%), they felt more involved in their own care (85.8%), they felt more prepared to undergo screening tests (87.4%), they were satisfied with the sessions' format (93.3%) and content (96.2%), their main questions were answered (88.3%), they would be interested in similar future radiologist-led sessions (88.5%), and they would recommend the sessions to friends (93.9%). The provided information (43.1%) and images (34.7%) were identified as the most helpful aspects of the sessions. CONCLUSION: Radiologist-led direct public education sessions about imaging-based cancer screening examinations yield high levels of audience satisfaction and add value to the public's understanding of the role of radiology and radiologists. Our experience may provide an encouraging model for other radiology practices in pursuing similar endeavors.

The objective of this study is to assess the impact on nodule detection and efficiency using a computer-aided detection (CAD) device seamlessly integrated into a commercially available picture archiving and communication system (PACS). Forty-eight consecutive low-dose thoracic computed tomography studies were retrospectively included from an ongoing multi-institutional screening study. CAD results were sent to PACS as a separate image series for each study. Five fellowship-trained thoracic radiologists interpreted each case first on contiguous 5 mm sections, then evaluated the CAD output series (with CAD marks on corresponding axial sections). The standard of reference was based on three-reader agreement with expert adjudication. The time to interpret CAD marking was automatically recorded. A total of 134 true-positive nodules, measuring 3 mm and larger were included in our study; with 85 >/= 4 and 50 >/= 5 mm in size. Readers detection improved significantly in each size category when using CAD, respectively, from 44 to 57 % for >/=3 mm, 48 to 61 % for >/=4 mm, and 44 to 60 % for >/=5 mm. CAD stand-alone sensitivity was 65, 68, and 66 % for nodules >/=3, >/=4, and >/=5 mm, respectively, with CAD significantly increasing the false positives for two readers only. The average time to interpret and annotate a CAD mark was 15.1 s, after localizing it in the original image series. The integration of CAD into PACS increases reader sensitivity with minimal impact on interpretation time and supports such implementation into daily clinical practice.

Introduction: While it is well described that an Interscalene Nerve Block (ISB) results in phrenic nerve paralysis on the ipsilateral side (1,2), concern exists that this, in the presence of preexisting contralateral hemi-diaphragmatic paralysis, can result in significant respiratory distress after a nerve block is performed. While knowledge of an elevated hemi-diaphragm on the contralateral side, indicating paralysis, would be a consideration as to whether an ISB should be performed, it is not routine for patients to have a Chest X-Ray (CXR) prior to receiving an ISB for shoulder surgery. The frequency of an elevated hemi-diaphragm as an incidental CXR finding is not described in the literature. We undertook a retrospective review of CXRs on patients admitted to the NYU Langone Medical Center for reasons other than orthopedic surgery, to determine the percent of patients who have an undiagnosed elevated hemi-diaphragm to determine if routine CXR should be performed prior to a patient receiving an ISB. Methods: After obtaining IRB approval, the official report of 1029 random CXRs were reviewed. All X-rays were evaluated by a board certified radiologist specializing in Thoracic Imaging. CXRs were considered positive if the Radiologist documented an elevated hemi-diaphragm and a review of the patients' chart did not reveal a pre-existing diagnosis or condition that would explain the findings. Results: 21/1029 patients were found to have an elevated hemi-diaphragm on routine CXR (2.04%). While the reported incidence was higher on the right (n = 14) than left (n = 7), this did not reach clinical significance. Discussion: Our data indicate that the incidence of hemi-diaphragmatic paralysis is low (2.04%) Therefore we do not recommend preoperative CXR screening for its presence. However, while it is not a common occurrence it has a place in the differential diagnosis of respiratory distress in the OR or PACU in patients who have received an ISB. Anesthesiologists are in agreement that due to the near 100% incidence of a phrenic nerve block after an ISB the finding of an elevated hemi-diaphragm on a pre-operative CXR would be a consideration prior to performing the block. The literature was lacking when it came to the percent of patients who have an elevated hemi-diaphragm as an incidental finding on CXR. Our review demonstrates a low prevalence (2.04% total, 1.36% right, 0.68% left) and therefore a routine CXR is not justified. Because a small number of our patients will have an elevated hemi-diaphragm on the contralateral side prior to the performance of an ISB, this should be a consideration in the PACU