Westcott J

Detection of Bronchial Abnormalities: Comparison of CT and Bronchoscopy

We evaluated the usefulness of CT as compared with both visual and pathologic findings from fiberoptic bronchoscopy (FOB) in detecting bronchial lesions in 100 consecutive patients undergoing both procedures. There was agreement between CT and visual FOB in 83% of cases and CT and pathologic FOB in 68%. In the malignant disease category CT detected bronchial abnormalities in 59% (27 of 46) as compared with 57% (26 of 46) by visual FOB; both agreed in 81% of the cases (37 of 46). On the basis of CT findings alone, we retrospectively divided the cases into those for which we expected FOB to have high diagnostic yield (peribronchial abnormalities, n = 49) and a low diagnostic yield (i.e., no bronchial abnormality, n = 51). For the malignant disease category, selection by CT findings resulted in successful diagnosis by FOB in 69% for the high yield group as compared with 29% for the low yield group. We conclude that CT has excellent correlation with visual and pathologic results of FOB in detecting bronchial abnormalities and that CT, when used as an initial screening test, can enhance the yield by allowing appropriate selection of patients.

MR imaging of the hilum and mediastinum: effects of cardiac gating.

The effect of cardiac gating (CG) on the diagnostic quality of magnetic resonance images of the hilum and mediastinum was evaluated by comparing gated with nongated scans in 20 patients. The advantages of CG varied depending on the regions and structures under study and the presence and extent of disease. In general, CG was more advantageous in normal subjects and patients with small or subtle lesions than in patients with advanced disease. In the posterior and superior portions of the thorax there was no clear-cut advantage of CG. Normal structures were usually seen slightly better on gated images, but lung and mediastinal masses were usually visualized equally well with or without CG. From the level of the pulmonary arteries to the diaphragm, gated images were superior for visualizing normal and abnormal structures in the hilum, mediastinum, and to a lesser extent, the lungs. Both hilar and mediastinal lymphadenopathy and mediastinal invasion at the level of the lung root were consistently better visualized with CG. Large masses were usually well demonstrated without CG, but the relationship of the mass to adjacent structures was better delineated with CG.

The practice of chest radiology in departments with residency programs.

OBJECTIVESThe authors assessed to what extent radiology teaching programs employed dedicated chest radiologists and their functions. METHODSInformation regarding the clinical, teaching, and research role of the chest radiologist was available from responses to a survey of radiology departments with residency training programs in the United States and Canada. Emphasis was placed on the role of chest subspecialists, “dedicated chest radiologists” (DCRs), who spent at least two thirds of their clinical time interpreting and directing chest-related imaging studies and procedures. RESULTSAmong the 171 residency programs that responded, 118 had DCRs. There were 262 full-time and 233 part-time DCR positions, of which 43 were not filled. Among departments with DCRs, 66% were medical school programs while the remaining 34% were independent or medical-school-affiliated programs; 30% were organized by organ system, 5% by technology, and 65% had a combination of both; and 78% had more than 12 residents. DCRs interpreted routine chest radiographs in 96%, critical care radiographs in 94%, chest computed tomography (CT) studies in 72%, and chest magnetic resonance imaging (MRI) studies in 44% of their departments. Departments without DCRs were usually smaller, 70% having 12 or fewer residents. Their designated chest radiologists interpreted all chest radiographs in 21%, all critical care radiographs in 19%, all chest CT studies in 13% and all chest MRI studies in 8% of these departments. CONCLUSIONSDedicated chest radiologists were more involved than non-DCRs in all aspects of chest imaging, teaching, and research including analysis of image quality and acquisition of new technology. The highest quality of chest radiology training, defined as programs in which the chest fellowship positions were filled in 1991, was found in departments in which DCRs interpreted all chest radiographs, all chest CT studies, and most MRI studies.