Purpose To assess the interreader variability of submillisievert CT for lung cancer screening in radiologists with various experience levels. Method Six radiologists with different degrees of clinical experience in radiology (range, 1-15 years), rated 100 submillisievert CT chest studies as either negative screening finding (no nodules, benign nodules, nodules <5 mm), indeterminate finding (nodules 5-10 mm), positive finding (nodules >10 mm). Each radiologist interpreted scans randomly ordered and reading time was recorded. Interobserver agreement was assessed with ak statistic. Reasons for differences in nodule classification were analysed on a case-by-case basis. Reading time was correlated with reader experience using Pearson correlation (r). Results The overall interobserver agreement between all readers was moderate (k = 0.454; p < 0.001). In 57 patients, all radiologists agreed on the differentiation of negative and indeterminate/positive finding. In 64 cases disagreement between readers led to different nodule classification. In 8 cases some readers rated the nodule as benign, whereas others scored the case as positive. Overall, disagreement in nodule classification was mostly due to failure in identification of target lesion (n = 40), different lesion measurement (n = 44) or different classification (n = 26). Mean overall reading time per scan was of 2 min 2 s (range: 7s-7 min 45 s) and correlated with reader-experience (r =-0.824). Conclusions Our study showed substantial interobserver variability for the detection and classification of pulmonary nodules in submillisievert CT. This highlights the importance for careful standardisation of screening programs with the objective of harmonizing efforts of involved radiologists across different institutions by defining and assuring quality standards.
Massive haemoptysis is a term used to describe a large amount of expectorated blood or rapid rate of bleeding (>100 ml blood in 24 h) and is associated with a serious risk of death. However, there is no clear consensus on its definition [1]. In the present we report the case of a 39-year-old male, investigated for haemoptysis, quickly turning bad during diagnostic flexible bronchoscopy due to a rare condition. The congenital abnormality with displaced right upper lobe segmental bronchus and lack of the apical segment bronchus of the right lower lobetogether with the endoscopic narrow-band imaging were the diagnostic clues for the presence of pulmonary Dieulafoy‘s disease and angiographic glue embolization (n-butyl-2-cyanoacrylate) the treatment of choice.
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