Introduction: Chest ports are typically inserted via the right internal jugular vein with the left side being utilized in certain patient populations. The purpose of this study was to evaluate the dynamic position of the chest port and catheter tip, comparing a demographically matched cohort of female breast cancer patients with right‐ or left‐sided chest ports.Methods: 142 female patients with breast cancer requiring chest port insertion for chemotherapy and imaging confirming catheter tip position initially with supine fluoroscopy and follow‐up with erect chest radiography over a 5‐year period were identified. Data points analyzed were catheter tip‐to‐carina distance and the distance from the port to the ipsilateral infraclavicular border. Intraprocedural measurements were taken in the supine position during chest port insertion and compared with follow‐up erect chest radiography. The catheter tip position was also allocated a zone within the venous system on both image sets to assess for significant retraction to a more proximal zone in the erect position. Imaging within 12‐months of chest port insertion was also screened to identify port‐related complications.Results: The whole cohort showed significant retraction of the catheter tip (cephalad) (p < 0.001) and protraction of the port (caudal) (p < 0.001). The median tip‐to‐carina distance decreased from 38.3 mm to 28.6 mm and the port‐to‐clavicle distance increased from 31.3 mm to 64.6 mm. Right‐sided chest ports had increased tip‐to‐catheter retraction (15 mm) compared with left‐sided (6.9 mm) (p = 0.310). A complication was identified in 8.5% of the right‐sided and 11% of the left‐sided ports. Zone migration was significantly associated with the occurrence of a complication in left‐sided ports (p = 0.023).Conclusion: When assessing chest port catheter tip position between supine and erect radiographic studies in female patients with breast cancer, retraction cephalad will occur and this is more apparent in right‐sided ports. Change in catheter tip position was not associated with a significant increase in complication rate unless it occurred in left‐sided ports where zone migration was evident.

BACKGROUND Incidental pulmonary nodules are an increasingly common finding on computed tomography (CT) scans of the thorax due to the exponential rise in CT examinations in everyday practice. The majority of incidental pulmonary nodules are benign and correctly identifying the small number of malignant nodules is challenging. Ultra-low-dose CT (ULDCT) has been shown to be effective in diagnosis of respiratory pathology in comparison with traditional standard dose techniques. Our hypothesis was that ULDCT chest combined with model-based iterative reconstruction (MBIR) is comparable to standard dose CT (SDCT) chest in the analysis of pulmonary nodules with significant reduction in radiation dose. AIM To prospectively compare ULDCT chest combined with MBIR with SDCT chest in the analysis of solid pulmonary nodules. METHODS A prospective cohort study was conducted on adult patients (n = 30) attending a respiratory medicine outpatient clinic in a tertiary referral university hospital for surveillance of previously detected indeterminate pulmonary nodules on SDCT chest. This study involved the acquisition of a reference SDCT chest followed immediately by an ULDCT chest. Nodule identification, nodule characterisation, nodule measurement, objective and subjective image quality and radiation dose were compared between ULDCT with MBIR and SDCT chest. RESULTS One hundred solid nodules were detected on ULDCT chest and 98 on SDCT chest. There was no significant difference in the characteristics of correctly identified nodules when comparing SDCT chest to ULDCT chest protocols. Signal-to-noise ratio was significantly increased in the ULDCT chest in all areas except in the paraspinal muscle at the maximum cardiac diameter level (P < 0.001). The mean subjective image quality score for overall diagnostic acceptability was 8.9/10. The mean dose length product, computed tomography volume dose index and effective dose for the ULDCT chest protocol were 5.592 mGy.cm, 0.16 mGy and 0.08 mSv respectively. These were significantly less than the SDCT chest protocol (P < 0.001) and represent a radiation dose reduction of 97.6%. CONCLUSION ULDCT chest combined with MBIR is non-inferior to SDCT chest in the analysis of previously identified solid pulmonary nodules and facilitates a large reduction in radiation dose.

Cystic fibrosis (CF) is one of the most common progressive life-shortening genetic conditions worldwide. Ground-breaking translational research has generated therapies that target the primary cystic fibrosis transmembrane conductance regulator (CFTR) defect, known as CFTR modulators. A crucial aspect of paediatric CF disease is the development and progression of irreversible respiratory disease in the absence of clinical symptoms. Accurate thoracic diagnostics have an important role to play in this regard. Chest radiographs are non-specific and insensitive in the context of subtle changes in early CF disease, with computed tomography (CT) providing increased sensitivity. Recent advancements in imaging hardware and software have allowed thoracic CTs to be acquired in paediatric patients at radiation doses approaching that of a chest radiograph. CFTR modulators slow the progression of CF, reduce the frequency of exacerbations and extend life expectancy. In conjunction with advances in CT imaging techniques, low-dose thorax CT will establish a central position in the routine care of children with CF. International guidelines regarding the choice of modality and timing of thoracic imaging in children with CF are lagging behind these rapid technological advances. The continued progress of personalised medicine in the form of CFTR modulators will promote the emergence of personalised radiological diagnostics.

Computed tomography (CT) imaging has become indispensable in the management of medical oncology patients. Risks associated with high cumulative effective dose (CED) are relevant in testicular cancer patients. Split-bolus protocols, whereby the contrast medium injection is divided into two, followed by combining the required phase images in a single scan acquisition has been shown to provide images of comparable image quality and less radiation dose compared to single-bolus split-phase CT for various indications. We retrospectively evaluated the performance of split-bolus and single-bolus protocols in patients having follow-up CT imaging for testicular cancer surveillance. 45 patients with testicular cancer undergoing surveillance CT imaging of the thorax, abdomen, and pelvis who underwent split-bolus and single-bolus protocols were included. Quantitative image quality analysis was conducted by placing region of interests in pre-defined anatomical sub-structures within the abdominal cavity. The signal-to-noise ratio (SNR) and radiation dose in the form of dose length product (DLP) and effective dose (ED) were recorded. The DLP and ED for the single-bolus, split-phase acquisition was 506 ± 89 mGy cm and 7.59 ± 1.3 mSv, respectively. For the split-bolus, single-phase acquisition, 397 ± 94 mGy∗cm and 5.95 ± 1.4 mSv, respectively (p < 0.000). This represented a 21.5 % reduction in radiation dose exposure. The SNR for liver, muscle and fat for the single-bolus were 7.4, 4.7 and 8, respectively, compared to 5.5, 3.8 and 7.4 in the split-bolus protocol (p < 0.001). In a testicular cancer patient cohort undergoing surveillance CT imaging, utilization of a split-bolus single-phase acquisition CT protocol enabled a significant reduction in radiation dose whilst maintaining subjective diagnostic acceptability. Use of split-bolus, single-phase acquisition has the potential to reduce CED in surveillance of testicular cancer patients.

Rationale: In cystic fibrosis (CF), body composition alterations are observed. The prevalence of obesity in CF is increasing, with evidence suggesting a subsequent increase in cardiometabolic risk. We sought to assess body composition using analytic morphomics from ultra-low–dose thoracic computed tomography (CT) scans in patients with CF on the triple CFTR (cystic fibrosis transmembrane conductance regulator) modulator therapy elexacaftor/tezacaftor/ivacaftor (ETI). Objectives: Our objective was to use analytical morphomics on routine ultra-low–dose CTs to assess patterns of change in body composition in patients with CF on ETI therapy. Methods: Forty-two patients with CF on ETI who had baseline and follow-up ultra-low–dose thoracic CT imaging were retrospectively analyzed. The CTs were acquired at a radiation dose equivalent to two frontal chest X-rays using our previously published acquisition parameters. The Bhalla score was used as a marker of structural lung disease severity. Analytic morphomics variables, including cross-sectional area and attenuation of pectoralis muscle, visceral fat (epicardial and upper abdominal), and subcutaneous fat, were extracted using the validated image segmentation software CoreSlicer. Paired-samples mean testing (Wilcoxon matched-pairs signed-rank test) and Spearman rank correlation analyses were performed. Results: Total Bhalla scores significantly improved over time in patients on ETI (P < 0.0001). In addition, body composition also changed, with an increase in the cross-sectional area of subcutaneous and epicardial visceral fat (P < 0.0001 and P = 0.0062, respectively). In those with a normal BMI at follow-up, epicardial and subcutaneous fat had also increased significantly in the interval (P = 0.0066 and P = 0.0002, respectively). Conclusions: In CF, ETI produced a significant improvement in structural lung disease over time; however, it also resulted in an increase in visceral and subcutaneous fat. The analytic morphomics methodology presented herein may help identify those patients for aggressive primary prevention strategies and permit the creation of more personalized nutritional plans.