Academic literature on the topic 'B-scan examinations'

Aims: A meaningful sonographic examination is decisively dependent on the B-scan quality of the ultrasound device. When selecting a suitable ultrasound device, B-scan quality should be an important purchase criterion. Although there is no generally accepted method to measure B-scan quality, we tried to evaluate comparable sonography devices from different manufacturers regarding B-scan quality.Material and methods: We systematically assessed the B-scan quality in ultrasound devices of seven different manufacturers from the mid-price segment. All 7 ultrasound units tested had comparable equipment features and the purchase value of approximately $20,000. We recorded video sequences and compared B-mode image quality. We used both physiological sectional images and pathological findings from abdominal ultrasound.Results: We identified three ultrasound units that scored significantly better in measuring the B-scan quality than the other devices. The Canon Xario 200, the General Electric Logiq P7 and the Mindray DC70 (in alphabetical order) were the units that outperformed all others.The differences identified were found to be statistically significant. A subgroup analysis showed that the contrasts in quality were more pronounced in near-field examinations than in examinations with greater penetration depth.Conclusions: There are considerable qualitative discrepancies in B-scan ultrasound devices despite being similar in terms of equipment and price. Our findings show that these differences are statistically detectable and likely clinically relevant.

Objective: To analyze the diagnostic value of combined abdominal and vaginal B-scan ultrasound in obstetricsand gynecology acute abdomen. Methods: A total of 80 patients with suspected obstetric and gynecological acute abdomen admitted from February 2021 to October 2023 were recruited. All patients underwent abdominal and vaginal B-scan ultrasound examinations, and the pathological results were compared to explore the joint diagnostic value. Results: Obstetric and gynecological acute abdomen was confirmed in 68 cases through pathology, 53 cases through abdominal B-scan ultrasound, 60 cases through vaginal B-scan ultrasound, and 67 cases through combined abdominal and vaginal B-scan ultrasound. The combined abdominal and vaginal B-scan ultrasound had significantly higher diagnostic efficiency than that of abdominal B-scan ultrasound alone and vaginal B-scan ultrasound alone (P < 0.05). The accuracy of combined abdominal and vaginal B-scan ultrasound in diagnosing obstetric and gynecological acute abdomen is higher than that ofabdominal B-scan ultrasound alone and vaginal B-scan ultrasound alone (P < 0.05). Conclusion: The diagnosis of acute abdomen in obstetrics and gynecology by combined abdominal and vaginal B-scan ultrasound may improve the diagnostic efficiency, enhance the accuracy of acute abdomen classification in obstetrics and gynecology, and have high consistency with pathological results.

The aim of this study was to analyze the use of the diagnostic B-scan ultrasound. Should it be made accessible to all surgical centers in Sub-Saharan Africa in order to (i) avoid unnecessary cataract surgery and (ii) evaluate extraocular pathology? This study was conducted in Kinshasa from 2006 to 2019. Three hundred and twenty-three patients were included and separated into two groups. Group 1 included 262 patients with dense cataract. Group 2 consisted of 61 patients with pathologies of the ocular adnexa, and all were examined with a B-scan ultrasound. In group 1, there were 437 systematically screened eyes. Three hundred and ninety-eight eyes (91.08%) showed no abnormalities, 13 (2.97%) retinal detachments were identified, and 15 (3.43%) demonstrated a detached posterior hyaloid membrane. In the second group, 61 patients were examined (group 2). In 20 of them, surgery was performed for biopsy, tumor excision, mucoceles drainage, and palliative treatment. The need for routine B-scan examinations in dense cataract patients seems to be limited and can most likely be replaced by a thorough application of locally available examination techniques. B-scan application is recommended to manage orbital patients in the most cost-effective way.

Abstract Purpose The quality of an ultrasound device’s B-scan mode is decisive in obtaining clear and informative images. High demands are placed upon ultrasound devices, particularly in cases where evidence of small lesions of parenchymal organs is being gathered. Methods We tested the quality of the B-scan mode in ultrasound devices of 7 different manufacturers. We performed ultrasound examinations of 3 predefined abdominal sections on 4 healthy subjects with 7 different ultrasound devices. Documentation was compiled digitally by recording video sequences. Any characteristics identifying the manufacturer were removed. Subsequently, the sequences were organized into corresponding pairs. The resulting 252 video pairs were shown side by side to a panel of 10 experienced ultrasound examiners who evaluated the quality of the scans by way of direct visual comparison. Results Two of the 7 devices were clearly judged to be of higher quality. In part, the differences in the overall evaluation and within the subgroups reached levels of statistical significance. The ranking of the tested devices did not correlate with their suggested retail prices. Conclusion There are relevant differences in the quality of the B-scan mode of modern high-end devices. The suggested retail prices do not correlate with the B-scan quality of the ultrasound devices.

Background: Positron emission tomography (PET) with 18F-FDG is being used more frequently to evaluate primary pelvic tumors (PTs). However, a standardized hydration protocol is essential for an optimal diuretic effect and constant results. Methods: We reviewed 109 patients with PTs who had undergone 18F-FDG PET/CT examinations between November 2006 and April 2013. Four different protocols were used: (a) no hydration (group 1); (b) oral hydration (800 mL) after an early scan (group 2); (c) intravenous (IV) hydration (500 mL) during an early scan followed by oral hydration (800 mL) and IV furosemide (20 mg) after an early scan (group 3); and (d) oral hydration (800 mL) before an FDG injection followed by the protocol from group 3 (group 4). The maximum standardized uptake (SUVmax) of the urinary bladder (UB) and PTs and the PT/UB SUVmax ratios were examined. Results: The UB SUVmax of group 4 was significantly lower in the early scan compared to that in the other three groups. Group 4 had a significantly higher PT/UB SUVmax ratio in the early scan than the other three groups, and it also had a 52.5% positivity rate for PTs. Conclusions: The pre-hydration plus forced diuresis protocol yielded the optimal effect of UB radiotracer washout and had the best PT/UB SUVmax ratio in both scans.

Background It has been reported that intravoxel incoherent motion (IVIM) diffusion magnetic resonance imaging (MRI) scan–rescan reproducibility is unsatisfactory. Purpose To study IVIM MRI parameter reproducibility for liver parenchyma after the removal of motion-contaminated and/or poorly fitted image data. Material and Methods Eighteen healthy volunteers had liver scans twice in the same session to assess scan–rescan repeatability, and again in another session after an average interval of 13 days to assess reproducibility. Diffusion-weighted images were acquired with a 3-T scanner using respiratory-triggered echo-planar sequence and 16 b-values (0–800 s/mm2). Measurement was performed on the right liver with segment-unconstrained least square fitting. Image series with evidential anatomical mismatch, apparent artifacts, and poorly fitted signal intensity vs. b-value curve were excluded. A minimum of three slices was deemed necessary for IVIM parameter estimation. Results With a total 54 examinations, six did not satisfy inclusion criteria, leading to a success rate of 89%, and 14 volunteers were finally included for the repeatability/reproducibility study. A total of 3–10 slices per examination (mean = 5.3 slices, median = 5 slices) were utilized for analysis. Using threshold b-value = 80 s/mm2, the coefficient of variation and within-subject coefficient of variation for repeatability were 2.86% and 3.36% for Dslow, 3.81% and 4.24% for perfusion fraction (PF), 18.16% and 24.88% for Dfast; and those for reproducibility were 2.48% and 3.24% for Dslow, 4.91% and 5.38% for PF, and 21.18% and 30.89% for Dfast. Conclusion Removal of motion-contaminated and/or poorly fitted image data improves IVIM parameter reproducibility.

This randomized prospective clinical study aims to analyze the differences between the computer-assisted planned implant position and the clinically realized implant position using dynamic navigation. In the randomized prospective clinical study, 30 patients were recruited, of whom 27 could receive an implant (BLT, Straumann Institut AG, Basel, Switzerland) using a dynamic computer-assisted approach. Patients with at least six teeth in their jaws to be implanted were included in the study. Digital planning was performed using cone beam tomography imaging, and the visualization of the actual situation was carried out using an intraoral scan. Two different workflows with differently prepared reference markers were performed with 15 patients per group. The actual clinically achieved implant position was recorded with scan bodies fixed to the implants and an intraoral scan. The deviations between the planned and realized implant positions were recorded using evaluation software. The clinical examinations revealed no significant differences between procedures A and B in the mesiodistal, buccolingual and apicocoronal directions. For the mean angular deviation, group B showed a significantly more accurate value of 2.7° (95% CI 1.6–3.9°) than group A, with a value of 6.3° (95% CI 4.0–8.7°). The mean 3D deviation at the implant shoulder was 2.35 mm for workflow A (95% CI 1.92–2.78 mm) and 1.62 mm for workflow B (95% CI 1.2–2.05 mm). Workflow B also showed significantly higher accuracy in this respect. Similar values were determined at the implant apex. The clinical examination shows that sufficiently accurate implant placement is possible with the dynamic navigation system used here. The use of different workflows sometimes resulted in significantly different accuracy results. The data of the present study are comparable with the published findings of other static and dynamic navigation procedures.

Background/Aim. In cases of blurred optic media the ultrasound diagnostics offers useful data about eventual presence of intraocular foreign body as well as about its precise localization in the eye. The aim of this study was to retrospectively analyze echographic findings in patients with the diagnosis of intraocular foreign body with a special interest in localizations of a intraocular foreign body in the eye and the presence of an eventual infection - endophthalmitis. The aim of this study was also to confirm the localization of intraocular foreign body by echography and to test the precision of this method. Methods. We performed analysis of all cases that had been referred to the ultrasound diagnostices, in which the presence of intraocular foreign body had been confirmed in the period of one year. All examinations were done with B-scan and were confirmed during the surgery - vitrectomy. Results. In the one-year period we were contacted by 27 patients with intraocular foreign body. In one injured eye the intraocular foreign body was in the lens (3.7%), in 10 injured eyes (37.03%) intraocular foreign body was in the vitreal body. In 15 patients (55.5%) intraocular foreign body was fixed in the retina. In one patient (3.7%) there was a perforating injury, intraocular foreign body was found in the retrobulbar part of the orbit. In 7 injured eyes (25.9%), with the presence of intraocular foreign body, we found signs of endophthalmitis (organized blurring in vitreal space, thickened choroid). Other accompanying echographic findings were: blood in vitreal space, haemophthalmus in 12 cases (44.4%), retinal detachment in 5 cases (18.5%) and subretinal hemorrhagies in 4 cases (14.8%). Conclusion. Ultrasound diagnostics can very precisely show the localization of intraocular foreign body in the eye that is very important in the choice of approach and timing of surgical treatment. Also the echographic diagnostics may find an accompanying endophthalmitis in the posterior segment of the eye, that is very important for an urgent therapeutic approach.

e16072 Background: A computer-aided diagnosis system for bone scan with semiquantitative index of Bone Scan Index (BSI) may be used to quantify the spread of bone metastases. This retrospective study aimed to examine associations between BSI, bone metabolic markers, and prostate specific antigen (PSA) in prostate cancer patients with bone metastases. Methods: A total of 158 scintigraphy of 52 patients (mean examinations/person 3, range 1-8; mean age 71 years, range 46 to 86) were studied. The intervals between bone scan and blood examinations were 0 to 16 days (median 0 day). Subjects were divided into 4 groups according to BSI; Group A: 0 - <2, Group B: 2 - <4, Group C: 4 - <8, and Group D: 8<. The markers of PSA, pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (1-CTP), bone alkaline phosphatase (BAP), and tartate resistant acid phosphatase-5b (TRAP-5b) were examined. As the values of PSA, BAP, and TRAP-5b covered a large range of scales, we also used the logarithms of the variables. BSI, which corresponded amount of metastatic lesions, was automatically calculated by BONENAVI software (FUJIFILM RIPharma, Co. Ltd., Tokyo, Japan; Exini Bone, Exini Diagnostics, Sweden). Results: All scans showed increased uptake at bone metastases. BSI correlated significantly with 1-CTP, BAP, logBAP, TRAP-5b, logTRAP-5b, and logPSA (r=0.39, 0.66, 0.71, 0.69, 0.61 and 0.41, respectively). Statistical F value was 11 in 1-CTP, 31 in BAP, 29 in logBAP, 19 in TRAP-5b, 14 in logTRAP-5b, 3 in PSA, and 9 in logPSA by ANOVA, respectively. Comparison by Dunnett’s test showed significantly higher values in Group D for all bone metabolic markers and logPSA, Group C for BAP, logBAP, TRAP-5b, and logTRAP-5b, and Group B for logTRAP-5b compared with Group A, respectively. However, PSA did not correlate significantly with extent of bone metastases as assessed by BSI. Conclusions: The changes in BSI showed close relationship with all bone metabolic markers but not with PSA. The BSI reflected the activity and extent of bone metastases, and might be used as an imaging biomarker.

Purpose: To present a rare case of optic nerve avulsion due to gun shot injury. Case Report: A 30-year-old man presented with sudden visual loss on the Right Eye (RE) after a gun shot on his left frontal bone. On examination of the RE, he had periorbital hematoma and edema, and also conjunctival chemosis. There was no light perception of the RE, and his pupil was dilated and nonreactive to light. There’s also an eye movement resistance. On the examination of the Left Eye, he had periorbital hematoma and edema, visual acuity was 1.0 and other examinations was within normal limit. B-scan USG of the RE showed a hyperechoic image on the retinal projection in front of the optic nerve. CT-scan showed multiple metal density fractions in the subcortical cortical left frontal lobe and right retrobulbar. On funduscopic examination, there was bleeding in the inferior vitreous originating from the optic nerve papilae. The patient underwent craniotomy, debridement, and corpus alienum extraction by neurosurgeon and plastic surgeon. The patient was treated with high dose steroid (methyl prednisolone 4 x 250 mg iv). After a week of therapy, there was no improvement of his RE visual acuity. Conclusion: Optic nerve avulsion is a rare case with devastating results because there’s still no definite therapy to improve the outcome.

Doppler examination is an integral part of the echocardiogram. Current systems are equipped with spectral Doppler in continuous wave mode (offering measurements of high velocities with limited spatial specificity due to integration of signal along the scan line), pulsed wave mode (high spatial specificity with maximal recordable velocity reduced by the Nyquist limit), and colour Doppler flow mapping (allowing rapid identification of flow pattern within a cross-sectional B-mode sector). Tissue Doppler echocardiography emerged as a basic tool for sampling regional myocardial velocities, in pulsed wave or colour velocity mapping mode. Finally, three-dimensional systems improve spatial presentation of flow phenomena by integrating Doppler-derived flow patterns in three-dimensional datasets.

The clinical applications of diagnostic ultrasound in ophthalmology were initiated by G.H. Mundt and w.F. Hughes ( 1 ) (1956) as well as A. Oksala and A. Lehtinen ( 2 ) (1957) introducing A-scan, and by G. Baum ( 3 ) (1958) introducing and pioneering B-scan. The first medical society for diagnostic ultrasound was founded in 1964 (Societas Internationalis de Diagnostica Ultrasonica in Ophthalmologia) with subsequent biennial congresses. Ophthalmic diagnostic ultrasound is the only ultrasonographic method heavily relying on A-scans besides the B-scans. Today, four distinct echographic methods (utilizing different types of instrumentation) are being used in ophthalmology: 1) Biometric A-scans for measuring the axial eye length. 2) Low-frequency B-scans for the examination of the posterior eye segment and the anterior orbit utilizing 10–20MHz. 3) High-frequency B-scans for the evaluation of the anterior eye segment applying 25–50MHz. 4) Standardized Echography , a combination of diagnostic as well as biometric A-scan (8MHz) and B-scan echography (10–50MHz) for a comprehensive ultrasonographic examination of the eye (anterior and posterior segments) and of the entire orbit and periorbital region. A-scan (8–12MHz) is used for measurements of the axial eye length, today an important contribution to the calculation of intraocular lens power in cataract surgery. F. Jansson ( 4 ) (1963) proposed biometric A-scan as an immersion (non-touch) technique and also measured the involved sound velocities of the anterior chamber, the lens, and the vitreous cavity which since then have been the accepted standard values. At first, axial eye length measurements were mostly used in studies regarding glaucoma and myopia. when, in the early 1970s, the implantation of artificial lenses during cataract surgery spread quickly, the much more precise but more time-consuming and demanding immersion method temporarily gave way to an easier and quicker contact method. Lately, however, advances in cataract surgery, especially the use of multifocal lenses as well as the competition from laser technology, resulted in a return of Jansson’s immersion method.

Finding new ways to prevent and reduce the incidence of dementia is a serious world problem. This study aimed to perform imaging comparisons between pre- and post-meridian sinew therapy using arterial spin labeling (ASL) and resting-state functional MRI (rs-fMRI). Meanwhile, the results were studied to provide imaging evidence to support the effect of this meridian sinew therapy to slow down the brain aging and to reveal the related neurological mechanisms. Eighteen sub-healthy volunteers were selected as subjects. Three treatment strategies were adopted, acupuncture (group A), myofascial release (group B), and the integrated acupuncture and myofascial release (group C). The subjects were assigned to receive the three treatment modalities sequentially. 3T MRI examinations were provided before and after each treatment, including routine brain MRI plain scan, ASL and rs-fMRI scan. Compared with the results before and after treatment, the number of brain regions with increased cerebral blood flow (CBF) values in the group A, group B, and group C were respectively 1, 15 and 10 brain regions, all including the right cingulate gyrus. And rs-fMRI showed that multiple brain regions was activated, mainly temporal lobe and frontal lobe. The independent component analysis showed that the right intraorbital superior frontal gyrus and the occipital region was activated. Meridian sinew therapy can increase CBF and enhance neuronal activity in brain regions significantly associated with cognitive and memory functions, which may be the main targets where it actions on to achieve “Xingshen Yizhi (waking up the spirit and reinforcing thinking activity)” effect. The combination of ASL and rs-fMRI may be an effective imaging modality for future quantitative monitoring of the preventive and therapeutic effects of the meridian sinew therapy.

Methods : in this prospective study, real time B Mode ultrasound imaging (USI) was compared to bilateral ascending contrast venography, double blindly, in 430 patients suspected of deep vein thrombosis (DVT) or pulmonary embolism.A complete scan of the venous system from the inferior vena cava to the calf veins, was performed with a high resolution duplex system (DIASONICS DRF 400) and coupled systematically with a C.W. Doppler examination. The results obtained by USI were thus compared to the venograms performed on a total of 854 legs.Results : there are corresponding results in 95% of the legs (808/854). If we consider venography as the standard of reference, the sensitivity of USI is 98% (325/333) and the specificity 94% (483/514). Isolated calf vein thrombosis are detected in 91% (84/92) of the legs and proximal DVT in 100% (241/241) in this series whatever the topography and the extension of the thrombosis and whatever the degree of the obstruction of the vein.Discrepancies found in 46 legs are related to :- 8 DVT located in the calf (6 in the presumed healthy leg) diagnosed only by venography.- 27 DVT (18 distal, 9 femoral or iliac) detected only by USI- 9 doubtful examinations with USI not confirmed by venography- 2 doubtful venograms with negative USI test.Comments : Calf vein thrombosis especially located in the soleal sinuses and the gastrocnemius with in most cases the direct image of the thrombus are more often detected by USI provided that the technique and the equipment are appropriate.The absence of visualisation of venous segments with venography is not specific of venous thrombosis. These veins non affected by the thrombosis are not filled by the contrast medium when located above in occluded ilio-femoral or ilio-caval junction or when they are the site of extrinsic compression. The direct image of the vein and the surrounding structures obtained with USI enhances the diagnostic sensitivity and specificity and provides precision of the exact extension of the thrombosis.Due to these differences, can venography still be considered as the standard of reference in the diagnosis of DVT and their precise localisation ?

The automation of various processes underlying maintenance and inspection of bridges using different robots have gained considerable attention in recent literature. For the development of effective methods to automate existing manual processes, a number of different solutions have been proposed. In this paper, the automation of rebar detection and localization will be discussed, which is one of the process for sub-surface health inspection of bridges. This study explores the utilization of Deep Encoder- Decoder Networks for the segmentation of GPR data in the form of B-scan images to extract parabolic rebar profiles. This research area is problematic, as the B-scan image data is fraught with noise, signal reflection and other artefacts that hinder the effective extraction of these rebar profiles. The data is collected in this study using Ground Penetrating Radar (GPR) sensor, which is employed in this study consist of data from 8 different bridges from different parts of the United States. A “leave-one-out” approach was used for the training and validation of the performance of the proposed system; the data from seven bridges was used for training and validation was performed on the remaining single bridge data. A number of different encoder modules have been trained and evaluated using SegNet as the backbone architecture. The performance of the proposed rebar detection and localization system has been evaluated in terms of different qualitative and quantitative metrics. On average, for the different encoder modules, the mean intersection-over-union (mIOU) values range between 60%-70%. The qualitative examination has highlighted the level of similarity between the ground truth and outputs from the different encoder modules within the SegNet framework.

Introduction: Cryptococcosis is an infection acquired through the lungs, the form of central nervous system involvement is neurocriptococcosis. The diagnosis is the investigation of yeasts in the cerebrospinal fluid using china ink. Treatment is amphotericin B and fluconazole. The aim is to report a case of neurocriptococcosis in an immunocompetent patient. This is a descriptive study, through the analysis of the medical record. Case report: Female, 23 years old, healthy, with severe headache for 15 days, with progressive worsening, neurological examination without changes, performed skull computed tomography (CT) scan, no changes, cerebrospinal fluid (CSF) examination showed nucleated cells 204, presence of yeast, Venereal Disease Research Laboratory (VDRL): non-reactive and culture of Cryptococcus gattii, positive China ink. Magnetic resonance imaging of the brain showed hypersignal on T2/FLAIR (T2-weighted-Fluid-Attenuated Inversion Recovery) affecting cortical sulci, encephalic fissures, cerebellar foliae and pial surface of the brainstem and diffuse leptomeningeal impregnation, volumetric reduction of the supratentorial ventricular system, suggestive of cerebrospinal fluid hypotension, findings of leptomeningitis, related to cryptococcosis. Treatment with amphotericin B and fluconazole was initiated. Patient with onset of focal neurological deficits, amaurosis and dysarthria. She presented with refractory headache, requiring serial liquoric punctures for relief of intracranial hypertension. She evolved with instability and underwent a right ventriculoperitoneal shunt. Postoperatively, he presented left hemiparesis. Skull CT showed hematoma and emphysema of adjacent extracranial soft tissues; right frontoparietal brain lesion and edema of adjacent parenchyma. She evolved with clinical instability and died after 61 days of hospitalization. Conclusion: A pattern of CSF hypotension was shown due to compression of the frontal horns of the lateral ventricles by the granulomas. There was a need for ventriculoperitoneal shunt, but patient had fatal complications.

Introduction: Sertoli-Leydig cell tumor (SLCT) is a rare ovarian tumor, Constitute less than 0.5% of ovarian tumors. Most tumors are unilateral, confined to the ovaries. They are seen during the second and third decades of life. They are characterized by the presence of testicular structures that produce androgens. Patients have symptoms of virilization (depending on the quantity of androgen). Case Report: A 42-year-old woman presented Amenorrhea for 14 months. Change in her voice for 1 year and Excessive hair growth on her face, chest, and limbs for the last 2 months. She complained of vague abdominal discomfort. No history of anorexia, weight loss, increased libido. Her medical and family history was unremarkable. On examination - Hirsutism and clitoromegaly. Lump of size 10x8 cm palpable in left iliac fossa. Vaginal examination revealed a firm and mobile cystic mass in the right adnexa. An ultrasound examination of the pelvis showed a 17x 13x 9-cm heterogeneous solid cystic mass replacing the left ovary. The right ovary and the uterus were normal. CECT Scan Abdomen-Large heterogenous encapsulated solid soft tissue mass lesions containing areas of calcification arising from left ovary of size 17x13x10.6cm causing displacement of urinary bladder and surrounding bowel loops. Serum testosterone level -2 ng/mL (normal, 0.2–1.2 ng/mL); (DHEAS), CA 125, and alpha fetoprotein (AFP) -normal. On Laparotmy-Large mass of size 17 X 13 cm arising from left adnexa. Uterus and right ovary grossly normal. Total Abdominal hysterectomy, B/L Salpingo-opherectomy and infracolic omentectomy was done. Peritoneal washing were sent for cytologic examination for malignant cells. No liver metastasis. The post operative period was uneventful. Histopathology revealed- confirmed it be Sertoli Leydig cell tumor. 3month follow up – resolution of her virilization symptoms. No increase of her hirsutism. Repeat testosterone levels - within normal range. Conclusion: Only few cases of SLCT have been reported till date Prognosis depends on extent of disease, stage of disease, tumour differentiation, grade. The treatment should be individualized according to the location, state of spread and the patient’s condition.

Compressed natural gas (CNG) storage well is a kind of pressure vessel buried underground. The detection of corrosion, which may be induced by the surrounding soil and different medium, is important for the safety security of the well, and protects it from CNG leakage or casing explosion. Among non-destructive examination techniques for corrosion detecting, the ultrasonic techniques are popularly utilized, in which the phased array approach can offer distinct advantages. To investigate both reliability and applicability of the phased array technique in the storage well, a complex design with a 512-element ultrasonic phased array that covered the entire cross-section was discussed, and phased array parameters were determined, including array elements, array element size, ultrasonic frequency and so on. An ultrasonic testing system was designed based on the above design, including a frame for holding phased array probes, a specific vessel for storing ultrasonic cards and other components, and an in-pipe robot designed for instruments’ moving in the storage well. The general corrosion condition described by thickness images were captured by the ultrasonic testing system with B, C and D-scan functions, in which circumferential electronic linear scanning was performed by the phased array probes and axial scanning was done by a mechanical scanning device. A method for minimizing the external pressure from water column necessary for coupling was put forward in the scanning and detection process. The sample for CNG storage well with artificial defects was built in laboratory environments and experiments were conducted to validate detection effects, and the phased array technique provided good sensitivity and efficiency, which may lead to a successful application in CNG storage well examination.

The purpose of this examination was to determine a) how bioimpedance scanning generates data about the human body and b) compare the Bodystat Multiscan 5000 and the Skulpt Chisel. The Bodystat Multiscan 5000 is bioelectrical impedance spectroscopy (BIS) device that performs a scan of 50 measurements, from 5 kHz to 1000 kHz. This scan generates a 2d Cole analysis plot that compares the resistance and reactance of the scanned muscle group. Higher frequencies measure the amount of intracellular fluid (ICF), and lower frequencies measure the amount of extracellular fluid (ECF). Lower values for the resistance and reactance relate to a greater level of fitness for the scanned area. The Skulpt Chisel is an electrical impedance myography (EIM) that performs a single 50 kHz measurement. This scan determines the muscle quality and percent body fat of the scanned muscle group. The test subject was scanned with each device. Each plane was scanned three times with the Bodystat Multiscan 5000, and scanned five times with the Skulpt Chisel. The data was recorded to Excel and analyzed using MATLAB. The Bodystat Multiscan measurements for the surfaces were examined at a frequency of 50 kHz to be comparable to the Skulpt Chisel data. The surfaces are recorded in descending order of magnitude for resistance: medial, 22.14 Ω; anterior, 20.31 Ω; posterior, 17.89 Ω; lateral, 12.6 Ω. The Cole Analysis for the right thigh at 45-degree intervals are recorded in descending order of magnitude for resistance: medial/posterior, 23.89 Ω; posterior/lateral, 23.06 Ω; anterior/medial, 21.09 Ω; lateral/anterior, 16.13 Ω. The Skulpt Chisel surfaces are recorded in an increasing order of magnitude, the first value being muscle quality and the second value being percent body fat: lateral, 81.12, 13.1%; posterior, 62.22, 16.46%; anterior, 50.88, 19.24%; medial, 42.16, 23.16%. The data display an inverse relationship between resistance/reactance and muscle quality, and a direct relationship between resistance/reactance and percent body fat. The larger the magnitude of the resistance/reactance recorded for a muscle group, the lower the level of muscle quality will be. This leads to a larger percent body fat value.

Case Report: A 56-year-old woman, multiparous patient, diabetic, hypertensive and tabagist, and taking insulin, metformin, losartan, propranolol, hydrochlorothiazide, and aspirin presents to a clinic. She also had a previous surgery for extraction of a duodenum carcinoma and a nodule in lower lateral quadrant of right breast about 15 years ago, which on previous ultrasound was hyperechoic, with heterogeneous content, measuring about 27×18.5×25 mm. Upon arrival at the hospital, the patient had an ulcerated lesion with a central necrotic area in the lower outer quadrant of the right breast, with drainage of bloody secretion and a foul odor, and a generalized hyperemia in the region of the right breast. On physical examination, the patient had local hyperemia and areas of fluctuation in lateral quadrants. There were no palpable lymph nodes. The results of her initial laboratory investigations showed a leukocytosis and an increased erythrocyte sedimentation rate and C-reactive protein. A computed tomography scan of the breast, chest, and abdomen showed massive subcutaneous emphysema in the right breast, extending from the subcutaneous region of the anterolateral and abdominal chest wall to the right iliac fossa, associated with diffuse densification of the muscular fascia and adjacent subcutaneous tissue. She was treated with intravenous broad-spectrum antibiotics that included 1 g of oxacillin and 1.5 g of metronidazole. She underwent surgical debridement for 3 consecutive days, starting 24 hours after hospital admission. She was recommended 1 g of ceftriaxone and amphotericin B along with antibiotic therapy. At the second surgery, a wound tissue was collected for histopathological examination discarding malignancy. Five weeks later, wounds appeared clean, healing with pink granulation tissue. Conclusion: This case shows that early diagnosis and management of necrotizing fasciitis of the breast can be lifesaving and may allow for breast conservation. Early aggressive debridement combined with antibiotic therapy resulted in successful wound healing and preservation of tissue with a satisfactory cosmetic outcome.

Introduction: Immature teratoma represents 3% of all teratomas, 1 % of all ovarian cancers and 20% of malignant ovarian germ cell tumors. It is found either in pure form or as a component of a mixed germ cell tumor. It occurs essentially during the first two decades of life. According to WHO, immature teratoma is defined as a teratoma containing a variable amount of immature embryonal type neuroectodermal tissue Case: We present here a report of 23 years old unmarried female who presented with complaint of abdominal pain since 1 month and her CT scan done outside, showed fibroid uterus. She had history of typhoid fever 1 month back for which USG was done which suggested large uterine fibroid. On examination she was hemodynamically stable. On abdominal examination a non-tender supra-pubic mass of 24 weeks size with firm consistency, irregular margin was felt. On investigation CA 125 was 64.90 IU/L, LD- 223, beta HCG- 1.14. On MRI a large abdomino-pelvic lesion, likely left adnexal lesion with multiple cystic areas, with hemorrhage, with ascites and enlarged retroperitoneal lymph nodes with omental infiltration suggestive of a possibility of malignant germ cell tumor. In view of large ovarian tumor, possibly malignant decision for staging laparotomy was taken. Intra-operatively a large irregular vascular solid mass of 20 x 20 cms with bosselated appearance with few cystic lesions over it was seen, arising from left ovary and was sent for frozen section which reported malignant mature teratoma with components of immature teratoma. She underwent laparotomy with left salpingo-oophorectomy with right ovarian biopsy, omentectomy, appendectomy with B/L pelvic lymphadenectomy. Histopathology was suggestive of grade III immature teratoma. In view of grade III immature teratoma, she received chemotherapy (BEP regimen) post-operatively and is currently under follow up. Conclusion: This case reflects the importance of early diagnosis in cases of pelvic masses in young females. Fertility preservation should be considered in young women with germ cell tumors. Patients with grade II or III tumors or a mere advanced stage disease should be treated with adjuvant chemotherapy (BEP) in addition to surgery.

Introduction: Infiltrating Lobular carcinoma (ILC) of the breast is second most common cancer of breast next only to Infiltrating ductal carcinoma (IDC). It has a different metastatic pattern as compared to the IDC. Breast cancer is the most frequent primary site which spreads to gynaecologic organs. Case Presentation: A 40 yrs old Iraqi lady presented as a diagnosed case of lobular carcinoma of left breast. She had already undergone a lumpectomy at Iraq a month back and now had come for completion of treatment. On metastatic workup with PETCT scan, we found a multicentric residual disease in the left breast along with some ipsilateral axillary LN with significant uptake. The concurrent CECT done showed a uterine leiomyomam also. As she was strongly hormone receptor positive, had completed her family and was having mennorhagia probably attributable to uterine fibroids. She was offered hysterectomy with B/L salpingo-oophorectomy. She was keen for breast preservation but in view of her multicentricity of disease on the left breast she was counselled for mastectomy with upfront whole breast reconstruction with TRAM flap. She underwent left modified radical mastectomy with hysterectomy with BSO and TRAM flap reconstruction. The histopathological examination revealed a multicentric, multifocal ILC, grade II with heavy nodal involvement including extracapsular extension. The leiomyoma of uterus also showed tumor deposits from lobular carcinoma breast. Conclusion: We report a very rare case of metastatic pattern of carcinoma of breast. On literature review we found that it is common for the lobular carcinomas of breast to metastasise to gynaecologic organs. Uterine corpus is a very rare site of metastasis for extragenital cancers including breast. All the patients of primary lobular carcinoma of breast should be screened for gynaecologic secondaries in the preoperative workup with high degree of suspicion.

Introduction: Cryptococcosis is prevalent in immunocompromised individuals. Immunocompetent patients can develop latent infections, the breast being a rare focus of primary disease, with few reports in the literature. Case report: GHMC, female, 27 years old, married, ticketing operator, resident in Valparaíso / GO, Brazil. She denied comorbidities, use of medication, smoking or drinking, as well as contact with caves, farms, farms, wild animals and ingestion of game meat. She reported fever (38°C), left mastalgia associated with hardened erythema with subsequent fistulization and removal of purulent secretion. Upon examination, she was in good general condition, with a palpable nodule of about 6 x 4 cm, in union of the lower quadrants (ULQ) of the left breast (LB), which was regular, soft, felt a little painful on palpation, with increased local temperature and without lymph node enlargement or papillary discharge. The ultrasound of the breasts showed a heterogeneous solid mass, with cystic areas of permeation, in ULQ of LB, of 4.2x2.2 cm, partially defined contours coinciding with a nodular image of 4 cm in the same topography in the mammography. Magnetic resonance imaging showed a nodular, irregular, hypodense image in T1, hyperdense in T2, with parietal enhancement and heterogeneous, progressive internal enhancement, in addition to capturing septa, measuring 6.1x4.0x4.6 cm, suggesting mucinous carcinoma. Core biopsy of the solid part of the lesion and collection of mucinous fluid was performed. Concomitantly, oxacillin was started for seven days. There was no laboratory change during the entire disease period. Fifteen days after the end of the antibiotic use, the lesion became an erythematous lenticular ulcer, with flat edges, of 5.0x4.0 cm, with colloid secretion leaving its bed. Histology showed cryptococcosis, and liquid cytology showed cryptococcus neoformans. During immunosuppression investigation, the patient underwent chest and skull CT scans, serology, tumor markers, ANF (antinuclear factor), rheumatoid factor, C3, C4, lumbar puncture and blood cultures (all excluded any immunosuppressive pathology). The treatment was carried out with Fluconazole 800 mg/day for three months, with a reduction to 300mg/day for another three months. Two months after the start of treatment, the lesion resolved. Cryptococcosis is an invasive mycosis with high morbidity and mortality. It affects immunosuppressed individuals, and is rare in immunocompetent individuals. The main pathogenic species, C. neoformans and C. gatti, are prevalent in tropical and subtropical climates. The main sites affected are the brain and the lungs; other sites are rare. The dosage and duration of breast therapy is unknown, but 2- 3g/day of amphotericin B or 400-800mg/day of fluconazole for 8–12 weeks has achieved therapeutic success in reported cases.

As a student undertaking a Longitudinal Integrated Clerkship (LIC)1 based in a GP practice in a rural community in the North of Scotland, I have been lucky to be given responsibility and my own clinic lists. Every day I conduct consultations that change my practice: the challenge of clinically applying the theory I have studied, controlling a consultation and efficiently exploring a patient's problems, empathising with and empowering them to play a part in their own care2 – and most difficult I feel – dealing with the vast amount of uncertainty that medicine, and particularly primary care, presents to both clinician and patient. I initially consulted with a lady in her 60s who attended with her husband, complaining of severe lower back pain who was very difficult to assess due to her pain level. Her husband was understandably concerned about the degree of pain she was in. After assessment and discussion with one of the GPs, we agreed some pain relief and a physio assessment in the next few days would be a practical plan. The patient had one red flag, some leg weakness and numbness, which was her ‘normal’ on account of her multiple sclerosis. At the physio assessment a few days later, the physio felt things were worse and some urgent bloods were ordered, unfortunately finding raised cancer and inflammatory markers. A CT scan of the lung found widespread cancer, a later CT of the head after some developing some acute confusion found brain metastases, and a week and a half after presenting to me, the patient sadly died in hospital. While that was all impactful enough on me, it was the follow-up appointment with the husband who attended on the last triage slot of the evening two weeks later that I found completely altered my understanding of grief and the mourning of a loved one. The husband had asked to speak to a Andrew MacFarlane Year 3 ScotGEM Medical Student 2 doctor just to talk about what had happened to his wife. The GP decided that it would be better if he came into the practice - strictly he probably should have been consulted with over the phone due to coronavirus restrictions - but he was asked what he would prefer and he opted to come in. I sat in on the consultation, I had been helping with any examinations the triage doctor needed and I recognised that this was the husband of the lady I had seen a few weeks earlier. He came in and sat down, head lowered, hands fiddling with the zip on his jacket, trying to find what to say. The GP sat, turned so that they were opposite each other with no desk between them - I was seated off to the side, an onlooker, but acknowledged by the patient with a kind nod when he entered the room. The GP asked gently, “How are you doing?” and roughly 30 seconds passed (a long time in a conversation) before the patient spoke. “I just really miss her…” he whispered with great effort, “I don’t understand how this all happened.” Over the next 45 minutes, he spoke about his wife, how much pain she had been in, the rapid deterioration he witnessed, the cancer being found, and cruelly how she had passed away after he had gone home to get some rest after being by her bedside all day in the hospital. He talked about how they had met, how much he missed her, how empty the house felt without her, and asking himself and us how he was meant to move forward with his life. He had a lot of questions for us, and for himself. Had we missed anything – had he missed anything? The GP really just listened for almost the whole consultation, speaking to him gently, reassuring him that this wasn’t his or anyone’s fault. She stated that this was an awful time for him and that what he was feeling was entirely normal and something we will all universally go through. She emphasised that while it wasn’t helpful at the moment, that things would get better over time.3 He was really glad I was there – having shared a consultation with his wife and I – he thanked me emphatically even though I felt like I hadn’t really helped at all. After some tears, frequent moments of silence and a lot of questions, he left having gotten a lot off his chest. “You just have to listen to people, be there for them as they go through things, and answer their questions as best you can” urged my GP as we discussed the case when the patient left. Almost all family caregivers contact their GP with regards to grief and this consultation really made me realise how important an aspect of my practice it will be in the future.4 It has also made me reflect on the emphasis on undergraduate teaching around ‘breaking bad news’ to patients, but nothing taught about when patients are in the process of grieving further down the line.5 The skill Andrew MacFarlane Year 3 ScotGEM Medical Student 3 required to manage a grieving patient is not one limited to general practice. Patients may grieve the loss of function from acute trauma through to chronic illness in all specialties of medicine - in addition to ‘traditional’ grief from loss of family or friends.6 There wasn’t anything ‘medical’ in the consultation, but I came away from it with a real sense of purpose as to why this career is such a privilege. We look after patients so they can spend as much quality time as they are given with their loved ones, and their loved ones are the ones we care for after they are gone. We as doctors are the constant, and we have to meet patients with compassion at their most difficult times – because it is as much a part of the job as the knowledge and the science – and it is the part of us that patients will remember long after they leave our clinic room. Word Count: 993 words References 1. ScotGEM MBChB - Subjects - University of St Andrews [Internet]. [cited 2021 Mar 27]. Available from: https://www.st-andrews.ac.uk/subjects/medicine/scotgem-mbchb/ 2. Shared decision making in realistic medicine: what works - gov.scot [Internet]. [cited 2021 Mar 27]. Available from: https://www.gov.scot/publications/works-support-promote-shared-decisionmaking-synthesis-recent-evidence/pages/1/ 3. Ghesquiere AR, Patel SR, Kaplan DB, Bruce ML. Primary care providers’ bereavement care practices: Recommendations for research directions. Int J Geriatr Psychiatry. 2014 Dec;29(12):1221–9. 4. Nielsen MK, Christensen K, Neergaard MA, Bidstrup PE, Guldin M-B. Grief symptoms and primary care use: a prospective study of family caregivers. BJGP Open [Internet]. 2020 Aug 1 [cited 2021 Mar 27];4(3). Available from: https://bjgpopen.org/content/4/3/bjgpopen20X101063 5. O’Connor M, Breen LJ. General Practitioners’ experiences of bereavement care and their educational support needs: a qualitative study. BMC Medical Education. 2014 Mar 27;14(1):59. 6. Sikstrom L, Saikaly R, Ferguson G, Mosher PJ, Bonato S, Soklaridis S. Being there: A scoping review of grief support training in medical education. PLOS ONE. 2019 Nov 27;14(11):e0224325.

Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.