Lung Cancer Case Study PDF

Group 2 Bermudez, Britt Brian —Billanes, Daniel Noah — Gumban, John Leander Jumlani, Abdullah — Lubrico, John Markfil — Sahi, Mashael Scenario: A 60-year-old smoker complains of a chronic cough and chest pain. A chest X-ray shows a suspicious mass, prompting a...

Group 2 Bermudez, Britt Brian —Billanes, Daniel Noah — Gumban, John Leander Jumlani, Abdullah — Lubrico, John Markfil — Sahi, Mashael Scenario: A 60-year-old smoker complains of a chronic cough and chest pain. A chest X-ray shows a suspicious mass, prompting a CT scan that reveals a 3 cm nodule in the right upper lobe with irregular borders, suggestive of lung cancer. A biopsy confirms non-small cell lung carcinoma. 1. Identify Pathology The pathology identified here is non-small cell lung carcinoma (NSCLC). NSCLC accounts for approximately 85% of all lung cancer cases and is most often associated with smoking. The irregular borders and location in the upper lobe observed on the CT scan further suggest malignancy. 2. Why CT Scan is the Best Modality to Rule Out This Pathology High Resolution: CT scans provide high-resolution, cross-sectional images, allowing for detailed visualization of lung nodules. 3D Imaging Capability: Enables better assessment of the nodule's size, shape, and location, including its relation to nearby structures. Detection of Small Lesions: CT is more sensitive than X-ray in detecting small lesions, which can be critical in early cancer diagnosis. Contrast Enhancement: The use of IV contrast in CT helps differentiate between benign and malignant lesions based on enhancement patterns. 3. Patient History and Symptoms Age and Smoking History: At 60 years old with a history of smoking, the patient has a higher risk for lung cancer. Chronic Cough and Chest Pain: These are common symptoms associated with lung cancer, often occurring due to tumor growth and its impact on surrounding structures. Suspicious Chest X-ray Findings: A mass on an X-ray justifies further investigation with a CT scan to determine the characteristics and extent of the lesion. 4. How to Perform the CT Scan Preparation: ○ Explain the procedure to the patient, ensuring they understand the need for IV contrast. ○ Ask about allergies, especially to contrast media, and review renal function if using contrast. Positioning: ○ The patient is positioned supine, with arms elevated above the head to prevent artifacts. Acquisition Parameters: ○ Use a thin-slice protocol (e.g., 1-2 mm slice thickness) for higher spatial resolution. ○ Perform both non-contrast and contrast-enhanced scans, if indicated, to evaluate lesion enhancement.  Post-Processing: ○ Use multiplanar reconstruction (MPR) to review the nodule in various planes for better evaluation. 5. Analyze CT Scan (Image) Characteristics: The nodule is 3 cm with irregular borders, which is suggestive of malignancy. Features such as spiculated edges and heterogeneity within the nodule further support the diagnosis. Location: The right upper lobe is a common site for primary lung cancers. Size Assessment: Given the 3 cm size, this nodule would be classified as a T1 tumor in the TNM staging system, though further evaluation is needed to determine staging fully. 6. Confirm Diagnosis Biopsy Confirmation: A biopsy confirms the presence of non-small cell lung carcinoma. Histopathological examination provides definitive diagnosis, type of NSCLC (e.g., adenocarcinoma, squamous cell carcinoma), and cellular characteristics. 7. Discuss How Images are Stored and Accessed using PACS PACS: Images from the CT scan are stored in the Picture Archiving and Communication System (PACS). This system digitally stores images, allows access by multiple users simultaneously, and provides tools for image manipulation. Access and Sharing: Authorized healthcare providers can access PACS to review, compare, and collaborate on patient images, improving diagnostic accuracy and patient care coordination. 8. Role of RIS in Scheduling and Managing CT Procedures Scheduling: The Radiology Information System (RIS) helps in scheduling the CT scan by managing appointment times, patient preparation, and available resources. Workflow Management: RIS tracks the status of procedures, from order entry to image interpretation, helping radiologists and technologists stay organized. Communication: It links with PACS to ensure images are labeled correctly and organized for timely review, reducing the risk of delays and errors. 9. Discuss How the Patient’s EHR Integrates Imaging Results into the HIS Integration with HIS: The Electronic Health Record (EHR) integrates imaging results and reports from the RIS and PACS systems into the Hospital Information System (HIS). Comprehensive Record: This integration provides a single, unified view of the patient's health records, including history, laboratory results, and imaging findings, facilitating coordinated care. Access and Continuity of Care: Authorized healthcare providers, including those outside radiology, can access the imaging findings, allowing for better-informed decisions and follow-up.