The premise of medical screening is to identify clinically occult disease, facilitating intervention at an early stage with the intention of improving prognosis. Identifying solid organ malignancy before nodal or distal metastases have occurred unanimously offers the best chance of successful radical treatment, thus there is clearly a potential significant mortality benefit for successful oncological screening programmes. However, the negative consequences of screening have to be considered, particularly the impact of intervening in asymptomatic populations. Diagnostic radiology has an invaluable ability to non-invasively detect disease and has developed an essential role in several oncological screening programmes with new programmes emerging. These include the established mammography screening programme for breast carcinoma, the emerging CT screening programme for lung carcinoma and a new proposed radiological screening programme for pancreatic carcinoma. Results from published randomized controlled trials analysing the benefits of radiological screening have been convoluted and conflicting. Cancer screening remains a widely contested topic and it is a challenge for both radiologist and clinician to assess the risks and benefits at both a population and individual patient level. In this article, we discuss radiological screening and analyse the current literature on these programmes, with evaluation of recently published studies and ongoing trials.

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A355sedation for endoscopic procedures that compared outcomes using pulse oximetry alone with pulse oximetry plus capnography. Adverse events (AEs) considered included apnea, bradycardia, desaturation, and hypotension. Interventions to treat AEs were taken from guidelines with costs derived from the Premier database and literature review. Adverse outcomes included unplanned admission and mortality. Odds ratio for events with capnography were taken from RCTs and a meta-analysis, where available, data specific to moderate sedation were used. The model base case assumed no progression into deep sedation and patients with mean characteristics of age 55 years, body mass index 26 kg/m 2 , and 45% male. Probabilistic sensitivity analyses were performed. Results: In the base case, utilization of capnography reduced the proportion of patients experiencing ≥ 1 AE by 18.0% and resulted in 1 AE of any severity being avoided every 9 procedures. The mean number needed to treat (95% credible interval [CrI]) to avoid an apnea or severe desaturation AE was 27 (−109-409) and 17 (4-308), respectively. Due to the reduction in AEs, capnography resulted in a saving of $55 (95% CrI −96-247) per procedure at 1 year. The key cost driver was reduced use of airway interventions with capnography. Assuming that AEs did not incur costs; capnography increased the cost per procedure by $9, costing $83 per adverse event avoided. ConClusions: Capnography is likely to be cost-effective for monitoring moderate sedation even without considering progression to deep sedation. Estimates indicate that it may also be cost saving.

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