Lung cancer is the leading cause of cancer-related death around the world, being the top cause of cancerrelated deaths among men and the second most common cause of cancer-related deaths among women in Singapore. Currently, no screening programme for lung cancer exists in Singapore. Since there is mounting evidence indicating a different epidemiology of lung cancer in Asian countries, including Singapore, compared to the rest of the world, a unique and adaptive approach must be taken for a screening programme to be successful at reducing mortality while maintaining cost-effectiveness and a favourable risk-benefit ratio. This review article promotes the use of low-dose computed tomography of the chest and explores the radiological challenges and future directions.

Whole-liver diffusion-weighted MRI histogram analysis showed a significant shift towards lower fifth percentile ADC values and higher SD in patients with colorectal liver metastasis compared with controls without liver disease.

Integration of distinct clinical perspectives in multi-disciplinary tumor board meetings is critical to determine optimal patient care. Digital tools can support the data consolidation needed for meeting preparation and data sharing during complex case reviews. In this paper, we assessed the value of a clinical decision support tool on workflow efficiency and conducting a complex case review of a dermatofibrosarcoma protuberans (DFSP) tumor. Methods: Case presentation was performed by each unique clinical specialty that had relevant information about the patient; an oncologist, a pathologist, and a radiologist. Virtual discussion was completed online with case presentation and documentation with NAVIFY Tumor Board. Workflow efficiency assessment was done through interviews and observation of the # of steps across different team members involved in preparing and conducting cancer multidisciplinary team (MDT) meetings before and after the implementation of the NAVIFY Tumor Board solution. Results: Case review consisted of surgical and therapeutic intervention history, distinct histological and sequencing patterns representative of DFSP, with radiological review to determine areas for surgical intervention. Consolidation of clinical input led to a recommendation of a formal external hemipelvectomy with potential chemotherapy. Workflow assessment demonstrated a 46% total reduction in the # of steps for meeting preparation (from 69 to 37), with specific changes based on role: data manager (33 to 15), pathologist (26 to 13), radiologist (no change), and logistics (5 to 4). There was a 31% total reduction in the # of steps for conducting the meeting (from 51 to 35). Conclusion: Utilizing a digital clinical decision support tool helped to consolidate patient data and improved case presentation through workflow efficiency. This allowed for improved interdisciplinary discussion on a complex DFSP case and supported the determination of a clinical decision.

Paragangliomas of the neck are rare somatostatin receptor-expressing neuroendocrine tumors. Somatostatin-receptor scintigraphy is useful in diagnosing and staging these tumors, as well as assessing residual or recurrent disease posttreatment. We describe the gallium 68 DOTA, D Phe 1 , Tyr 3 -octreotate positron-emission tomography-CT ( 68 Ga-DOTATATE PET-CT) findings of bilateral neck paragangliomas as seen in the following patient. A previously healthy 40-year-old woman presented with asymmetric sensorineural hearing loss, right more than left, which was confirmed on an audiogram. There was no other neurologic deficit. MR imaging of the internal auditory meati did not reveal any abnormality at the cerebellopontine angles or internal auditory canals; however, a left carotid space mass was partially visualized. A dedicated MR image of the neck revealed avidly enhancing lobulated masses within bilateral carotid spaces (Figs 1 and 2A). The right neck mass extended from the level of the carotid bifurcation to the level of the nasopharynx and splayed the right internal and external carotid arteries. The left neck mass extended from the level of the oropharynx to the left jugular foramen, splaying the left internal jugular vein and internal carotid artery.68 Ga-DOTATATE PET-CT demonstrated intense tracer uptake within the bilateral carotid space masses ( Fig 2B). There was no other abnormal focus of increased tracer uptake in the rest of the body to suggest the presence of metastasis. These imaging findings confirmed a right carotid body tumor and a left glomus vagale. Biochemical screening revealed elevated urine norepinephrine (622 nmol/day; normal, 89 -473 nmol/day) and normetanephrine (2895 nmol/day; normal, 600-1900 nmol/day) levels. The patient opted for and is scheduled to undergo radiation therapy. DOTATATE is a somatostatin analog, which can be radio-labeled with 68 Ga. 68 Ga is a positron emitter with a half-life of 68 minutes, produced by elution from 68 Ge in a 68 Ga generator. 68 Ga-DOT-ATATE shows a high affinity for somatostatin type 2 receptors (SSR-2), is rapidly excreted from nontarget sites, and offers good target-to-nontarget imaging properties. Compared with indium 111-diethylene triamine pentaacetic acid-octreotide, 68 Ga-DOTATATE demonstrates better sensitivity for neuroendocrine tumors 1 and is useful for the diagnosis of small tumors and evaluation of disease response following therapy. 2 The mainstay of treatment for paragangliomas in the head and neck region has been surgical resection, preoperative embolization, and/or external beam radiation therapy, though a role for stereotactic radiosurgery is emerging. 3 There is also a promising role for peptide-receptor radionuclide therapy, where the somatostatin analog DOTATATE is radio-labeled with the ␤ emitter lutetium 177 ( 177 Lu) to deliver highly targeted doses to tumors expressing the SSR-2, with low doses to the normal organs. 4Our case highlights the intense and specific tracer uptake of 68 Ga-DOTATATE in paragangliomas of the neck, wh...