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Summary

This engaging on-demand session by the British Radiology Journal Club focuses on the topic of respiratory radiology, predominantly on imaging and specific CT scans. This relatively new organization's ultimate goal is to gather individuals interested in and involved with radiology to discuss the latest findings in the field. This session highlights the significance of imaging lung abnormalities, diving into their clinical significance, and association with lung cancer. It offers a thorough breakdown of lung abnormalities, explaining their causes, progression, and eventual impact on patients. The session also clarifies the correlation between abnormal lung findings and lung cancer, emphasizing the need to closely monitor those findings for early lung cancer detection and effective treatments. A must-attend session for medical professionals interested in respiratory radiology.

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Description

Chest Radiology focusing on Lung Cancer in particular

Learning objectives

  1. Understand the role of The British Radiology Journal Club and its activities in disseminating latest research findings in the field of radiology.
  2. Gain detailed insights into the concepts, manifestations, and classifications of interstitial lung abnormalities, focusing on radiographic analysis through computed tomography (CT) scans.
  3. Explore the correlation between interstitial lung abnormalities and the risk of lung cancer incidence, prognosis, and treatment complications.
  4. Enhance knowledge on the management and monitoring protocols for patients diagnosed with interstitial lung abnormalities, including patient history assessment, risk factor reduction, and follow-up care.
  5. Critically evaluate select articles from recent literature, such as those published in RSNA Radiographics and the European Respiratory Journal, to deepen understanding of the relationship between interstitial lung abnormalities and lung cancer.
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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

Hi, everyone. Thanks for joining us this evening. I know um it's a working week and um everyone wants to be quite busy, but hopefully you should be uh good insightful event ahead. This is just for those who haven't joined our events before. This is with the British Radiology Journal Club and we aim to meet on a monthly basis and we've been around since the start of the year. So we are quite a new organization. Uh But essentially our aim is just to bring like minded individuals who are keen and currently involved in the world of radiology and discuss the latest papers. Um And uh just moving on. If you want to follow us, there are two ways we have a whatsapp community. Um I'm not sure if this link actually works. I just um so do let me know in the chat if it does work or if it doesn't, otherwise please follow us on Instagram or alternatively, uh follow us through our website and I'll pop the link for that in the chat once we get started. Um So today the focus is on uh respiratory radiology. Um and we'll be focusing on imaging in particular CT scans. I think. So, our first presenter is MRI and uh I'll hand it to you Marriam now. So I'm just gonna stop sharing my screen and if you um able to share yours, that'd be great. Thank you all the best. Thank you. No, she is that screen ch um So have you um clicked on the present now and then? Share. Good help. Yeah. Is it all? Yeah, that's perfect. Right. OK. So the paper I'm presenting is about lung abnormalities at CD subtypes clinical significance and its association with lung cancer. And it was published in RSNA Radiographics in September 2022. So a bit of the about what's interstitial in the lung, uh we know that there is a lump and then there is initia given that, that the we have the proper addition going on that's in the Veli air in the lungs will add in six days. And then we have blood vessels running along with it and between the alveoli and the blood vessels, there are some fibro uh fibrotic cells and the lining of the two things, the sac as well as the blood vessel and these three things make up our interstitial. So if there is anything that's causing scarring or fibrosis, in that case, that will definitely make a exchange different. And this is a this uh phenomena behind any interstitial lung abnormality or disease. So, coming up to the paper, we have a general overview of it, lung abnormalities could be differentiating her eye liver from interstitial lung disease. We have three subcategories of Ira and uh her view of the management of her interstitial level. And then we'll be seeing how I is significantly uh linked to lung cancer and a bit of the so coming uh to the I A decision, lung abnormality. So we basically define it on CT, it's a purely incidental finding. We normally don't get a request for a CT scan to diagnose any eyelid, but we are doing CT scan for something else. And then we find it incidentally on the stent. So basically defined as incidental finding of non dependent abnormalities that affect more than 5% of the process of is one of three young zones and cities. It could include a architecture distortion cases, honeycombing and non cases. So these are the CT images uh of the abovementioned uh condition. So, first of all, in the picture, a the first on the left side, we can see some ground loss abnormalities. So ground loss is basically a right shadowing uh slight white uh uh you can say shade in the lung at some places, there's some ha or abnormalities. Second one, we have reticulations which are thin strand like structures which could be present in the subur areas or sometimes in prepar, then we have traction basis. So traction is like something else uh pulling up the, so that basically looks like a small tiny tube tube formation. And this is the picture C and then in the D we have honey, right, which is a form of this spectrum. And in this SWS form, the chain is actually irreversible. So, damage is quite high and now we cannot expect any reverse in this chain. Uh No, and this is basically formed of uh fibrotic scarring. We have fibrosis as well as some tiny and some big cysts in the area. So what is ULD? Then we are normally aware of the term uld interstitial lung disease, which is very common when we're working in or and other area as well. So, IUD is not the absence of symptoms or functional decline. It's only a finding that we saw on seeing, but the indecision lung disease is a whole spectrum of the symptoms of neurological pictures. And it's also confirmed on histopathological things like we do biopsy for confirming I and then we move on to the treatment and stuff like that. But for I, it is an incidental thing which we need to keep an eye on because it can progress to cancer and it is a risk factor for cancer as we'll see in the later part. So you have three subcategories for I. The first one is no, sorry if you hold on for a minute. People are seeing this. Can we um cancel the slide sharing and reha the slides? Oh, yeah, sure. I can see it on my screen. But I think maybe it's just uh lagged. Yeah, let me. Yeah. And is it reasonable now? Um, it seems to me if people come in the chat, they can see it. Yeah, great. May I proceed now? Yeah, I had like a slide or three on it. You, you kind of jump into the slide seven maybe. Sorry. Do you want to go back to slide seven? Ok. Yeah, so I can restart from here then. So these are the four basic spectrum, uh four basic things that we can find in eyelids. The most uh subtle finding is this grav that we can see in the picture a given by these four arrows. And it's a very subtle finding very slight gray shadowing here. Second one is reticulation with a thin strand like findings and it's a bit swear for third distraction. Don't give this instruction is for like something is pulling up the buli and we can see tiny tubules form here in the picture. See. And then the last and the form is honeycombing in honeycombing. We have fibrosis which could be of variable sizes and this form is actually the irreversible stage. So the lungs are quite damaged at this stage and are more prone to infections as well as have more uh risk of cancer coming up to and IRA. So we come across interstitial lung disease in S and a lot of spaces there. So the finding I LA is like it's a multidisciplinary uh thing. We have findings and we have CD findings and then we have biopsy reports as well. But I LA is typically are ct finding, incidental finding. Next are three categories we see in I would be non sub where you meet with uh which is basically the thing which is in the pan, which is not, but the pleural is the subur space is spare. Then we have no a subpleural nonfibrotic, nonfibrotic is a milder form that the damage is there, but the fibrosis is not developed here. So the when we have fibrosis, it's uh quite difficult that the thing can get reversed. Then the last is clal fibrotic. And uh fibrosis refers to architectural distortion with bronchitis and or honeycombing. So that's a very form and plural. I was correlated with greater likelihood of progression. So, uh there is um uh compared with the findings in individuals without I the fibrosis in individuals with I correlated with these mal. So now we know two things that if we find any thing that we saw in these four slides and which is more in the seal location and has uh element of fibrosis like the, the one in the honeycombing pattern or the one like you have reticulation development. Then this is uh alarming sign that the thing can progress to cancer. And it could be even even if uh if it develops into, then, then we can have increased chances of uh mortality. So, these are three types. If you define uh in the uh picture. A, we have non subur island, we can see this very subtle and faint abnormality given by the arrows here in the central and sub areas in picture A but not predominant in the sub area uh which is a form then coming up to be, we have subur nonfibrotic, we have brown glasses in the sub space, but it's not yet developed into front like we can't see any reticulations or any. So it's still the moderate form. But coming up to the sub fibrooptic form, ground glass abnormality as well as the linear obesity, which are all reticulations and traction is seen here with the arrows in the picture. See and the arrows are showing these reticulations. So this is a rare form and we really need to keep eye on this uh for the development of lung cancer and any severity of progressive disease. This is a bit of management what we can do about these patients. Uh First of all, we'll uh ask about the, the history and other factors, personal factors if the patient is uh smoking, if he's having any medications like chemotherapies or any radiation therapy for any other cancer or any other disease. And if there is any other physiological abnormality or any history of thoracic surgery, and then we have, these are logic factors that we saw in the previous pictures. So these uh two things combined will calculate the risk of progression. And given that, if the individual is having both risk grows, then we advise them to reduce the risk factor which can be controlled such as cigarette smoking. And if the patient is high risk group, we uh do active monitoring initially will be doing the pulmonary function test such as spirometry that we do and some other tests in 3 to 12 months and we'll do a follow up CT in a year or depending on the severity of the findings we finding CT then uh the association of I A and lung cancer. The basic uh the idea behind this do do is to know that how can I A affect the M as well as the risk of lung cancer. So the studies have shown that the risk of lung cancer is significantly increased in patients with a, a given the prognosis of patients with lung cancer who had certain findings of I becomes poorer and they uh associated with high mortality. Moreover, if the patient had developed lung cancer and he had, I unfortunately, the lung cancer treatment is uh related to many complications in such patients. The complications could be related to surgery could be related to chemotherapy and even radiotherapy. So this is a really important factor by diagnosing the lung cancer as well as in the CT chest. This is another study from the European Respiratory Journal in December 2020. So showing significant uh risk of uh significant development of lung cancer in patients with in a and even the mortality. The, the two lines in the second graph uh are about the one is about I incidence uh and lung cancer. And the second is showing mortality and we can see that both of these are going upward, making it uh high mortality disease. So coming up to the summary, we know what is a is a is a common finding on CT scans with potentially clinical significance. Then we know the subcategories of which are non subur milder form, subur nonfibrotic, moderate form and then subpleural fibrotic which is a rare. And I then we have potentially clinically significant ILD interstitial lung disease which we need to identify from a. Uh now we know how we can do that then uh knowing the risk factors for the progression of which we discussed with your clinical as related. And then we calculate the risk and uh advise the patient accordingly. I think with lung cancer incidence, we saw that in two studies now and the complications and the cancer thrombosis as well as cancer incidence, all are increased in patients with I. So we really need to identify I as soon as possible whenever we can uh whatever the patient is IC for and last but not the least. All this play a role in identifying Ira and recommending further workup. So recognition of this concept and knowledge of the imaging of IRA is mandate by this. So that's all for my. Thank you. Great, thank you. Uh Excellent. As a patient, I think it's very interesting uh kind of uh how is uh diagnosed and uh the different sub types, especially when you have the association with the lung cancer. Really highlights the uh does anyone have any uh comments that they wanna put in the chart or any questions they have, feel free to um pop those in the chat? Um I've um recreated the whatsapp QR link for our Radiology Journal Club um announcement page. So, um if you want to stay involved, um I know any upcoming events that we have uh do um join the whatsapp community and now we'll move on to our second presentation with Sara and it will be progressing on from the theme of lung cancer. Um And I'll stop sharing my screen now. So if you have a got sharing yours, hello, I tried to share my screen. I'm not sure. Do you have my screen or not? Uh Not yet perhaps try again because you know, we're sharing. So there's also like an overlap. OK. So I think there is a problem not coming up the Google page. And then if you click on the present now, function on the bottom and then click share tab should work with. Great. So we can see your, the middle uh page for you at the moment. So let's uh to the presentation. So I guess Now, can you see the presentation? Yes. If you um in slideshow mode probably would be best. Yeah. Yeah. Now, is there any different, um, it's still not in slideshow mode but it's ok. Um But click slideshow version at the top on the where it says anni next animation. So pull your cursor down slightly, not taking a slide show. It's just that, oh, it's, it's kind of overlapping but don't worry. I think it, it's perfectly fine to see. Yeah. All right. Uh Take care. Yeah. And should I continue now? Yes, please. Thank you. Um Yes, I can see overlapping that. Mhm It was, it was fine before. So if you go back on the powerpoint, make it full and now um now we can see it well, so just OK. Well, uh I would like to talk about the lung cancer staging and response. CT 18 F FDG, Pet CT and Mr and uh uh site of the Mr WDW si. So, uh I want to talk about uh introduction about uh can lung cancer and TNM eight description of non uh non small cell carcinoma and lung cancer staging and response. And about 18 FF DG pet CT Artificial in intelligence and deep learning and a conclusion. But lung cancer is the most common diagnosed cancer and leading to cause of death in both gender, female and male and non small cell. Lung cancer is the most common type of lung cancer and includes adenocarcinoma squamous cell carcinoma and large cell carcinoma. Well, management of the lung cancer in patient really depends the histopathological subtype Muar characteristic of the tumor and the stage of the disease. So, if we just uh I put this slide to show you about uh three type of lung cancer that we have non small cell lung cancer, a small cell lung cancer and other less common type of lung cancer. I told about the non small, which is in this paper, we talk more about non small cell cancer cancers, adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. A small cells is uh less common and other less common type of lung cancer is about the lung carcinoid tumors, mesothelioma, uh sarcomas and uh also about the other uncommon lung cancers. Well, um about the lung cancer staging and response. We normally we do CT in low dose in screening, for example, typically with IV contrast. And then uh we diagnosed the cancer and it is very crucial for the initial staging of lung cancer. Then uh PT and CT is staging and response evolution about the minimally invasive endoscopic biopsy target of radiotherapy, minimally invasive surgery and Muar and immunotherapies and patient diagnosed with possible lung cancer. Then we can offer 18 FF DG pet CT for staging completion. The and uh there is a uh classification TNM tumor nodal metastasis, uh which is this one is eight edition of TNM. Uh We are using this classification for uh a stage lung cancer. So what is this stage? If I talk about T NMT is elements referred to the preoperative before operation, primary tumor, which is size being important for us. And uh progressive reduction in patients or wife observed if the size is less than, for example, one centimeter. And we categorize this from T one to T four. If I show you in the, this picture, it is, as you said, T is preoperative primary tumor is from, we have at zero which is not primary tumor and T one venous tumor size is less than three centimeter. And T one has a inside of herself has at one at one BT one C. We have at two T two about again about the tumor of tumor size and uh T four and T three and T four. And you can see in T four is a tumor measurement is more than seven centimeter. And we have a, another N classification is defined by the involvement of inter thoracic lung nodes and nodes are measured in shortest di uh dimeter. And uh has uh also here FD G PCT plays a central role in a mapping nodal disease in lung cancer and identifying target for histological sampling and radiotherapy. And we have AM for metastasis. If we go here, for example, N zero is a no regional lymph node, metastasis. N one is a ipsilateral uh peribronchial and ipsilateral haler nodes. Me uh lymph nodes, N two also has a subcranial nodes and ipsilateral mediastinal nodes. And N three is contralateral medicinal nodes and it's not everywhere. And M is for metastasis. As we told you, for example, M one C, it is about uh extra thoracic metastasis. And uh we have a classification like includes which lymph uh we use the TNM for uh staging classification and offering treatment for patients. So here, uh there are some example of CT that we uh measure the TNM. For example, in uh picture A, we have a axial ct chest showed 2.5 centimeter middle lobe tumor in a 65 years old woman with hys emphysema. And this one is T one B disease. If you look at on picture B, we have a XL CT chest shown 3.7 centimeter right upper lobe tumor in a 76 years old woman which is T two A disease. Uh In C we have a axial CT again showed a 6.6 0.5 centimeters, very big lingual tumor in a 70 years old man with emphysema and T three disease. And uh the coral CT uh CT chest showed the eight centimeter right uh upper lobe tumor in a 63 years old woman which involves a superior vena cava and T four disease. And here in PIC picture, E we have a uh axial ct chest again shows 4.5 centimeter, upper left upper lobe tumor with uh atalia uh T two B disease. And at f last picture, we have axial ct chest shown eight centimeters, which is quite big, right, lower lobe tumor with a further two centimeters tumor in separate lobe in the right and IPs alone, which is T four disease. So CT and 18 FF DG pet CT in a staging non small cell carcinoma, we've uh this uh FFD PCT provide both anatomical and metabolical information with particular strengths and assessment of lymph nodes and anticipated staging of disease. Therefore, results can really significantly, we can impact on treatment. That's why it's important for us and uh has a definitely has a higher sensitivity and specifically density alone. There are some important limitation also. OK. There are something positive but we have a limitation. Uh sometimes we might have a false negative if the no dose is uh below 10 millimeter or false positive. When for example, a patient has atb or sarcoidosis. In terms of the response to treatment, we have a uh R EC. Are I ST 1 to 1. What does this mean response to treatment, accurate and timely assessment of response to treatment? I mean tumor shrink and time to the progression is vital in order to optimize patient outcome. So it it R ES ISD it means response, evaluation criteria in solid tumor uses to change in tumor uh burden on CT MRI to assess response of treatment. Also re cis T is uh available in it's introspective sharing I thought maybe my computer malfunctioned but somebody has popped it in the chat. Do you want to reha them and go back to one of your slides if that's ok. Uh, so Ahmed, uh, it's overlap again. I'm sting. Yeah. It, problems are you happen all the time and, um, I think most people are used to using teams rather than me. So, it's different challenge, right? If anyone has any questions, uh, during, please pop them in the chat. Um Macaron has a, you know, question about picture a being possible. T one C disease. Uh I think Sara just rejoining and then hopefully we can address that question. Then. I'm sorry, I'm not sure what happened. I think I'm sharing from Mac might be just a problem. Uh No worries. Um Do you wanna, if you could present now and share tab? I know we can see it at the moment. Uh What you had going on earlier was correct. So I just click. So let me stop it again. Uh No. Uh I'm so sorry. I don't know really what's happening with the sharing the screen. So I no, don't worry. Uh one moment, let me see if I can share and then you can just, it would be great. Yeah. No, don't worry. Um The rest the these are things happen, right? OK. Um Which slide, I was in S 15 slide 15. Uh There's a question, I can't see the chat but there was a question in the chat about, I think slide 11. Can you see the charts? Ok. We can, uh, yeah, sure. Let me have a look. Uh, I cannot see the slice anymore. I just get this. Nothing else. That's last things from Ahmed. Ok. Ok. Ok. Don't worry. Um, ok, I can go from the 11. Yeah, somebody asked. Ok. Uh, in the chat I'll read out the question. Isn't picture a, uh, classified as T one C disease rather than T one B. Um T one B disease. So you've heard that it's T one B disease. But uh somebody has popped in the chat, whether it's T one C disease. Uh Actually, no, it is. Let me do it. It says T one B OK. I'll go to the TNM classification and then perhaps if you explain it, I'll be, yeah, it isn't the Yeah, there you go. Uh Yes. Yeah. OK. T one B Well, in terms of the classification uh of the tumor that we have, it's at is preoperative primary tumor. So, um in this, uh we have a primary tumor, for example, TX is a primary tumor that we don't have any uh cannot be assessed very small. And uh T one, there is a tumor is less than three centimeters. So we have it in T one. We have at one at one B and T one C. So uh in this picture in the A axial CT scan just showed that. Yes, it is. More than two centimeters. Somebody asked, is it, is it more than two centimeter? But it is, um, actually just not because of more than two centimeters. It's, uh, uh, it's a middle lobe tumor, I can say. Yeah, I guess it's at one because it is, um, in the paper they showed at one bi will find the reasons why, but they might be, have reasons behind that. I get your point. You told it it, it's more than two centimeter and less than three centimeter. It might be T one C but there was an explanation about it. So I understand from where you're coming from. That's OK. Um If you have a look in the paper and we can always pop a um is T one B OK? No, we'll go off the paper, of course, because that's what's published but we'll, the paper is in the page three. It's fine. Yeah, it's published. Yeah, they might have a small error but uh it, it should be T ct one ci agreed, but at least the paper is T one B but I maybe there are another reason behind that that I don't know why. Oh, no, that's OK. This is a learning environment, right? So it's good. Um Somebody has mentioned this. Yes and thank you for being careful about this. It's very good question to me. OK. Uh Maybe a typing error. Yes, it might be. Um Yes, but it is exactly in the paper in page three of the paper is T one B disease. OK. And uh good, you know, sorry, which slide should I go for now? Ok. Uh next slide, please. OK. Here for example, uh C axial ct chest shows here we have a 6.5 centimeter lingu tumor. Uh patient is 70 years old man with emphysema T three disease. And here indeed, the next uh sizes we have a Colonel CT chest and a centimeter. There is in the upper uh lobe of tumor in the 63 years old woman, which um also involve the super Vena caval and it's at four disease, right? The next slide, please. So, uh for axial ct chest in the uh picture, E we have a um 4.5 centimeter left upper lobe tumor with the Atalia. And uh I guess I have a problem with the pre I can't. Oh yeah. Now, I can't see now. OK. And uh in f uh there's a bigger tumor, a centimeter lower lobe tumor with a further two centimeter tumor separated lobe right upper of the ipsilateral lung. And that's why it's T four. Thank you. Next slide. So, uh uh so CT and uh uh in the slides using uh CT and 18 FF DG PET CT in a staging on non small cell carcinoma. So SDG pet CT provide both anatomical and metab information with particular strengths and in the assessment of lymph nodes and uh and they cannot anticipate a stage of disease very well. So therefore, what we do with the results can significantly impact the treatment. So, uh we know that F FD pet CT has a significant higher sensitivity and specificity compared with CT alone on the staging. So, there are important limitation such as, for example, if a pa sometimes we have a false negative and if the tumor is it to a small 10 millimeter, or sometimes we might have a false positive. Uh For example, in a patient who has a tuberculosis or sarcoidosis, next side, please. Uh So here, responsive treatment and uh resist. Here we to be honest, accurate and timely assessment is a very important for L cell treatment. Uh and it's vital. So if we go to response evaluation criteria in solid tumor, we can use the uh we can change, for example, because we can change a board and which is on CT and MRI to assess response treatment. So, uh there are some studies that show that even though uh response evaluation criteria sometimes is a limited to the assessing uh based on slowly on size of lung cancer. If you just say, OK, let go to the, we need to assess holistic of the everything and measurement and check and sometimes it might be difficult to because of uh ground glass noodles, semi-solid noodles, a type of nodes might be different. So techniques such as uh dual energy CT 18 FF DG pet CT Mr and diffusion weight imaging like a DVI Mr are increased uh increasingly used to provide a function, functional and metabolic information in both assessment and prediction of response of treatment. Because we do need a diffusion and functional. Next slide please. Uh The main purpose of uh this presentation and this paper, I think it's about talking artificial intelligence and deep learning artificial intelligence is very huge uh topic. And uh there are a subtitle like a deep learning. So for example, if a patient, we examine the patient, if I just explained the picture in the examination, we think that patient might have a lung cancer. So we do CT MRI and 18 F FDG pet CT. And after primary diagnostic tool of lung cancer, we can uh I'm just explaining the PIC picture here. Uh uh We can um um we can specifically which parts that we want, we can focus on that part, for example, two D or 3D. And uh before I explain further, I want to tell an example, uh for example, if a very simple example, if you have a cat picture, for example, 100s and thousands of cats with different pictures with different family. If you put all in this picture in the A I and deep learning provided very complex algorithm for it. So when we give another picture to the computer, to the machine learning, they can predict. OK, maybe we give a dog picture or A flower or maybe C they can understand that. OK. It is a cat from previous prerecorded images that we have. So in that case, the planning and A I is really uh AO is more um huge. Um and the planning is more specific and accurate. So, um, if I come back to the subject again, uh we examine the patient, we do some um investigations and we can specifically see which part we want in two D or 3D and then A I and D planing do data analysis. Uh like I plain cat pictures, there are prerecorded label of 1000 100s depends on model. And then we can uh exactly A I and D planning can exactly tell us the shape of the tumor texture of the tumor intensity of tumor and uh loss of information. And then we can manage a therapy and the exact uh treatment plan. Next slide, please. OK. If you go, if you come back to deep learning is a sub area of machine learning. So we have a AOL and we have a mesh learning and deep learning, deep learning is more complex and there is a group of more complex algorithms than when applied to medical image. This facial can be automated segmentation feature extraction and identification of the complex patterns in the image data. So this approach uh very important why? Because with this approach, with deep learning, we can demonstrate it really this all can demons a similar performance to their radiologist. And in in future might be take a job, take a job of radiologist. So additionally, we can uh we can evaluate the response of treatment and we can provide a model individual model for individual treatment. We just not need to do uh the one treatment for whole lung cancer, we can do individually. What is the patient's texture, lung cancer subtype and what is the best treatment for him? Uh Next, right, please. In conclusion, uh as we know various treatment options for lung cancer have been developed in the past 20 years. So imaging really play a crucial role in development of lung cancer treatment. So the routine use of CT and 18 FFD PHC T is in staging and response evaluation is important. The use of MRI and DWI for problem solving and automat and semi automat assessment of solitary pulmonary nodules and target lung screening of a high risk population. We can do this. But it, it's very important to know A I artificial intelligence and machine learning are anticipated to play a crucial role in future improvement of diagnosis and treatment as well as tailored uh position medical based up individual tumor for patient and for characterizing what is the tumor and what is going on. And uh they can um having all these after do all this imaging, we can uh have a very accurate overview because they compare the our uh patient CT scan with 100s or thousands images that prerecorded before in the module. And uh it was my presentation. Thank you for listening. Thank you. Um Excellent presentation. Um I know we had a bit of a slip with it, but at least we got there in the end. Right. And I think it really shows um the advancements in um uh in lung cancer, in lung imaging. It's particularly um in lung cancer, which is uh significant problem I think is the third most common cancer affecting the UK population. So it's not something which will go away any time soon. Um If anyone has any uh pointers or any questions, please uh pop them in the chat for either of our um speakers today. So I'll give um everyone a couple of minutes just to uh gather their thoughts. And uh in the meantime, um just to advertise our next event is in um just over two weeks away. And um I think your question come up for me, give me one second. So our next event is in two weeks away on interventional radiology. It will be on meal. Um again, same time, two different speakers. And um it looks to be quite promising. I've seen the ideas that the presenters are talking about in terms of the direction of the presentation. So I think it'll be one, it will be as beneficial as this, hopefully. Uh Yeah, go ahead, Sarah. Uh Sorry to interrupt. Yes. Yeah. Uh Someone asked, how can we fix the algorithm for it. OK. Good question. Actually, this program is very complex and uh needs a very high advanced mathematics and algorithms. It's just they have a uh the people who did uh phd and post phd in national learning and deep learning and A I, they can uh sometimes they know uh some medical knowledge, they have some medical knowledge and uh advanced level of engineering because it, they can't provide this model. And as a medics, we need to tell them which model we want and what is important for us and they work on it. So it is a very highly advanced mathematics algorithm and it's not something that we do. Uh this, the engineering, the work in research with the doctors. In the meantime, they uh create this algorithm. Great hope that answered your question. If anyone else has any other questions, do put them in the chat. Um Otherwise, I think we will round off there. Um Thanks to both presenters for presenting today and spending the time to make the slides. And thank you for everyone who joined. Please do follow us on whatsapp and Instagram and our website newsletter. Um We do have a lot of things planned going forward and we're always welcome and open to ideas. And finally, the most important thing, if you'll receive a form sent to your email address to provide feedback for the event and the speakers. And it's particularly important that the speakers get feedback. So, so they can know what went well and if there's anything they should work on going forwards and um, it will also be beneficial in terms of their applications for the future. So, uh please don't just ignore that. It will take you about 10 seconds to fill out and, um, it would, er, be really beneficial and, um, please do get in touch with the team through the whatsapp community. Um, and the link is in the messaging chat if you would, um, like to stay up to date with what's going on. Ok. Uh Thank you everyone.