The edition · Radiology
Saline in the biopsy tract cut pneumothorax by half and chest tubes by nearly 80%
A meta-analysis of seven studies found instilling sterile saline into the tract after CT-guided lung biopsy reduced pneumothorax risk to less than half, the ACR has updated its myelopathy appropriateness criteria, and commercial AI cut pulmonary nodule reporting time by 14.6% while slowing emergency department reporting.
The edition in brief
Pneumothorax complicates roughly a quarter of CT-guided lung biopsies, and 5-6% need a chest tube. Tract-sealing with autologous blood, fibrin glue or collagen plugs reduces that but costs money or provokes local reaction. This meta-analysis of seven studies and 1,455 patients, 680 of whom received saline, examined the cheapest possible alternative: instilling sterile saline into the tract immediately after biopsy. Pneumothorax risk fell substantially (risk ratio 0.46, 95% CI 0.35-0.61) as did the need for chest tube placement (risk ratio 0.22, 95% CI 0.12-0.42). The American College of Radiology has published the 2026 update of its Appropriateness Criteria for myelopathy, covering acute, chronic and vascular causes, and framing imaging choice to guide surgical or medical intervention. A retrospective study of 39,323 chest CT examinations across pre- and post-implementation periods found commercial AI for pulmonary nodule assessment reduced adjusted median reporting time from 21.3 to 18.2 minutes, a 14.6% reduction. The effect was not uniform: ECG-gated thoracic CT fell 41.1% and thoracic radiologists gained 25.0%, while emergency department examinations took 7.1% longer. A prospective study in 126 women found photon-counting CT performed comparably to MRI for breast lesion characterisation and better for nodal metastasis, but missed 44% of microcalcifications detected on mammography.
Saline tract sealing halved pneumothorax after lung biopsy
Instilling sterile saline into the tract after CT-guided lung biopsy more than halved pneumothorax and cut chest tube placement by nearly 80%, at essentially no cost, and is worth adopting as routine.
ACR Appropriateness Criteria for myelopathy, 2026 update
The ACR has updated its myelopathy appropriateness criteria for 2026, covering acute, chronic and vascular causes — but note that where evidence is lacking the ratings rest on expert opinion rather than trial data.
AI cut nodule reporting time overall, and slowed emergency reporting
Commercial pulmonary nodule AI cut chest CT reporting time by 14.6% overall but slowed emergency department reporting by 7.1%, so deployment should target settings where nodule assessment is the actual clinical question.
Photon-counting CT matched MRI in breast cancer, but missed microcalcifications
Photon-counting CT matched MRI for breast lesion characterisation and beat it for nodal assessment, but missed nearly half of microcalcifications, so it cannot replace mammography and is best viewed as a potential combined staging study.
Ask where the AI is helping, not whether
Evaluate any imaging AI by subgroup rather than in aggregate, because the same tool can save a quarter of reporting time for one reader group while adding time for another, and averages conceal both.
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