Overview of artificial intelligence in point-of-care ultrasound. New horizons for respiratory system diagnoses.

Throughout the past decades ultrasonography did not prove to be a procedure of choice if regarded as part of the routine bedside examination. The reason was the assumption defining the lungs and the bone structures as impenetrable by ultrasound. Only during the recent several years has the approach to the use of such tool in clinical daily routines changed dramatically to offer so-called point-of-care ultrasonography (POCUS). Both vertical and horizontal artefacts became valuable sources of information about the patient's clinical condition, assisting therefore the medical practitioner in differential diagnosis and monitoring of the patient. What is important is that the information is delivered in real time, and the procedure itself is non-invasive. The next stage marking the progress made in this area of diagnostic imaging is the development of arti-ficial intelligence (AI) based on machine learning algorithms. This article is intended to present the available, innovative solutions of the ultrasound systems, including Smart B-line technology, to ensure automatic identification process, as well as interpretation of B-lines in the given lung area of the examined patient. The article sums up the state of the art in ultrasound artefacts and AI applied in POCUS.

Comparative diagnoses of respiratory disease in preweaned dairy calves using sequential thoracic ultrasonography and clinical respiratory scoring.

AIMS: Bovine respiratory disease (BRD) has serious impacts on dairy production and animal welfare. It is most commonly diagnosed based on clinical respiratory signs (CRS), but in recent years, thoracic ultrasonography (TUS) has emerged as a diagnostic tool with improved sensitivity and specificity. This study aimed to assess the alignment of BRD diagnoses based on a Clinical Respiratory Scoring Chart (CRSC) and weekly TUS findings throughout the progression of BRD of variable severity in preweaned Holstein dairy heifers. METHODS: A total of 60 calves on two farms were followed from the 2nd week of life through the 11th week of life and assessed on a weekly basis for CRS and lung consolidation via TUS. The alignment of BRD diagnoses based on CRSC scores and TUS findings was evaluated across disease progression (pre-consolidation, onset, chronic, or recovered) and severity (lobular or lobar lung consolidation) using receiver operator curves and area under the curves combined with Cohen's kappa (κ), sensitivity, and specificity. RESULTS: The diagnosis of BRD using CRSC scores ≥5 aligned best with the onset of lobar lung consolidation (>1 cm in width and full thickness). This equated to an acceptable level of discrimination (AUC = 0.76), fair agreement (κ = 0.37), and a sensitivity of 29% and specificity of 99%. Similarly, there was acceptable discrimination (AUC = 0.70) and fair agreement (κ = 0.33) between CRSC ≥5 and the onset of a less severe threshold of disease based on lobular (1-3 cm2 but not full thickness) or lobar consolidation. Discrimination remained acceptable (AUC = 0.71) with fair agreement (κ = 0.28) between CRSC scores ≥2 for nasal discharge and/or cough (spontaneous or induced) and the onset of lobar consolidation. However, sensitivity was <40% across comparisons and outside of the onset of disease there tended to be poor discrimination, slight agreement, and lowered sensitivity between CRS and TUS diagnoses of lobular or lobar consolidation (pre-consolidation, chronic, or recovered). Conversely, specificity was relatively high (≥92%) across comparisons suggesting that CRSC diagnoses indicative of BRD and associated lung consolidation tend to result in few false positive diagnoses and accurate identification of healthy animals. CONCLUSIONS AND CLINICAL RELEVANCE: Although we found the specificity of clinical signs for diagnosing lung consolidation to be ≥92% across all methods of TUS evaluations, the low levels of sensitivity dictate that clinical assessments lead to many false negative diagnoses. Consequently, depending on clinical signs alone to diagnose BRD within populations of dairy calves will likely result in overlooking a substantial proportion of subclinically affected animals that could inform the success of treatment and prevention protocols and guide management decisions.

Videofluoroscopic swallow study abnormalities identify aerodigestive disorders in dogs with respiratory disease versus healthy controls.

BACKGROUND: Aerodigestive diseases (AeroD) pathologically link respiratory and alimentary tracts. Dogs with respiratory signs lacking dysphagia, vomiting, or regurgitation typically do not undergo diagnostic testing that identifies comorbid alimentary disease. A videofluoroscopic swallow study (VFSS) identifies defects in swallowing, reflux, and aspiration. OBJECTIVES/HYPOTHESIS: We hypothesized that dogs with respiratory and no alimentary disease (RESP) would have significantly more abnormal VFSS metrics versus controls (CON). We hypothesized RESP dogs with pulmonary parenchymal disease would have more reflux and higher penetration-aspiration score (PAS) than those with airway disease. ANIMALS: Client-owned dogs: RESP (n = 45) and CON (n = 15) groups. METHODS: Prospectively, all dogs underwent VFSS. The RESP dogs had advanced respiratory diagnostic testing. Eight subjective and 3 objective VFSS metrics (pharyngeal constriction ratio [PCR], PAS, and esophageal transit time [ETT]) were assessed. Fisher's exact test compared differences between groups (presence or absence of VFSS abnormalities). The Mann-Whitney rank sum test was used to compare PCR and PAS. RESULTS: Subjective VFSS abnormalities were present in 34/45 (75%) RESP and 2/15 (13%) CON dogs, with RESP dogs significantly more likely to have VFSS abnormalities (P = .01). No difference in PCR was found between groups. Pathologic PAS was more common in RESP than CON dogs (P = .03). The RESP dogs with airway disease had higher PAS than CON dogs (P = .01) but not RESP dogs with parenchymal disease (P = .25). CONCLUSIONS: Most (75%) RESP dogs had VFSS abnormalities, emphasizing that AeroD are common. The VFSS has value in diagnostic evaluation of respiratory disease.

Use of thoracic ultrasound on Scottish dairy cattle farms to support the diagnosis and treatment of bovine respiratory disease in calves.

BACKGROUND: Bovine respiratory disease (BRD) is common in cattle youngstock on UK dairy farms. The current diagnostic methods lack sensitivity and specificity. Thoracic ultrasound (TUS) is a relatively new BRD diagnostic tool with increased accuracy. METHOD: Data were collected from TUS examinations of 347 calves on Scottish dairy farms and compared to farmer BRD treatment rates. A calf health scoring tool was used to collect information on youngstock health and management on these farms. RESULTS: Of 347 ultrasonographic examinations, 53 (15.3%) were classified as abnormal and 294 (84.7%) as normal. Of the 53 calves classified as abnormal, only 13 (24.5%) were treated by the farmer; however, of the 294 classified as normal, 22 (7.5%) were treated. CONCLUSION: The results indicated farmers were misdiagnosing BRD in youngstock. Use of TUS on UK farms may improve diagnostic rates and accuracy, reduce the unnecessary use of antimicrobials and demonstrate the value of preventive healthcare programmes.

Pediatric Neck Masses: Imaging Guidelines and Recommendations.

Neck masses commonly present in children and several potential diagnostic and management pathways exist, though with a paucity of evidence-based recommendations. The purpose of this article is to evaluate the current literature and utilization of various diagnostic imaging modalities , with a review of imaging features and management pearls for pediatric neck masses. A comprehensive understanding and practical imaging workflow will guide optimal patient workup and management.

Emergency Management for Donkeys and Mules.

This article provides an overview of initial assessment and management of common emergency presentations in donkeys and mules. The principles are similar to those in horses (and ponies), but clinicians must be aware of differences in recognition of signs of pain/disease, approach to handling, pharmacology of some drugs, and subtle differences in the physiology and local anatomy in donkeys and mules. The epidemiology of common disease presentations will vary between pet/companion or working/farmed donkeys and mules. Regular dental checks, deworming, vaccination, and monitoring of behavior and quality of life are important aspects of preventive care.

Diagnosis of respiratory disease in preweaned dairy calves using sequential thoracic ultrasonography and clinical respiratory scoring: Temporal transitions and association with growth rates.

Bovine respiratory disease (BRD) in dairy calves is a multifactorial condition, involving environmental, host, and pathogen factors. Thoracic ultrasound scoring (TUS) has recently been validated as an accurate method of detecting BRD-related lung pathology in dairy calves. Previous studies investigating the use of TUS in preweaned dairy calves have largely been based on cross-sectional data from all-year production systems. The objectives of this longitudinal observational study were to characterize the temporal transitions in TUS scores in dairy calves from pasture-based, seasonal-calving herds using sequential examinations during the preweaning period, and to investigate the relationship between the presence and temporal pattern of BRD, diagnosed by TUS or clinical respiratory scoring (CRS), and average daily gain (ADG). In spring of 2019, 317 preweaned calves from 7 commercial dairy farms were recruited at less than 4 wk old (ranging from 1-27 d of age). Each farm was examined on at least 3 occasions at 20- to 28-d intervals and housed indoors in group or individual pens. At each visit TUS scores, CRS scores based on the University of Wisconsin Calf Respiratory Score Chart (https://www.vetmed.wisc.edu/fapm/wp-content/uploads/2020/01/calf_respiratory_scoring_chart.pdf), and live weight using a dairy breed-specific weigh band were recorded. All data were recorded by the same 2 veterinarians over the course of the study. The final data set consisted of 966 TUS and CRS scores collected from 317 calves over a period of approximately 6 wk from 7 farms. The data were analyzed in multivariable, mixed effects, linear regression models, with separate models constructed for TUS and CRS scores. Random effects (intercepts) were included for calf, farm, and visit week. Additionally, a random slope was included for age at sampling by farm. Median farm TUS score ranged from 0 to 2.5 over the 3 visits (possible range: 0-5). The percentage of calves with a TUS score ≥3 (consolidation of the full thickness of 1 lung lobe), on each farm ranged from 0 to 50%. The median CRS in calves on individual farms ranged from 1 to 3 over the 3 visits (possible range: 0-12). The percentage of calves on each farm with a CRS score ≥5 (possible range: 0-12) ranged from 0 to 26%. The TUS and CRS scores were weakly correlated. The TUS was associated with reduced ADG. Calves with TUS scores ≥3 grew at 126 g/d less than unaffected calves over the 3-wk period before examination. The predicted effect on ADG was dependent on the age and duration over which the animal was affected. Calves affected later (i.e., between visits 2 and 3) had lower predicted weights at 63 d compared with calves with increased TUS scores earlier in the study period. Calves with a TUS score ≥3 at each of the 3 sampling points had the lowest weight at 63 d of age. There was no association of CRS with ADG. This study showed that in contrast to CRS, higher TUS scores are associated with lower ADG, with weight loss being more pronounced in chronic cases.

DIFFUSIBLE IODINE-BASED CONTRAST-ENHANCED COMPUTED TOMOGRAPHY AS A NECROPSY AID: A CASE REPORT EVALUATING RESPIRATORY DISEASE IN MACROCEPHALON MALEO.

This study describes the novel use of diffusible iodine-based contrast-enhanced computed tomography (diceCT) as a digital necropsy aid. DiceCT was used postmortem to evaluate the cause of progressive respiratory disease in a juvenile maleo (Macrocephalon maleo). The technique facilitated soft-tissue contrast and a three-dimensional investigation of sinus and choanal anatomy as a means to identify normal and pathologic morphologies. Results showed right-sided narial occlusion by mucoid debris, along with left-sided choanal stenosis caused by osteomyelitis and reactive bone formation. The high spatial resolution afforded by diceCT enabled targeted histology and quantification of the clinical impact of pathologies, which contributed to an effective 60% loss in nasal airway aperture for this individual. This study demonstrates how adding diceCT to traditional necropsy can proffer additional understanding of an individual's pathology, and the resulting data can enhance research programs in vertebrate anatomy, evolution, and health.

Diagnostic Imaging of the Respiratory Tract of the Reptile Patient.

Detailed information is given about technique and image interpretation of radiography and computed tomography of the respiratory tract in reptiles. MRI and sonography are mentioned when supporting differential diagnoses. Various diseases and imaging pitfalls are described with multiple figures and graphics. One focus is on lung compression in chelonians, which may be misinterpreted as pneumonia in dyspneic patients without the help of imaging tools.

Prospective Evaluation of Free-Breathing Fast T2-Weighted MultiVane XD Sequence at 3-T MRI for Large Airway Assessment in Pediatric Patients.

OBJECTIVE. The purpose of our study was to prospectively evaluate the technical feasibility of the free-breathing fast T2-weighted MultiVane XD sequence (sequence with non-Cartesian k-space filling using radial rectangular blades) at 3-T MRI for large airway assessment in pediatric patients. SUBJECTS AND METHODS. Forty consecutive pediatric patients (23 boys and 17 girls; age range, 5-15 years) referred for MRI examination for indications not related to neck, chest, or large airway disorders were enrolled in this prospective research study. All children underwent MRI in three planes using a free-breathing fast T2-weighted MultiVane XD sequence at 3-T MRI. The MR images were assessed by two pediatric radiologists independently for visualization of the large airways at six levels. The quality of the MR images was assessed and graded. Interobserver agreement between two radiologists was assessed using the kappa test, McNemar test, and intraclass correlation coefficients. RESULTS. High-quality MR images of the large airways were obtained in at least one plane in 38 MRI examinations (95.0%) by reviewer 1 and 37 MRI examinations (92.5%) by reviewer 2. Best-quality MR images with the least artifacts were seen in the sagittal plane followed by the coronal plane and the axial plane. The kappa test of agreement showed almost-perfect agreement between the two radiologists for MR image quality in the sagittal (κ = 1), coronal (κ = 0.96), and axial (κ = 0.81) planes. The McNemar test and intraclass correlation coefficients revealed similar results. CONCLUSION. The free-breathing fast T2-weighted MultiVane XD sequence at 3-T MRI is a technically feasible and promising new MRI technique for evaluating the large airways of pediatric patients in daily clinical practice.

Inteligencia artificial en las enfermedades respiratorias / Artificial Intelligence in Respiratory Diseases

No disponible

Growth performance and hematological changes of weaned beef calves diagnosed with respiratory disease using respiratory scoring and thoracic ultrasonography.

This study investigated 1) the effect of clinical bovine respiratory disease (BRD) and associated lung consolidations on growth performance and hematological profiles of recently weaned beef calves and 2) the relationship between clinical respiratory signs and lung consolidation detected by thoracic ultrasonography (TUS). One hundred and fifty-three weaned beef calves (209 days old [SD: 35.8] and 306 kg [SD: 26.3], at arrival) purchased and transported from auction markets were accommodated indoors in concrete slatted floor pens. Calves were weighed weekly from arrival until day 28 and on day 65 post-arrival. Assessment of BRD and blood sample collection for hematological profiles were performed on scheduled days (at arrival, on days 7, 14, and 28) and on other days upon BRD diagnosis. Animals were assessed for BRD using a total clinical respiratory score (CRS) of five clinical signs (rectal temperature, ear position, cough, nasal secretion, and eye secretion with each ranging from normal [0] to abnormal [3]) and TUS scores (normal [0] to lung consolidation ≥ 1 cm2 [2]). Based on CRS, 35% of calves were CRS+ (CRS ≥ 5) and 65% were CRS- (CRS < 5). Although no lung consolidations (TUS-) were detected at arrival, 34% of calves developed lung consolidation (≥1 cm2) (TUS+) during the first 28 d post-arrival. Only fever (>39.6 °C) and nasal discharge were weakly associated (r = 0.19, P <0.05) with lung consolidation. On the day of BRD detection, neutrophil number and neutrophil:lymphocyte ratio were 58% and 73% greater, respectively, in BRD calves with lung consolidation compared with healthy calves. From day 0 to 65, calf average daily gain (ADG) did not differ (P >0.05) between CRS+ and CRS- calves but was 0.09 kg/d lower (P < 0.05) for TUS+ compared with TUS- calves. Calves classified as BRD (CRS + TUS ≥ 5) with lung consolidation had lower (P < 0.05) ADG from arrival until day 28 than healthy calves and BRD calves without lung consolidation (0.11 ± 0.10 vs. 0.53 ± 0.07 vs. 0.57 ± 0.10 kg/d, respectively); however, no differences in ADG were observed from day 0 to 65. Conventional methods to diagnose BRD failed to detect calves with lung lesions. TUS is a useful tool to detect lung lesions and its implementation in combination with CRS should provide a more accurate and early diagnosis of BRD, which is fundamental to successful treatment, animal welfare, and growth performance.

Computed tomography of tympanic bullae in pre-weaned dairy calves diagnosed with clinical respiratory disease.

Clinical disease from otitis media in calves is a significant problem in the dairy industry and evaluation of disease severity, chronicity, and imaging remains a challenge. Our objectives were to compare imaging findings in calves with an early diagnosis of respiratory disease to calves with treatment failure. This was a prospective study of 30 Jersey heifer calves, 26-95 days of age, with elevated clinical respiratory scores. Ten clinically healthy calves served as controls for clinical scoring. Three groups of calves were selected based on elevated scores using the McGuirk respiratory scoring system and treatment history. Group A included new cases, group B included primary treatment failures, and group C included multiple treatment failures. Calves underwent a skull CT, four view radiography, post-mortem photography of the tympanic bulla and bacteriological diagnostics. Imaging and post-mortem results were evaluated using normalized scoring schemes. Computed tomography imaging of the tympanic bulla differentiated calves early in the course of disease (group A) from calves that had not responded to treatment (groups B and C). Radiographs differentiated only group C from groups A and B. Use of a 35 degree angle dorsal-right or dorsal-left ventral oblique projection for radiography allowed effective evaluation of the tympanic bulla. Clinical respiratory scores were similar among all three groups. Computed tomography imaging can differentiate early from advanced otitis media. Radiographs, which can be performed in the field, also have utility to identify advanced otitis media to aid management decisions.

Imaging in the Evaluation of Chest Pain in the Primary Care Setting, Part 2: Sources of Noncardiac Chest Pain.

Chest pain is a common presenting complaint in the primary care setting. Imaging plays a key role in the evaluation of the multiple organ systems that can be responsible for chest pain. With numerous imaging modalities available, determination of the most appropriate test and interpretation of the findings can be a challenge for the clinician. In this 2-part series, we offer resources to guide primary care physicians in the selection of imaging studies and present the imaging findings of various causes of nonemergent chest pain. In Part 2, we focus on the radiologic appearance of common noncardiac sources of chest pain, including gastrointestinal, pulmonary, and musculoskeletal etiologies.

Amyloidosis in the head and neck: CT findings with clinicopathological correlation.

PURPOSE: To characterize the CT imaging features of head and neck amyloidosis and correlate with extent of disease and clinical outcomes. MATERIALS AND METHODS: This retrospective study included 80 patients with head and neck amyloidosis who underwent soft tissue neck CT imaging between November 2003 and April 2018. The CT imaging features including lesion distribution, morphology (focal, diffuse/circumferential, or combined), presence and pattern of calcification, (punctate or diffuse), and thickness of airway lesion were evaluated and compared with the extent of amyloidosis (localized or systemic), and clinical course (stable, no recurrence, or progression requiring repeated surgical treatment). RESULTS: Localized disease (83.8%, 67/80) was most common with AL type (97.6%, 41/42) representing nearly all cases of head and neck amyloidosis. The larynx was the most frequently affected organ (60.0%, 48/80), specifically the glottis (43.8%, 35/80). Calcification was seen in 65.0% of cases (52/80). Non-airway or tongue lesions were significantly associated with systemic (92.3%, 12/13) as opposed to localized amyloidosis (4.5%, 3/67; P < 0.001). Repeated surgical treatment was significantly associated with laryngeal amyloidosis (35.3%, 12/34; P = 0.002) and multi-centric disease (33.3%, 10/30; P = 0.048). Airway wall thickness in patients who required repeated surgical treatment was significantly greater than in patients with stable or no recurrent disease (P = 0.016). CONCLUSION: Knowledge of the imaging features of head and neck amyloidosis can aid the diagnosis, disease monitoring, and prediction of patients requiring repeated surgical intervention.

Echocardiography during the coronavirus disease 2019 (COVID-19) pandemic: expert opinion of the Working Group on Echocardiography of the Polish Cardiac Society.

Transthoracic and transesophageal echocardiography may be required in patients with coronavirus disease 2019 (COVID­19), resulting in direct contact with the patient and risk of transmitting the infection from patients to medical personnel. Therefore, we recommend to perform problem­oriented time­limited transthoracic examinations. Whenever possible, examinations should be analyzed offline, outside the isolation zones. Transesophageal echocardiography is considered an aerosol­generating procedure and should be performed only as a lifesaving procedure. Personnel should use appropriate personal protection equipment in the immediate vicinity of the patients in accordance with the relevant guidelines.

Imaging features of mucopolysaccharidoses in the head and neck.

Ear, Nose and Throat (ENT) involvement by mucopolysaccharidoses is very common, affecting over 90% of patients, and occurs early in the course of the disease. Airway narrowing secondary to glycosaminoglycan deposition results in greatly increased morbidity, mortality and risk of anesthetic complications in these patients. Macroglossia, restricted mouth opening, tracheobronchomalacia, adenotonsillar hypertrophy along with other factors such as a short, rigid and unstable cervical spine, cardiac disease and increased susceptibility to respiratory infections result in a high perioperative mortality and morbidity. Imaging is most beneficial for evaluation of the airway, in particular in patients with obstructive symptoms and prior to intubation. We review the ENT manifestations of mucopolysaccharidoses including airway involvement, otological, oral and dental complications. 3-D reconstructions of the trachea, which is routinely captured on CT imaging of the spine, can be of great value for planning intubation in this patient population.

Use of high frequency jet ventilation as a refinement for imaging macaques with respiratory disease.

Imaging is used in human medicine to diagnose disease and monitor treatment efficacy. Computed tomography (CT) positron emission tomography (PET) and magnetic resonance (MR) are applied to animal models of infectious diseases to increase data quality, enhance their relevance to the clinical situation, and to address ethical issues through reduction of numbers and refinement of study designs. The time required for collection of MR and PET-CT scans means that normal breathing produces motion artefacts that can render images unacceptable. We report, for the first time, the use of high frequency jet ventilation (HFJV) for respiratory management during imaging of macaques. HFJV enables continuous gaseous exchange, resulting in cessation of spontaneous breathing motion thus providing a motionless field without the potential stresses induced by repeated breath-hold strategies.

Imaging Evaluation of Airway Complications After Lung Transplant.

Airway complications (ACs) after lung transplant remain a challenge and include bronchial dehiscence, bronchial stenosis, tracheobronchomalacia, infections, and bronchial fistulas. The spectrum of complications may coexist along a continuum and can be classified as early (<1 month after transplant) or late (>1 month), and anastomotic or nonanastomotic. Bronchiolitis obliterans is the most common form of chronic lung allograft rejection. Airway compromise is seen in rare instances of lung torsion, and imaging may provide helpful diagnostic clues. Computed tomography (CT) and bronchoscopy play major roles in the diagnosis and treatment of ACs after lung transplant. Chest CT with advanced postprocessing techniques is a valuable tool in evaluating for airways complications, for initial bronchoscopic treatment planning and subsequent posttreatment assessment. Various bronchoscopic treatment options may be explored to maintain airway patency. The goal of this article is to review imaging findings of ACs after lung transplantation, with emphasis on chest CT and bronchoscopic correlation.

Artificial intelligence and machine learning in respiratory medicine.

Introduction: The application of artificial intelligence (AI) and machine learning (ML) in medicine and in particular in respiratory medicine is an increasingly relevant topic.Areas covered: We aimed to identify and describe the studies published on the use of AI and ML in the field of respiratory diseases. The string '(((pulmonary) OR respiratory)) AND ((artificial intelligence) OR machine learning)' was used in PubMed as a search strategy. The majority of studies identified corresponded to the area of chronic obstructive pulmonary disease (COPD), in particular to COPD and chest computed tomography scans, interpretation of pulmonary function tests, exacerbations and treatment. Another field of interest is the application of AI and ML to the diagnosis of interstitial lung disease, and a few other studies were identified on the fields of mechanical ventilation, interpretation of images on chest X-ray and diagnosis of bronchial asthma.Expert opinion: ML may help to make clinical decisions but will not replace the physician completely. Human errors in medicine are associated with large financial losses, and many of them could be prevented with the help of AI and ML. AI is particularly useful in the absence of conclusive evidence of decision-making.