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2.
Acad Radiol ; 2020 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-32061469

RESUMEN

RATIONALE AND OBJECTIVES: We describe a model of multi-institutional, multisociety, online case conferences that is a case-based group discussion of selected (nonrandom) cases which are subsequently hosted on social media and online platforms (e.g., YouTube, websites) to be available for a wider audience. MATERIALS AND METHODS: Using online conferencing software (Zoom, GoToMeeting), participants from both abdominal and cardiothoracic radiologists engage in separate, subspecialty one-hour meetings discussing a variety of meaningful cases. Participants take turns presenting their cases to the group and discuss significant findings, interpretations, differential diagnoses, and any other teaching points. All of the case conferences for both societies are recorded and edited to be uploaded on YouTube and their respective websites. RESULTS: Participants from these conferences log in from 14 institutions in 7 states across the United States. The YouTube videos reach thousands of people around the world. The abdominal case conference on YouTube has received almost 1,300 views with 90 videos uploaded. The thoracic (the Society of Thoracic Radiology) case conference has been running for over 7 years, with 226 videos uploaded to YouTube and 38,200 views, 1426 subscribers, and a total watch time of over 525,800 minutes. Twitter has been utilized by both groups to promote online viewership. CONCLUSION: Our model is feasible and effective compared to traditional peer review. The cases selected are deliberate and focused on quality improvement and/or education. We harness online engagement, specifically social media presence, which has opened new opportunities to educate our peers and reach a global audience, including the nonradiologic community, to learn about radiology and unique practices.

3.
Radiology ; 294(3): 491-505, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31990264

RESUMEN

Proposed as a safer alternative to smoking, the use of electronic cigarettes has not proven to be innocuous. With numerous deaths, there is an increasing degree of public interest in understanding the symptoms, imaging appearances, causes of, and treatment of electronic cigarette or vaping product use-associated lung injury (EVALI). Patients with EVALI typically have a nonspecific clinical presentation characterized by a combination of respiratory, gastrointestinal, and constitutional symptoms. EVALI is a diagnosis of exclusion; the patient must elicit a history of recent vaping within 90 days, other etiologies must be eliminated, and chest imaging findings must be abnormal. Chest CT findings in EVALI most commonly show a pattern of acute lung injury on the spectrum of organizing pneumonia and diffuse alveolar damage. The pathologic pattern found depends on when in the evolution of the disease process the biopsy sample is taken. Other less common forms of lung injury, including acute eosinophilic pneumonia and diffuse alveolar hemorrhage, have also been reported. Radiologists and pathologists help play an important role in the evaluation of patients suspected of having EVALI. Accurate and rapid identification may decrease morbidity and mortality by allowing for aggressive clinical management and glucocorticoid administration, which have been shown to decrease the severity of lung injury in some patients. In this review, the authors summarize the current state of the art for the imaging and pathologic findings of this disorder and outline a few of the major questions that remain to be answered.

4.
AJR Am J Roentgenol ; 214(3): 498-505, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31593518

RESUMEN

To listen to the podcast associated with this article, please select one of the following: iTunes or Google Play. OBJECTIVE. E-cigarettes are devices that aerosolize nicotine- or cannabis-based concentrates mixed with other solvents and have been marketed as an alternative to cigarettes. E-cigarette use, or vaping, is increasingly popular but has not been proven to be an innocuous substitute for traditional smoking. Several patterns of vaping-associated inhalational lung injuries have been reported in the past few years. This article reviews many of the imaging patterns that have been encountered in association with e-cigarette use. CONCLUSION. E-cigarette use is associated with a range of lung injury patterns that have only recently been recognized as use of these products continues to rise. When the radiologist sees one of these patterns of lung injury, it is important to raise the possibility of vaping-induced lung injury because cessation of vaping is an important step in treatment.

5.
Radiol Clin North Am ; 58(1): 93-103, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31731905

RESUMEN

This article describes an approach to analyzing the distribution of intravenous contrast on chest computed tomography and illustrates the various pathologies and pitfalls that may be encountered by the imager, especially in the hospitalized patient. Understanding normal and abnormal distribution of intravenous contrast can be used as a clue to detect alterations in physiology and flow.


Asunto(s)
Medios de Contraste , Cardiopatías/diagnóstico por imagen , Pacientes Internos , Embolia Pulmonar/diagnóstico por imagen , Intensificación de Imagen Radiográfica , Tomografía Computarizada por Rayos X/métodos , Corazón/diagnóstico por imagen , Hospitalización , Humanos , Pulmón/diagnóstico por imagen , Radiografía Torácica/métodos
6.
Radiol Clin North Am ; 58(1): xiii, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31731906
8.
Acad Radiol ; 2019 Dec 14.
Artículo en Inglés | MEDLINE | ID: mdl-31848074

RESUMEN

RATIONALE AND OBJECTIVES: Peer learning is a case-based group-learning model intended to improve performance. In this descriptive paper, we describe multi-institutional, multi-subspecialty, web-based radiology case conferences and summarize the participants' experiences. MATERIALS AND METHODS: A semi-structured, 27-question survey was administered to radiologists participating in abdominal, cardiothoracic, and musculoskeletal case conferences. Survey questions included demographics, perceived educational value and challenges experienced. Survey question formats were continuous, binary, five-point Likert scale or text-based. The measures of central tendencies, proportions of responses and patterns were tabulated. RESULTS: From 57 responders, 12/57 (21.1%) were abdominal, 16/57 (28.1%) were cardiothoracic, and 29/57 (50.8%) were musculoskeletal conference participants; 50/56 (89.3%) represented academic practice. Median age was 45 years (range 35-74); 43/57 (75.4%) were male. Geographically, 16/52 (30.8%) of participants were from the East Coast, 16/52 (30.8%) Midwest, 18/52 (34.6%) West Coast, and 2/52 (3.8%) International. The median reported educational value was 5/5 (interquartile range 5-5). Benefits of the case conference included education (50/95, 52.6%) and networking (39/95, 41.1%). Participants reported presenting the following cases: "great call" 32/48 (66.7%), learning opportunity 32/48 (66.7%), new knowledge 41/49 (83.7%), "zebras" 46/49 (93.9%), and procedural-based 16/46 (34.8%). All 51/51 (100%) of responders reportedly gained new knowledge, 49/51 (96.1%) became more open to group discussion, 34/51 (66.7%) changed search patterns, and 50/51 (98%) would continue to participate. Reported challenges included time zone differences and support from departments for a protected time to participate. CONCLUSION: Peer learning through multi-institutional case conferences provides educational and networking opportunities. Current challenges and desires include having department-supported protected time and ability to receive continuing medical education credit.

10.
Clin Chest Med ; 40(3): 655-666, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31376898

RESUMEN

Imaging, specifically computed tomography (CT), is a key component in the characterization, management, and follow-up of patients with connective tissue disease (CTD)-related diffuse lung disease. The main role of CT is to help direct treatment by determining the primary pattern of lung injury present. Other roles include follow-up of lung disease over time, evaluation of acute symptoms, and monitoring for treatment complications. Although diagnosis is typically made using clinical and serologic criteria, CT plays an important role when lung disease is the dominant presenting feature. This article delineates the roles of CT in patients with CTD-related lung disease.

11.
Am J Respir Crit Care Med ; 200(9): 1154-1163, 2019 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-31268371

RESUMEN

Rationale: Rare genetic variants in telomere-related genes have been identified in familial, idiopathic, and rheumatoid arthritis-associated pulmonary fibrosis. Short peripheral blood leukocyte (PBL) telomere length predicts poor outcomes in chronic hypersensitivity pneumonitis (CHP).Objectives: Determine the prevalence and clinical relevance of rare protein-altering variants in telomere-related genes in patients with CHP.Methods: Next-generation sequences from two CHP cohorts were analyzed to identify variants in TERT (telomerase reverse transcriptase), TERC (telomerase RNA component), DKC1 (dyskerin pseudouridine synthase 1), RTEL1 (regulator of telomere elongation helicase 1), PARN (poly[A]-specific RNase), and TINF2 (TERF1-interacting nuclear factor 2). To qualify, variants were required to have a minor allele frequency less than 0.005 and be predicted to be damaging to protein function. Variant status (binary variable) was used in statistical association tests, including Cox proportional hazard models for transplant-free survival. PBL telomere length was measured using quantitative PCR.Measurements and Main Results: Qualifying variants were identified in 16 of 144 patients (11.1%; 95% confidence interval [CI], 6.5-17.4) in the discovery cohort and 17 of 209 patients (8.1%; 95% CI, 4.8-12.7) in the replication cohort. Age- and ancestry-adjusted PBL telomere length was significantly shorter in the presence of a variant in both cohorts (discovery: -561 bp; 95% CI, -933 to -190; P = 0.003; replication: -612 bp; 95% CI, -870 to -354; P = 5.30 × 10-6). Variant status was significantly associated with transplant-free survival in both cohorts (discovery: age-, sex-, and ancestry-adjusted hazard ratio, 3.73; 95% CI, 1.92-7.28; P = 0.0001; replication: hazard ratio, 2.72; 95% CI, 1.26-5.88; P = 0.011).Conclusions: A substantial proportion of patients diagnosed with CHP have rare, protein-altering variants in telomere-related genes, which are associated with short peripheral blood telomere length and significantly reduced transplant-free survival.

12.
J Thorac Imaging ; 34(5): W109-W120, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31206454

RESUMEN

Nonuniform contrast opacification of vasculature is frequently encountered on thoracic computed tomographic angiography. The purpose of this pictorial essay is to discuss the appearance of, and factors underlying mixing artifacts, which we term "smoke." We provide an approach to distinguish it from pathology including pulmonary embolism, aortic dissection, and thrombus. Smoke results from a combination of technical factors, abnormal physiology, or inflow of unopacified blood. Smoke produces ill-defined filling defects that may be confidently diagnosed in many cases if these fundamentals are applied.


Asunto(s)
Artefactos , Angiografía por Tomografía Computarizada/métodos , Radiografía Torácica/métodos , Enfermedades Torácicas/diagnóstico por imagen , Enfermedades Torácicas/patología , Diagnóstico Diferencial , Humanos
13.
Semin Ultrasound CT MR ; 40(3): 229-238, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31200871

RESUMEN

Smoke from cigarettes and other sources may induce a variety of patterns of lung injury. While smoking related lung diseases, in general, have a better prognosis than many other diffuse lung diseases, they may be a cause of significant symptoms and, in some cases, may even require lung transplantation. On histology, the manifestations of these patterns range from reversible inflammation to irreversible emphysema or fibrosis. High-resolution chest CT plays a critical role in the diagnosis of smoking related lung diseases. It has several roles including (1) helping determine diagnosis, (2) assessing the pattern of injury that is present, (3) evaluating the extent and severity of disease, and (4) determining the response to treatment. The practicing radiologist must have a knowledge of the clinical, pathologic, and imaging features of the differnent patterns of lung injury associated with smoke inhalation.


Asunto(s)
Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pulmonares/etiología , Fumar/efectos adversos , Tomografía Computarizada por Rayos X/métodos , Humanos , Pulmón/diagnóstico por imagen
14.
Artículo en Inglés | MEDLINE | ID: mdl-31153661

RESUMEN

OBJECTIVES: We aimed to evaluate the impact of collaborative discussion between diagnostic radiologists and radiation oncologists on radiation oncology management for thoracic oncology patients. METHODS: We reviewed cases presented at multidisciplinary thoracic tumor boards (TTB) (n = 122) and diagnostic radiology/radiation oncology rounds (DR/ROR) (n = 45). Changes in planned radiation management following imaging discussion were categorized-no change, timing change, and treatment volume change. Phase of care was also classified. In DR/ROR, radiation oncologists were surveyed regarding (1) change in radiation oncology management and (2) change in confidence (both 5-point Likert scales). RESULTS: Discussion of imaging with a radiologist changed radiation oncology management in 31.1% of TTB cases and 68.9% of DR/ROR cases (P < 0.001). Changes to the timing of initiating radiation therapy occurred with similar frequency in the 2 settings (31.1% vs 46.7%, P = 0.063). Changes to target volume occurred more frequently in DR/ROR (35.6% vs <1%), P < 0.001. Over half of imaging discussions in DR/ROR resulted in at least "moderate" change in radiation oncology management, and the level of confidence held by the radiation oncologists increased following discussion with radiologists in 95.6% of cases. CONCLUSION: Collaborative discussions between radiation oncologists and diagnostic radiologists in a multispecialty tumor board and in targeted 2-specialty rounds are not redundant, but result in different management changes and at different phases of care. Our study emphasizes the importance of consultation with physicians as an area where radiologists can add value, specifically the added benefit of smaller collaborative discussions.

15.
J Am Coll Radiol ; 16(5S): S227-S234, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31054749

RESUMEN

Rib fractures are the most common thoracic injury after minor blunt trauma. Although rib fractures can produce significant morbidity, the diagnosis of injuries to underlying organs is arguably more important as these complications are likely to have the most significant clinical impact. Isolated rib fractures have a relatively low morbidity and mortality and treatment is generally conservative. As such, evaluation with standard chest radiographs is usually sufficient for the diagnosis of rib fractures, and further imaging is generally not appropriate as there is little data that undiagnosed isolated rib fractures after minor blunt trauma affect management or outcomes. Cardiopulmonary resuscitation frequently results in anterior rib fractures and chest radiographs are usually appropriate (and sufficient) as the initial imaging modality in these patients. In patients with suspected pathologic fractures, chest CT or Tc-99m bone scans are usually appropriate and complementary modalities to chest radiography based on the clinical scenario. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

16.
Histopathology ; 74(7): 1088-1097, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30742318

RESUMEN

AIMS: To evaluate the clinical significance of bronchiolocentric fibrosis (BCF) in patients with a histopathological pattern of usual interstitial pneumonia (UIP). METHODS AND RESULTS: Two hundred and fifty-two patients with pathological UIP pattern were identified. Two hundred and fifteen of these patients (215 of 252) had the multidisciplinary diagnosis of idiopathic pulmonary fibrosis (IPF). Prospectively defined clinical, radiological and pathological features (including BCF) were recorded, and peripheral blood MUC5B genotype and telomere length were measured. BCF was observed in 38% (96 of 252) of all patients and 33% (72 of 215) of IPF patients; its presence was associated with a non-IPF diagnosis on multivariate analysis (odds ratio = 3.71, 95% confidence interval = 1.68-8.19). BCF was not significantly associated with environmental exposures, gastroesophageal reflux, cigarette smoking or radiological patterns. There was no significant association of BCF with MUC5B genotype or telomere length. BCF has no significant impact on survival time. CONCLUSIONS: Most patients with BCF and a histopathological pattern of UIP have IPF. However, this combined fibrotic pattern is associated with a non-IPF multidisciplinary diagnosis, with approximately one-quarter of these patients being diagnosed as chronic hypersensitivity pneumonia or unclassifiable interstitial fibrosis. The presence of BCF in these patients is not significantly associated with presumed clinical risk factors for bronchiolocentric involvement, radiological findings, MUC5B genotype, telomere length or survival time.


Asunto(s)
Fibrosis Pulmonar Idiopática/patología , Enfermedades Pulmonares Intersticiales/patología , Mucina 5B/genética , Fibrosis Pulmonar/patología , Anciano , Femenino , Genotipo , Humanos , Fibrosis Pulmonar Idiopática/cirugía , Estimación de Kaplan-Meier , Pulmón/patología , Pulmón/cirugía , Enfermedades Pulmonares Intersticiales/cirugía , Masculino , Persona de Mediana Edad , Fibrosis Pulmonar/cirugía , Sistema de Registros , Factores de Riesgo , Telómero
17.
J Magn Reson Imaging ; 50(3): 682-701, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30779459

RESUMEN

Thoracic MRI presents important and unique challenges. Decreased proton density in the lung in combination with respiratory and cardiac motion can degrade image quality and render poorly executed sequences uninterpretable. Despite these challenges, thoracic MRI has an important clinical role, both as a problem-solving tool and in an increasing array of clinical indications. Advances in scanner and sequence design have also helped to drive this development, presenting the radiologist with improved techniques for thoracic MRI. Given this evolving landscape, radiologists must be familiar with what thoracic MR has to offer. The first step in developing an effective thoracic MRI practice requires the creation of efficient and malleable protocols that can answer clinical questions. To do this, radiologists must have a working knowledge of the MR sequences that are used in the thorax, many of which have been adapted from use elsewhere in the body. These sequences can be broadly divided into three categories: traditional/anatomic, functional, and cine based. Traditional/anatomic sequences allow for the depiction of anatomy and pathologic processes with the ability for characterization of signal intensity and contrast enhancement. Functional sequences, including diffusion-weighted imaging, and high temporal resolution dynamic contrast enhancement, allow for the noninvasive measurement of tissue-specific parameters. Cine-based sequences can depict the motion of structures in the thorax, either with retrospective ECG gating or in real time. The purpose of this article is to review these categories, the building block sequences that comprise them, and identify basic questions that should be considered in thoracic MRI protocol design. Level of Evidence: 5 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2019;50:682-701.

19.
J Am Coll Radiol ; 15(11S): S341-S346, 2018 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-30392603

RESUMEN

Lung cancer remains the leading cause of cancer death in both men and women. Smoking is the single greatest risk factor for the development of lung cancer. For patients between the age of 55 and 80 with 30 or more pack years smoking history who currently smoke or who have quit within the last 15 years should undergo lung cancer screening with low-dose CT. In patients who do not meet these criteria but who have additional risk factors for lung cancer, lung cancer screening with low-dose CT is controversial but may be appropriate. Imaging is not recommended for lung cancer screening of patient younger than 50 years of age or patients older than 80 years of age or patients of any age with less than 20 packs per year history of smoking and no additional risk factor (ie, radon exposure, occupational exposure, cancer history, family history of lung cancer, history of COPD, or history of pulmonary fibrosis). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.


Asunto(s)
Neoplasias Pulmonares/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Detección Precóz del Cáncer , Medicina Basada en la Evidencia , Humanos , Neoplasias Pulmonares/etiología , Persona de Mediana Edad , Selección de Paciente , Factores de Riesgo , Fumar/efectos adversos , Sociedades Médicas , Estados Unidos
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