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Carroll MB, Kanne JP, Martin Rother MD. Update on Interstitial Pneumonias. Clin Chest Med 2024; 45:419-431. [PMID: 38816097 DOI: 10.1016/j.ccm.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
The American Thoracic Society/European Respiratory Society/Japanese Respiratory Society/Asociación Latinoamericana de Tórax 2018 clinical practice guideline and 2022 update provide recommendations to define and diagnose idiopathic pulmonary fibrosis (IPF) in patients with newly diagnosed interstitial lung disease. The guideline emphasizes recognition of usual interstitial pneumonia (UIP) and probable UIP patterns of fibrosis on high-resolution CT, which can obviate the need for surgical lung biopsy and allow timely initiation of antifibrotic pharmacotherapy citing a high correlation with UIP on histopathology. This article reviews the recent 2022 IPF clinical practice guideline with a focus on the imaging updates.
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Affiliation(s)
- Melissa B Carroll
- Department of Radiology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - Jeffrey P Kanne
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA
| | - Maria Daniela Martin Rother
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA
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Case AH, Beegle S, Hotchkin DL, Kaelin T, Kim HJ, Podolanczuk AJ, Ramaswamy M, Remolina C, Salvatore MM, Tu C, de Andrade JA. Defining the pathway to timely diagnosis and treatment of interstitial lung disease: a US Delphi survey. BMJ Open Respir Res 2023; 10:e001594. [PMID: 38007235 PMCID: PMC10680004 DOI: 10.1136/bmjresp-2022-001594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 10/31/2023] [Indexed: 11/27/2023] Open
Abstract
INTRODUCTION Timely diagnosis of interstitial lung disease (ILD) is limited by obstacles in the current patient pathway. Misdiagnosis and delays are common and may lead to a significant burden of diagnostic procedures and worse outcomes. This Delphi survey aimed to identify consensus on the key steps that facilitate the patient journey to an accurate ILD diagnosis and appropriate management in the US. METHODS A modified Delphi analysis was conducted, comprising three online surveys based on a comprehensive literature search. The surveys spanned five domains (guidelines, community screening, diagnosis, management and specialist referral) and were completed by a panel of US physicians, including primary care physicians and pulmonologists practising in community or academic settings. A priori definitions of consensus agreement were median scores of 2-3 (agree strongly/agree), with an IQR of 0-1 for questions on a 7-point Likert scale from -3 to 3, or ≥80% agreement for binary questions. RESULTS Forty-nine panellists completed the surveys and 62 statements reached consensus agreement. There was consensus agreement on what should be included in the primary care evaluation of patients with suspected ILD and the next steps following workup. Regarding diagnosis in community pulmonology care, consensus agreement was reached on the requisition and reporting of high-resolution CT scans and the appropriate circumstances for holding multidisciplinary discussions. Additionally, there was consensus agreement on which symptoms and comorbidities should be monitored, the frequency of consultations and the assessment of disease progression. Regarding specialist referral, consensus agreement was reached on which patients should receive priority access to ILD centres and the contents of the referral package. CONCLUSIONS These findings clarify the most common issues that should merit further evaluation for ILD and help define the steps for timely, accurate diagnosis and appropriate collaborative specialty management of patients with ILD.
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Affiliation(s)
- Amy Hajari Case
- Pulmonary, Critical Care, and Sleep Medicine, Piedmont Healthcare Inc, Atlanta, Georgia, USA
| | - Scott Beegle
- Division of Pulmonary & Critical Care Medicine, Albany Medical College, Albany, New York, USA
| | - David L Hotchkin
- Division of Pulmonary, Critical Care & Sleep Medicine, The Oregon Clinic, Portland, Oregon, USA
| | - Thomas Kaelin
- Lowcountry Lung and Critical Care, Charleston, South Carolina, USA
| | - Hyun Joo Kim
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep, University of Minnesota, Minneapolis, Minnesota, USA
| | - Anna J Podolanczuk
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Murali Ramaswamy
- LeBauer Pulmonary and Critical Care and PulmonIx, LLC at Cone Health, Greensboro, North Carolina, USA
| | - Carlos Remolina
- Department of Pulmonology, Trinitas Regional Medical Center, Elizabeth, New Jersey, USA
| | - Mary M Salvatore
- Department of Radiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Conan Tu
- Internal Medicine, ProHEALTH, part of Optum, New York, New York, USA
| | - Joao A de Andrade
- Medicine, Div. of Allergy, Pulmonary, and Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Stowell JT, Abril A, Khoor A, Lee AS, Baig HZ. The Role of Radiology in Multidisciplinary Discussion of Patients With Interstitial Lung Diseases. J Thorac Imaging 2023; 38:S38-S44. [PMID: 37616505 DOI: 10.1097/rti.0000000000000721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Radiologists fulfill a vital role in the multidisciplinary care provided to patients with interstitial lung diseases and other diffuse parenchymal lung disorders. The diagnosis of interstitial lung diseases hinges on the consensus of clinical, radiology, and pathology medical subspecialists, but additional expertise from rheumatology, immunology, or hematology can be invaluable. The thin-section computed tomography (CT) features of lung involvement informs the diagnostic approach. Radiologists should be familiar with radiologic methods (including inspiratory/expiratory and prone imaging) and be well versed in the recognition of the CT features of fibrosis, assessment of the overall pattern of lung involvement, and classification according to the latest guidelines. We present a case-based review that highlights examples wherein CT features and subspecialist radiologist interpretation informed the multidisciplinary team consensus diagnosis and care pathways.
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Affiliation(s)
| | | | | | - Augustine S Lee
- Division of Pulmonology and Critical Care, Mayo Clinic, Jacksonville, FL
| | - Hassan Z Baig
- Division of Pulmonology and Critical Care, Mayo Clinic, Jacksonville, FL
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Mehrsheikh AL, Strnad BS, Shetty AS, Itani M. Second-opinion interpretation of outside facility general ultrasound studies: rate of discrepancies and management change. Abdom Radiol (NY) 2023; 48:2716-2723. [PMID: 37256331 DOI: 10.1007/s00261-023-03960-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Second-opinion reads on imaging studies are common for CT and MRI, but many institutions are hesitant to implement a workflow for second read of ultrasound studies performed at other facilities due to quality considerations. OBJECTIVE The purpose of this study was to assess discrepancy rates between initial and second-opinion general ultrasound reports METHODS: We reviewed all requests of second-opinion US studies referred to our tertiary care center between 02/01/2020 and 06/23/2022. We evaluated percentage of exams that were interpreted versus archived. Whenever the original report was available (n = 196 studies), we evaluated any discrepancy in findings, interpretation, and potential management change based on second report compared to the initial report as evaluated by consensus agreement of 3 subspecialized radiologists. RESULTS A total of 586 ultrasound studies for 533 patients were nominated for consult. After excluding 58 studies for technical reasons (e.g., duplicate nomination, images for procedure guidance, modality is not ultrasound) and 282 studies that were archived by the reading radiologist due to various objective (e.g., studies such as echocardiography not interpreted by the abdominal imagers or more recent study available obviating need for consultation) and subjective (e.g., suboptimal image quality, lack of cine clips) reasons, a total of 246 studies were reinterpreted and were further analyzed. Only 21/246 patients (8.5%) got repeat ultrasound of the same body part within 3 months of original study date. The original (first-read) report was available for 196/246 studies, with discrepancy present between the first and second reads in 74/196 (37.8%) studies, with potential management change in 51/196 (26.0%) studies. CONCLUSION Second-opinion interpretation of outside ultrasound examinations by subspecialized radiologists can result in recommended management change in 26% of studies indicating potential for added value to reinterpreting ultrasound studies despite the concerns for quality control.
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Affiliation(s)
- Amanda L Mehrsheikh
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd Campus Box 8131, St. Louis, MO, 63110, USA
| | - Benjamin S Strnad
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd Campus Box 8131, St. Louis, MO, 63110, USA
| | - Anup S Shetty
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd Campus Box 8131, St. Louis, MO, 63110, USA
| | - Malak Itani
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd Campus Box 8131, St. Louis, MO, 63110, USA.
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Chan J, Auffermann WF. Artificial Intelligence in the Imaging of Diffuse Lung Disease. Radiol Clin North Am 2022; 60:1033-1040. [DOI: 10.1016/j.rcl.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Virarkar M, Jensen C, Klekers A, Wagner-Bartak NA, Devine CE, Lano EA, Sun J, Tharakeswara B, Bhosale P. Clinical importance of second-opinion interpretations of abdominal imaging studies in a cancer hospital and its impact on patient management. Clin Imaging 2022; 86:13-19. [DOI: 10.1016/j.clinimag.2022.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 11/03/2022]
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Evaluation of interstitial lung disease: An algorithmic review using ILD-RADS. Clin Imaging 2022; 88:45-52. [DOI: 10.1016/j.clinimag.2022.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/25/2022] [Accepted: 04/29/2022] [Indexed: 11/03/2022]
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Dontchos BN, Dodelzon K, Dogan BE, Sonnenblick EB, Destounis S, Yang R, Dialani V, Perera V, Grimm LJ. Variations and Challenges to Performing Outside Study Interpretations in Breast Imaging: A National Survey of the Society of Breast Imaging Membership. JOURNAL OF BREAST IMAGING 2022; 4:153-160. [PMID: 38422430 DOI: 10.1093/jbi/wbab101] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Second-opinion interpretations of outside facility breast imaging provide value-added care but are operationally challenging for breast radiologists. Our objective was to survey members of the Society of Breast Imaging (SBI) to assess practice patterns and perceived barriers to performing outside study interpretations (OSIs). METHODS An anonymous survey was developed by the Patient Care and Delivery Committee of the SBI and distributed via e-mail to SBI radiologist members. Survey questions included practice demographics and OSI volumes, billing practices, clinical scenarios, and imaging modalities, logistics, and barriers. Responses were aggregated and comparisons were made by univariate analysis using likelihood ratio tests, t-tests, and Spearman's rank correlation tests as appropriate. Ordinal or nominal logistic modeling and linear regression modeling was also performed. RESULTS There were 371 responses (response rate of 13%). Most respondents practice at an affiliated specialty breast care center (306/371, 83%) and said their practice performed OSIs (256/371, 69%). Academic practices reported the highest OSI volumes (median 75 per month) and were most likely to indicate increases in OSI volumes over time (100/144, 69%). The most common indication for OSI was second opinion for a biopsy recommendation (245/256, 96%). Most practices provide a final BI-RADS assessment (183/261, 70%). The most cited barrier to performing OSIs was physician time constraints (252/369, 68%). CONCLUSION Breast imaging OSI practice patterns are variable among SBI members with notable differences by practice setting and multiple barriers identified. More unified guidelines and recommendations may be needed for radiologists to better perform this valuable task.
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Affiliation(s)
- Brian N Dontchos
- Massachusetts General Hospital, Department of Radiology, Boston, MA, USA
| | - Katerina Dodelzon
- Weill Cornell at New York-Presbyterian, Department of Radiology, New York, NY, USA
| | - Basak E Dogan
- The University of Texas Southwestern Medical Center, Department of Radiology, Dallas, TX, USA
| | - Emily B Sonnenblick
- Icahn School of Medicine at Mount Sinai, Department of Diagnostic, Molecular, and Interventional Radiology, New York, NY, USA
| | | | - Roger Yang
- Rutgers Robert Wood Johnson Medical School, Department of Radiology, New Brunswick, NJ, USA
| | - Vandana Dialani
- Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA, USA
| | - Vidushani Perera
- McGaw Medical Center of Northwestern University, Department of Radiology, Chicago, IL,USA
| | - Lars J Grimm
- Duke University Medical Center, Department of Radiology, Durham, NC, USA
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Tagliafico AS, Campi C, Bianca B, Bortolotto C, Buccicardi D, Francesca C, Prost R, Rengo M, Faggioni L. Blockchain in radiology research and clinical practice: current trends and future directions. Radiol Med 2022; 127:391-397. [PMID: 35194720 PMCID: PMC8863512 DOI: 10.1007/s11547-022-01460-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/21/2022] [Indexed: 12/31/2022]
Abstract
Blockchain usage in healthcare, in radiology, in particular, is at its very early infancy. Only a few research applications have been tested, however, blockchain technology is widely known outside healthcare and widely adopted, especially in Finance, since 2009 at least. Learning by history, radiology is a potential ideal scenario to apply this technology. Blockchain could have the potential to increase radiological data value in both clinical and research settings for the patient digital record, radiological reports, privacy control, quantitative image analysis, cybersecurity, radiomics and artificial intelligence. Up-to-date experiences using blockchain in radiology are still limited, but radiologists should be aware of the emergence of this technology and follow its next developments. We present here the potentials of some applications of blockchain in radiology.
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Affiliation(s)
- Alberto Stefano Tagliafico
- IRCCS Ospedale Policlinico San Martino, Genova, Genoa, Italy. .,Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
| | - Cristina Campi
- Dipartimento Di Matematica, Università Di Genova, via Dodecaneso 35, 16146, Genova, Italy
| | - Bignotti Bianca
- IRCCS Ospedale Policlinico San Martino, Genova, Genoa, Italy
| | - Chandra Bortolotto
- Dipartimento Di Radiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Coppola Francesca
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Roberto Prost
- Azienda Ospedaliera Brotzu, Cagliari, Sardegna, Italy
| | - Marco Rengo
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome - I.C.O.T. Hospital, Via Franco Faggiana, 1668, 04100, Latina, Italy
| | - Lorenzo Faggioni
- Diagnostic and Interventional Radiology, University Hospital of Pisa, Via Paradisa 2, 56100, Pisa, Italy
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Li JL, Phillips D, Towfighi S, Wong A, Harris A, Black PC, Chang SD. Second-opinion reads in prostate MRI: added value of subspecialty interpretation and review at multidisciplinary rounds. Abdom Radiol (NY) 2022; 47:827-837. [PMID: 34914006 PMCID: PMC8674412 DOI: 10.1007/s00261-021-03377-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 12/16/2022]
Abstract
Purpose This study evaluates the impact of second-opinion review of multiparametric prostate MRI for cancer detection by a multidisciplinary review board at a tertiary care center when compared with the initial community radiologist interpretation. Methods Cases were collected retrospectively from multidisciplinary prostate MRI rounds from 2017 to 2020 at a single tertiary care center. Patients with suspected prostate cancer or on active surveillance were referred for consideration of TRUS/MRI-fusion biopsy based on community-read prostate MRIs. All MRIs were re-read by subspecialized abdominal radiologists and a PI-RADS score assigned. Targeted fusion and 8–12 core systematic biopsy was performed in patients with PIRADS ≥ 3 lesions. Cohen kappa values were used to quantify interobserver agreement. Positive predictive value (PPV) was used to determine accuracy of PI-RADS score for detection of clinically significant prostate cancer (csPCa) (ISUP Grade Group ≥ 2). Results Three hundred and thirty-two lesions in 303 patients were reviewed and 252 lesions in 198 patients biopsied. The PI-RADS score was concordant in 60.5% of lesions, downgraded in 17.8%, and upgraded in 7.8%. Agreement between community and tertiary center interpretation was fair (κ = 0.354), with greater agreement for PI-RADS ≥ 4 (κ = 0.523) than PI-RADS ≥ 3 (κ = 0.456), and peripheral zone (κ = 0.419) than transition zone lesions (κ = 0.251). Prevalence of csPCa in biopsied lesions was 40.9%. Conclusion There is variability in community and tertiary care center interpretation of prostate MRI in cancer detection, with higher concordance rates for higher grade and peripheral zone lesions. These differences demonstrate the added value of multidisciplinary round review and highlight the need for ongoing education and feedback. Graphical abstract ![]()
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Affiliation(s)
- Jessica L. Li
- Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion, 899 W 12th Ave, Vancouver, BC V5Z 1M9 Canada
| | - Drew Phillips
- Department of Urology, Vancouver General Hospital, #190, 855 W 12th Ave, Vancouver, BC V5Z 1M9 Canada
| | - Sohrab Towfighi
- Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion, 899 W 12th Ave, Vancouver, BC V5Z 1M9 Canada
| | - Amanda Wong
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada
| | - Alison Harris
- Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion, 899 W 12th Ave, Vancouver, BC V5Z 1M9 Canada
| | - Peter C. Black
- Department of Urologic Sciences, University of British Columbia, Level 6, 2775 Laurel St, Vancouver, BC V5Z 1M9 Canada
| | - Silvia D. Chang
- Department of Radiology, Vancouver General Hospital, Jim Pattison Pavilion, 899 W 12th Ave, Vancouver, BC V5Z 1M9 Canada
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