Seminars in respiratory and critical care medicine
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Semin Respir Crit Care Med · Dec 2022
Evaluation and Management of Indeterminate Pulmonary Nodules on Chest Computed Tomography in Asymptomatic Subjects: The Principles of Nodule Guidelines.
With the rapidly increasing number of chest computed tomography (CT) examinations, the question of how to manage lung nodules found in asymptomatic patients has become increasingly important. Several nodule management guidelines have been developed that can be applied to incidentally found lung nodules (the Fleischner Society guideline), nodules found during lung cancer screening (International Early Lung Cancer Action Program protocol [I-ELCAP] and Lung CT Screening Reporting and Data System [Lung-RADS]), or both (American College of Chest Physicians guideline [ACCP], British Thoracic Society guideline [BTS], and National Comprehensive Cancer Network guideline [NCCN]). ⋯ The diameter can be manually measured as a single maximal diameter or as an average of two-dimensional diameters, and software can be used to obtain volumetric measurements. It is important to properly evaluate and measure nodules and familiarize ourselves with the relevant guidelines to appropriately utilize medical resources and minimize unnecessary radiation exposure to patients.
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Recently, interest and advances in artificial intelligence (AI) including deep learning for medical images have surged. As imaging plays a major role in the assessment of pulmonary diseases, various AI algorithms have been developed for chest imaging. Some of these have been approved by governments and are now commercially available in the marketplace. ⋯ While AI is a powerful technology that can be applied to medical imaging and is expected to improve our current clinical practice, some obstacles must be addressed for the successful implementation of AI in workflows. Understanding and becoming familiar with the current status and potential clinical applications of AI in chest imaging, as well as remaining challenges, would be essential for radiologists and clinicians in the era of AI. This review introduces the potential clinical applications of AI in chest imaging and also discusses the challenges for the implementation of AI in daily clinical practice and future directions in chest imaging.
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Semin Respir Crit Care Med · Dec 2022
Community-Acquired Pneumonia: Postpandemic, Not Post-COVID-19.
The coronavirus disease 2019 (COVID-19) pandemic upended our approach to imaging community-acquired pneumonia, and this will alter our diagnostic algorithms for years to come. In light of these changes, it is worthwhile to consider several postpandemic scenarios of community-acquired pneumonia: (1) patient with pneumonia and recent positive COVID-19 testing; (2) patient with air space opacities and history of prior COVID-19 pneumonia (weeks earlier); (3) multifocal pneumonia with negative or unknown COVID-19 status; and (4) lobar or sublobar pneumonia with negative or unknown COVID-19 status. In the setting of positive COVID-19 testing and typical radiologic findings, the diagnosis of COVID-19 pneumonia is generally secure. ⋯ Lobar or sublobar pneumonia will continue to suggest the diagnosis of pneumococcus or consideration of other pathogens in the setting of local outbreaks. A positive COVID-19 test accompanied by these imaging patterns may suggest coinfection with one of the above pathogens, or when the prevalence of COVID-19 is very low, a false positive COVID-19 test. Clinicians may still proceed with testing for COVID-19 when radiologic patterns are atypical for COVID-19, dependent on the patient's exposure history and the local epidemiology of the virus.
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Semin Respir Crit Care Med · Dec 2022
ReviewChronic Thromboembolic Pulmonary Disease and Chronic Thromboembolic Pulmonary Hypertension.
Chronic thromboembolic pulmonary hypertension (CTEPH) and chronic thromboembolic pulmonary disease (CTEPD) are two terms characterizing symptomatic patients with chronic thromboembolic occlusions of pulmonary arteries with or without pulmonary hypertension at rest. Their diagnosis follows evolving schemas that integrate technological advances of pivotal imaging modalities among which computed tomography angiography plays a major role. ⋯ The requirements for imaging at the time of therapeutic decisions are also described in the light of recent updates in the literature from multidisciplinary groups of experts. Because an early diagnosis of CTEPH remains a challenge for the medical community, several practical issues are included in this article with the objective of improving the knowledge and collaboration between radiologists and clinicians in service to the patient.