BAL Fluid Cellular Analysis and Radiologic Patterns in Patients With Fibrotic Interstitial Lung Disease.

Background: BAL cellular analysis is often recommended during the initial diagnostic evaluation of fibrotic interstitial lung disease (ILD). Despite recommendation for its use, between-center heterogeneity exists and supportive data concerning the clinical utility and correlation of BAL findings with radiologic features or patterns remain sparse.

Research Question: In patients with fibrotic ILD, are BAL findings associated with radiologic features, patterns, and clinical diagnoses?

Study Design And Methods: Patients with fibrotic ILD who underwent BAL for diagnostic evaluation and who were enrolled in the prospective Canadian Registry for Pulmonary Fibrosis were re-reviewed in a standardized multidisciplinary discussion (MDD).

Lung imaging patterns in connective tissue disease-associated interstitial lung disease impact prognosis and immunosuppression response.

Objectives: Interstitial lung disease (ILD) in CTDs has highly variable morphology. We aimed to identify imaging features and their impact on ILD progression, mortality, and immunosuppression response.

Methods: Patients with CTD-ILD had high-resolution chest CT (HRCT) reviewed by expert radiologists blinded to clinical data for overall imaging pattern [usual interstitial pneumonia (UIP); non-specific interstitial pneumonia (NSIP); organizing pneumonia (OP); fibrotic hypersensitivity pneumonitis (fHP); and other].

Integration and Application of Radiologic Patterns From Clinical Practice Guidelines on Idiopathic Pulmonary Fibrosis and Fibrotic Hypersensitivity Pneumonitis.

Background: Clinical practice guidelines separately describe radiologic patterns of usual interstitial pneumonia (UIP) and fibrotic hypersensitivity pneumonitis (fHP), without direction on whether or how to apply these approaches concurrently within a single patient.

Research Question: How can we integrate guideline-defined radiologic patterns to diagnose interstitial lung disease (ILD) and what are the pitfalls associated with described patterns that require reassessment in future guidelines?

Study Design And Methods: Patients from the Canadian Registry for Pulmonary Fibrosis underwent detailed reevaluation in standardized multidisciplinary discussion. CT scan features were quantified by chest radiologists masked to clinical data, and guideline-defined patterns were assigned.

Knowing the Enemy: Health Care Provider Knowledge of Computed Tomography Radiation Dose and Associated Risks.

Background: There is ionizing radiation and associated risk from many medical imaging examinations, especially computed tomography (CT). Unfortunately, health care providers often have limited knowledge regarding radiation dose levels and potential risk.

Research Objectives: To assess knowledge of dose levels and risk among referring physicians, imaging technologists, and radiologists in Saskatoon, Saskatchewan, and to identify potential differences between and within those groups.

Fetal shielding combined with state of the art CT dose reduction strategies during maternal chest CT.

Purpose: Custom bismuth-antimony shields were previously shown to reduce fetal dose by 53% on an 8DR (detector row) CT scanner without dynamic adaptive section collimation (DASC), automatic tube current modulation (ATCM) or adaptive statistical iterative reconstruction (ASiR). The purpose of this study is to compare the effective maternal and average fetal organ dose reduction both with and without bismuth-antimony shields on a 64DR CT scanner using DASC, ATCM and ASiR during maternal CTPA.

Materials And Methods: A phantom with gravid prosthesis and a bismuth-antimony shield were used.

An unusual case of dual left anterior descending artery with coronary computed tomographic angiographic correlation.

Dual left anterior descending artery (LAD) is a rare coronary anomaly that is important to recognize at coronary imaging as it may influence reperfusion strategies. Four types of dual LAD are described by the traditional literature. We present a novel case of dual LAD with coronary computed tomographic angiographic correlation that does not fit into this classification system.

Changing radiation dose from diagnostic computed tomography examinations in Saskatchewan.

Purpose: Follow-up study to observe if provincial mean effective radiation dose for head, chest, and abdomen-pelvis (AP) computed tomographies (CTs) remained stable or changed since the initial 2006 survey.

Methods: Data were collected in July 2008 from Saskatchewan's 13 diagnostic CT scanners of 3358 CT examinations. These data included the number of scan phases and projected dose length product (DLP).

Normal expiratory flow rate and lung volumes in patients with combined emphysema and interstitial lung disease: a case series and literature review.

Pulmonary function tests in patients with idiopathic pulmonary fibrosis characteristically show a restrictive pattern including small lung volumes and increased expiratory flow rates resulting from a reduction in pulmonary compliance due to diffuse fibrosis. Conversely, an obstructive pattern with hyperinflation results in emphysema by loss of elastic recoil, expiratory collapse of the peripheral airways and air trapping. When the diseases coexist, pulmonary volumes are compensated, and a smaller than expected reduction or even normal lung volumes can be found.

Lead versus bismuth-antimony shield for fetal dose reduction at different gestational ages at CT pulmonary angiography.

Purpose: To compare the effective fetal dose reduction at different stages of gestation during maternal computed tomographic (CT) pulmonary angiography by using traditional lead apron and bismuth-antimony shields combined with limited z-axis and tube current.

Materials And Methods: Phantom with gravid prosthesis, 0.5-mm lead, and two grades of bismuth-antimony shield was used.

Familial interstitial pulmonary fibrosis: a large family with atypical clinical features.

A large kindred of familial pulmonary fibrosis is reported. Six members from the first two generations of this particular kindred were described more than 40 years previously; six more individuals from the third and fourth generations have also been evaluated. The proband, now 23 years of age, has mild disease; the other 11 documented affected family members all died from their disease at an average age of 37 years (range 25 to 50 years).

A man in the barrel with neck pain.

A 38-year-old man presented with an abrupt onset of occipital and neck pain, radiating to both shoulders. The pain was accompanied by inability to lift his arms against gravity (the "man-in-the-barrel" syndrome). These symptoms were associated with bilateral hand paresthesias, right-sided throbbing headache, vertigo, nausea, and vomiting.

Computed tomography radiation dose: a primer for administrators.

The use of computed tomography (CT) is growing, and, consequently, the associated radiation dose to patients is increasing as well. There is also increasing evidence linking the radiation dose within the range of diagnostic CT with a significantly increased risk of malignancy. These two factors combine to make radiation dose from diagnostic CT a public health concern.

Radiation dose from diagnostic computed tomography in Saskatchewan.

Objective: To calculate the effective dose from diagnostic computed tomography (CT) scans in Saskatchewan, Canada, and compare with other reported dose levels.

Methods: Data from CT scans were collected from 12 scanners in 7 cities across Saskatchewan. The patient age, scan type, and selected technique parameters including the dose length product and the volume computed tomography dose index were collected for a 2-week period.

Thyroid shields versus z-axis automatic tube current modulation for dose reduction at neck CT.

Purpose: To assess the effectiveness of in-plane bismuth thyroid shields and a z-axis automatic tube current modulation (ATCM) technique with respect to dose reduction and image noise in the thyroid and other regional tissues during neck computed tomography (CT).

Materials And Methods: Because this was a phantom study, neither institutional review board approval nor HIPAA compliance was required. A female phantom, thyroid shields, and an eight-section CT scanner were used.

The reliability of ultrasound measurements of carotid stenosis compared to MRA and DSA.

Objective: Carotid ultrasound (US) is a screening test for patients with transient ischemic attacks (TIAs) or stroke who then undergo Digital Subtraction Angiogram (DSA) or Magnetic Resonance Angiography (MRA). Gold standard DSA is invasive with inherent risks and costs. MRA is an evolving technology.

Radiation cost of helical high-resolution chest CT.

Objective: In our department, most high-resolution CT (HRCT) scans of the lungs are performed in conjunction with a standard helical examination to assess the entire chest. This requires scanning the patient twice. The goal of this study was to determine if the radiation dose could be decreased by performing a single combination helical scan of the chest from which both 5-mm standard and 1.