Radiology & Imaging Archives - PulmCCM
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Radiology & Imaging Articles

Feb 022017
 
CDC Releases Ventilator-Associated Events Criteria

A new term has been coined by the Centers for Disease Control and Prevention, ventilator-associated events (VAEs)¹. In 2011, the CDC convened a working group composed of members of several stakeholder organizations to address the limitations of the definition of ventilator-associated pneumonia (VAP) definition². The organizations represented in the Working Group include: the Critical Care [… read more]

Dec 242016
 
Pneumonia or Atelectasis?  Here's a trick to tell them apart

By Jon-Emile S. Kenny [@heart_lung] “New York is cold, but I like where I’m living … There’s music on Clinton Street all through the evening.” -Leonard Cohen It’s the end of December; we collectively reflect on the year that was and try to find our footing for the next.  In the short winter days of 2016, it [… read more]

Dec 162016
 
Inferior vena cava filters are overused. What's the harm?

Inferior vena cava filters (IVCF) are placed to prevent deep venous thromboses (DVT) from traveling to the heart and lungs, causing pulmonary embolism (PE). IVC filters’ rationale makes sense, but despite their wide use, the benefits and risks of IVCF remain unclear. With about 50,000 IVC filters placed annually in the U.S., that’s a lot of unclarity. [… read more]

Jan 212016
 
That Fallible IVC

Jon-Emile S. Kenny [@heart_lung] A 58 year old man with ethanol-related cirrhosis is admitted to the floor with anuria and a rising creatinine.  Over the day, serial ultrasounds of his interior vena cava [IVC] consistently reveal that it is diminutive and collapsing.  He receives many liters of crystalloid without much change in his urine output.  [… read more]

Sep 172015
 
Overdiagnosis of pulmonary embolism on CT-angiogram by radiologists may be widespread

Contrasted CT-angiography of the chest, often called a “PE protocol CT,” has dramatically improved the diagnosis of pulmonary embolism. When used in conjunction with validated clinical decision tools like modified Wells criteria, CT-angiography is highly sensitive (good at detecting PE when it’s there and ruling it out when it’s not) and specific (generating few false-positive [… read more]

Mar 042015
 
Lung-RADS launches: New system for lung cancer screening chest CTs

The American College of Radiology has started implementing its new system for risk-stratifying the findings on low dose chest CTs performed for lung cancer screening. The ACR’s new system is called Lung-RADS™, and it emulates the ACR’s familiar Bi-RADS’s 0-4 scoring system for mammography: Lung-RADS 0: Incomplete, meaning previous chest CTs are still being located [… read more]

Feb 112015
 
Medicare will pay for lung cancer screening chest CT -- now up to age 77

Medicare will pay for annual low-dose chest CT for lung cancer screening, for former and current heavy smokers between the ages of 55 and 77. The Centers for Medicare and Medicaid Services (CMS) announced the decision last week. CMS had previously signaled they would set the upper age limit at 74, the same as in the National Lung Screening Trial [… read more]

Dec 192014
 
Age-adjusted D-dimer to rule out PE: coming of age?

Put a CT scanner in every U.S. emergency department, add the non-specific signs and symptoms of pulmonary embolism, stir in its potential lethality and morbidity, and line up a few thousand lawyers on the sidelines ready to capitalize on any missed diagnoses, and it’s no wonder that the use of CT-angiograms to rule out pulmonary embolism has risen 11-fold [… read more]

Jul 172014
 
Inspiratory collapse of the inferior vena cava: What is it telling us?

image: EM Ultrasonography ICU Physiology in 1,000 Words: “Inspiratory collapse of the inferior vena cava: What is it telling us?” Jon-Emile S. Kenny M.D. With the dissemination of small, portable, ultrasound devices [or SPUDs], it seems that it is every house-officer’s dream to own the ability and wherewithal to place an ultrasound probe on a [… read more]

Mar 252014
 

May 10th and 11th (pre-congress courses on may 9th), Montreal. Great speakers, great topics, great city, great weather (well…hopefully no snow!). Do you know how to use ultrasound to help you diagnose or manage coma, bowel obstruction, CHF, dyspnea, swollen joints and renal failure, among other things?  No matter how good you are at the [… read more]

Jan 292014
 
CCUS 2014: 7th Annual Critical Care Ultrasound Symposium

For the 7th edition of our Annual Symposium, we’ve assembled a great cast of characters to bring your bedside ultrasound game to a whole new level! Whether you’re a novice or have some experience in bedside ultrasound, we’re sure you’ll find our program very interesting, as the perspective we have chosen to take is patient-based, [… read more]

Jan 292014
 
Choosing Wisely's five top "no-no's" in critical care

Choosing Wisely is an initiative of the American Board of Internal Medicine (ABIM) with the stated goal of “promoting conversations between physicians and patients by helping patients choose care that is supported by evidence, not duplicative, free from harm, and truly necessary.” Sounds good, huh? Politically, ABIM’s Choosing Wisely demonstrates to policymakers responsible self-governance by us [… read more]

Jan 262014
 
US Gov't pronounces lung cancer screening the standard of care

It’s official: the U.S. Preventive Services Task Force (USPSTF) announced its formal recommendation for yearly low-dose chest CT screening for lung cancer in high-risk individuals on December 30, 2013. The final grade B recommendation (“Suggestion: offer or provide this service”) was virtually unchanged from the draft recommendations the USPSTF made in July 2013. It advises [… read more]

Dec 152013
 
Overdiagnosis rate with lung cancer screening CT is 18%

Low-dose CT screening reduced death from lung cancer by about 20% in the National Lung Screening Trial, and the U.S. Preventive Services Task Force signaled it would recommend CT screening for most people with a heavy smoking history. The Affordable Care Act stipulates that USPSTF-recommended screening tests be completely free to consumers, so lung cancer screening will [… read more]

Oct 302013
 
"Choosing Wisely" campaign targets pulmonary hypertension drugs' off-label use

Choosing Wisely, the initiative for medical cost-effectiveness (don’t call it rationing!) of the American Board of Internal Medicine, included the use of vasodilators for pulmonary hypertension owing to left heart disease or hypoxemic lung disease (WHO Groups II and III) as #2 on its top five “no-no’s” in its new pulmonology section. The “Five Things Physicians and [… read more]

Aug 112013
 
USPSTF Recommends Lung Cancer Screening CT; Obamacare Pays

USPSTF Endorses Lung Cancer Screening CT; New Standard of Care Begins Lung cancer screening CT took its most important step toward widespread implementation last week, when the U.S. Preventive Services Task Force (USPSTF) released a draft of its forthcoming recommendation that the 9 million U.S. people meeting entry criteria for the National Lung Screening Trial [… read more]

Jul 272013
 
How to ration lung cancer screening CTs, rationally

Restrict Lung Cancer Screening CT To Highest-Risk People? The National Lung Screening Trial showed that 3 annual low-dose chest CT scans in people with heavy smoking histories (30+ pack-years) saved lives, reducing the risk of death from lung cancer by a relative 20% compared to screening with annual chest X-rays. With 160,000 lung cancer deaths [… read more]

Jun 162013
 
Ultrasound in the ICU: Hypotension after a cholecystectomy (Case 1)

Ultrasound Case 1 Hypotension after a Cholecystectomy: Why? From Philippe Rola and the Critical Care & Ultrasound Institute, the first in a series of educational ultrasound cases on PulmCCM: A 64 year-old male is admitted to the ICU from the surgical ward with hypotension, 3 days post-cholecystectomy. He is intubated for airway protection following loss [… read more]

Jun 072013
 
Managing anticoagulation for surgery and invasive procedures (Review)

Managing Anticoagulation Therapy For Surgery and Procedures (NEJM) See also: How to manage anticoagulation perioperatively (ACCP Guidelines) NOTE: This is a summary of an article in a medical journal, provided as a service to physicians. It is not medical advice. No one should ever make changes to their anticoagulation treatment except under a physician’s supervision. [… read more]