Thoracic infections in human immunodeficiency virus/acquired immune deficiency syndrome.
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Acquired Immunodeficiency Syndrome↗
Biomedical subjects
Phillip M Boiselle
Publications and source records attributed to Phillip M Boiselle.
Relapsing polychondritis: prevalence of expiratory CT airway abnormalities.
PURPOSE: To retrospectively determine the prevalence of expiratory computed tomographic (CT) abnormalities, including malacia and air trapping, in patients with relapsing polychondritis and to retrospectively determine the frequency with which expiratory abnormalities are accompanied by inspiratory abnormalities on CT scans. MATERIALS AND METHODS: Institutional review board approval was obtained, and informed consent was not required for this retrospective HIPAA-compliant study. A computerized hospital information system was used to identify all patients with clinically diagnosed or biopsy-proved relapsing polychondritis who were referred for CT airway imaging during a 17-month period. The study cohort comprised 18 patients (15 women, three men; mean age, 47 years; age range, 20-71 years). Multidetector helical CT was performed in all patients by using a standard protocol, which included end-inspiratory and dynamic expiratory volumetric imaging. Two observers who were blinded to the original scan interpretations simultaneously reviewed CT scans. Findings were recorded in consensus. Dynamic expiratory CT scans were assessed for malacia that involved the trachea and main bronchi (reduction in cross-sectional area of more than 50%) and for air trapping (failure of lung parenchyma to increase in attenuation during expiration). Air trapping was visually classified according to pattern and extent (lobular, segmental, lobar, or whole lung). Inspiratory CT scans were evaluated for tracheal and bronchial stenosis (>25% luminal diameter narrowing compared with a corresponding uninvolved segment), wall thickening (>2 mm), and calcification. RESULTS: Expiratory CT abnormalities were present in 17 (94%) of 18 patients and included malacia in 13 patients (72%) and air trapping in 17 patients (94%). Inspiratory CT abnormalities were found in eight (47%) of 17 patients who had expiratory CT abnormalities. Calcification of the airway walls was present in seven (39%) of 18 patients. All patients who had inspiratory CT abnormalities demonstrated expiratory CT abnormalities. CONCLUSION: Expiratory CT abnormalities were present in the majority of patients with relapsing polychondritis who were referred for airway imaging, yet only half of these patients demonstrated abnormalities on routine inspiratory CT scans. Thus, dynamic expiratory CT should be a standard component of imaging assessment in patients with relapsing polychondritis.
Adult↗
Loss of anteroposterior intralobar attenuation gradient of the lung: Correlation with pulmonary function.
RATIONALE AND OBJECTIVES: Since the initial description of an intralobar attenuation gradient by Webb et al, it has been suggested that departure from the intralobar attenuation gradient could indicate early lung diseases. However, its significance has not been determined in detail. We aimed to quantify the anteroposterior intralobar attenuation gradient on volumetric end-inspiratory and end-expiratory high-resolution computed tomography (CT) in patients with emphysema and to correlate the gradient values with pulmonary function. MATERIALS AND METHODS: The study population consisted of 21 consecutive patients with emphysema evaluated with volumetric expiratory high-resolution CT and 6 patients with normal high-resolution CT findings. The anteroposterior intralobar attenuation gradient values were quantified on end-inspiratory and end-expiratory sagittal reformations using a lung analysis software program and were correlated with pulmonary function tests results. RESULTS: The intralobar attenuation gradient values in patients with forced expiratory volume in 1 second (FEV1) < or =70% were significantly smaller compared with those in patients with FEV1 >70% in bilateral lower lobes at end-expiration (P = .0061, P = .047, respectively, unpaired t-test). The FEV1 values in patients with attenuation gradient values < or =0.02 were significantly lower than in those with attenuation gradient values >0.02 (right lower lobe: P = .024; left lower lobe: P = .0034; chi-squared test). The intralobar attenuation gradient values in bilateral lower lobes at end-expiration were significantly correlated with FEV1 and FEV1/forced vital capacity (right: P = .031, P = .039, respectively; left: P = .036, P = .030, respectively, Pearson correlation). CONCLUSIONS: The quantitative measurement of the anteroposterior intralobar attenuation gradient values of the lung showed that these gradients at end-expiration in both lower lobes correlate with obstructive physiology.
Adult↗
Incidence of pulmonary embolism in younger versus older patients using CT.
OBJECTIVE: The aim of this study is to compare the incidence of pulmonary embolism (PE) on computed tomography (CT) studies between younger and older patients to determine if there is an age-related bias for overutilization of CT pulmonary angiography (CTPA) in younger patients. MATERIAL AND METHODS: Six hundred thirty-one consecutive CTPA cases for suspected acute PE between 11/10/2003 and 3/19/2004 were retrospectively studied. Of these 631 cases, 59 patients were found to have clots in the pulmonary arteries (ranging from central to subsegmental PA). CTPA was performed using multidetector CT at 1.25-mm collimation, 120 kVp, 320 mA. Patients were categorized by gender and age: A, less than 20 (n = 11); B, 20 to 29 (n = 44); C, 30 to 39 (n = 59); D, 40 to 49 (n = 90); E, 50 to 59 (n = 120); F, 60 to 69 (n = 114); G, 70 to 79 (n = 104); H, 80 to 89 (n = 72); I, 90 or more (n = 21). The incidences of PE were calculated in each gender and age group. To compare the incidence of PE between younger and older groups, they were divided into 2 groups at the ages of 40 (<39 and > or = 40), 50 (<49 and > or = 50), and 60 (<59 and > or = 60). Statistical analysis was performed using the chi test. RESULTS: The incidences of PE were 11.9% in males (A, 0%; B, 17.6%; C, 10%; D, 8.3%; E, 13.3%; F, 6.9%; G, 17.5%; H, 23.5%; I, 0%), 7.7% in females (A, 0%; B, 7.4%; C, 5.1%; D, 12.5%; E, 4.2%; F, 14.5%; G, 7.8%; H, 5.5%; I, 0%), and 9.4% in total patients (A, 0%; B, 11.1%; C, 6.8%; D, 11.1%; E, 7.5%; F, 10.5%; G, 11.5%; H, 9.7%; I, 0%). No significant differences in the incidences of PE were observed when patients were divided at the age of 40 (male, female, total; P=1.0, 0.6252, 0.7220), at the age of 50 (male, female, total; P = 0.6748, 0.6879, 1.0), or at the age of 60 (male, female, total; P = 0.8458, 0.7046, 0.6820). CONCLUSION: No statistically significant difference in the incidence of PE was observed between younger and older patients. Our findings suggest that there is no age-related bias for overutilization of CT angiography (CTA) in younger patients.
Adolescent↗
Tracheal morphology in patients with tracheomalacia: prevalence of inspiratory lunate and expiratory "frown" shapes.
OBJECTIVE: To identify the spectrum of tracheal morphologies in patients with tracheomalacia, and to determine the prevalence of specific inspiratory (lunate) and expiratory (frown) shapes that have been associated with this condition. MATERIALS AND METHODS: A retrospective review was performed of a consecutive series of patients with bronchoscopically-proven tracheomalacia who were imaged with inspiratory and dynamic-expiratory computed tomography (CT). The CT images of each patient were reviewed in a blinded, randomized fashion by an experienced thoracic radiologist. For each case, the shape of the trachea at end-inspiration and dynamic expiration was classified using specific tracheal morphologies described in the literature. RESULTS: The study population included 17 patients, with a mean age of 54 years. At inspiration, 16 (94%) of 17 subjects demonstrated a normal tracheal configuration (round, oval, horseshoe, or inverted-pear shape), and 1 (6%) of 17 subjects demonstrated an abnormal "lunate" tracheal configuration (coronal: sagittal ratio >1). At expiration, 9 (53%) of 17 subjects demonstrated a crescenteric, "frown" shape; 1 (6%) subject demonstrated complete collapse; and 7 (41%) subjects demonstrated other morphologies. CONCLUSIONS: Inspiratory tracheal morphology is almost always normal in patients with tracheomalacia, with a lunate configuration only rarely observed. In contrast, an expiratory "frown sign" is observed in approximately half of patients with this condition. This sign has the potential to aid the detection of tracheomalacia when patients inadvertently breathe during routine CT scans.
Adult↗
Cine CT during coughing for assessment of tracheomalacia: preliminary experience with 64-MDCT.
OBJECTIVE: 64-MDCT is advantageous for functional imaging because of its high spatial and temporal resolution combined with its length of coverage. Our purpose is to describe the technical aspects of using 64-MDCT for cine CT during coughing and to share our preliminary clinical experience using this method. CONCLUSION: This method is technically feasible and offers a promising alternative to previous cine CT methods for diagnosing tracheomalacia.
Cough↗
Lung cancer detected in patients presenting to the Emergency Department studies for suspected pulmonary embolism on computed tomography pulmonary angiography.
PURPOSE: To study the frequency and demographics of lung cancer on CT pulmonary angiography in patients with suspected pulmonary embolism referred from the Emergency Department. MATERIALS AND METHODS: Retrospective review of the medical records and radiology reports, clinical and imaging follow-up studies and pathological reports revealed 1106 CT pulmonary angiography studies referred from our Emergency Department during the 15-month period between March 2003 and June 2004. RESULTS: Five incidental lung cancer cases were found in 1106 studies from 1081 patients (0.47%). Pulmonary embolism was found in 95 patients (8.5%). Among the five incidental cases three patients were female and two were male (62-81 years old; mean 73 years, 17-130 packs year; mean 51 packs year). Tumor size ranged from 1.8 to 4.5 cm (mean 3.3 cm). The stagings of the lung cancers were IIIB in one patient and IV in four patients. CONCLUSION: Previously undiagnosed lung cancer was detected in 0.45% of patients among 1081 patients referred from Emergency Department, one of whom had coexistent pulmonary embolism. All five patients presented at advanced lung cancer stages of IIIB and IV.
Aged↗
Tracheobronchomalacia: comparison between end-expiratory and dynamic expiratory CT for evaluation of central airway collapse.
PURPOSE: To compare dynamic expiratory and end-expiratory computed tomography (CT) for depicting central airway collapse in patients with acquired tracheobronchomalacia (TBM). MATERIALS AND METHODS: Institutional review board approval was obtained, and informed consent was not needed. Retrospective review was performed of all patients with a CT diagnosis of TBM in a 10-month period (n = 34) who underwent evaluation of airway disease by means of three different sequences at multi-detector row CT: end inspiration, dynamic expiration, and end expiration (the latter was performed only at the levels of the aortic arch, carina, and bronchus intermedius). Fourteen patients (11 men, three women; age range, 19-79 years) who had comparable images obtained with all three sequences at any of these three levels were included in the study. The degree of airway collapse was measured by two thoracic radiologists in consensus by calculating the percentage change in the area of the airway between inspiratory and expiratory scanning. Statistical analysis was performed by using the paired t test. RESULTS: Dynamic expiratory CT elicited a significantly greater degree of airway collapse than end-expiratory CT at all three levels (P < .005). The mean percentages of airway collapse at each of the three levels were as follows: aortic arch, 53.9% with dynamic expiration versus 35.7% with end expiration (P = .0046); carina, 53.6% with dynamic expiration versus 30.9% with end expiration (P < .0001); and bronchus intermedius, 57.5% with dynamic expiration versus 28.6% with end expiration (P = .0022). CONCLUSION: Dynamic expiratory CT elicits a significantly greater degree of airway collapse than standard end-expiratory CT in patients with TBM.
Adult↗
Bronchomalacia in sarcoidosis: evaluation on volumetric expiratory high-resolution CT of the lung.
RATIONALE AND OBJECTIVES: The aim of this study is to investigate the frequency of bronchomalacia associated with sarcoidosis and compare the extent of air trapping in patients with sarcoidosis with and without bronchomalacia. MATERIALS AND METHODS: Eighteen consecutive patients (6 men, 12 women; age, 29-64 years; mean age, 47 years) with pathologically proven sarcoidosis who underwent clinical volumetric expiratory high-resolution computed tomography were studied. On contiguous end-expiratory images, the presence and severity of bronchomalacia and extent of air trapping were evaluated. The extent of air trapping was compared between patients with sarcoidosis with and without bronchomalacia. RESULTS: Bronchomalacia was noted in 11 of 18 patients (61%) with sarcoidosis (grade 1 [mild], n = 6; grade 2 [moderate], n = 4; and grade 3 [severe], n = 1). Air trapping was observed in 17 of 18 patients (94%; grade 1 [1%-25%], n = 8; grade 2 [26%-50%], n = 9). The extent of air trapping in patients with bronchomalacia was significantly greater than that in patients without bronchomalacia (P = .027, chi-squared test). CONCLUSION: Bronchomalacia frequently was associated with sarcoidosis, and the extent of air trapping was significantly greater in patients with sarcoidosis with bronchomalacia compared with those without bronchomalacia.
Adult↗
Comparison of artifacts on coronal reformation and axial CT pulmonary angiography images using single-detector and 4- and 8-detector multidetector-row helical CT scanners.
RATIONALE AND OBJECTIVES: The aim of this study is to compare the degree of stair-step artifact on coronal reformation computed tomographic (CT) pulmonary angiography images obtained using single-detector helical CT (SDCT), four-detector (4-MDCT), and eight-detector multidetector-row CT (8-MDCT) and compare the degree of motion artifact on the corresponding axial CT images. MATERIALS AND METHODS: Three groups of consecutive patients imaged by means of CT angiography for suspected pulmonary embolus were retrospectively identified by using CT records at our institution: (1) group A (n = 38), SDCT; (2) group B (n = 36), 4-MDCT; and (3) group C (n = 74), 8-MDCT. For each case, coronal multiplanar volume reformation maximal intensity projection images were created by using a standard technique. All images were reviewed in a randomized fashion by two thoracic radiologists who were blinded to the type of CT scanner. Stair-step artifact of pulmonary arteries on coronal reformation images was graded by consensus agreement using a four-point scale (0 = no artifact to 3 = severe artifact). Axial images were assessed for six parameters of motion artifact. The sum of these grades resulted in a total motion score, with a potential range of 0 (no motion) to 12 (severe motion). Statistical analysis was performed using the Mann-Whitney test. RESULTS: Stair-step artifacts were significantly higher for SDCT (mean, 2.9; median, 3) compared with 4-MDCT (mean, 2.2; median, 2; P < .0001) and 8-MDCT (mean, 1.5; median, 1; P < .0001). Total motion scores were significantly higher for SDCT (mean, 9.3) compared with 4-MDCT (mean, 8.4; P = .03) and 8-MDCT (mean, 6.8; P < .0001). CONCLUSION: Stair-step artifacts are significantly higher with SDCT compared with MDCT. For MDCT, eight-detector scanners produce images with significantly less artifact than four-detector scanners.
Adolescent↗
A remedy for resident evaluation and remediation.
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Clinical Competence↗
Congenital absence of the right upper lobe bronchus with double segmental tracheal bronchi.
A multidisciplinary approach revealed an absent right upper lobe bronchus and atretic bronchioles in a child with recurrent pulmonary infections. Use of a multidimensional computed tomographic scan and bronchoscopy clearly delineated the anatomical aberration. The child underwent an uncomplicated right upper anterior segmentectomy with an expedient recovery.
Abnormalities, Multiple↗
Multislice CT evaluation of airway stents.
Tracheobronchial stents are playing an increasing role in the palliative treatment of large airway obstruction due to a variety of conditions, including extrinsic compression, intraluminal disease, and malacia. Computed tomography (CT) plays an important role in aiding planning of stent placement and in detecting various stent complications. In this pictorial essay, we illustrate and review the role of multislice CT in the pre- and post-stent placement settings. A special emphasis is placed upon the characteristic CT appearance of specific stent complications and upon the role of CT multiplanar reformations and 3-dimensional (3-d) reconstruction techniques.
Airway Obstruction↗
Multidetector CT of the central airways.
Multidetector CT (MDCT) has revolutionized non-invasive imaging of the central airways. Compared to single-detector helical CT scans, MDCT results in higher spatial resolution, faster speed, greater anatomic coverage, and higher quality multiplanar reformation and 3-D reconstruction images. This article reviews recent advances in central airway imaging with MDCT. A special emphasis is placed upon the role of advanced reconstruction methods and functional imaging.
Contrast Media↗
Dynamic CT evaluation of the central airways in patients undergoing tracheoplasty for tracheobronchomalacia.
OBJECTIVE: The objective of this study was to describe the role of pre- and postoperative dynamic CT in patients undergoing tracheoplasty, a novel surgical method for treatment of severely symptomatic tracheobronchomalacia. CONCLUSION: Five patients were referred for dynamic MDCT before and after undergoing tracheoplasty at our institution. Preoperatively, all patients showed signs of tracheobronchomalacia (> or = 50% airway collapse) on bronchoscopy, and four (80%) of these five patients showed evidence of malacia on dynamic forceful expiratory CT scans. In all five cases, postoperative CT showed a reduction in the degree of airway collapse during expiration, changes in shape of the trachea during inspiration, and posterior wall thickening related to the procedure. Our preliminary results suggest a potentially important role for CT in the pre- and postoperative assessments of patients with tracheobronchomalacia referred for tracheoplasty.
Aged↗
Evaluation of an online faculty appraisal instrument: comparison of resident and faculty perceptions.
RATIONALE AND OBJECTIVES: Our purpose was to compare faculty and resident perceptions regarding an online faculty appraisal instrument and the potential impact of the appraisal process. MATERIALS AND METHODS: Faculty members and residents at an academic medical center diagnostic radiology department were asked to complete anonymous surveys that sought feedback regarding an online faculty appraisal form and process. Questions were asked regarding the relative importance of various faculty performance measures, preferences for narrative versus quantitative components of the instrument, and the likely impact of the evaluation process on future faculty behavior. RESULTS: The survey was completed by 19 (45%) of 42 faculty members and by 16 (80%) of 20 residents who participated in the initial faculty appraisal process. Residents and faculty both assigned generally high rankings to the six measures of faculty performance. The vast majority (86 %) of faculty and residents found the narrative component of the survey (either alone or in combination with quantitative data) most helpful. Based on the appraisal process, 74% of the faculty planned to modify one or two aspects of their behavior, whereas a significant minority (44%) of residents thought that the faculty would not make any changes. CONCLUSION: Faculty and residents generally agree on a core set of faculty performance measures, and both groups show a preference for an appraisal instrument that incorporates a narrative component. Concerning the perceived impact of the appraisal process, faculty members were slightly more optimistic than residents regarding its ability to serve as an impetus for faculty behavioral changes.
Employee Performance Appraisal↗
Comprehensive innovative solution for resident education using the Intranet Journal of Chest Radiology.
RATIONALE AND OBJECTIVES: Because of the rapid increase in clinical workload in academic radiology departments, time for teaching rotating residents is getting more and more limited. As a solution to this problem, we introduced the Intranet Journal of Chest Radiology as a comprehensive innovative tool for assisting resident education. MATERIALS AND METHODS: The Intranet Journal of Chest Radiology is constructed using Microsoft FrontPage version 2002 (Microsoft Corp, Redmond, WA) and is hosted in our departmental web server (Beth Israel Deaconess Medical Center, Boston, MA). The home page of the intranet journal provides access to the main features, "Cases of the Month," "Teaching File," "Selected Articles for Residents," "Lecture Series," and "Current Publications." These features provide quick access to the selected radiology articles, the interesting chest cases, and the lecture series and current publication from the chest section. RESULTS: Our intranet journal has been well utilized for 6 months after its introduction. It enhances residents' interest and motivation to work on case collections, to search and read articles, and to generate interest in research. Frequent updating is necessary for the journal to be kept current, relevant, and well-utilized. CONCLUSION: The intranet journal serves as a comprehensive innovative solution for resident education, providing basic educational resources and opportunities of interactive participation by residents.
Computer Communication Networks↗