{"id":2554,"date":"2016-06-19T09:09:47","date_gmt":"2016-06-19T13:09:47","guid":{"rendered":"http:\/\/allphasepharma.com\/dir\/?p=2554"},"modified":"2016-06-23T08:20:14","modified_gmt":"2016-06-23T12:20:14","slug":"lung-ultrasound-has-come-a-long-way","status":"publish","type":"post","link":"https:\/\/allphasepharma.com\/dir\/2016\/06\/19\/2554\/lung-ultrasound-has-come-a-long-way\/","title":{"rendered":"Lung Ultrasound has Come a Long Way"},"content":{"rendered":"

\"Lung<\/a><\/p>\n

The old-fashioned portable chest X-ray is still the preferred way of documenting pneumonia at the bedside. Although more cumbersome, CT scans are also frequently employed for more definitive diagnosis, esp. in the ER or the ICU setting.<\/p>\n

Historically, ultrasound\u00a0of the lungs (LUS) was always problematic as the sound waves do not penetrate the air-filled spaces well. It was always a very useful diagnostic tool for localizing pleural fluid and for guiding a drainage procedure but did not get much use above the diaphragm for other pathology.<\/p>\n

A recent review article makes a case for a much broader use of LUS, specifically for diagnosing pneumonia. There are the obvious theoretical benefits of portability and safety that US has over X-ray based technologies. But how does it stack up compared to SoC techniques, what is the reproducibility of findings, and how much training is required?<\/p>\n

Interestingly, LUS does extremely well in comparative studies. Compared to CXR or CT-scans or a discharge diagnosis of pneumonia, LUS findings were in excellent agreement with those standards. LUS performed on par with CT scans, and it was often more reliable than the time-honored portable A-P chest X-ray.<\/p>\n

This may be surprising but we need to remember how much US technology has advanced in the last 2 decades. What makes it so appealing in addition to its reliability and safety is the fact that it can be used sequentially without any concerns for patient discomfort or incurring radiation exposure for patient or operator. \u00a0It seems to be an excellent tool to gauge prognosis.<\/p>\n

The article does not address the training needs in much detail but this would not seem to be a major hurdle.<\/p>\n

There is another consideration, not mentioned in the article. The field of ID is one of a few subspecialties that does not have a procedure to its name. As is well known, purely cognitive skills don\u2019t get much respect, they certainly are not reimbursed like a procedural skill. \u00a0It is a major reason why ID physicians find themselves consistently on the bottom rung of the comparative salary structure for subspecialties.\u00a0 Not having a scope to look, or a needle to biopsy or to tap fluid, with technicians only allowed to do a Gram stain for a delayed \u201cearly\u201d diagnosis, ID is a very unattractive specialty from the financial perspective. It is not a great choice for a potential fellow with significant student loans.<\/p>\n

It is unclear\u00a0where IDSA stands on this issue but I suggest that ID programs start training fellows in LUS. \u00a0And once you are at it, have a look below the diaphragm as well, for a liver or a splenic abscess. Your overworked radiology colleague will thank you for taking off some of his workload\u2026<\/p>\n

 <\/p>\n

Publication
\n<\/strong>Schenk E. Ultrasound in the diagnosis and management of pneumonia. Curr Opin Infect Dis 2016, 29:223<\/p>\n","protected":false},"excerpt":{"rendered":"

The old-fashioned portable chest X-ray is still the preferred way of documenting pneumonia at the bedside. Although more cumbersome, CT scans are also frequently employed for more definitive diagnosis, esp. in the ER or the ICU setting. Historically, ultrasound\u00a0of the lungs (LUS) was always problematic as the sound waves do Continue reading Lung Ultrasound has Come a Long Way<\/span>→<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":2584,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[227,3],"tags":[403,1666,1583,1675,1673,27,1663,1674,1664,1672,1667,1670,1669,1671,1668,1665],"class_list":["post-2554","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-recent_literature","category-the_news","tag-antibiotic-blog","tag-ct-chest","tag-harald-reinhart","tag-id-specialty","tag-id-training","tag-idsa","tag-lung-ultrasound","tag-lus","tag-pneumonia-diagnosis","tag-pneumonia-imaging","tag-radiation-exposure","tag-reproducibility","tag-ultrasound-safety","tag-validation-of-lung-ultrasound","tag-x-ray-safety","tag-x-ray-vs-ultrasound"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/06\/Lung-US-and-pneumonia-slider.jpg?fit=638%2C179&ssl=1","jetpack_shortlink":"https:\/\/wp.me\/p4KWFr-Fc","jetpack_sharing_enabled":true,"jetpack-related-posts":[{"id":2942,"url":"https:\/\/allphasepharma.com\/dir\/2016\/12\/15\/2942\/antibiotic-inhalers-galore-part-1-more-combinations-permutations-rubiks-cube\/","url_meta":{"origin":2554,"position":0},"title":"Antibiotic Inhalers Galore (Part 1): \u00a0More Combinations and Permutations than a Rubik\u2019s Cube","author":"Harald","date":"December 15, 2016","format":false,"excerpt":"There is much interest in inhaled antibiotics these days.\u00a0 Prima facie, the logic for this approach is compelling: Getting the antibiotic (and a lot of it) directly to the site of infection, while avoiding systemic toxicity, sounds like optimized efficacy plus optimized safety combined.\u00a0 However, some high-profile failures were published\u2026","rel":"","context":"In "QIDP Antibiotics"","block_context":{"text":"QIDP Antibiotics","link":"https:\/\/allphasepharma.com\/dir\/category\/qidp_antibiotic\/"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/12\/Inhalational-Abx-slider.jpg?resize=350%2C200","width":350,"height":200,"srcset":"https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/12\/Inhalational-Abx-slider.jpg?resize=350%2C200 1x, https:\/\/i0.wp.com\/allphasepharma.com\/dir\/wp-content\/uploads\/2016\/12\/Inhalational-Abx-slider.jpg?resize=525%2C300 1.5x"},"classes":[]},{"id":4501,"url":"https:\/\/allphasepharma.com\/dir\/2025\/06\/14\/4501\/about-a-prepared-mind-in-rd\/","url_meta":{"origin":2554,"position":1},"title":"About A Prepared Mind – In R&D","author":"Harald","date":"June 14, 2025","format":false,"excerpt":"\u201cChance favors the prepared mind\u201d is the short form of a statement by Louis Pasteur which actually reads: \u201cIn the fields of observation chance favours only the prepared mind\u201d or \u201d Dans les champs de l'observation le hasard ne favorise que les esprits prepares\u201d. 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