It’s good for us as doctors to get feedback when we speak to bigger groups, to hear what’s getting through and how we can communicate better. This is really educational for me as a doctor, just as much as I hope it is for you.
I’ll talk for a minute about the importance of radiology. As Shelly, Scott, and others know, I’m married to a radiologist who is ILD-specific trained. So I’m very familiar with how important radiology is, and I get a lot of free extra consultations whenever I have questions.
Having a high-resolution CT scan is critical. Some of you may have had a regular CT scan at another doctor’s office, and then you go to your lung doctor and hear, “I’d really like you to get a high-resolution scan.” You might wonder, “Why another one?”
Here’s why: high-resolution CTs have thinner cuts, higher resolution images. Think of it like going from an old camera to the latest iPhone, the images are sharper and clearer. It’s always done without contrast, because IV contrast can interfere with how we view the lung parenchyma, the area between the alveoli.
A true high-resolution CT scan includes three full views: one when you breathe in, one when you breathe all the way out, and one when you’re lying prone, on your stomach. These maneuvers help us detect whether any subtle ILD changes vary by position, whether gravity is a factor, and whether air trapping is present.
Here’s an example of air trapping from a past patient. You can see, on either side of the heart, areas of the lung sponge that show different colors when the patient exhales. These color differences show how effectively (or not) the patient is expelling air. Air trapping happens when ILD affects the small airways. It’s common in asthma and COPD, but in more severe cases, it may indicate bronchiolitis or hypersensitivity pneumonitis.
One audience member asked whether HRCTs are really a patient’s “friend,” since it’s not ideal to have multiple CT scans per year due to radiation. That’s a valid concern. But ideally, you’re not getting repeated HRCTs often. Most patients don’t need them unless something is changing or there’s a clinical concern. At the first visit, especially during the ILD diagnostic process, one high-resolution scan can be incredibly helpful.
Another person asked whether the air trapping pattern looks the same as mosaic attenuation. Mosaic attenuation can suggest air trapping, but it’s not definitive. Mosaic refers to a pattern, patches of lighter and darker gray areas. But the context is critical. Some mild air trapping can be seen even in healthy people or with asthma. Mosaicism can also occur in heart failure, when there’s fluid in the lungs, or in pulmonary hypertension. So no radiology finding stands alone. It’s a clue, not a diagnosis. It has to be interpreted in context with everything else going on.
Dr. Susan Mathai is a pulmonary and critical care specialist at Baylor University Medical Center in Dallas, Texas, where she serves as Program Director of the Pulmonary and Critical Care Fellowship. She specializes in interstitial lung disease (ILD), actively leads clinical trials in IPF, and is passionate about advancing patient access to emerging therapies.
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This video is for informational purposes only and is not a substitute for professional medical advice. Always consult your doctor for medical concerns. No personal recording or redistribution without PF Warriors written permission.