CHEST Guidelines-Chest-Ultrasonography-as-a-Replacement-for-Chest-R

Chest-Ultrasonography-as-a-Replacement-for-Chest-R_28

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The article discusses the potential role of chest ultrasonography (CUS) as an initial diagnostic tool in emergency departments (EDs), primarily for evaluating patients with acute dyspnea. Authors Maurizio Zanobetti, Claudio Poggioni, and Riccardo Pini clarify that their proposition is focused on the use of CUS in the ED rather than general clinical practice. They argue that CUS presents certain advantages over standard chest radiography: it is less time-consuming and does not involve ionizing radiation.<br /><br />The response addresses concerns from Dr. Medford about using CUS as a first-line test and emphasizes that the authors never suggested replacing chest radiography with CUS universally. Instead, they advocate for CUS as a complementary modality in emergency settings. Due to its limited and focused application, the training for competency in CUS is considered to be shorter than that required for radiography, with recommendations suggesting a 1-day course and a minimum 2-week rotation involving 150 examinations. This is consistent with guidelines by the American College of Emergency Physicians.<br /><br />The authors further discuss that incorporating ultrasonography into emergency medical education could standardize the skillset among future emergency physicians, although widespread adoption could take time. They also note that many EDs already possess ultrasound equipment, but further studies are needed to assess cost-effectiveness compared to radiography, particularly for conditions like pneumothorax where CUS has shown to detect cases that might be missed by radiography.<br /><br />In an additional note, the article briefly mentions a study by Wade et al. on the progression and outcomes of coal workers with pneumoconiosis and progressive massive fibrosis. The study observed a rapid disease progression in several patients over 5-12 years and reported a 15% mortality rate among the cohort.

Keywords

chest ultrasonography

emergency departments

acute dyspnea

diagnostic tool

Maurizio Zanobetti

Claudio Poggioni

Riccardo Pini

radiography

emergency medicine education

pneumoconiosis