Thoracic Oncology and Chest Procedures Network
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Artificial intelligence in lung cancer management
As artificial intelligence continues to integrate into clinical practice, the future of lung cancer management is shifting toward precision-driven, data-informed strategies and risk prediction models.
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Managing central airway obstruction
New guidelines on central airway obstruction standardize diagnosis and management recommendations, emphasizing therapeutic bronchoscopy, rigid bronchoscopy, and multidisciplinary care.
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Revival of the aspiration vs chest tube debate for PSP
Considerable heterogeneity exists in the management of primary spontaneous pneumothorax (PSP). American and European guidelines have been grappling with this question for decades: What is the best way to manage PSP? A 2023 randomized, controlled trial (Marx et al. AJRCCM) sought to answer this. The study recruited 379 adults aged 18 to 55 years between…
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Lung ultrasound: An indispensable yet underutilized tool
An assessment using bedside thoracic ultrasound (TUS) improves diagnostic evaluation and therapeutic management in critically ill patients without undue risk. With changes in diagnosis occurring in 23% of cases and alterations in management in 39% of critically ill patients, TUS can improve length of stay, reduce complications, minimize delays in therapy, and lower hospitalization costs.1…
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Atypical pulmonary cysts: Why to care
Since the American College of Radiology (ACR) updated its Lung CT Screening Reporting & Data System (Lung-RADS) to include atypical pulmonary cysts in 2022, there has been little discussion among chest physicians regarding the significance of pulmonary cysts and why these changes were made. Lung-RADS 2022 defined atypical pulmonary cysts as single, unilocular cysts with…
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Diagnostic yield reporting of bronchoscopic peripheral pulmonary nodule biopsies: A call for standardization
More than 1.5 million Americans are diagnosed with an incidental CT scan-detected lung nodule annually. Advanced bronchoscopy, as a diagnostic tool for evaluation of these nodules, has evolved rapidly, incorporating a range of techniques and tools beyond CT scan-guided biopsies to assess peripheral lesions. The primary goal is to provide patients with accurate benign or…
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Primary vs secondary: A review of pneumothorax management
Optimal management of primary spontaneous (PSP) and secondary spontaneous pneumothorax (SSP) remains an area of ongoing debate, with both CHEST and the British Thoracic Society (BTS) offering guidelines to address management decisions. The consensus for treatment of PSP depends on the size of the pneumothorax; if smaller than 2-3 cm, the patient can be observed…
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Electrical impedance tomography: Visualization and integration of the impact of mechanical ventilation
Lung protective ventilation (LPV) is the cornerstone to minimizing ventilator-induced lung injury. Hence, LPV is associated with better survival in patients both with and without ARDS.1 2 3 Continuous monitoring of the tidal volume, plateau pressure, and positive end-expiratory pressure (PEEP) is crucial to maintain LPV. Electrical impedance tomography (EIT) is a noninvasive, radiation-free, imaging…
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Transesophageal ultrasound: The future of ultrasound in the ICU
Historically, transesophageal ultrasound (TEE) has been regarded as a diagnostic and management tool for structural heart disease in relatively stable patients. However, TEE is more commonly being utilized by intensivists as a first-line tool in the diagnostics and management of patients in the ICU. TEE, with its unobstructed superior cardiac views, facilitates rapid diagnosis in…
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Nurturing health equity in smoking cessation care
Lung cancer stands as the leading cause of cancer-related deaths globally, with its prevalence casting a long and challenging shadow. The most important risk factor for lung cancer is tobacco use, a relationship strongly substantiated by data. The impact of smoking cessation to reduce lung cancer incidence is underscored by the US Preventive Services Task…
