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  • MinIP reconstructions boost CT’s COVID-19 performance

    Posted by poymd25 on December 16, 2020 at 10:03 pm

    minip should be looked at on every chest ct for chrissake, takes but a moment

    JohnnyFever replied 2 years, 6 months ago 9 Members · 12 Replies
  • 12 Replies
  • lucabi

    Member
    December 17, 2020 at 6:06 am

    Not when they aren’t generated and sent to PACS automatically… 
     
    There’s probably a case for minIP reconstructions be a standard part of HRCT protocols, but there aren’t many cases when I would send a routine chest to terarecon just to take a peek at the minIPs on the off chance it was a COVID patient with subtle GGO. 

    • Unknown Member

      Deleted User
      December 17, 2020 at 7:24 am

      Removed due to GDPR request

      • cytek1

        Member
        December 17, 2020 at 2:49 pm

        Highly accurate severity assessment is pretty funny. Youre sick enough to be admitted, or youre well enough to stay home. Dont think anyone is changing management of presumptive covid based on the CT appearance, and you definitely dont need minIPs at any point. Classic useless garbage academic article.

        • Unknown Member

          Deleted User
          December 19, 2020 at 4:27 pm

          silly stuff.

          • Unknown Member

            Deleted User
            December 19, 2020 at 6:55 pm

            Removed due to GDPR request

        • khurramdr11_312

          Member
          January 12, 2022 at 4:35 am

          I guess you are not a radiologist, if you consider an increase of specificity of an imaging technique as “classic garbage” result.
          Nobody is saying that treatment is gonna change, but probably CT can spot even those cases of patients with mild symptoms and positive PCR swab test.

          • Unknown Member

            Deleted User
            January 12, 2022 at 6:59 am

            Not a radiologist because he doesn’t care about another useless set of images he is forced to look at and waste time on? Sounds like he’s a radiologist that does actual work, not an academic who read 15 chest CTs a day waxing poetically about the nature of micronodularity in the lung in a two page report no one will ever read. It’s another useless article from the ivory tower publication mill. 

            • pranav.devata

              Member
              January 12, 2022 at 7:42 am

              Quote from Skripnik

              Not a radiologist because he doesn’t care about another useless set of images he is forced to look at and waste time on? Sounds like he’s a radiologist that does actual work, not an academic who read 15 chest CTs a day waxing poetically about the nature of micronodularity in the lung in a two page report no one will ever read. It’s another useless article from the ivory tower publication mill. 

               
              ABSOFREAKINGLUTELY. If you aren’t adept enough to see the pretty obvious ground glass opacities on a (sick) COVID patient CT, then A)they aren’t there, or B)you shouldn’t be reading any chest CTs.  Adding a separate imaging sequence to find some super subtle opacity doesn’t help anyone but the lawyers who will ask you about the (other) tiny thing only seen on that additional sequence. It will never be clinically significant relative to COVID.  Bottom line: if the patient doesn’t have enough airspace disease to see on a standard CT, they are not sick enough to even be at the hospital in the first place. They do not need you complicating their hospital visit by confusing the ordering clinician with your impending inevitable list of ddx.

              • drhuseyingunduz_61

                Member
                January 12, 2022 at 3:48 pm

                I’ve never looked at a single MinIP image in my entire life (and don’t plan to), and I did a chest mini fellowship (including endless ILD conferences). Maybe I’m terrible at my job? [8|]

                • andy.lippman_422

                  Member
                  January 13, 2022 at 3:16 am

                  I don’t know why minIPs exist.

                  • JohnnyFever

                    Member
                    January 13, 2022 at 6:10 am

                    Statistical vs clinical significance has become a casualty of the publish or perish culture in academia

          • ruszja

            Member
            January 12, 2022 at 7:10 am

            God I hope some of this is ‘lost in translation’.
             
            [i]Accurate and efficient chest imaging by means of chest radiographs and computed tomography (CT) plays a key role, since pulmonary manifestation of COVID-19 in terms of viral pneumonia indicates a severe course of infection and is associated with increased morbidity and mortality. Presence or absence of chest imaging findings significantly influence clinical patient management with regards to the decision to hospitalize versus home-isolate.  CT represents the current imaging standard for the assessment of pulmonary manifestation of COVID-19 . Notably, several studies indicated that chest CT offers greater sensitivity for COVID-19 compared to RT-PCR . This high sensitivity is mainly based on the ability to detect early infiltration of lung parenchyma as indicated by ground-glass opacity (GGO) . GGO, however, can be missed on standard transverse CT reconstructions and multiplanar reformats (MPRs) in certain cases due to overlying bronchovascular structures , which may be critical because even subtle GGO commonly tend to worsen rapidly in COVID-19 patients causing the need for prompt hospitalization and oxygen therapy . Therefore, it is crucial to detect GGO in the earliest stages in order to enable highly accurate severity assessment thereby improving clinical patient management and outcome.[/i]
            [link=https://www.ejradiology.com/article/S0720-048X(20)30668-9/fulltext]https://www.ejradiology.c…8X(20)30668-9/fulltext[/link]
             
            The way this is written, it suggests that otherwise stable patients get hospitalized based on subtle GGOs that can only be detected on the min-IPs. [8|] . Now, if someone told me that you can use this to triage high risk patients for a covid specific intervention like monoclonal AB, Paxlovid or Remdesivir, it would make some sense, but as written, this is just a tortured strung together chain of facts used to justify this study. The illustation given in the AM article would certainly be at variance with how covid care is practiced in the US. If a 38 year old shows up with ‘cough and fever’, they get their vitals checked, a walking pulsox, a CXR and a rapid PCR for Sars-Cov2, Inf-A, Inf-B, RSV. Regardless of the PCR and imaging result, you get sent home if you can be safely discharged. Admission in a otherwise healthy 38 year old is not going to be conditional of some GGOs, its conditional of requiring more oxygen than the home oxygen company can set you up for at 10 o’clock at night. 
            (the article is a good illustration that when comparing across countries, you can’t treat something like ‘hospitalization rate’ as a criterion as it is based on local healthcare structures and is not a absolute measure.)
             
            Now, to be fair, if you read the paper, this was submitted in August 2020 based on studies obtained March/April 2020. Of course, its not fair to look back at this with the two year retrospectoscope and judge it based on what we know NOW. In March/April 2020, this was truly a novel virus and everyone was scrambling to figure out what to do with it. I actually mused at the time whether CT could have a role if you were asked by incident command to ‘triage a few buses full of people’ for isolation vs. release back to the community. Never ended up having to do that.
            I do have to say that over the past 2 years, I have pointed my clinical colleagues towards covid as a consideration on few otherwise ‘negative’ kidney stone and appendicitis workups. A good number of them actually had ‘GI covid’ that caused them to be seen but it hadn’t occured to the practicioner to test them. But those were sort of fortuitous, we didn’t intentionally use CT to diagnose the disease.