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Impact Of Body Habitus On Radiologic Interpretations.

C. Rajapakse, Gregory A. Chang
Published 2014 · Medicine

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An enormous percentage of Americans are becoming overweight, obese, or morbidly obese (1). Obese population directly impacts the health care system with an increased incidence of diabetes and heart disease. The impact of obesity is also indirectly felt by radiology departments (4). Routinely used imaging modalities, for example, have limited ability to accommodate patients with very large body habitus. Loss of quality of images acquired from overweight patients is another problem faced by radiologists during clinical interpretations (2). In this issue of Academic Radiology, Larson et al. reported the impact of body mass index (BMI, the weight in kilograms divided by the square of the height in meters) on the detection of pleural thickening in subjects who had prior asbestos exposure. Asbestos is a major cause of both benign and malignant pleural disorders (3). Although the role of asbestos as a health hazard has long been recognized (4), its use is not restricted in many countries (5). The identification of pleural thickening, either localized or diffuse, is important because it is a biomarker of prior significant asbestos exposure, which itself is a major risk factor for mesothelioma, an aggressive malignancy that has 5-year survival rates as low as 1% (6–8). The detection of pleural thickening is currently made on chest radiographs. However, Larson et al. have shown that this approach has limitations in subjects with high BMI. Studying patients who were imaged by radiographs and high-resolution computed tomography (median interval 30 days between imaging tests), the authors showed that elevated BMI (and the associated subpleural fat deposition) can actually result in a false-positive diagnosis of pleural thickening and therefore prior asbestos exposure. This is important because obesity is a rising epidemic worldwide and because a false-positive diagnosis of prior asbestos exposure could have critical implications for patients in terms of their future clinical management, medico-legally, and psychologically. Overall, Larson et al.’s study points toward the frequent issue in medicine of balancing the use of two-dimensional
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