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All right.

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Welcome to the talk on fibrotic lung disease.

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And I like to call this a practical approach

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to fibrotic lung disease.

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I, I make this joke all the time where I say,

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in the time allotted, there's no way you could learn all

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of pulmonary fibrosis, right?

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It's in the, whatever it is, 20 to 30 minutes

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of this didactic to do that,

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it would take me 40 minutes to do that.

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And I, I think I stole that joke from one

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of the more senior radiologists out there.

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I think I might have stolen from Dr. Webb

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or, uh, one of the, one

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of the HRC team masks that came before.

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But, um, it's, it's a little tongue in cheek here,

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but only what I'm trying to say is

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that this is not rocket science.

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It's not it's algorithm approach.

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So if you know the algorithm, if you know some basic facts,

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and it's just probably like 20

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or 30 facts, you can be pretty darn good at pulmonary

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fibrosis on ILD.

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So don't, don't be intimidated by this.

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You should be excited. You can add much

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value in terms of this.

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Let's talk about where we're gonna be going.

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We're gonna talk about the current classification system

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of pulmonary fibrosis,

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but more importantly, we're gonna be talking about the

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practical approach to pulmonary fibrosis.

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The approach that I teach my fellows

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and my senior residents,

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and even my peers who maybe aren't as well-versed in how

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to approach an ILD that has pulmonary fibrosis on it.

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If you were to look at an HRCT

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and you saw pulmonary fibrosis,

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and you really didn't look at all the images,

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you just noted there was pulmonary fibrosis,

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and then you just guessed, you said to yourself, all right,

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I'm just gonna give a differential diagnosis

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of these four things.

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Usual interstitial pneumonia,

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nonspecific interstitial pneumonia, hypersensitivity,

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pneumonitis, and sarcoidosis.

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You'd be right over 90% of the time in most clinics.

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You'd also be completely useless to your pulmonologists

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and clinicians 'cause they know this.

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So if they listen auscultate to the patient's lungs

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and they hear crackles, significant crackles,

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I mean on x-ray, clearly there's reticular abnormality

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and low lung volumes.

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They know there's fibrosis there.

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And so everyone knows that this patient has some type

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of pulmonary fibrosis.

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And in most clinics across the US

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and Western Europe, these are gonna be the most common types

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of pulmonary fibrosis.

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So our job really isn't just

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to give a differential diagnosis

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and say, oh, these four things could be

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causing this pulmonary fibrosis.

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Again, what we want to do is we want to add value.

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And the way we add value as radiologists is by trying

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to give the most specific diagnosis

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as possible within the realm of accurate RLC analysis.

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So you have to be accurate,

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but you also wanna be as specific as possible.