0:00

Let's look at this chest CT from the perspective

0:03

of findings in the lung parenchyma that are not lung cancer,

0:06

but may be important medically to be managed

0:08

for the patient's health and wellbeing.

0:11

As we look at the axial images,

0:12

and we can see here nicely on the coronal images

0:15

of the apices, we have paraseptal emphysema,

0:19

paraseptal emphysema,

0:20

and apical blobs place a patient at increased risk

0:23

of spontaneous pneumothorax.

0:26

As we scroll down the lines, we see a lot

0:28

of ground glass opacities, some slightly denser areas,

0:32

some very subtle light densities of ground glass.

0:36

A lot of them are around bronchovascular bundles

0:39

with intervening normal areas of lung.

0:41

Being the relatively small amount of lung, most

0:44

of the lung tissue here is actually abnormal across these

0:47

images here throughout the upper lungs.

0:49

We do have some nodules, which we'll talk about

0:52

at another time as we discuss lung nodules

0:56

and lung reds categorization.

0:58

As we come down a little bit further,

1:00

we have bronchiectasis another form

1:02

of obstructive pulmonary disease

1:03

with dilated bronchi right here fo.

1:07

And as we get towards the lung basis, we have a lot

1:09

of dependent atelectasis.

1:12

Dependent Atelectasis is noted to be seen more frequently

1:16

in people with increased age

1:18

and also with a higher frequency in people

1:21

who smoke cigarettes.

1:22

So the fact that we see a lot of it in patients

1:24

who have lung cancer screening exams, generally people

1:27

who are older and have smoke cigarettes is not surprising.

1:31

As we look at the coronal images, we see

1:33

that paraseptal emphysema ni nicely

1:36

outlined along the apical

1:38

and para mediastinal pleural surfaces.

1:41

And we can also see that that ground glass opacity

1:45

is more severe in the upper lobes

1:46

and the lower lobes, which is so characteristic

1:49

of respir respiratory bronchiolitis

1:50

in individuals with smoke.

1:52

I've heard pulmonary medicine physicians

1:54

and primary care physicians say that

1:57

by radiologists reporting things like respiratory

2:00

bronchiolitis that are reversible.

2:02

If an individual were to stop smoking cigarettes,

2:05

this is something that they can use in discussing their lung

2:08

cancer screening results

2:09

and their lung health with their patients to try

2:12

and help them stop cigarette smoking, cigarette abstinence

2:17

and smoking cessation is a journey

2:19

and it takes multiple touch points with an average

2:22

of nearly eight quit attempts for an individual,

2:24

the average individual to quit smoking.

2:27

Some people are able to do so as they say,

2:29

cold Turkey right away and be successful.

2:33

But nicotine is a chemically addictive substance.

2:37

And like anything where there is

2:40

chemical addiction in the system, it can cause a lot

2:43

of difficulty for patients

2:45

to actually be able to quit smoking.

2:47

And let's not forget that many of these patients

2:49

who are currently smoking began smoking at a young age

2:53

as adolescents and as teenagers long

2:56

before they were cognizant enough to

2:58

Recognize the long-term harms of what could happen

3:01

to them in smoking cigarettes and with social pressures

3:05

and peer pressure in the environments in which they exist,

3:08

including their young age and school systems,

3:11

and not yet being adults out in the workplace.

3:13

So it's important to recognize that cigarettes smoking is

3:18

a chemical addiction.

3:20

It is difficult for many people to quit, not

3:23

because they haven't tried or they're not trying

3:25

or they don't want to, or they don't recognize it.

3:28

People who smoke cigarettes feel a lot of stigma

3:32

and people who come for lung cancer screaming

3:35

and have lung cancer feel the stigma

3:37

associated with cigarettes.

3:39

It makes it difficult for some patients to even seek care.

3:44

It makes it difficult for some patients to talk

3:46

to their family members

3:47

and their friends about their diagnoses

3:49

that are cigarette smoking related.

3:51

There are feelings of shame

3:55

and nihilism that there's nothing you can do.

3:57

The damage is done,

3:59

and their feelings of blames that the lung disease

4:02

and their lung cancer is self-inflicted.

4:05

And it's very important that we try

4:07

and de-stigmatize the language

4:09

that we use from our front desk staff

4:11

to the parking lot attendants, to radiologists talking

4:13

to patients and not use the word smoker in our practice,

4:18

but to use smoking simply as a risk factor, not as a way

4:21

that we define patients.

4:23

And while this may not seem as radiology centric as looking

4:27

for nodules and finding emphysema

4:29

and respiratory bronchiolitis, treating these individuals

4:33

with patient first language is very important

4:35

to encourage them to come forward for care,

4:37

to encourage them to stick with lung cancer screening

4:40

because ultimately early detection can save their lives.

4:43

And how we treat people

4:45

and how we make them feel when they come

4:47

to our practices is really important component

4:50

to making sure they come back for screening annually.