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Correspondence |

Radiation Exposure Early in Life Can Be Reduced by Lung Ultrasound FREE TO VIEW

Luigi Cattarossi, MD; Roberto Copetti, MD; Besa Poskurica, MD
Author and Funding Information

From the Department of Paediatrics (Drs Cattarossi and Poskurica) and Department of Emergency Medicine (Dr Copetti), San Antonio Abate Hospital.

Correspondence to: Luigi Cattarossi, MD, San Antonio Abate Hospital, Tolmezzo Via Morgagni 8 IT-33028 Tolmezzo (Udine), Italy; e-mail: lcattarossi@hotmail.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(3):730-731. doi:10.1378/chest.10-2338
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To the Editor:

Serious concern has been raised lately about the negative effects of the ionizing irradiation exposure in diagnostic procedures (radiography, CT scan, angiography, radionuclide scan, PET scan, etc), which carries a potentially high risk for development of malignancies.1,2 Moreover, precocious exposure of infants and children to radiation may lead to a higher risk of developing malignancies later in life due to both the latency of the effect of radiation exposure on the cells and the fact that growing children are inherently more radiosensitive because they have a larger proportion of dividing cells. Sick neonates, mature and premature, still are regularly exposed to serial radiographic imaging for the diagnosis of pulmonary diseases, and it is not difficult to calculate how many millisieverts each newborn in the neonatal ICU can accumulate during the hospitalization.

Since 2005, our group has standardized and applied an ultrasonographic diagnostic approach for the pulmonary pathology of the newborn3-5 according to previous experiences in adults.6 Ultrasound images of uniformly aerated lungs are not visible as real images but as artifacts that appear black with regularly distributed horizontal white artifacts (A lines) representing the visual phenomenon of reverberance of the pleura within the aerated lung (Fig 1A). In the presence of fluid in the interstitial space, in the alveoli, or in both, the artifacts are vertical (ultrasound lung comets) (Fig 1B), and tend to coalesce with increasing amount of fluid up to a totally white appearance (ultrasonographic white lung) (Fig 1C).

Figure Jump LinkFigure 1. A, Normal lung of a term infant. Note the regular pleural line and the horizontal artifacts (A lines). B, The presence of vertical artifact (ULCs) expression of increased extravascular lung fluid. C, Coalescent ULCs with echographic white-lung expression of severe alveolar interstitial syndrome due to the presence of a very high amount of lung fluid both in the interstitium and in the alveoli. ULC = ultrasound lung comet.Grahic Jump Location

During the neonatal period, lung echography can be used to accurately diagnose transient tachypnea in the newborn, respiratory distress syndrome, atelectasis, pneumothorax, and bronchopulmonary dysplasia.3-5 Due to the accuracy of the diagnostic information obtained by lung echography in our institution, this method replaces radiography as the first-line diagnostic approach in this age. We believe that this technique should be understood as an extension of clinical examination and should be performed by the clinicians who know what they are searching and who understand what they see.

So far, the interest of the neonatal and pediatric community of specialists toward lung ultrasound is growing very slowly. However, we strongly believe that the use of ultrasound in respiratory diseases of the newborn and the child needs to be encouraged not just as a valid diagnostic alternative but as a necessary ethical choice.

Smith-Bindman R. Is computed tomography safe? N Engl J Med. 2010;3631:1-4. [CrossRef] [PubMed]
 
Council Directive 97/43/Euratom of 30 June 30 1997 on health protection of individuals against the danger of ionizing radiation in relation to medical exposure, and repealing Directive 84/466/Euratom. Official Journal of the European Community. OJ L 180, 9.7. 1997:22-27.
 
Copetti R, Cattarossi L. The ‘double lung point’: an ultrasound sign diagnostic of transient tachypnea of the newborn. Neonatology. 2007;913:203-209. [CrossRef] [PubMed]
 
Copetti R, Cattarossi L, Macagno F, Violino M, Furlan R. Lung ultrasound in respiratory distress syndrome: a useful tool for early diagnosis. Neonatology. 2008;941:52-59. [CrossRef] [PubMed]
 
Cattarossi L, Copetti R, Poskurica B, Miserocchi G. Surfactant administration for neonatal respiratory distress does not improve lung interstitial fluid clearance: echographic and experimental evidence. J Perinat Med. 2010;385:557-563. [CrossRef] [PubMed]
 
Lichtenstein D, Mézière G, Biderman P, Gepner A, Barré O. The comet-tail artifact. An ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med. 1997;1565:1640-1646. [PubMed]
 

Figures

Figure Jump LinkFigure 1. A, Normal lung of a term infant. Note the regular pleural line and the horizontal artifacts (A lines). B, The presence of vertical artifact (ULCs) expression of increased extravascular lung fluid. C, Coalescent ULCs with echographic white-lung expression of severe alveolar interstitial syndrome due to the presence of a very high amount of lung fluid both in the interstitium and in the alveoli. ULC = ultrasound lung comet.Grahic Jump Location

Tables

References

Smith-Bindman R. Is computed tomography safe? N Engl J Med. 2010;3631:1-4. [CrossRef] [PubMed]
 
Council Directive 97/43/Euratom of 30 June 30 1997 on health protection of individuals against the danger of ionizing radiation in relation to medical exposure, and repealing Directive 84/466/Euratom. Official Journal of the European Community. OJ L 180, 9.7. 1997:22-27.
 
Copetti R, Cattarossi L. The ‘double lung point’: an ultrasound sign diagnostic of transient tachypnea of the newborn. Neonatology. 2007;913:203-209. [CrossRef] [PubMed]
 
Copetti R, Cattarossi L, Macagno F, Violino M, Furlan R. Lung ultrasound in respiratory distress syndrome: a useful tool for early diagnosis. Neonatology. 2008;941:52-59. [CrossRef] [PubMed]
 
Cattarossi L, Copetti R, Poskurica B, Miserocchi G. Surfactant administration for neonatal respiratory distress does not improve lung interstitial fluid clearance: echographic and experimental evidence. J Perinat Med. 2010;385:557-563. [CrossRef] [PubMed]
 
Lichtenstein D, Mézière G, Biderman P, Gepner A, Barré O. The comet-tail artifact. An ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med. 1997;1565:1640-1646. [PubMed]
 
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