Utility of high-resolution CT for management of diffuse lung disease: Results of a survey of U.S. pulmonary physicians

Rationale and Objectives. This study was performed to determine how U.S. pulmonologists rate the clinical contributions of high-resolution computed tomography (CT) in patients with diffuse lung disease, to ascertain how the technique affects management decisions, and to determine the effect of three physician characteristics on these attitudes. Materials and Methods. The authors surveyed 450 practicing pulmonologists. The questionnaire explored perceptions of the efficacy of high-resolution CT for achieving five clinical objectives, the importance of high-resolution CT in 17 diseases, and the effects of the CT results on management decisions. Responses were examined by type of clinical practice, monthly referral volume, and year of completion of pulmonary fellowship. Results. The response rate was 52.6%. High-resolution CT was rated most helpful for determining the extent of diffuse lung disease and least helpful for assessing disease activity and prognosis. Pulmonologists believed that high-resolution CT was most important in the idiopathic interstitial pneumonias and least important in Pneumocystis carinii pneumonia and emphysema. High-resolution CT results frequently increased the physician's confidence in a presumptive diagnosis. Recently trained pulmonologists were more likely to report that high-resolution CT results altered their management plan. There were no significant differences related to type of practice. Conclusion. U.S. pulmonologists in a variety of practice settings value the contributions of high-resolution CT in patients with diffuse lung disease and find it particularly important in the chronic interstitial pneumonias. High-resolution CT results have their greatest effect in confirming a presumptive clinical diagnosis and less frequently alter the management plan.