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Radiographic Identification of Interstitial Lung Disease
Diagnosis and Classification of Interstitial Lung Disease: Considerations for Radiologists

Released: September 14, 2023

David Lynch
David Lynch, MB, BCh
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Key Takeaways
  • There are notable health disparities in the treatment and diagnosis of interstitial lung disease.
  • Multidisciplinary diagnosis, which often changes the diagnosis in a substantial number of individuals, is crucial to improving the diagnostic process and achieving health equity.
  • Having multidisciplinary discussions virtually works reasonably well and is a great option for challenging cases where you cannot hold meetings locally or want to collaborate with a larger center.

Interstitial lung diseases (ILDs) are a diverse group of pulmonary fibrotic and inflammatory conditions that cause scarring and stiffness in the lungs, making it difficult to breathe and get oxygen into the bloodstream. Because lung damage from ILD is irreversible, it is important for healthcare professionals and radiologists to be aware of the health disparities and gaps in treatment affecting certain patient populations. Radiologist David A. Lynch, MB, BCh, provides expert commentary regarding healthcare disparities and the importance of multidisciplinary discussions in the realm of ILD care.

Health Disparity Education
As a radiologist, I usually do not have direct contact with patients. So, in a way, I am blinded when it comes to skin color. In my personal experience, radiologic diagnoses should not be associated with disparities or different levels of care. However, my colleagues have noticed delays in accessing specialist evaluation for racial and ethnic minority populations or communities with lower socioeconomic status. In addition, these communities may be subject to certain exposures that may increase risk of fibrosis. 

Lack of insurance is a major issue in accessing and providing care. This is largely due to treatments being expensive, and then the issue of lung transplantation arises for severe disease. Unfortunately, this is a very costly decision and may not be achievable for some people. Therefore, it is clear that there are healthcare disparities in the care of people with pulmonary fibrosis.

Multidisciplinary Discussions
These discussions are a very important part of our work in ILD, and we have been holding them at our institution every week for more than 30 years. They always include pulmonary physicians, nurse practitioners, physician associates, radiologists, rheumatologists or other specialists, and pathologists (if pathology slides are available). As the physician presents the case, a radiologist can go through the imaging and provide insight into the correct diagnosis. Multidisciplinary diagnosis changes the diagnosis in a substantial portion of individuals, which is crucial for guiding management.

Other important aspects of these discussions are deciding on appropriate treatments and providing education to junior faculty members, residents, and medical students. Group discussions are extremely helpful for drawing up a consensus regarding patient diagnosis and management, so a team approach is recommended for standardization across a range of healthcare professionals. It is also important to note that practitioners are sometimes isolated; they sit in their office and talk to patients, and this cycle is repeated until the day ends. By participating in multidisciplinary discussions, we, as healthcare professionals, ensure that there is a sense of community and collaboration.

It is difficult to have these multidisciplinary discussions when you are in a smaller practice, and it is especially difficult to find a group of pulmonologists and radiologists who are willing to attend. However, because of COVID-19, these meetings have been held virtually. This works reasonably well and is a great option for challenging cases where you cannot hold meetings locally or want to collaborate with a larger center. It is hard to find time to do this, but it is important to the care of patients and really makes a difference when we do.

Addressing the Treatment Gap
Not every patient is given the opportunity for their case to be presented in a multidisciplinary discussion. At some institutions, every person with ILD is seen, but the volume of patients is often too large for that. Because we want to be able to provide appropriate care, we tend to review the more challenging cases where diagnosis is not straightforward. I am unsure if there is a selection bias when selecting patients, but it is something of which to be aware. However, there are certainly implications for timely and accurate diagnosis of fibrosing ILD.

One of the earliest and most effective ways to diagnose ILD is with a CT scan, because lung changes are often visible on the CT scan before the patient even develops symptoms. So, if a patient happens to get a CT scan for any reason, they are more likely to be diagnosed with ILD or followed in a certain way. However, there is an important issue of awareness among radiologists, as early findings of ILD may be ignored, not reported, or underreported due to the fear of overdiagnosis. Regardless, early diagnosis of these entities is important. Diagnostic delay is associated with significantly increased mortality, and we often see patients who have had lung fibrosis for years without treatment who are now at a different stage of their disease. Such delay is a major source of health disparities, so having conversations with your colleagues about how to tackle these issues is the first step in achieving health equity.

Your Thoughts?
Do you participate in multidisciplinary discussions to improve diagnosis and treatment of your patients? Let us know by posting a comment below.

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