News From CHEST Physician®

Pleural Disease Section

Aspirate or wait: changing the paradigm for PSP care

There is considerable heterogeneity in the management of primary spontaneous pneumothorax (PSP). Although observation for small asymptomatic PSP is supported by current guidelines, management recommendations for larger PSP remains unclear (MacDuff, et al. Thorax. 2010;65[Suppl 2]:ii18-ii31; Tschopp JM, et al. Eur Respir J. 2015;46[2]:321). Two recent RCTs explore conservative vs intervention-based management in those with larger or symptomatic PSP. In the PSP trial, Brown and colleagues prospectively randomized 316 patients with moderate to large PSP to either conservative management (≥ 4 hour observation) or small-bore chest tube without suction (Brown, et al. N Engl J Med. 2020;382[5]:405). Although noninferiority criteria were met, the primary outcome of radiographic resolution of pneumothorax within 8 weeks of randomization was not statistically robust to conservative assumptions about missing data. They concluded that conservative management was noninferior to intervention, and it resulted in a lower risk of serious adverse events or PSP recurrence than interventional management. The multicenter randomized Ambulatory Management of Primary Pneumothorax (RAMPP) trial compared ambulatory management of PSP using an 8F drainage device to a guideline-driven approach (drainage, aspiration, or both) amongst 236 patients with symptomatic PSP. Intervention shortened length of hospital stay (median 0 vs 4 days, P<.0001), but the intervention arm experienced more adverse events (including enlargement of pneumothorax, as well as device malfunction) (Hallifax RJ, et al. Lancet. 2020;396[10243]:39). These two trials challenge the current guidelines for management for patients with PSP, but both had limitations. Though more data are needed to establish a clear consensus, these studies suggest that a conservative pathway for PSP warrants further consideration.

Tejaswi R. Nadig, MBBS
Member-at-Large

Yaron Gesthalter, MD
Member-at-Large

Priya P. Nath, MD
Member-at-Large

Pleural Disease Section

Aspirate or wait: changing the paradigm for PSP care

There is considerable heterogeneity in the management of primary spontaneous pneumothorax (PSP). Although observation for small asymptomatic PSP is supported by current guidelines, management recommendations for larger PSP remains unclear (MacDuff, et al. Thorax. 2010;65[Suppl 2]:ii18-ii31; Tschopp JM, et al. Eur Respir J. 2015;46[2]:321). Two recent RCTs explore conservative vs intervention-based management in those with larger or symptomatic PSP. In the PSP trial, Brown and colleagues prospectively randomized 316 patients with moderate to large PSP to either conservative management (≥ 4 hour observation) or small-bore chest tube without suction (Brown, et al. N Engl J Med. 2020;382[5]:405). Although noninferiority criteria were met, the primary outcome of radiographic resolution of pneumothorax within 8 weeks of randomization was not statistically robust to conservative assumptions about missing data. They concluded that conservative management was noninferior to intervention, and it resulted in a lower risk of serious adverse events or PSP recurrence than interventional management. The multicenter randomized Ambulatory Management of Primary Pneumothorax (RAMPP) trial compared ambulatory management of PSP using an 8F drainage device to a guideline-driven approach (drainage, aspiration, or both) amongst 236 patients with symptomatic PSP. Intervention shortened length of hospital stay (median 0 vs 4 days, P<.0001), but the intervention arm experienced more adverse events (including enlargement of pneumothorax, as well as device malfunction) (Hallifax RJ, et al. Lancet. 2020;396[10243]:39). These two trials challenge the current guidelines for management for patients with PSP, but both had limitations. Though more data are needed to establish a clear consensus, these studies suggest that a conservative pathway for PSP warrants further consideration.

Tejaswi R. Nadig, MBBS
Member-at-Large

Yaron Gesthalter, MD
Member-at-Large

Priya P. Nath, MD
Member-at-Large

Pleural Disease Section

Aspirate or wait: changing the paradigm for PSP care

There is considerable heterogeneity in the management of primary spontaneous pneumothorax (PSP). Although observation for small asymptomatic PSP is supported by current guidelines, management recommendations for larger PSP remains unclear (MacDuff, et al. Thorax. 2010;65[Suppl 2]:ii18-ii31; Tschopp JM, et al. Eur Respir J. 2015;46[2]:321). Two recent RCTs explore conservative vs intervention-based management in those with larger or symptomatic PSP. In the PSP trial, Brown and colleagues prospectively randomized 316 patients with moderate to large PSP to either conservative management (≥ 4 hour observation) or small-bore chest tube without suction (Brown, et al. N Engl J Med. 2020;382[5]:405). Although noninferiority criteria were met, the primary outcome of radiographic resolution of pneumothorax within 8 weeks of randomization was not statistically robust to conservative assumptions about missing data. They concluded that conservative management was noninferior to intervention, and it resulted in a lower risk of serious adverse events or PSP recurrence than interventional management. The multicenter randomized Ambulatory Management of Primary Pneumothorax (RAMPP) trial compared ambulatory management of PSP using an 8F drainage device to a guideline-driven approach (drainage, aspiration, or both) amongst 236 patients with symptomatic PSP. Intervention shortened length of hospital stay (median 0 vs 4 days, P<.0001), but the intervention arm experienced more adverse events (including enlargement of pneumothorax, as well as device malfunction) (Hallifax RJ, et al. Lancet. 2020;396[10243]:39). These two trials challenge the current guidelines for management for patients with PSP, but both had limitations. Though more data are needed to establish a clear consensus, these studies suggest that a conservative pathway for PSP warrants further consideration.

Tejaswi R. Nadig, MBBS
Member-at-Large

Yaron Gesthalter, MD
Member-at-Large

Priya P. Nath, MD
Member-at-Large

In my previous article in June, 2022, we plowed through the billing and coding updates regarding critical care services, and, I hope that it helped our readers get more acquainted with the nuances of billing and coding in the ICU. In this piece, I would like to briefly elucidate three other areas of practice, which will be relevant to all physicians across various specialties.

Telehealth services

The Centers for Medicare & Medicaid Services (CMS) graciously added telehealth services temporarily to its list of services due to the COVID-19 public health emergency (PHE). Initially, the plan was to remove these from the list of covered services by the latter end of the COVID-19 PHE, which, created some uncertainty, or by December 31, 2021. Fortunately, CMS finalized that they will extend it through the end of the calendar year (CY) 2023. So, now all the telehealth services will remain on the CMS list until December 31, 2023. The general principle behind this ruling is to allow for more time for CMS and stakeholders to gather data and to submit support for requesting these services to be permanently added to the Medicare telehealth services list.

Not only has CMS extended the deadline for telehealth services but also they have gone far and beyond to extend some of the codes for cardiac and intensive cardiac rehabilitation until December 31, 2023, as well.

There has been a lot of debate regarding the geographic restrictions when it comes to telehealth visits for diagnosis, evaluation, or treatment of a mental health disorder. As per the latest Consolidated Appropriations Act of 2021 (Section 123), the home of the patient is a permissible site. But, the caveat is that there must be an in-person service with the practitioner/physician within 6 months prior to the initial telehealth visit. Additionally, there has to be a set frequency for subsequent in-person visits. And, usually the subsequent visits will need to be provided at least every 12 months. These requirements are not set in stone and can be changed on a case-by-case basis provided there is appropriate documentation in the chart.

Lastly, it is important to understand and use the appropriate telecommunication systems for the telehealth visits and the modifiers that are associated with them. By definition, it has to be audio and video equipment that allows two-way, real-time interactive communication between the patient and the provider when used for telehealth services for the diagnosis, evaluation, or treatment of mental health disorders. But, CMS is in the process of amending it to include audio-only communications technology. At this time, the use of audio-only interactive telecommunications system is limited to practitioners who have the capability to provide two-way audio/video communications but, where the patient is not capable, or does not consent to, the use of two-way audio/video technology. Modifier FQ should be attached to all the mental health services that were furnished using audio-only communications. And, mental health services can include services for treatment of substance use disorders (SUD). Please do not confuse modifier FQ with modifier 93 as FQ is only for behavioral health services. And, remember that the totality of the communication of information exchanged between the provider and the patient during the course of the synchronous telemedicine service (rendered via telephone or other real-time interactive audio only telecommunication system) must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction.

Teaching physician services

As a general rule, a teaching physician can bill for the resident services only if they are present for the critical (key) portion of the service. But, there is one exception called the “primary care exception” under which in certain teaching hospital primary care centers, the teaching physician can bill for certain services as furnished independently by the resident without the teaching physician being physically present, but with the teaching physician’s review.

The current model to bill for office/outpatient E/M visit level is either based on either total time spent (personally) or medical-decision-making (MDM). When time is used to select the visit level only the time spent by the teaching physician in qualifying activities can be included for the purposes of the visit level selection. And, this includes the time the teaching physician was present with the resident performing those qualifying activities. Also, under the primary care exception, time cannot be used to select the visit level. This is to guard against the possibility of inappropriate coding that reflects residents’ inefficiencies rather than a measure of the total medically necessary time required to furnish the E/M services.

ICD-10 updates

Usually, the ICD-10 codes are updated annually and take effect every October 1. Some of the most relevant updates are as follows:

1. U09.9 Post COVID-19 condition, unspecified: This should be used to document sequelae of COVID-19 or “long COVID” conditions, after the acute illness has resolved. But, remember to code the conditions related to COVID-19 first and do not use this code with an active or current COVID-19 infection.

2. U07.0 Vaping-related disorder: This should be used for all vaping-related illnesses. However, additional codes for other diagnoses such as acute respiratory failure, acute respiratory distress syndrome, or pneumonitis can also be used with this code. Other respiratory signs and symptoms such as cough and shortness of breath should not be coded separately.

3. Cough is one of the most common reasons for referral to a pulmonologist. The CDC has expanded these codes so please remember to code the most specific diagnosis as deemed appropriate.

R05.1 Acute cough

R05.2 Subacute cough

R05.3 Chronic cough

R05.4 Cough, syncope

R05.8 Other specified cough

R05.9 Cough, unspecified

We will be back with some more exciting and intriguing billing and coding updates in our next article and hope to see everyone at CHEST 2022 in Nashville., TN.

In my previous article in June, 2022, we plowed through the billing and coding updates regarding critical care services, and, I hope that it helped our readers get more acquainted with the nuances of billing and coding in the ICU. In this piece, I would like to briefly elucidate three other areas of practice, which will be relevant to all physicians across various specialties.

Telehealth services

The Centers for Medicare & Medicaid Services (CMS) graciously added telehealth services temporarily to its list of services due to the COVID-19 public health emergency (PHE). Initially, the plan was to remove these from the list of covered services by the latter end of the COVID-19 PHE, which, created some uncertainty, or by December 31, 2021. Fortunately, CMS finalized that they will extend it through the end of the calendar year (CY) 2023. So, now all the telehealth services will remain on the CMS list until December 31, 2023. The general principle behind this ruling is to allow for more time for CMS and stakeholders to gather data and to submit support for requesting these services to be permanently added to the Medicare telehealth services list.

Not only has CMS extended the deadline for telehealth services but also they have gone far and beyond to extend some of the codes for cardiac and intensive cardiac rehabilitation until December 31, 2023, as well.

There has been a lot of debate regarding the geographic restrictions when it comes to telehealth visits for diagnosis, evaluation, or treatment of a mental health disorder. As per the latest Consolidated Appropriations Act of 2021 (Section 123), the home of the patient is a permissible site. But, the caveat is that there must be an in-person service with the practitioner/physician within 6 months prior to the initial telehealth visit. Additionally, there has to be a set frequency for subsequent in-person visits. And, usually the subsequent visits will need to be provided at least every 12 months. These requirements are not set in stone and can be changed on a case-by-case basis provided there is appropriate documentation in the chart.

Lastly, it is important to understand and use the appropriate telecommunication systems for the telehealth visits and the modifiers that are associated with them. By definition, it has to be audio and video equipment that allows two-way, real-time interactive communication between the patient and the provider when used for telehealth services for the diagnosis, evaluation, or treatment of mental health disorders. But, CMS is in the process of amending it to include audio-only communications technology. At this time, the use of audio-only interactive telecommunications system is limited to practitioners who have the capability to provide two-way audio/video communications but, where the patient is not capable, or does not consent to, the use of two-way audio/video technology. Modifier FQ should be attached to all the mental health services that were furnished using audio-only communications. And, mental health services can include services for treatment of substance use disorders (SUD). Please do not confuse modifier FQ with modifier 93 as FQ is only for behavioral health services. And, remember that the totality of the communication of information exchanged between the provider and the patient during the course of the synchronous telemedicine service (rendered via telephone or other real-time interactive audio only telecommunication system) must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction.

Teaching physician services

As a general rule, a teaching physician can bill for the resident services only if they are present for the critical (key) portion of the service. But, there is one exception called the “primary care exception” under which in certain teaching hospital primary care centers, the teaching physician can bill for certain services as furnished independently by the resident without the teaching physician being physically present, but with the teaching physician’s review.

The current model to bill for office/outpatient E/M visit level is either based on either total time spent (personally) or medical-decision-making (MDM). When time is used to select the visit level only the time spent by the teaching physician in qualifying activities can be included for the purposes of the visit level selection. And, this includes the time the teaching physician was present with the resident performing those qualifying activities. Also, under the primary care exception, time cannot be used to select the visit level. This is to guard against the possibility of inappropriate coding that reflects residents’ inefficiencies rather than a measure of the total medically necessary time required to furnish the E/M services.

ICD-10 updates

Usually, the ICD-10 codes are updated annually and take effect every October 1. Some of the most relevant updates are as follows:

1. U09.9 Post COVID-19 condition, unspecified: This should be used to document sequelae of COVID-19 or “long COVID” conditions, after the acute illness has resolved. But, remember to code the conditions related to COVID-19 first and do not use this code with an active or current COVID-19 infection.

2. U07.0 Vaping-related disorder: This should be used for all vaping-related illnesses. However, additional codes for other diagnoses such as acute respiratory failure, acute respiratory distress syndrome, or pneumonitis can also be used with this code. Other respiratory signs and symptoms such as cough and shortness of breath should not be coded separately.

3. Cough is one of the most common reasons for referral to a pulmonologist. The CDC has expanded these codes so please remember to code the most specific diagnosis as deemed appropriate.

R05.1 Acute cough

R05.2 Subacute cough

R05.3 Chronic cough

R05.4 Cough, syncope

R05.8 Other specified cough

R05.9 Cough, unspecified

We will be back with some more exciting and intriguing billing and coding updates in our next article and hope to see everyone at CHEST 2022 in Nashville., TN.

In my previous article in June, 2022, we plowed through the billing and coding updates regarding critical care services, and, I hope that it helped our readers get more acquainted with the nuances of billing and coding in the ICU. In this piece, I would like to briefly elucidate three other areas of practice, which will be relevant to all physicians across various specialties.

Telehealth services

The Centers for Medicare & Medicaid Services (CMS) graciously added telehealth services temporarily to its list of services due to the COVID-19 public health emergency (PHE). Initially, the plan was to remove these from the list of covered services by the latter end of the COVID-19 PHE, which, created some uncertainty, or by December 31, 2021. Fortunately, CMS finalized that they will extend it through the end of the calendar year (CY) 2023. So, now all the telehealth services will remain on the CMS list until December 31, 2023. The general principle behind this ruling is to allow for more time for CMS and stakeholders to gather data and to submit support for requesting these services to be permanently added to the Medicare telehealth services list.

Not only has CMS extended the deadline for telehealth services but also they have gone far and beyond to extend some of the codes for cardiac and intensive cardiac rehabilitation until December 31, 2023, as well.

There has been a lot of debate regarding the geographic restrictions when it comes to telehealth visits for diagnosis, evaluation, or treatment of a mental health disorder. As per the latest Consolidated Appropriations Act of 2021 (Section 123), the home of the patient is a permissible site. But, the caveat is that there must be an in-person service with the practitioner/physician within 6 months prior to the initial telehealth visit. Additionally, there has to be a set frequency for subsequent in-person visits. And, usually the subsequent visits will need to be provided at least every 12 months. These requirements are not set in stone and can be changed on a case-by-case basis provided there is appropriate documentation in the chart.

Lastly, it is important to understand and use the appropriate telecommunication systems for the telehealth visits and the modifiers that are associated with them. By definition, it has to be audio and video equipment that allows two-way, real-time interactive communication between the patient and the provider when used for telehealth services for the diagnosis, evaluation, or treatment of mental health disorders. But, CMS is in the process of amending it to include audio-only communications technology. At this time, the use of audio-only interactive telecommunications system is limited to practitioners who have the capability to provide two-way audio/video communications but, where the patient is not capable, or does not consent to, the use of two-way audio/video technology. Modifier FQ should be attached to all the mental health services that were furnished using audio-only communications. And, mental health services can include services for treatment of substance use disorders (SUD). Please do not confuse modifier FQ with modifier 93 as FQ is only for behavioral health services. And, remember that the totality of the communication of information exchanged between the provider and the patient during the course of the synchronous telemedicine service (rendered via telephone or other real-time interactive audio only telecommunication system) must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction.

Teaching physician services

As a general rule, a teaching physician can bill for the resident services only if they are present for the critical (key) portion of the service. But, there is one exception called the “primary care exception” under which in certain teaching hospital primary care centers, the teaching physician can bill for certain services as furnished independently by the resident without the teaching physician being physically present, but with the teaching physician’s review.

The current model to bill for office/outpatient E/M visit level is either based on either total time spent (personally) or medical-decision-making (MDM). When time is used to select the visit level only the time spent by the teaching physician in qualifying activities can be included for the purposes of the visit level selection. And, this includes the time the teaching physician was present with the resident performing those qualifying activities. Also, under the primary care exception, time cannot be used to select the visit level. This is to guard against the possibility of inappropriate coding that reflects residents’ inefficiencies rather than a measure of the total medically necessary time required to furnish the E/M services.

ICD-10 updates

Usually, the ICD-10 codes are updated annually and take effect every October 1. Some of the most relevant updates are as follows:

1. U09.9 Post COVID-19 condition, unspecified: This should be used to document sequelae of COVID-19 or “long COVID” conditions, after the acute illness has resolved. But, remember to code the conditions related to COVID-19 first and do not use this code with an active or current COVID-19 infection.

2. U07.0 Vaping-related disorder: This should be used for all vaping-related illnesses. However, additional codes for other diagnoses such as acute respiratory failure, acute respiratory distress syndrome, or pneumonitis can also be used with this code. Other respiratory signs and symptoms such as cough and shortness of breath should not be coded separately.

3. Cough is one of the most common reasons for referral to a pulmonologist. The CDC has expanded these codes so please remember to code the most specific diagnosis as deemed appropriate.

R05.1 Acute cough

R05.2 Subacute cough

R05.3 Chronic cough

R05.4 Cough, syncope

R05.8 Other specified cough

R05.9 Cough, unspecified

We will be back with some more exciting and intriguing billing and coding updates in our next article and hope to see everyone at CHEST 2022 in Nashville., TN.

CHEST is proud to announce the launch of the newest addition to our e-learning options: the CHEST Asthma Curriculum Pathway.

This unique offering combines a variety of bite-sized educational resources from among CHEST’s most popular and effective products, including case-based CHEST SEEK™ questions, podcasts and videos from asthma experts, the latest research from the journal CHEST®, and more.

The pathway comprises several different “paths,” or tracks, that enable clinicians to target their education based on their knowledge gaps and career level. Users can opt to follow the curriculum from start to finish to gain a comprehensive overview of asthma management. Or, they can select individual paths to focus their learning on topics including asthma pathophysiology, diagnosis and classification, exacerbations, phenotypes, and more.

According to early learners of the pathway: “The multiple ways of looking at different therapies in the management of asthma was helpful in remembering the information. It helped a lot with the knowledge check-in.” Another commented: “It is very comprehensive on all aspects of asthma. I enjoyed the higher-level learning on the choice of biologics and asthma mimickers.” The education modalities were highlighted, as well, with this feedback: “I really enjoyed the variety of media (lectures, discussions, papers, games).”

Exploring the education

The Asthma Curriculum Pathway offers targeted education options to fit the career level and clinical interest of clinicians, ranging from trainees and early career physicians to experienced asthma specialists and advanced practice providers.

Paths include:

• Path 1: Pathophysiology

• Path 2: Diagnosis & Classification

• Path 3: Management

• Path 4: Mimickers

• Path 5: Comorbidities

• Path 6: Phenotypes

• Path 7: Exacerbations

• Path 8: Special Situations



Plus, each path offers claiming credit, including CME, for completion—all while driving clinicians to consistently advance best outcomes for their patients with asthma.

Visit (https://bit.ly/asthma-pathway) to access the best of CHEST’s asthma education with the new Asthma Curriculum Pathway, accessible via web or mobile device.

CHEST is proud to announce the launch of the newest addition to our e-learning options: the CHEST Asthma Curriculum Pathway.

This unique offering combines a variety of bite-sized educational resources from among CHEST’s most popular and effective products, including case-based CHEST SEEK™ questions, podcasts and videos from asthma experts, the latest research from the journal CHEST®, and more.

The pathway comprises several different “paths,” or tracks, that enable clinicians to target their education based on their knowledge gaps and career level. Users can opt to follow the curriculum from start to finish to gain a comprehensive overview of asthma management. Or, they can select individual paths to focus their learning on topics including asthma pathophysiology, diagnosis and classification, exacerbations, phenotypes, and more.

According to early learners of the pathway: “The multiple ways of looking at different therapies in the management of asthma was helpful in remembering the information. It helped a lot with the knowledge check-in.” Another commented: “It is very comprehensive on all aspects of asthma. I enjoyed the higher-level learning on the choice of biologics and asthma mimickers.” The education modalities were highlighted, as well, with this feedback: “I really enjoyed the variety of media (lectures, discussions, papers, games).”

Exploring the education

The Asthma Curriculum Pathway offers targeted education options to fit the career level and clinical interest of clinicians, ranging from trainees and early career physicians to experienced asthma specialists and advanced practice providers.

Paths include:

• Path 1: Pathophysiology

• Path 2: Diagnosis & Classification

• Path 3: Management

• Path 4: Mimickers

• Path 5: Comorbidities

• Path 6: Phenotypes

• Path 7: Exacerbations

• Path 8: Special Situations



Plus, each path offers claiming credit, including CME, for completion—all while driving clinicians to consistently advance best outcomes for their patients with asthma.

Visit (https://bit.ly/asthma-pathway) to access the best of CHEST’s asthma education with the new Asthma Curriculum Pathway, accessible via web or mobile device.

CHEST is proud to announce the launch of the newest addition to our e-learning options: the CHEST Asthma Curriculum Pathway.

This unique offering combines a variety of bite-sized educational resources from among CHEST’s most popular and effective products, including case-based CHEST SEEK™ questions, podcasts and videos from asthma experts, the latest research from the journal CHEST®, and more.

The pathway comprises several different “paths,” or tracks, that enable clinicians to target their education based on their knowledge gaps and career level. Users can opt to follow the curriculum from start to finish to gain a comprehensive overview of asthma management. Or, they can select individual paths to focus their learning on topics including asthma pathophysiology, diagnosis and classification, exacerbations, phenotypes, and more.

According to early learners of the pathway: “The multiple ways of looking at different therapies in the management of asthma was helpful in remembering the information. It helped a lot with the knowledge check-in.” Another commented: “It is very comprehensive on all aspects of asthma. I enjoyed the higher-level learning on the choice of biologics and asthma mimickers.” The education modalities were highlighted, as well, with this feedback: “I really enjoyed the variety of media (lectures, discussions, papers, games).”

Exploring the education

The Asthma Curriculum Pathway offers targeted education options to fit the career level and clinical interest of clinicians, ranging from trainees and early career physicians to experienced asthma specialists and advanced practice providers.

Paths include:

• Path 1: Pathophysiology

• Path 2: Diagnosis & Classification

• Path 3: Management

• Path 4: Mimickers

• Path 5: Comorbidities

• Path 6: Phenotypes

• Path 7: Exacerbations

• Path 8: Special Situations



Plus, each path offers claiming credit, including CME, for completion—all while driving clinicians to consistently advance best outcomes for their patients with asthma.

Visit (https://bit.ly/asthma-pathway) to access the best of CHEST’s asthma education with the new Asthma Curriculum Pathway, accessible via web or mobile device.

Point-of-care ultrasound (POCUS) is a useful, practice-changing bedside tool that spans all medical and surgical specialties. While the definition of POCUS varies, most would agree it is an abbreviated exam that helps to answer a specific clinical question. With the expansion of POCUS training, the clinical questions being asked and answered have increased in scope and volume. The types of exams being utilized in “point of care ultrasound” have also increased and include transthoracic echocardiography; trans-esophageal echocardiography; and lung, gastric, abdominal, and ocular ultrasound. POCUS is used across multiple specialties, including critical care, anesthesiology, emergency medicine, and primary care.

CHEST

Not only has POCUS become increasingly important clinically, but specialties now test these skills on their respective board examinations. Anesthesia is one of many such examples. The content outline for the American Board of Anesthesiology includes POCUS as a tested item on both the written and applied components of the exam. POCUS training must be directed toward both optimizing patient management and preparing learners for their board examination. A method for teaching this has yet to be defined (Naji A, et al. Cureus. 2021;13[5]:e15217).

One question – how should different specialties approach this educational challenge and should specialties train together? The answer is complicated. Many POCUS courses and certifications exist, and all vary in their content, didactics, and length. No true gold standard exists for POCUS certification for radiology or noncardiology providers. Additionally, there are no defined expectations or testing processes that certify a provider is “certified” to perform POCUS. While waiting for medical society guidelines to address these issues, many in graduate medical education (GME) are coming up with their own ways to incorporate POCUS into their respective training programs (Atkinson P, et al. CJEM. 2015 Mar;17[2]:161).

Who’s training whom?

Over the past decade, several expert committees, including those in critical care, have developed recommendations and consensus statements urging training facilities to independently create POCUS curriculums. The threshold for many programs to enter this realm of expertise is high and oftentimes unobtainable. We’ve seen emergency medicine and anesthesia raise the bar for ultrasound education in their residencies, but it’s unclear whether all fellowship-trained physicians can and should be tasked with obtaining official POCUS certification.

While specific specialties may require tailored certifications, there’s a considerable overlap in POCUS exam content across specialties. One approach to POCUS training could be developing and implementing a multidisciplinary curriculum. This would allow for pooling of resources (equipment, staff) and harnessing knowledge from providers familiar with different phases of patient care (ICU, perioperative, ED, outpatient clinics). By approaching POCUS from a multidisciplinary perspective, the quality of education may be enhanced (Mayo PH, et al. Intensive Care Med. 2014;40[5]:654). Is it then prudent for providers and trainees alike to share in didactics across all areas of the hospital and clinic? Would this close the knowledge gap between specialties who are facile with ultrasound and those not?

Determining the role of transesophageal echocardiography in a POCUS curriculum

This modality of imaging has been, until recently, reserved for cardiologists and anesthesiologists. More recently transesophageal echocardiography (TEE) has been utilized by emergency and critical care medicine physicians. TEE is part of recommended training for these specialties as a tool for diagnostic and rescue measures, including ventilator management, emergency procedures, and medication titration. Rescue TEE can also be utilized perioperatively where the transthoracic exam is limited by poor windows or the operative procedure precludes access to the chest. While transthoracic echocardiography (TTE) is often used in a point of care fashion, TEE is utilized less often. This may stem from the invasive nature of the procedure but likely also results from lack of equipment and training. Like POCUS overall, TEE POCUS will require incorporation into training programs to achieve widespread use and acceptance.

A deluge of research on TEE for the noncardiologist shows this modality is minimally invasive, safe, and effective. As it becomes more readily available and technology improves, there is no reason why an esophageal probe can’t be used in a patient with a secured airway (Wray TC, et al. J Intensive Care Med. 2021;36[1]:123).

Ultrasound for hemodynamic monitoring

There are many methods employed for hemodynamic monitoring in the ICU. Although echocardiographic and vascular parameters have been validated in the cardiac and perioperative fields, their application in the ICU setting for resuscitation and volume management remain somewhat controversial. The use of TEE and more advanced understanding of spectral doppler and pulmonary ultrasonography using TEE has revolutionized the way providers are managing critically ill patients. (Garcia YA, et al. Chest. 2017;152[4]:736).

In our opinion, physiology and imaging training for residents and fellows should be required for critical care medicine trainees. Delving into the nuances of frank-starling curves, stroke work, and diastolic function will enrich their understanding and highlight the applicability of ultrasonography. Furthermore, all clinicians caring for patients with critical illness should be privy to the nuances of physiologic derangement, and to that end, advanced echocardiographic principles and image acquisition. The heart-lung interactions are demonstrated in real time using POCUS and can clearly delineate treatment goals (Vieillard-Baron A, et al. Intensive Care Med. 2019;45[6]:770).

Documentation and billing

If clinicians are making medical decisions based off imaging gathered at the bedside and interpreted in real-time, documentation should reflect that. That documentation will invariably lead to billing and possibly audit or quality review by colleagues or other healthcare staff. Radiology and cardiology have perfected the billing process for image interpretation, but their form of documentation and interpretation may not easily be implemented in the perioperative or critical care settings. An abbreviated document with focused information should take the place of the formal study. With that, the credentialing and board certification process will allow providers to feel empowered to make clinical decisions based off these focused examinations.

Dr. Goertzen is Chief Fellow, Pulmonary/Critical Care; Dr. Knuf is Program Director, Department of Anesthesia; and Dr. Villalobos is Director of Medical ICU, Department of Internal Medicine, San Antonio Military Medical Center, San Antonio, Texas.

Point-of-care ultrasound (POCUS) is a useful, practice-changing bedside tool that spans all medical and surgical specialties. While the definition of POCUS varies, most would agree it is an abbreviated exam that helps to answer a specific clinical question. With the expansion of POCUS training, the clinical questions being asked and answered have increased in scope and volume. The types of exams being utilized in “point of care ultrasound” have also increased and include transthoracic echocardiography; trans-esophageal echocardiography; and lung, gastric, abdominal, and ocular ultrasound. POCUS is used across multiple specialties, including critical care, anesthesiology, emergency medicine, and primary care.

CHEST

Not only has POCUS become increasingly important clinically, but specialties now test these skills on their respective board examinations. Anesthesia is one of many such examples. The content outline for the American Board of Anesthesiology includes POCUS as a tested item on both the written and applied components of the exam. POCUS training must be directed toward both optimizing patient management and preparing learners for their board examination. A method for teaching this has yet to be defined (Naji A, et al. Cureus. 2021;13[5]:e15217).

One question – how should different specialties approach this educational challenge and should specialties train together? The answer is complicated. Many POCUS courses and certifications exist, and all vary in their content, didactics, and length. No true gold standard exists for POCUS certification for radiology or noncardiology providers. Additionally, there are no defined expectations or testing processes that certify a provider is “certified” to perform POCUS. While waiting for medical society guidelines to address these issues, many in graduate medical education (GME) are coming up with their own ways to incorporate POCUS into their respective training programs (Atkinson P, et al. CJEM. 2015 Mar;17[2]:161).

Who’s training whom?

Over the past decade, several expert committees, including those in critical care, have developed recommendations and consensus statements urging training facilities to independently create POCUS curriculums. The threshold for many programs to enter this realm of expertise is high and oftentimes unobtainable. We’ve seen emergency medicine and anesthesia raise the bar for ultrasound education in their residencies, but it’s unclear whether all fellowship-trained physicians can and should be tasked with obtaining official POCUS certification.

While specific specialties may require tailored certifications, there’s a considerable overlap in POCUS exam content across specialties. One approach to POCUS training could be developing and implementing a multidisciplinary curriculum. This would allow for pooling of resources (equipment, staff) and harnessing knowledge from providers familiar with different phases of patient care (ICU, perioperative, ED, outpatient clinics). By approaching POCUS from a multidisciplinary perspective, the quality of education may be enhanced (Mayo PH, et al. Intensive Care Med. 2014;40[5]:654). Is it then prudent for providers and trainees alike to share in didactics across all areas of the hospital and clinic? Would this close the knowledge gap between specialties who are facile with ultrasound and those not?

Determining the role of transesophageal echocardiography in a POCUS curriculum

This modality of imaging has been, until recently, reserved for cardiologists and anesthesiologists. More recently transesophageal echocardiography (TEE) has been utilized by emergency and critical care medicine physicians. TEE is part of recommended training for these specialties as a tool for diagnostic and rescue measures, including ventilator management, emergency procedures, and medication titration. Rescue TEE can also be utilized perioperatively where the transthoracic exam is limited by poor windows or the operative procedure precludes access to the chest. While transthoracic echocardiography (TTE) is often used in a point of care fashion, TEE is utilized less often. This may stem from the invasive nature of the procedure but likely also results from lack of equipment and training. Like POCUS overall, TEE POCUS will require incorporation into training programs to achieve widespread use and acceptance.

A deluge of research on TEE for the noncardiologist shows this modality is minimally invasive, safe, and effective. As it becomes more readily available and technology improves, there is no reason why an esophageal probe can’t be used in a patient with a secured airway (Wray TC, et al. J Intensive Care Med. 2021;36[1]:123).

Ultrasound for hemodynamic monitoring

There are many methods employed for hemodynamic monitoring in the ICU. Although echocardiographic and vascular parameters have been validated in the cardiac and perioperative fields, their application in the ICU setting for resuscitation and volume management remain somewhat controversial. The use of TEE and more advanced understanding of spectral doppler and pulmonary ultrasonography using TEE has revolutionized the way providers are managing critically ill patients. (Garcia YA, et al. Chest. 2017;152[4]:736).

In our opinion, physiology and imaging training for residents and fellows should be required for critical care medicine trainees. Delving into the nuances of frank-starling curves, stroke work, and diastolic function will enrich their understanding and highlight the applicability of ultrasonography. Furthermore, all clinicians caring for patients with critical illness should be privy to the nuances of physiologic derangement, and to that end, advanced echocardiographic principles and image acquisition. The heart-lung interactions are demonstrated in real time using POCUS and can clearly delineate treatment goals (Vieillard-Baron A, et al. Intensive Care Med. 2019;45[6]:770).

Documentation and billing

If clinicians are making medical decisions based off imaging gathered at the bedside and interpreted in real-time, documentation should reflect that. That documentation will invariably lead to billing and possibly audit or quality review by colleagues or other healthcare staff. Radiology and cardiology have perfected the billing process for image interpretation, but their form of documentation and interpretation may not easily be implemented in the perioperative or critical care settings. An abbreviated document with focused information should take the place of the formal study. With that, the credentialing and board certification process will allow providers to feel empowered to make clinical decisions based off these focused examinations.

Dr. Goertzen is Chief Fellow, Pulmonary/Critical Care; Dr. Knuf is Program Director, Department of Anesthesia; and Dr. Villalobos is Director of Medical ICU, Department of Internal Medicine, San Antonio Military Medical Center, San Antonio, Texas.

Point-of-care ultrasound (POCUS) is a useful, practice-changing bedside tool that spans all medical and surgical specialties. While the definition of POCUS varies, most would agree it is an abbreviated exam that helps to answer a specific clinical question. With the expansion of POCUS training, the clinical questions being asked and answered have increased in scope and volume. The types of exams being utilized in “point of care ultrasound” have also increased and include transthoracic echocardiography; trans-esophageal echocardiography; and lung, gastric, abdominal, and ocular ultrasound. POCUS is used across multiple specialties, including critical care, anesthesiology, emergency medicine, and primary care.

CHEST

Not only has POCUS become increasingly important clinically, but specialties now test these skills on their respective board examinations. Anesthesia is one of many such examples. The content outline for the American Board of Anesthesiology includes POCUS as a tested item on both the written and applied components of the exam. POCUS training must be directed toward both optimizing patient management and preparing learners for their board examination. A method for teaching this has yet to be defined (Naji A, et al. Cureus. 2021;13[5]:e15217).

One question – how should different specialties approach this educational challenge and should specialties train together? The answer is complicated. Many POCUS courses and certifications exist, and all vary in their content, didactics, and length. No true gold standard exists for POCUS certification for radiology or noncardiology providers. Additionally, there are no defined expectations or testing processes that certify a provider is “certified” to perform POCUS. While waiting for medical society guidelines to address these issues, many in graduate medical education (GME) are coming up with their own ways to incorporate POCUS into their respective training programs (Atkinson P, et al. CJEM. 2015 Mar;17[2]:161).

Who’s training whom?

Over the past decade, several expert committees, including those in critical care, have developed recommendations and consensus statements urging training facilities to independently create POCUS curriculums. The threshold for many programs to enter this realm of expertise is high and oftentimes unobtainable. We’ve seen emergency medicine and anesthesia raise the bar for ultrasound education in their residencies, but it’s unclear whether all fellowship-trained physicians can and should be tasked with obtaining official POCUS certification.

While specific specialties may require tailored certifications, there’s a considerable overlap in POCUS exam content across specialties. One approach to POCUS training could be developing and implementing a multidisciplinary curriculum. This would allow for pooling of resources (equipment, staff) and harnessing knowledge from providers familiar with different phases of patient care (ICU, perioperative, ED, outpatient clinics). By approaching POCUS from a multidisciplinary perspective, the quality of education may be enhanced (Mayo PH, et al. Intensive Care Med. 2014;40[5]:654). Is it then prudent for providers and trainees alike to share in didactics across all areas of the hospital and clinic? Would this close the knowledge gap between specialties who are facile with ultrasound and those not?

Determining the role of transesophageal echocardiography in a POCUS curriculum

This modality of imaging has been, until recently, reserved for cardiologists and anesthesiologists. More recently transesophageal echocardiography (TEE) has been utilized by emergency and critical care medicine physicians. TEE is part of recommended training for these specialties as a tool for diagnostic and rescue measures, including ventilator management, emergency procedures, and medication titration. Rescue TEE can also be utilized perioperatively where the transthoracic exam is limited by poor windows or the operative procedure precludes access to the chest. While transthoracic echocardiography (TTE) is often used in a point of care fashion, TEE is utilized less often. This may stem from the invasive nature of the procedure but likely also results from lack of equipment and training. Like POCUS overall, TEE POCUS will require incorporation into training programs to achieve widespread use and acceptance.

A deluge of research on TEE for the noncardiologist shows this modality is minimally invasive, safe, and effective. As it becomes more readily available and technology improves, there is no reason why an esophageal probe can’t be used in a patient with a secured airway (Wray TC, et al. J Intensive Care Med. 2021;36[1]:123).

Ultrasound for hemodynamic monitoring

There are many methods employed for hemodynamic monitoring in the ICU. Although echocardiographic and vascular parameters have been validated in the cardiac and perioperative fields, their application in the ICU setting for resuscitation and volume management remain somewhat controversial. The use of TEE and more advanced understanding of spectral doppler and pulmonary ultrasonography using TEE has revolutionized the way providers are managing critically ill patients. (Garcia YA, et al. Chest. 2017;152[4]:736).

In our opinion, physiology and imaging training for residents and fellows should be required for critical care medicine trainees. Delving into the nuances of frank-starling curves, stroke work, and diastolic function will enrich their understanding and highlight the applicability of ultrasonography. Furthermore, all clinicians caring for patients with critical illness should be privy to the nuances of physiologic derangement, and to that end, advanced echocardiographic principles and image acquisition. The heart-lung interactions are demonstrated in real time using POCUS and can clearly delineate treatment goals (Vieillard-Baron A, et al. Intensive Care Med. 2019;45[6]:770).

Documentation and billing

If clinicians are making medical decisions based off imaging gathered at the bedside and interpreted in real-time, documentation should reflect that. That documentation will invariably lead to billing and possibly audit or quality review by colleagues or other healthcare staff. Radiology and cardiology have perfected the billing process for image interpretation, but their form of documentation and interpretation may not easily be implemented in the perioperative or critical care settings. An abbreviated document with focused information should take the place of the formal study. With that, the credentialing and board certification process will allow providers to feel empowered to make clinical decisions based off these focused examinations.

Dr. Goertzen is Chief Fellow, Pulmonary/Critical Care; Dr. Knuf is Program Director, Department of Anesthesia; and Dr. Villalobos is Director of Medical ICU, Department of Internal Medicine, San Antonio Military Medical Center, San Antonio, Texas.

As the presidency of the American College of Chest Physicians changes hands in January 2023, so will the role of President of the CHEST Foundation. To get to know the incoming President of the CHEST Foundation, we spoke with Robert (Bob) De Marco, MD, FCCP, about his philanthropy work and his goals for the philanthropic arm of CHEST.

Tell me about your history with philanthropy work.

My philanthropy work started long before the CHEST Foundation. While I’ve been a member of CHEST since my second year of fellowship, it wasn’t until much later that I became involved with the philanthropic side of the organization. Earlier in my career, I was involved more so with the American Cancer Society. I had gotten involved with them by chance – participating in an event of theirs – and was encouraged to get more involved by one of their board members. Being involved with them made a lot of sense seeing as a strong percentage of my patients at the time were being treated for lung cancer. My most notable accomplishments with the American Cancer Society were in serving as the Chairmen of my local Relay for Life program for 10 years, as a board member, and then as a president of my local chapter.



When did you get involved with the CHEST Foundation?

I had served in a handful of positions within CHEST, including Chair of the (since reinvented) Practice Management Committee, so I was deeply involved in the association, and I thought to myself, “I have experience in fundraising through my work with the American Cancer Society, why don’t I use it to help our association?” When I moved to Florida, I no longer had the local connection to the American Cancer Society, so it was an opportune time to transition over to the CHEST Foundation.

How has the Foundation changed in the time that you’ve been involved?

The Foundation has changed drastically since I first joined the Board of Trustees 9 years ago. When I first got involved, the primary goal of the Foundation was staying “out of the red.” At that time, we were an organization that gave away more than we made.

After years of building a corpus to fund our own projects, we’re in a really good place now with some phenomenal goals and some excellent initiatives to fundraise around, including a CHEST diversity initiative, First 5 Minutes™, and Bridging Specialties™: Timely Diagnosis for ILD Patients, which seeks to break down silos within medicine to improve patient care.

What will be a focus of your Foundation presidency?

You know, one thing I always appreciated about the American Cancer Society was that there were always notable accomplishments to point back to when supporting fundraising efforts. You could say, “Did you know that bone marrow transplantation was initially funded by the American Cancer Society?” and other examples that would truly inspire someone to want to get involved in supporting those efforts.

The CHEST Foundation may not have funded bone marrow transplantation, but in 25 years of awarding grants, there are equally good stories to share. The impact of the Foundation is tremendous, and we’ve only just begun to share examples of where grant recipients went with their research or community service projects.

A recent grant story that was shared with me was that of Panagis Galiatsatos, MD, MHS, who received a community service grant to start a program educating children in the Baltimore community about lung health. This program was so moving that it inspired one of the Baltimore teachers to pursue a career in medicine and that individual is now a practicing MD.

This is just one example of the Foundation’s impact and it’s through these stories that we share the “why” behind every dollar that is raised, and my first goal is to tell these stories.

Another key focus of not only my presidency, but Dr. Ian Nathanson’s, as well, as we collaborated a lot on our roles, will be on member involvement and awareness. Even I wasn’t involved in the CHEST Foundation until years into my CHEST membership, so I understand that there are competing demands. But I also know that there is a lot to be gained from the work with the Foundation. I want the CHEST members to be excited about the Foundation and to want to support its efforts.

These two goals go hand in hand, and I look forward to sharing the Foundation’s impact with a new audience and reinvigorating the support of our existing donors.

Is there anything else you’d like to say to the reader?

We cannot accomplish anything without the support of our donors, and I want to sincerely thank everyone who has donated to the CHEST Foundation. I also encourage those who have never donated or have yet to donate this year to visit the Foundation’s website (foundation.chestnet.org) and explore some of the inspiring initiatives you can support to strengthen the impact of the CHEST Foundation because the possibilities are truly endless.

As the presidency of the American College of Chest Physicians changes hands in January 2023, so will the role of President of the CHEST Foundation. To get to know the incoming President of the CHEST Foundation, we spoke with Robert (Bob) De Marco, MD, FCCP, about his philanthropy work and his goals for the philanthropic arm of CHEST.

Tell me about your history with philanthropy work.

My philanthropy work started long before the CHEST Foundation. While I’ve been a member of CHEST since my second year of fellowship, it wasn’t until much later that I became involved with the philanthropic side of the organization. Earlier in my career, I was involved more so with the American Cancer Society. I had gotten involved with them by chance – participating in an event of theirs – and was encouraged to get more involved by one of their board members. Being involved with them made a lot of sense seeing as a strong percentage of my patients at the time were being treated for lung cancer. My most notable accomplishments with the American Cancer Society were in serving as the Chairmen of my local Relay for Life program for 10 years, as a board member, and then as a president of my local chapter.



When did you get involved with the CHEST Foundation?

I had served in a handful of positions within CHEST, including Chair of the (since reinvented) Practice Management Committee, so I was deeply involved in the association, and I thought to myself, “I have experience in fundraising through my work with the American Cancer Society, why don’t I use it to help our association?” When I moved to Florida, I no longer had the local connection to the American Cancer Society, so it was an opportune time to transition over to the CHEST Foundation.

How has the Foundation changed in the time that you’ve been involved?

The Foundation has changed drastically since I first joined the Board of Trustees 9 years ago. When I first got involved, the primary goal of the Foundation was staying “out of the red.” At that time, we were an organization that gave away more than we made.

After years of building a corpus to fund our own projects, we’re in a really good place now with some phenomenal goals and some excellent initiatives to fundraise around, including a CHEST diversity initiative, First 5 Minutes™, and Bridging Specialties™: Timely Diagnosis for ILD Patients, which seeks to break down silos within medicine to improve patient care.

What will be a focus of your Foundation presidency?

You know, one thing I always appreciated about the American Cancer Society was that there were always notable accomplishments to point back to when supporting fundraising efforts. You could say, “Did you know that bone marrow transplantation was initially funded by the American Cancer Society?” and other examples that would truly inspire someone to want to get involved in supporting those efforts.

The CHEST Foundation may not have funded bone marrow transplantation, but in 25 years of awarding grants, there are equally good stories to share. The impact of the Foundation is tremendous, and we’ve only just begun to share examples of where grant recipients went with their research or community service projects.

A recent grant story that was shared with me was that of Panagis Galiatsatos, MD, MHS, who received a community service grant to start a program educating children in the Baltimore community about lung health. This program was so moving that it inspired one of the Baltimore teachers to pursue a career in medicine and that individual is now a practicing MD.

This is just one example of the Foundation’s impact and it’s through these stories that we share the “why” behind every dollar that is raised, and my first goal is to tell these stories.

Another key focus of not only my presidency, but Dr. Ian Nathanson’s, as well, as we collaborated a lot on our roles, will be on member involvement and awareness. Even I wasn’t involved in the CHEST Foundation until years into my CHEST membership, so I understand that there are competing demands. But I also know that there is a lot to be gained from the work with the Foundation. I want the CHEST members to be excited about the Foundation and to want to support its efforts.

These two goals go hand in hand, and I look forward to sharing the Foundation’s impact with a new audience and reinvigorating the support of our existing donors.

Is there anything else you’d like to say to the reader?

We cannot accomplish anything without the support of our donors, and I want to sincerely thank everyone who has donated to the CHEST Foundation. I also encourage those who have never donated or have yet to donate this year to visit the Foundation’s website (foundation.chestnet.org) and explore some of the inspiring initiatives you can support to strengthen the impact of the CHEST Foundation because the possibilities are truly endless.

As the presidency of the American College of Chest Physicians changes hands in January 2023, so will the role of President of the CHEST Foundation. To get to know the incoming President of the CHEST Foundation, we spoke with Robert (Bob) De Marco, MD, FCCP, about his philanthropy work and his goals for the philanthropic arm of CHEST.

Tell me about your history with philanthropy work.

My philanthropy work started long before the CHEST Foundation. While I’ve been a member of CHEST since my second year of fellowship, it wasn’t until much later that I became involved with the philanthropic side of the organization. Earlier in my career, I was involved more so with the American Cancer Society. I had gotten involved with them by chance – participating in an event of theirs – and was encouraged to get more involved by one of their board members. Being involved with them made a lot of sense seeing as a strong percentage of my patients at the time were being treated for lung cancer. My most notable accomplishments with the American Cancer Society were in serving as the Chairmen of my local Relay for Life program for 10 years, as a board member, and then as a president of my local chapter.



When did you get involved with the CHEST Foundation?

I had served in a handful of positions within CHEST, including Chair of the (since reinvented) Practice Management Committee, so I was deeply involved in the association, and I thought to myself, “I have experience in fundraising through my work with the American Cancer Society, why don’t I use it to help our association?” When I moved to Florida, I no longer had the local connection to the American Cancer Society, so it was an opportune time to transition over to the CHEST Foundation.

How has the Foundation changed in the time that you’ve been involved?

The Foundation has changed drastically since I first joined the Board of Trustees 9 years ago. When I first got involved, the primary goal of the Foundation was staying “out of the red.” At that time, we were an organization that gave away more than we made.

After years of building a corpus to fund our own projects, we’re in a really good place now with some phenomenal goals and some excellent initiatives to fundraise around, including a CHEST diversity initiative, First 5 Minutes™, and Bridging Specialties™: Timely Diagnosis for ILD Patients, which seeks to break down silos within medicine to improve patient care.

What will be a focus of your Foundation presidency?

You know, one thing I always appreciated about the American Cancer Society was that there were always notable accomplishments to point back to when supporting fundraising efforts. You could say, “Did you know that bone marrow transplantation was initially funded by the American Cancer Society?” and other examples that would truly inspire someone to want to get involved in supporting those efforts.

The CHEST Foundation may not have funded bone marrow transplantation, but in 25 years of awarding grants, there are equally good stories to share. The impact of the Foundation is tremendous, and we’ve only just begun to share examples of where grant recipients went with their research or community service projects.

A recent grant story that was shared with me was that of Panagis Galiatsatos, MD, MHS, who received a community service grant to start a program educating children in the Baltimore community about lung health. This program was so moving that it inspired one of the Baltimore teachers to pursue a career in medicine and that individual is now a practicing MD.

This is just one example of the Foundation’s impact and it’s through these stories that we share the “why” behind every dollar that is raised, and my first goal is to tell these stories.

Another key focus of not only my presidency, but Dr. Ian Nathanson’s, as well, as we collaborated a lot on our roles, will be on member involvement and awareness. Even I wasn’t involved in the CHEST Foundation until years into my CHEST membership, so I understand that there are competing demands. But I also know that there is a lot to be gained from the work with the Foundation. I want the CHEST members to be excited about the Foundation and to want to support its efforts.

These two goals go hand in hand, and I look forward to sharing the Foundation’s impact with a new audience and reinvigorating the support of our existing donors.

Is there anything else you’d like to say to the reader?

We cannot accomplish anything without the support of our donors, and I want to sincerely thank everyone who has donated to the CHEST Foundation. I also encourage those who have never donated or have yet to donate this year to visit the Foundation’s website (foundation.chestnet.org) and explore some of the inspiring initiatives you can support to strengthen the impact of the CHEST Foundation because the possibilities are truly endless.

Lung Cancer Section

What is comprehensive biomarker testing and who should order it? For non–small cell lung cancer, comprehensive biomarker testing is generally defined as testing eligible patients for all biomarkers that direct the use of FDA-approved therapies (Mileham KF, et al. Cancer Med. 2022;11[2]:530. What comprises comprehensive testing has changed over time and will likely continue to change as advances in biomarkers, therapies, and indications for their use continue to evolve. There are also some potential benefits to testing biomarkers without FDA-approved therapies, such as assessing eligibility for treatment as part of a clinical trial or for identifying treatment options that gain FDA-approval in the future. As for who should be responsible for biomarker test ordering, this remains unclear and variable between institutions and practices (Fox AH, et al. Chest. 2021;160[6]:2293). All subspecialties involved, including pulmonology, pathology, interventional radiology, surgery, and oncology, have the potential for knowledge gaps surrounding biomarker testing (Gregg JP, et al. Transl Lung Cancer Res. 2019;8[3]:286; Smeltzer MP, et al. J Thorac Oncol. 2020;15[9]:1434). Those obtaining diagnostic tissue, including pulmonologists, surgeons, and interventional radiologists may not appreciate the downstream use of each biomarker but are in the place to order testing as soon as the time of biopsy. Pathologists may be unaware of clinical aspects to the patient’s case, such as the suspected clinical stage of disease. Oncologists arguably have the best chance of having the expertise to order testing but, ideally, biomarker results would be available by the time a patient meets with an oncologist to discuss treatment options. There is no perfect solution to this question at present, but if you are involved with the diagnosis of lung cancer, you should collaborate with your multidisciplinary team to streamline testing and strategize how to best serve patients. 

Adam Fox, MD

Section Fellow-in-Training

Lung Cancer Section

What is comprehensive biomarker testing and who should order it? For non–small cell lung cancer, comprehensive biomarker testing is generally defined as testing eligible patients for all biomarkers that direct the use of FDA-approved therapies (Mileham KF, et al. Cancer Med. 2022;11[2]:530. What comprises comprehensive testing has changed over time and will likely continue to change as advances in biomarkers, therapies, and indications for their use continue to evolve. There are also some potential benefits to testing biomarkers without FDA-approved therapies, such as assessing eligibility for treatment as part of a clinical trial or for identifying treatment options that gain FDA-approval in the future. As for who should be responsible for biomarker test ordering, this remains unclear and variable between institutions and practices (Fox AH, et al. Chest. 2021;160[6]:2293). All subspecialties involved, including pulmonology, pathology, interventional radiology, surgery, and oncology, have the potential for knowledge gaps surrounding biomarker testing (Gregg JP, et al. Transl Lung Cancer Res. 2019;8[3]:286; Smeltzer MP, et al. J Thorac Oncol. 2020;15[9]:1434). Those obtaining diagnostic tissue, including pulmonologists, surgeons, and interventional radiologists may not appreciate the downstream use of each biomarker but are in the place to order testing as soon as the time of biopsy. Pathologists may be unaware of clinical aspects to the patient’s case, such as the suspected clinical stage of disease. Oncologists arguably have the best chance of having the expertise to order testing but, ideally, biomarker results would be available by the time a patient meets with an oncologist to discuss treatment options. There is no perfect solution to this question at present, but if you are involved with the diagnosis of lung cancer, you should collaborate with your multidisciplinary team to streamline testing and strategize how to best serve patients. 

Adam Fox, MD

Section Fellow-in-Training

Lung Cancer Section

What is comprehensive biomarker testing and who should order it? For non–small cell lung cancer, comprehensive biomarker testing is generally defined as testing eligible patients for all biomarkers that direct the use of FDA-approved therapies (Mileham KF, et al. Cancer Med. 2022;11[2]:530. What comprises comprehensive testing has changed over time and will likely continue to change as advances in biomarkers, therapies, and indications for their use continue to evolve. There are also some potential benefits to testing biomarkers without FDA-approved therapies, such as assessing eligibility for treatment as part of a clinical trial or for identifying treatment options that gain FDA-approval in the future. As for who should be responsible for biomarker test ordering, this remains unclear and variable between institutions and practices (Fox AH, et al. Chest. 2021;160[6]:2293). All subspecialties involved, including pulmonology, pathology, interventional radiology, surgery, and oncology, have the potential for knowledge gaps surrounding biomarker testing (Gregg JP, et al. Transl Lung Cancer Res. 2019;8[3]:286; Smeltzer MP, et al. J Thorac Oncol. 2020;15[9]:1434). Those obtaining diagnostic tissue, including pulmonologists, surgeons, and interventional radiologists may not appreciate the downstream use of each biomarker but are in the place to order testing as soon as the time of biopsy. Pathologists may be unaware of clinical aspects to the patient’s case, such as the suspected clinical stage of disease. Oncologists arguably have the best chance of having the expertise to order testing but, ideally, biomarker results would be available by the time a patient meets with an oncologist to discuss treatment options. There is no perfect solution to this question at present, but if you are involved with the diagnosis of lung cancer, you should collaborate with your multidisciplinary team to streamline testing and strategize how to best serve patients. 

Adam Fox, MD

Section Fellow-in-Training

Chest Infections Section

An evolving diagnostic tool: Microbial cell-free DNA

The diagnosis of the microbial etiology of pneumonia remains a significant challenge with <50% yield of blood and sputum cultures in most studies. More reliable samples, like bronchoalveolar lavage, require invasive procedures. Undifferentiated pneumonia hampers antimicrobial stewardship and increases the risk of suboptimal treatment. New diagnostic tools that detect degraded microbial DNA in plasma, known as microbial cell-free DNA (cfDNA), may offer improved diagnostic yield. Through metagenomic next-generation approaches, these tools sequence DNA fragments to identify viral, bacterial, and fungal sequences.

Earlier studies of cfDNA in pneumonia have been mixed, correctly identifying the pathogen in 55% to 86% of cases – though notably cfDNA was superior to PCR and cultures and provided early detection of VAP in some cases (Farnaes L, et al. Diagn Microbiol Infect Dis. 2019;94:188; Langelier C, et al. Am J Respir Crit Care Med. 2020;201:491). However, a recent study of cfDNA in severe complicated pediatric pneumonia had promising results with significant clinical impact. cfDNA provided an accurate microbial diagnosis in 89% of cases, with it being the only positive study in 70% of cases. Further, cfDNA narrowed the antimicrobial regimen in 81% of cases (Dworsky ZD, et al. Hosp Pediatr. 2022;12:377).

The use of cfDNA is still in its infancy. Limitations, such as a lack of validated thresholds to differentiate colonization vs infection are noted given its detection sensitivity. Its utility, including ideal timing and patient population, needs further investigation. However, diagnostic cfDNA may soon provide earlier and less invasive microbial diagnostics in patients with chest infections and beyond.

Gregory Wigger, MD

Section Fellow-in-Training

Chest Infections Section

An evolving diagnostic tool: Microbial cell-free DNA

The diagnosis of the microbial etiology of pneumonia remains a significant challenge with <50% yield of blood and sputum cultures in most studies. More reliable samples, like bronchoalveolar lavage, require invasive procedures. Undifferentiated pneumonia hampers antimicrobial stewardship and increases the risk of suboptimal treatment. New diagnostic tools that detect degraded microbial DNA in plasma, known as microbial cell-free DNA (cfDNA), may offer improved diagnostic yield. Through metagenomic next-generation approaches, these tools sequence DNA fragments to identify viral, bacterial, and fungal sequences.

Earlier studies of cfDNA in pneumonia have been mixed, correctly identifying the pathogen in 55% to 86% of cases – though notably cfDNA was superior to PCR and cultures and provided early detection of VAP in some cases (Farnaes L, et al. Diagn Microbiol Infect Dis. 2019;94:188; Langelier C, et al. Am J Respir Crit Care Med. 2020;201:491). However, a recent study of cfDNA in severe complicated pediatric pneumonia had promising results with significant clinical impact. cfDNA provided an accurate microbial diagnosis in 89% of cases, with it being the only positive study in 70% of cases. Further, cfDNA narrowed the antimicrobial regimen in 81% of cases (Dworsky ZD, et al. Hosp Pediatr. 2022;12:377).

The use of cfDNA is still in its infancy. Limitations, such as a lack of validated thresholds to differentiate colonization vs infection are noted given its detection sensitivity. Its utility, including ideal timing and patient population, needs further investigation. However, diagnostic cfDNA may soon provide earlier and less invasive microbial diagnostics in patients with chest infections and beyond.

Gregory Wigger, MD

Section Fellow-in-Training

Chest Infections Section

An evolving diagnostic tool: Microbial cell-free DNA

The diagnosis of the microbial etiology of pneumonia remains a significant challenge with <50% yield of blood and sputum cultures in most studies. More reliable samples, like bronchoalveolar lavage, require invasive procedures. Undifferentiated pneumonia hampers antimicrobial stewardship and increases the risk of suboptimal treatment. New diagnostic tools that detect degraded microbial DNA in plasma, known as microbial cell-free DNA (cfDNA), may offer improved diagnostic yield. Through metagenomic next-generation approaches, these tools sequence DNA fragments to identify viral, bacterial, and fungal sequences.

Earlier studies of cfDNA in pneumonia have been mixed, correctly identifying the pathogen in 55% to 86% of cases – though notably cfDNA was superior to PCR and cultures and provided early detection of VAP in some cases (Farnaes L, et al. Diagn Microbiol Infect Dis. 2019;94:188; Langelier C, et al. Am J Respir Crit Care Med. 2020;201:491). However, a recent study of cfDNA in severe complicated pediatric pneumonia had promising results with significant clinical impact. cfDNA provided an accurate microbial diagnosis in 89% of cases, with it being the only positive study in 70% of cases. Further, cfDNA narrowed the antimicrobial regimen in 81% of cases (Dworsky ZD, et al. Hosp Pediatr. 2022;12:377).

The use of cfDNA is still in its infancy. Limitations, such as a lack of validated thresholds to differentiate colonization vs infection are noted given its detection sensitivity. Its utility, including ideal timing and patient population, needs further investigation. However, diagnostic cfDNA may soon provide earlier and less invasive microbial diagnostics in patients with chest infections and beyond.

Gregory Wigger, MD

Section Fellow-in-Training

Nonrespiratory Sleep Section

Sleep in cancer patients

Sleep disturbance is among the most common symptoms in patients with cancer with an estimated prevalence of up to two out of three patients experiencing sleep disruption during their cancer journey.^1,2Sleep disruption arises from a variety of preexisting clinical factors and is compounded by adjustment to cancer diagnosis and therapy.^3,4

Insomnia: Cancer patients have at least a two-fold higher incidence of insomnia compared with the general population.^5,6 Predisposing factors may include age, the presence of hyper-arousability,a prior history of insomnia, or a preexisting psychiatric disorder. Cancer-related factors include surgery, hospitalization, chemotherapy, hormonal therapy, radiation therapy, and use of steroids.⁷ If sedative-hypnotics are considered, they should be used in conjunction with cognitive and behavioral therapy for insomnia (CBT-I). Recent meta-analyses provide data to support a strong recommendation to utilize CBT-I to treat insomnia in cancer patients.^6,8,9

Hypersomnolence: Hypersomnolence or excessive daytime sleepiness is a common symptom noted among cancer patients.¹⁰ Hypersomnia related to cancer can be often classified as either hypersomnia due to a medical condition or hypersomnia due to a drug or substance, especially for those patients taking opioid or other sedative medications.

Movement Disorders: Sleep movement disorders occur in patients with cancer and may be primary or attributable to chemotherapy-related neuropathy from therapy regimens, including platinum compounds, taxanes, vinca alkaloids, proteasome inhibitors, or thalidomide-based agents.^11,12

Obstructive sleep apnea (OSA): OSA occurs in patients with cancer and may be increased in patients with specific cancers such as head and neck tumors.¹³ Patients with sleep apnea have a five-fold increased risk of cancer-related mortality, and several studies show an increased incidence of cancer in those with sleep apnea.^14-16There is an increasing realization that not only sleep apnea, but sleep disturbance, in general, may be oncogenic based on increased autonomic tone, chronic stress, variation in the pituitary-hypothalamic axis, as well as circadian mechanisms.¹⁷

Early recognition/treatment of sleep issues is essential to improve quality of life in cancer patients.
 

Diwakar Balachandran, MD, FCCP

Member-at-Large

References

1. Balachandran DD, Miller MA, Faiz SA, Yennurajalingam S, Innominato PF. Evaluation and management of sleep and circadian rhythm disturbance in cancer. Curr Treat Options Oncol. 2021;22(9):81.

2. Yennurajalingam S, Balachandran D, Pedraza Cardozo SL, et al. Patient-reported sleep disturbance in advanced cancer: frequency, predictors and screening performance of the Edmonton Symptom Assessment System sleep item. BMJ Support Palliat Care. 2017;7(3):274-80.

3. Harris B, Ross J, Sanchez-Reilly S. Sleeping in the arms of cancer: A review of sleeping disorders among patients with cancer. Cancer J. 2014;20(5):299-305.

4. Charalambous A, Berger AM, Matthews E, Balachandran DD, Papastavrou E, Palesh O. Cancer-related fatigue and sleep deficiency in cancer care continuum: concepts, assessment, clusters, and management. Support Care Cancer. 2019;27(7):2747-53.

5. Palesh OG, Roscoe JA, Mustian KM, et al. Prevalence, demographics, and psychological associations of sleep disruption in patients with cancer: University of Rochester Cancer Center-Community Clinical Oncology Program. J Clin Oncol. 2010;28(2):292-8.

6. Savard J, Simard S, Blanchet J, Ivers H, Morin CM. Prevalence, clinical characteristics, and risk factors for insomnia in the context of breast cancer. Sleep. 2001;24(5):583-90.

7. Savard J, Morin CM. Insomnia in the context of cancer: a review of a neglected problem. J Clin Oncol. 2001;19(3):895-908.

8. Garland SN, Johnson JA, Savard J, et al. Sleeping well with cancer: a systematic review of cognitive behavioral therapy for insomnia in cancer patients. Neuropsychiatr Dis Treat. 2014;10:1113-24.

9. Johnson JA, Rash JA, Campbell TS, et al. A systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy for insomnia (CBT-I) in cancer survivors. Sleep Med Rev. 2016;27:20-8.

10. Jaumally BA, Das A, Cassell NC, et al. Excessive daytime sleepiness in cancer patients. Sleep Breath. 2021;25(2):1063-7.

11. Gewandter JS, Kleckner AS, Marshall JH, et al. Chemotherapy-induced peripheral neuropathy (CIPN) and its treatment: an NIH Collaboratory study of claims data. Support Care Cancer. 2020;28(6):2553-62.

12. St Germain DC, O’Mara AM, Robinson JL, Torres AD, Minasian LM. Chemotherapy-induced peripheral neuropathy: Identifying the research gaps and associated changes to clinical trial design. Cancer. 2020;126(20):4602-13.

13. Faiz SA, Balachandran D, Hessel AC, et al. Sleep-related breathing disorders in patients with tumors in the head and neck region. Oncologist. 2014;19(11):1200-6.

14. Campos-Rodriguez F, Martinez-Garcia MA, Martinez M, et al. Association between obstructive sleep apnea and cancer incidence in a large multicenter Spanish cohort. Am J Respir Crit Care Med. 2013;187(1):99-105.

15. Martinez-Garcia MA, Campos-Rodriguez F, Duran-Cantolla J, et al. Obstructive sleep apnea is associated with cancer mortality in younger patients. Sleep Med. 2014;15(7):742-8.

16. Martinez-Garcia MA, Campos-Rodriguez F, Barbe F. Cancer and OSA: Current evidence from human studies. Chest. 2016;150(2):451-63.

17. Gozal D, Farre R, Nieto FJ. Putative links between sleep apnea and cancer: From hypotheses to evolving evidence. Chest. 2015;148(5):1140-7.

Nonrespiratory Sleep Section

Sleep in cancer patients

Sleep disturbance is among the most common symptoms in patients with cancer with an estimated prevalence of up to two out of three patients experiencing sleep disruption during their cancer journey.^1,2Sleep disruption arises from a variety of preexisting clinical factors and is compounded by adjustment to cancer diagnosis and therapy.^3,4

Insomnia: Cancer patients have at least a two-fold higher incidence of insomnia compared with the general population.^5,6 Predisposing factors may include age, the presence of hyper-arousability,a prior history of insomnia, or a preexisting psychiatric disorder. Cancer-related factors include surgery, hospitalization, chemotherapy, hormonal therapy, radiation therapy, and use of steroids.⁷ If sedative-hypnotics are considered, they should be used in conjunction with cognitive and behavioral therapy for insomnia (CBT-I). Recent meta-analyses provide data to support a strong recommendation to utilize CBT-I to treat insomnia in cancer patients.^6,8,9

Hypersomnolence: Hypersomnolence or excessive daytime sleepiness is a common symptom noted among cancer patients.¹⁰ Hypersomnia related to cancer can be often classified as either hypersomnia due to a medical condition or hypersomnia due to a drug or substance, especially for those patients taking opioid or other sedative medications.

Movement Disorders: Sleep movement disorders occur in patients with cancer and may be primary or attributable to chemotherapy-related neuropathy from therapy regimens, including platinum compounds, taxanes, vinca alkaloids, proteasome inhibitors, or thalidomide-based agents.^11,12

Obstructive sleep apnea (OSA): OSA occurs in patients with cancer and may be increased in patients with specific cancers such as head and neck tumors.¹³ Patients with sleep apnea have a five-fold increased risk of cancer-related mortality, and several studies show an increased incidence of cancer in those with sleep apnea.^14-16There is an increasing realization that not only sleep apnea, but sleep disturbance, in general, may be oncogenic based on increased autonomic tone, chronic stress, variation in the pituitary-hypothalamic axis, as well as circadian mechanisms.¹⁷

Early recognition/treatment of sleep issues is essential to improve quality of life in cancer patients.
 

Diwakar Balachandran, MD, FCCP

Member-at-Large

References

1. Balachandran DD, Miller MA, Faiz SA, Yennurajalingam S, Innominato PF. Evaluation and management of sleep and circadian rhythm disturbance in cancer. Curr Treat Options Oncol. 2021;22(9):81.

2. Yennurajalingam S, Balachandran D, Pedraza Cardozo SL, et al. Patient-reported sleep disturbance in advanced cancer: frequency, predictors and screening performance of the Edmonton Symptom Assessment System sleep item. BMJ Support Palliat Care. 2017;7(3):274-80.

3. Harris B, Ross J, Sanchez-Reilly S. Sleeping in the arms of cancer: A review of sleeping disorders among patients with cancer. Cancer J. 2014;20(5):299-305.

4. Charalambous A, Berger AM, Matthews E, Balachandran DD, Papastavrou E, Palesh O. Cancer-related fatigue and sleep deficiency in cancer care continuum: concepts, assessment, clusters, and management. Support Care Cancer. 2019;27(7):2747-53.

5. Palesh OG, Roscoe JA, Mustian KM, et al. Prevalence, demographics, and psychological associations of sleep disruption in patients with cancer: University of Rochester Cancer Center-Community Clinical Oncology Program. J Clin Oncol. 2010;28(2):292-8.

6. Savard J, Simard S, Blanchet J, Ivers H, Morin CM. Prevalence, clinical characteristics, and risk factors for insomnia in the context of breast cancer. Sleep. 2001;24(5):583-90.

7. Savard J, Morin CM. Insomnia in the context of cancer: a review of a neglected problem. J Clin Oncol. 2001;19(3):895-908.

8. Garland SN, Johnson JA, Savard J, et al. Sleeping well with cancer: a systematic review of cognitive behavioral therapy for insomnia in cancer patients. Neuropsychiatr Dis Treat. 2014;10:1113-24.

9. Johnson JA, Rash JA, Campbell TS, et al. A systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy for insomnia (CBT-I) in cancer survivors. Sleep Med Rev. 2016;27:20-8.

10. Jaumally BA, Das A, Cassell NC, et al. Excessive daytime sleepiness in cancer patients. Sleep Breath. 2021;25(2):1063-7.

11. Gewandter JS, Kleckner AS, Marshall JH, et al. Chemotherapy-induced peripheral neuropathy (CIPN) and its treatment: an NIH Collaboratory study of claims data. Support Care Cancer. 2020;28(6):2553-62.

12. St Germain DC, O’Mara AM, Robinson JL, Torres AD, Minasian LM. Chemotherapy-induced peripheral neuropathy: Identifying the research gaps and associated changes to clinical trial design. Cancer. 2020;126(20):4602-13.

13. Faiz SA, Balachandran D, Hessel AC, et al. Sleep-related breathing disorders in patients with tumors in the head and neck region. Oncologist. 2014;19(11):1200-6.

14. Campos-Rodriguez F, Martinez-Garcia MA, Martinez M, et al. Association between obstructive sleep apnea and cancer incidence in a large multicenter Spanish cohort. Am J Respir Crit Care Med. 2013;187(1):99-105.

15. Martinez-Garcia MA, Campos-Rodriguez F, Duran-Cantolla J, et al. Obstructive sleep apnea is associated with cancer mortality in younger patients. Sleep Med. 2014;15(7):742-8.

16. Martinez-Garcia MA, Campos-Rodriguez F, Barbe F. Cancer and OSA: Current evidence from human studies. Chest. 2016;150(2):451-63.

17. Gozal D, Farre R, Nieto FJ. Putative links between sleep apnea and cancer: From hypotheses to evolving evidence. Chest. 2015;148(5):1140-7.

Nonrespiratory Sleep Section

Sleep in cancer patients

Sleep disturbance is among the most common symptoms in patients with cancer with an estimated prevalence of up to two out of three patients experiencing sleep disruption during their cancer journey.^1,2Sleep disruption arises from a variety of preexisting clinical factors and is compounded by adjustment to cancer diagnosis and therapy.^3,4

Insomnia: Cancer patients have at least a two-fold higher incidence of insomnia compared with the general population.^5,6 Predisposing factors may include age, the presence of hyper-arousability,a prior history of insomnia, or a preexisting psychiatric disorder. Cancer-related factors include surgery, hospitalization, chemotherapy, hormonal therapy, radiation therapy, and use of steroids.⁷ If sedative-hypnotics are considered, they should be used in conjunction with cognitive and behavioral therapy for insomnia (CBT-I). Recent meta-analyses provide data to support a strong recommendation to utilize CBT-I to treat insomnia in cancer patients.^6,8,9

Hypersomnolence: Hypersomnolence or excessive daytime sleepiness is a common symptom noted among cancer patients.¹⁰ Hypersomnia related to cancer can be often classified as either hypersomnia due to a medical condition or hypersomnia due to a drug or substance, especially for those patients taking opioid or other sedative medications.

Movement Disorders: Sleep movement disorders occur in patients with cancer and may be primary or attributable to chemotherapy-related neuropathy from therapy regimens, including platinum compounds, taxanes, vinca alkaloids, proteasome inhibitors, or thalidomide-based agents.^11,12

Obstructive sleep apnea (OSA): OSA occurs in patients with cancer and may be increased in patients with specific cancers such as head and neck tumors.¹³ Patients with sleep apnea have a five-fold increased risk of cancer-related mortality, and several studies show an increased incidence of cancer in those with sleep apnea.^14-16There is an increasing realization that not only sleep apnea, but sleep disturbance, in general, may be oncogenic based on increased autonomic tone, chronic stress, variation in the pituitary-hypothalamic axis, as well as circadian mechanisms.¹⁷

Early recognition/treatment of sleep issues is essential to improve quality of life in cancer patients.
 

Diwakar Balachandran, MD, FCCP

Member-at-Large

References

1. Balachandran DD, Miller MA, Faiz SA, Yennurajalingam S, Innominato PF. Evaluation and management of sleep and circadian rhythm disturbance in cancer. Curr Treat Options Oncol. 2021;22(9):81.

2. Yennurajalingam S, Balachandran D, Pedraza Cardozo SL, et al. Patient-reported sleep disturbance in advanced cancer: frequency, predictors and screening performance of the Edmonton Symptom Assessment System sleep item. BMJ Support Palliat Care. 2017;7(3):274-80.

3. Harris B, Ross J, Sanchez-Reilly S. Sleeping in the arms of cancer: A review of sleeping disorders among patients with cancer. Cancer J. 2014;20(5):299-305.

4. Charalambous A, Berger AM, Matthews E, Balachandran DD, Papastavrou E, Palesh O. Cancer-related fatigue and sleep deficiency in cancer care continuum: concepts, assessment, clusters, and management. Support Care Cancer. 2019;27(7):2747-53.

5. Palesh OG, Roscoe JA, Mustian KM, et al. Prevalence, demographics, and psychological associations of sleep disruption in patients with cancer: University of Rochester Cancer Center-Community Clinical Oncology Program. J Clin Oncol. 2010;28(2):292-8.

6. Savard J, Simard S, Blanchet J, Ivers H, Morin CM. Prevalence, clinical characteristics, and risk factors for insomnia in the context of breast cancer. Sleep. 2001;24(5):583-90.

7. Savard J, Morin CM. Insomnia in the context of cancer: a review of a neglected problem. J Clin Oncol. 2001;19(3):895-908.

8. Garland SN, Johnson JA, Savard J, et al. Sleeping well with cancer: a systematic review of cognitive behavioral therapy for insomnia in cancer patients. Neuropsychiatr Dis Treat. 2014;10:1113-24.

9. Johnson JA, Rash JA, Campbell TS, et al. A systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy for insomnia (CBT-I) in cancer survivors. Sleep Med Rev. 2016;27:20-8.

10. Jaumally BA, Das A, Cassell NC, et al. Excessive daytime sleepiness in cancer patients. Sleep Breath. 2021;25(2):1063-7.

11. Gewandter JS, Kleckner AS, Marshall JH, et al. Chemotherapy-induced peripheral neuropathy (CIPN) and its treatment: an NIH Collaboratory study of claims data. Support Care Cancer. 2020;28(6):2553-62.

12. St Germain DC, O’Mara AM, Robinson JL, Torres AD, Minasian LM. Chemotherapy-induced peripheral neuropathy: Identifying the research gaps and associated changes to clinical trial design. Cancer. 2020;126(20):4602-13.

13. Faiz SA, Balachandran D, Hessel AC, et al. Sleep-related breathing disorders in patients with tumors in the head and neck region. Oncologist. 2014;19(11):1200-6.

14. Campos-Rodriguez F, Martinez-Garcia MA, Martinez M, et al. Association between obstructive sleep apnea and cancer incidence in a large multicenter Spanish cohort. Am J Respir Crit Care Med. 2013;187(1):99-105.

15. Martinez-Garcia MA, Campos-Rodriguez F, Duran-Cantolla J, et al. Obstructive sleep apnea is associated with cancer mortality in younger patients. Sleep Med. 2014;15(7):742-8.

16. Martinez-Garcia MA, Campos-Rodriguez F, Barbe F. Cancer and OSA: Current evidence from human studies. Chest. 2016;150(2):451-63.

17. Gozal D, Farre R, Nieto FJ. Putative links between sleep apnea and cancer: From hypotheses to evolving evidence. Chest. 2015;148(5):1140-7.

Starting January 1, 2023, current President-Elect Doreen J. Addrizzo-Harris, MD, FCCP, will become the new President of the American College of Chest Physicians. Dr. Addrizzo-Harris is a pulmonary/critical care physician with an extensive background in bronchiectasis and nontuberculous mycobacterial infection and medical education working as a Professor of Medicine at the NYU Grossman School of Medicine.

Before she steps into the role of President, we spoke with Dr. Addrizzo-Harris for a glimpse into what she looks to bring to the CHEST organization.

What would you like to accomplish as President of CHEST?

For my presidency, I want to continue the great trajectory CHEST is on by focusing on increasing membership, expanding our educational offerings and advancing our communication strategies, and continuing the initiatives that strive to make diversity seamless and a part of everything we do.

As many know, I have a very strong passion for the work of the CHEST Foundation, and, throughout my presidency, I will focus on how CHEST can support and integrate with the Foundation’s goal of improving patient care – whether it’s through supporting clinical research grants, expanding patient education and advocacy events, or through funding programs like the First 5 Minutes™, which touches on strengthening the rapport and trust between clinician and patient and enhances cultural competency by building an understanding of barriers to care. I can also see increasing patient involvement in CHEST to lend a unique perspective to upcoming initiatives.

Another key focus will be to strengthen and expand our membership through many venues.

We will focus on increasing physician membership of both new members and lapsed members but will also focus on increasing membership of those other providers who help us care for our patients, including advanced practice providers, respiratory therapists and more. CHEST is already an inclusive organization to a variety of health care providers, but we can do more.

My presidency will also focus on increasing collaborations with our sister societies to find new ways to reach fellows-in-training, as well as residents and medical students who are interested in pulmonary, critical care, or sleep medicine.

Along those lines, I’m also planning a dedicated focus on providing more opportunities to fellows and early career members. The goal is to enhance communications between trainees and key thought-leaders in a way that is simple, seamless, and welcoming. CHEST already does this better than anyone else, but an expanded offering, particularly in the area of career development, can help reach even more individuals – both on a national and on an international level. One such event was our successful Young Professionals Event at the Belmont event in New York City this past June.
 

What do you consider to be the greatest strength of CHEST, and how will you build upon this during your presidency?

CHEST has many strengths, but I think our greatest is the strength of our team – our members, our faculty, our volunteer leaders, and our staff.

To build on this, my presidency will include a strong communications strategy to reach, educate, and share the variety of opportunities with our members. I want to build on some of the excellent initiatives Dr. David Schulman started this year to continue engaging and showing our newer members, or soon-to-be members how to get involved with CHEST.
 

What are some challenges facing CHEST, and how will you address these challenges?

A challenge for all associations, CHEST included, will be redefining what associations look like in the wake of a global pandemic now that virtual and hybrid learning has become a part of what we do on a day-to-day basis. What will the CHEST Annual Meeting look like 3 years from now? What will keep learners coming to a physical meeting when so much is accessible on the internet? What will keep members engaged in settings where we no longer get together in-person – like the board review that is now virtual?

This all will take a lot of strategy, which is already being worked on. It will include ideas like enhancing the networking opportunities to extend beyond the annual meeting, strengthening our international strategy, and continuing to innovate in the area of medical education.
 

And finally, what do you ask of the members and Fellows of CHEST to support you during your presidency?

I ask that everyone get involved. Please reach out if you have questions. I am (and all our leaders are) very accessible and we can connect you with the right people to get you engaged. Also, please spread the word. Tell your colleagues, trainees, etc., how great CHEST is and get them involved with CHEST too. We have so much to offer.#

Starting January 1, 2023, current President-Elect Doreen J. Addrizzo-Harris, MD, FCCP, will become the new President of the American College of Chest Physicians. Dr. Addrizzo-Harris is a pulmonary/critical care physician with an extensive background in bronchiectasis and nontuberculous mycobacterial infection and medical education working as a Professor of Medicine at the NYU Grossman School of Medicine.

Before she steps into the role of President, we spoke with Dr. Addrizzo-Harris for a glimpse into what she looks to bring to the CHEST organization.

What would you like to accomplish as President of CHEST?

For my presidency, I want to continue the great trajectory CHEST is on by focusing on increasing membership, expanding our educational offerings and advancing our communication strategies, and continuing the initiatives that strive to make diversity seamless and a part of everything we do.

As many know, I have a very strong passion for the work of the CHEST Foundation, and, throughout my presidency, I will focus on how CHEST can support and integrate with the Foundation’s goal of improving patient care – whether it’s through supporting clinical research grants, expanding patient education and advocacy events, or through funding programs like the First 5 Minutes™, which touches on strengthening the rapport and trust between clinician and patient and enhances cultural competency by building an understanding of barriers to care. I can also see increasing patient involvement in CHEST to lend a unique perspective to upcoming initiatives.

Another key focus will be to strengthen and expand our membership through many venues.

We will focus on increasing physician membership of both new members and lapsed members but will also focus on increasing membership of those other providers who help us care for our patients, including advanced practice providers, respiratory therapists and more. CHEST is already an inclusive organization to a variety of health care providers, but we can do more.

My presidency will also focus on increasing collaborations with our sister societies to find new ways to reach fellows-in-training, as well as residents and medical students who are interested in pulmonary, critical care, or sleep medicine.

Along those lines, I’m also planning a dedicated focus on providing more opportunities to fellows and early career members. The goal is to enhance communications between trainees and key thought-leaders in a way that is simple, seamless, and welcoming. CHEST already does this better than anyone else, but an expanded offering, particularly in the area of career development, can help reach even more individuals – both on a national and on an international level. One such event was our successful Young Professionals Event at the Belmont event in New York City this past June.
 

What do you consider to be the greatest strength of CHEST, and how will you build upon this during your presidency?

CHEST has many strengths, but I think our greatest is the strength of our team – our members, our faculty, our volunteer leaders, and our staff.

To build on this, my presidency will include a strong communications strategy to reach, educate, and share the variety of opportunities with our members. I want to build on some of the excellent initiatives Dr. David Schulman started this year to continue engaging and showing our newer members, or soon-to-be members how to get involved with CHEST.
 

What are some challenges facing CHEST, and how will you address these challenges?

A challenge for all associations, CHEST included, will be redefining what associations look like in the wake of a global pandemic now that virtual and hybrid learning has become a part of what we do on a day-to-day basis. What will the CHEST Annual Meeting look like 3 years from now? What will keep learners coming to a physical meeting when so much is accessible on the internet? What will keep members engaged in settings where we no longer get together in-person – like the board review that is now virtual?

This all will take a lot of strategy, which is already being worked on. It will include ideas like enhancing the networking opportunities to extend beyond the annual meeting, strengthening our international strategy, and continuing to innovate in the area of medical education.
 

And finally, what do you ask of the members and Fellows of CHEST to support you during your presidency?

I ask that everyone get involved. Please reach out if you have questions. I am (and all our leaders are) very accessible and we can connect you with the right people to get you engaged. Also, please spread the word. Tell your colleagues, trainees, etc., how great CHEST is and get them involved with CHEST too. We have so much to offer.#

Starting January 1, 2023, current President-Elect Doreen J. Addrizzo-Harris, MD, FCCP, will become the new President of the American College of Chest Physicians. Dr. Addrizzo-Harris is a pulmonary/critical care physician with an extensive background in bronchiectasis and nontuberculous mycobacterial infection and medical education working as a Professor of Medicine at the NYU Grossman School of Medicine.

Before she steps into the role of President, we spoke with Dr. Addrizzo-Harris for a glimpse into what she looks to bring to the CHEST organization.

What would you like to accomplish as President of CHEST?

For my presidency, I want to continue the great trajectory CHEST is on by focusing on increasing membership, expanding our educational offerings and advancing our communication strategies, and continuing the initiatives that strive to make diversity seamless and a part of everything we do.

As many know, I have a very strong passion for the work of the CHEST Foundation, and, throughout my presidency, I will focus on how CHEST can support and integrate with the Foundation’s goal of improving patient care – whether it’s through supporting clinical research grants, expanding patient education and advocacy events, or through funding programs like the First 5 Minutes™, which touches on strengthening the rapport and trust between clinician and patient and enhances cultural competency by building an understanding of barriers to care. I can also see increasing patient involvement in CHEST to lend a unique perspective to upcoming initiatives.

Another key focus will be to strengthen and expand our membership through many venues.

We will focus on increasing physician membership of both new members and lapsed members but will also focus on increasing membership of those other providers who help us care for our patients, including advanced practice providers, respiratory therapists and more. CHEST is already an inclusive organization to a variety of health care providers, but we can do more.

My presidency will also focus on increasing collaborations with our sister societies to find new ways to reach fellows-in-training, as well as residents and medical students who are interested in pulmonary, critical care, or sleep medicine.

Along those lines, I’m also planning a dedicated focus on providing more opportunities to fellows and early career members. The goal is to enhance communications between trainees and key thought-leaders in a way that is simple, seamless, and welcoming. CHEST already does this better than anyone else, but an expanded offering, particularly in the area of career development, can help reach even more individuals – both on a national and on an international level. One such event was our successful Young Professionals Event at the Belmont event in New York City this past June.
 

What do you consider to be the greatest strength of CHEST, and how will you build upon this during your presidency?

CHEST has many strengths, but I think our greatest is the strength of our team – our members, our faculty, our volunteer leaders, and our staff.

To build on this, my presidency will include a strong communications strategy to reach, educate, and share the variety of opportunities with our members. I want to build on some of the excellent initiatives Dr. David Schulman started this year to continue engaging and showing our newer members, or soon-to-be members how to get involved with CHEST.
 

What are some challenges facing CHEST, and how will you address these challenges?

A challenge for all associations, CHEST included, will be redefining what associations look like in the wake of a global pandemic now that virtual and hybrid learning has become a part of what we do on a day-to-day basis. What will the CHEST Annual Meeting look like 3 years from now? What will keep learners coming to a physical meeting when so much is accessible on the internet? What will keep members engaged in settings where we no longer get together in-person – like the board review that is now virtual?

This all will take a lot of strategy, which is already being worked on. It will include ideas like enhancing the networking opportunities to extend beyond the annual meeting, strengthening our international strategy, and continuing to innovate in the area of medical education.
 

And finally, what do you ask of the members and Fellows of CHEST to support you during your presidency?

I ask that everyone get involved. Please reach out if you have questions. I am (and all our leaders are) very accessible and we can connect you with the right people to get you engaged. Also, please spread the word. Tell your colleagues, trainees, etc., how great CHEST is and get them involved with CHEST too. We have so much to offer.#

Absence does make the heart grow fonder. Three years have passed since our last in person CHEST Challenge Championship.

It was CHEST 2019 New Orleans when we last saw the enthusiasm and camaraderie of talented fellow teams cheered on by that irreplaceable, engaged audience, creating moments and memories through that magical combination of education and entertainment (“edutainment”). We were blissfully ignorant then to the terrible challenges that would soon come with the pandemic.

Since its inception, now 21 years ago, the live CHEST Challenge Championship has become a highly anticipated capstone event at the annual scientific meeting.

Courtesy CHEST

Fellows from across the country first compete in a challenging, secure online knowledge quiz from which top-performing programs are selected as finalists.

All along the way, the participants engage in social media challenges that build excitement and collegiality (see tweeted image above). A recent commentary in the CHEST^® journal highlighted the competition’s important milestones,¹ and organizers continue to innovate year after year.

Dr. William Kelly, creator of CHEST Challenge, noted, “Our 20th anniversary broadcast during CHEST 2021 was our most innovative, had the most generous prizes, and the largest, most interactive audience to date. Our team of amazing committee members, CHEST staff, and contributors are somehow going even bigger this year! When combining never-before-seen challenges, surprises, giveaways, and a special ‘opening act’ with the joy and energy of all of us being back together again in person – I just can’t wait.

“That necessary pivot to online-only events in 2020 and 2021 brought new challenges to the game but also provided lessons to be learned, inspired reflection, and gave us opportunities to interact, play, and learn together in new ways.

“As chair of the Training and Transitions Committee, I recall the innovations: CHEST Challenge has always been about innovation in medical education.

“Two decades of history allowed pushing the boundaries into the online arena, allowing competitors to play from their own institutions, audience to join from home, and the camaraderie and support characteristics of the CHEST community to transcend virtual barriers.

“Using advanced, remote video recordings with virtual proctoring by judges, we were able to offer more extensive skills challenges. Highly engaged online audiences had contagious and hilarious chat room banter. And, virtual watch parties allowed for greatly increased viewership. Leveraging social media, the audience became part of the competition, including winning substantial prizes for themselves.

“It takes an extraordinary number of dedicated individuals to deliver the experience.”

Dr. Matthew Miles, past chair of T&T Committee, comments: “One of the joys of working on CHEST Challenge is just being part of the production team. We have brilliant faculty who specialize in cutting-edge education, visionaries who concoct new and imaginative ways for fellows to compete, and incredible CHEST staff who somehow pull off an amazing event every year.

Courtesy CHEST

“I’m so thankful for the way that our CHEST community celebrates learning and prioritizes our fellows-in-training,” he added.

“Years after each in-person championship, the attendees still comment on the electrifying atmosphere they thoroughly enjoyed.

“It is literally a nail-biter – you can see people in the audience sitting at the edge of their seats, holding their breath while teams play to win big in surprise hands-on simulation-based challenges during the Championship,” says Dr. Subani Chandra, who helped implement surprise simulation challenges into the live CHEST Challenge Championship in 2017 that are now an integral part of the experience.

On October 18, at CHEST 2022, championship fellow teams from New York Presbyterian Brooklyn Methodist, Mayo Clinic, and Brooke Army Medical Center, cheered on live by all of us, will compete in order to hoist the Rosen Cup and be declared the CHEST Challenge Champions!

Come experience for yourself the rapid-fire pulmonary, critical care, and sleep medicine knowledge review, the thrill of competition, and see the energy of some of our best and brightest fellows.

Being together in person again to support and learn with each other will be a big win for all of us.

CHEST Challenge is sponsored by VIATRIS

Reference

1. Danckers M, et al. CHEST Challenge turns twenty. Chest. 2022;161(3):860.

Absence does make the heart grow fonder. Three years have passed since our last in person CHEST Challenge Championship.

It was CHEST 2019 New Orleans when we last saw the enthusiasm and camaraderie of talented fellow teams cheered on by that irreplaceable, engaged audience, creating moments and memories through that magical combination of education and entertainment (“edutainment”). We were blissfully ignorant then to the terrible challenges that would soon come with the pandemic.

Since its inception, now 21 years ago, the live CHEST Challenge Championship has become a highly anticipated capstone event at the annual scientific meeting.

Courtesy CHEST

Fellows from across the country first compete in a challenging, secure online knowledge quiz from which top-performing programs are selected as finalists.

All along the way, the participants engage in social media challenges that build excitement and collegiality (see tweeted image above). A recent commentary in the CHEST^® journal highlighted the competition’s important milestones,¹ and organizers continue to innovate year after year.

Dr. William Kelly, creator of CHEST Challenge, noted, “Our 20th anniversary broadcast during CHEST 2021 was our most innovative, had the most generous prizes, and the largest, most interactive audience to date. Our team of amazing committee members, CHEST staff, and contributors are somehow going even bigger this year! When combining never-before-seen challenges, surprises, giveaways, and a special ‘opening act’ with the joy and energy of all of us being back together again in person – I just can’t wait.

“That necessary pivot to online-only events in 2020 and 2021 brought new challenges to the game but also provided lessons to be learned, inspired reflection, and gave us opportunities to interact, play, and learn together in new ways.

“As chair of the Training and Transitions Committee, I recall the innovations: CHEST Challenge has always been about innovation in medical education.

“Two decades of history allowed pushing the boundaries into the online arena, allowing competitors to play from their own institutions, audience to join from home, and the camaraderie and support characteristics of the CHEST community to transcend virtual barriers.

“Using advanced, remote video recordings with virtual proctoring by judges, we were able to offer more extensive skills challenges. Highly engaged online audiences had contagious and hilarious chat room banter. And, virtual watch parties allowed for greatly increased viewership. Leveraging social media, the audience became part of the competition, including winning substantial prizes for themselves.

“It takes an extraordinary number of dedicated individuals to deliver the experience.”

Dr. Matthew Miles, past chair of T&T Committee, comments: “One of the joys of working on CHEST Challenge is just being part of the production team. We have brilliant faculty who specialize in cutting-edge education, visionaries who concoct new and imaginative ways for fellows to compete, and incredible CHEST staff who somehow pull off an amazing event every year.

Courtesy CHEST

“I’m so thankful for the way that our CHEST community celebrates learning and prioritizes our fellows-in-training,” he added.

“Years after each in-person championship, the attendees still comment on the electrifying atmosphere they thoroughly enjoyed.

“It is literally a nail-biter – you can see people in the audience sitting at the edge of their seats, holding their breath while teams play to win big in surprise hands-on simulation-based challenges during the Championship,” says Dr. Subani Chandra, who helped implement surprise simulation challenges into the live CHEST Challenge Championship in 2017 that are now an integral part of the experience.

On October 18, at CHEST 2022, championship fellow teams from New York Presbyterian Brooklyn Methodist, Mayo Clinic, and Brooke Army Medical Center, cheered on live by all of us, will compete in order to hoist the Rosen Cup and be declared the CHEST Challenge Champions!

Come experience for yourself the rapid-fire pulmonary, critical care, and sleep medicine knowledge review, the thrill of competition, and see the energy of some of our best and brightest fellows.

Being together in person again to support and learn with each other will be a big win for all of us.

CHEST Challenge is sponsored by VIATRIS

Reference

1. Danckers M, et al. CHEST Challenge turns twenty. Chest. 2022;161(3):860.

Absence does make the heart grow fonder. Three years have passed since our last in person CHEST Challenge Championship.

It was CHEST 2019 New Orleans when we last saw the enthusiasm and camaraderie of talented fellow teams cheered on by that irreplaceable, engaged audience, creating moments and memories through that magical combination of education and entertainment (“edutainment”). We were blissfully ignorant then to the terrible challenges that would soon come with the pandemic.

Since its inception, now 21 years ago, the live CHEST Challenge Championship has become a highly anticipated capstone event at the annual scientific meeting.

Courtesy CHEST

Fellows from across the country first compete in a challenging, secure online knowledge quiz from which top-performing programs are selected as finalists.

All along the way, the participants engage in social media challenges that build excitement and collegiality (see tweeted image above). A recent commentary in the CHEST^® journal highlighted the competition’s important milestones,¹ and organizers continue to innovate year after year.

Dr. William Kelly, creator of CHEST Challenge, noted, “Our 20th anniversary broadcast during CHEST 2021 was our most innovative, had the most generous prizes, and the largest, most interactive audience to date. Our team of amazing committee members, CHEST staff, and contributors are somehow going even bigger this year! When combining never-before-seen challenges, surprises, giveaways, and a special ‘opening act’ with the joy and energy of all of us being back together again in person – I just can’t wait.

“That necessary pivot to online-only events in 2020 and 2021 brought new challenges to the game but also provided lessons to be learned, inspired reflection, and gave us opportunities to interact, play, and learn together in new ways.

“As chair of the Training and Transitions Committee, I recall the innovations: CHEST Challenge has always been about innovation in medical education.

“Two decades of history allowed pushing the boundaries into the online arena, allowing competitors to play from their own institutions, audience to join from home, and the camaraderie and support characteristics of the CHEST community to transcend virtual barriers.

“Using advanced, remote video recordings with virtual proctoring by judges, we were able to offer more extensive skills challenges. Highly engaged online audiences had contagious and hilarious chat room banter. And, virtual watch parties allowed for greatly increased viewership. Leveraging social media, the audience became part of the competition, including winning substantial prizes for themselves.

“It takes an extraordinary number of dedicated individuals to deliver the experience.”

Dr. Matthew Miles, past chair of T&T Committee, comments: “One of the joys of working on CHEST Challenge is just being part of the production team. We have brilliant faculty who specialize in cutting-edge education, visionaries who concoct new and imaginative ways for fellows to compete, and incredible CHEST staff who somehow pull off an amazing event every year.

Courtesy CHEST

“I’m so thankful for the way that our CHEST community celebrates learning and prioritizes our fellows-in-training,” he added.

“Years after each in-person championship, the attendees still comment on the electrifying atmosphere they thoroughly enjoyed.

“It is literally a nail-biter – you can see people in the audience sitting at the edge of their seats, holding their breath while teams play to win big in surprise hands-on simulation-based challenges during the Championship,” says Dr. Subani Chandra, who helped implement surprise simulation challenges into the live CHEST Challenge Championship in 2017 that are now an integral part of the experience.

On October 18, at CHEST 2022, championship fellow teams from New York Presbyterian Brooklyn Methodist, Mayo Clinic, and Brooke Army Medical Center, cheered on live by all of us, will compete in order to hoist the Rosen Cup and be declared the CHEST Challenge Champions!

Come experience for yourself the rapid-fire pulmonary, critical care, and sleep medicine knowledge review, the thrill of competition, and see the energy of some of our best and brightest fellows.

Being together in person again to support and learn with each other will be a big win for all of us.

CHEST Challenge is sponsored by VIATRIS

Reference

1. Danckers M, et al. CHEST Challenge turns twenty. Chest. 2022;161(3):860.