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Emerging treatments require appropriate CT targeting of a selected lobe or lobes and target airways to obtain a successful response. CT scan is used in pretreatment planning to select patients and plan treatment strategy and posttreatment to confirm correct deployment of devices and assess treatment response. Increasingly treatments are being developed to treat patients who have emphysema who require accurate quantitation of extent and distribution of the process. Functional assessment can be made by inference of detailed anatomic correlates and by direct measurement of regional function using dynamic scan protocols. This article summarizes the current role of imaging in the assessment of patients who have emphysema.

Our purpose was to determine if a home-based faculty radiologist equipped with a high-resolution workstation could add new information to residents' readings on overnight computed chest images that was equivalent to the new information generated by faculty reviewers inside the hospital. Teleconferencing software was installed on home workstations for online supervision of residents by faculty on chest images from a cardiothoracic intensive care unit. Critical observations that could affect patient care were recorded by first-year radiology residents before and after teleconferencing with the home-based radiologist. The amount of information added was compared with that which was added on the same 50 images through direct consultations with faculty inside the medical center. The amount of critical information that was added by teleconferencing with a chest radiologist at home was equivalent statistically to the information added through direct supervision of residents by faculty inside the hospital. Teleconferencing resulted in 149 changes in critical image findings as reported initially by the residents, out of 800 possible findings on 50 chest images, as opposed to 142 changes in residents' readings by faculty inside the medical center. Faculty subspecialists can supervise radiology residents effectively from their homes after hours, using high-resolution workstations and special teleconferencing software.