In the last 2 years, due to the widespread popularity of multi-row spiral CT, especially the so-called low-dose spiral CT census work, patients with small lung nodule CT report in hand to my specialist clinic health enthusiasts are more and more, 4 weeks ago, my each specialist clinic to see only 10 patients, and then found that my number actually appeared in the scalper ticket situation, so last month started my clinic unlimited number, 4 weeks I have been unable to cope with the situation! Therefore, from last week onwards there is still a limit to change to 30 full. (There is no time for that. I’ll continue this conversation when I have time—) But still, out-of-town friends continue to show up needing extra numbers, and last week I saw #55! At the same time through the network, especially consulting me about the small pulmonary nodules of friends are also obvious diagnosis, my personal website clicked to 600,000 times, say these are not indicating that the small pulmonary nodules really more? From my two-year clinic observation, the absolute value of the increase in small pulmonary nodules does not necessarily rise, however, because our vigilance is high, know that more routine physical examination; our detection means advanced, a lot of local lung cancer screening to CT instead of conventional fluoroscopy and chest X-ray; some of our units on the recognition of small pulmonary nodules fuzzy, as long as there is an increase in density in the lungs, the report on the small pulmonary nodules or pulmonary nodules or glassy nodules The whole society puts too much pressure on the doctors, the original thought that there is no active lesion of the lesion, fear that in the future in the vicinity of a malignant lesion, and then come to be used as the handle of doctor-patient disputes, so also reported pulmonary nodules; air pollution and other environmental changes make the occurrence of pulmonary nodules is also more; living conditions are better, and the contact with pets closely, a variety of parasitic infections more often; the abuse of drugs, and the situation of the more. For example, people think that the work of a doctor is simple, as if anyone can become a doctor by reading a brief introduction on the Internet, and casually go to the pharmacy to buy drugs to eat; the use of immunosuppressive drugs has increased, and there are more transplant patients or AIDS patients who have a low level of immunity and are prone to opportunistic infections; some infectious diseases, such as tuberculosis, are still not controlled effectively enough, and treatment and isolation have not been put in place. And so on, many reasons why we feel that there are small lung nodules everywhere. (To be continued) All of these small lung nodules, especially the 3CM or less, are found by physical examination, or in the emergence of other symptoms to do the examination is accidentally found, because the lung nodule is very small generally does not produce symptoms, to produce symptoms, perhaps it grows close to the site of the blood vessels and nerves, or perhaps the degree of malignancy is high, the progress of fast, to the surrounding institutions to produce infiltration or extrusion, at this time will produce the symptom we can feel, and of course, the pain sensitivity of each person. Related to each person’s sensitivity to pain, daily work, we found that the mass in the lungs to 5cm, the patient also did not feel because it grows in the area, the space is large, and only produces nudging to the surrounding structures. Or biased benign biological behavior. It is because small lung nodules are generally asymptomatic and often incidentally detected that health managers have come up with so-called screening or routine physical examinations to try to be able to detect them relatively early, follow up and observe them, and treat them as early as possible to improve quality of life. So as China’s economy grows, people are in a position to do routine checkups. 30 years ago. Thirty years ago, we simply did not have the economic conditions or the sophisticated technology of computerized imaging that we have now, so we have seen an increase in the frequency of news about who has small pulmonary nodules in recent years, as if PM2,5 had suddenly arrived. In this way there are many reasons why there is so much concern about small lung nodules today. Lung nodules are detected! What to do? Previously, I also told you how to face in the article, but many global Chinese friends still have a lot of questions I need to come to a targeted answer, many friends do not know that I am a diagnostic imaging professional doctor, so many friends do not provide detailed image information to me to answer a lot of questions, this is unscientific, so the answer to the question is not scientific, because the performance of the CT image from the eye Because the performance on the CT image, from the eyes to the brain thinking and then through the text description to reach the media will have a link on the error, and each doctor to the same performance of the observation level is not the same, so I only believe in my own eyes to observe things, this so-called, seeing is believing! Why do you trust your eyes so much? Because the performance on a CT image is directly related to the technique used to form the image, and we cannot recognize the nature of the image without examining how the image was created. You must ask, what is the essence of what the CT image is meant to reflect? It is the general pathologic anatomy of the disease, that is to say, the appearance of the defective part that we can see with the naked eye, or the shape of the specimen that is taken down from the surgical operation with the naked eye. If you do not pay attention to the technical conditions of the scan, it will not truly reflect the essence of the disease. Then the doctor will misdiagnose the disease. In our postgraduate studies, we are studying what kind of technical conditions show the pathological essence of different diseases, from which we can find out certain manifestations with certain specificity, and then compare the similarities and differences of their manifestations with the morphology of pathological specimens in a similar perspective, so as to improve the diagnostic level. Most units do not pay attention to these basic research work, is to read books to cope with the daily work, so it is inevitable to recognize the bias. Of course, to do these studies, first of all, we need to have research conditions, but also have an academic atmosphere, in fact, very boring, very laborious, good energy, but it can really improve our analytical ability. It is because of these research foundations of the Department of Radiology of Zhongshan Hospital, Fudan University, that many scholars have been attracted to further their studies here over the past 70 years. So, usually when we are consulting, the most common question we ask is, where was the examination done? This is to assess the credibility of the information you give me, and we peers know what hospitals and what conditions. Others say, can you write an opinion on the chart card, sometimes we find it so difficult because your CT information does not meet our requirements, I have questions about what is on the image, how can I write it? Sometimes I do, but I have a statement that says to our own hospital physicians, “Outside information, for our clinicians only!” This is to tell the doctors in our hospital that the information is not necessarily reliable. If you really can’t look at it, we suggest that you review it with us. Of course, now Zhongshan Hospital’s imaging examination, more than 1,200 people a day, such a large workload, sometimes it is inevitable to individualize the operation, because individualized operation to take up time, the flow of the operation is imperative. Sometimes we have regrets about our own examinations. Unlike 20 years ago when 100 people were examined every day, we still think it’s hard to be busy anymore. In my consultation room, I ask the second most is the patient’s medical history, that is, the history of the onset of the disease, this is very important, this is the basic skills as a doctor, is the need for verbal communication skills, ask the level will interfere with the diagnostic thinking (honestly, doctors are not really anyone can be!). The most important thing is to ask the doctor what is the problem and what is the best way to solve it. Our lungs, through the bronchial tubes, trachea, larynx, mouth and nose and the outside world is connected, in the course of a person’s life, the external environmental stimuli through these pipes on the lungs will be injured in the injury parts of the “memory”, the diagnosis of the cause of the injury process, and the judge is very similar to the case; a process of injury is just like a movie, do not produce! The patient’s discomfort will not go to the hospital to check, will not be recorded on the film, once the discomfort, we call the emergence of symptoms, before it is possible to go to the hospital, before it is possible to do X-ray examination, so we see from the film, just a fragment of the movie, equivalent to the reality of the movie in the advertisement photographs, the process of asking for a history of the disease is to try to link up the film footage to restore the “movie or a disease”. The process of taking a medical history is an attempt to link the movie clips together and to restore the real onset of the “movie or disease”. Each person’s “movie” story, i.e., the disease process, is different, but the performance recorded on film through CT and other diagnostic imaging technologies is sometimes similar; or the movie story (history) is the same, but the performance recorded on the CT image is different. This is what we call “different images for the same disease” or “different diseases for the same image”. This is a situation that requires the judgment of a clinician with clinical experience (written on May 1, to be continued), which is something that cannot be solved by internet users who want to study lung nodules for a few days through the internet. Even clinicians will have the same difficulty, because they read the film lacks the technical background of radiologists, many times will be misdiagnosed. What else do my friends need to know about small lung nodules? You can leave me a comment and then I will continue to do some explanations for your reference.