I first began to hear about high-resolution CT toward the end of my radiology residency in 1991. I was new to radiology, and so was high-resolution CT. In a way, that newness leveled the playing field between residents and faculty; none of us were very sure what we were looking at. I remember seeing new high-resolution CT images and scouring the literature to figure out what we were seeing. When it was my turn to present at our weekly Friday morning CT conference, I spent the entire hour presenting only high-resolution CT cases to our group of thoracic and abdominal CT radiologists and residents. Many squinted their eyes to see what was being described. As a thoracic radiology fellow, I remember trying to figure out what was a normal finding on high-resolution CT and what was not.
Now, a decade later, high-resolution CT continues to be an area of great interest to me, and sometimes a source of considerable frustration. As I have matured as a thoracic radiologist, so has the use of high-resolution CT. It is part of my daily clinical work and research. My collaborations with my pulmonary medicine and thoracic surgery colleagues in a specialized center of research for interstitial lung disease, with our lung transplantation program and lung volume reduction surgery, continue to raise questions about what high-resolution CT can tell us about diffuse lung disease, and what more we need to know to accurately diagnose and predict response to therapy and survival in patients with diffuse lung disease. For many patients, their disease will be the cause of their mortality, and both the disease and the therapy itself, the source of morbidity.