Society News

As the Vascular Annual Meeting approaches, we hope you are gearing up for a great few days of vascular programming, networking, receptions and fun! We invite you to share meeting details with your peers and colleagues on social media to generate excitement and increase attendance. To help you do this, we've put together a social media kit with directions, example posts and images you may use to spread the word about VAM. Start posting with directions listed here.

As the Vascular Annual Meeting approaches, we hope you are gearing up for a great few days of vascular programming, networking, receptions and fun! We invite you to share meeting details with your peers and colleagues on social media to generate excitement and increase attendance. To help you do this, we've put together a social media kit with directions, example posts and images you may use to spread the word about VAM. Start posting with directions listed here.

As the Vascular Annual Meeting approaches, we hope you are gearing up for a great few days of vascular programming, networking, receptions and fun! We invite you to share meeting details with your peers and colleagues on social media to generate excitement and increase attendance. To help you do this, we've put together a social media kit with directions, example posts and images you may use to spread the word about VAM. Start posting with directions listed here.

A community has opened specifically for our PA Section members on SVSConnect. This community is meant to provide a private space for vascular PAs to engage and collaborate with one another. Members will be able to have in depth discussions surrounding important issues including case complications and surgical procedures, research projects, wellness topics and much more. If you haven’t logged into SVSConnect yet, what are you waiting for? All you need are your SVS log in credentials to get started. Email [email protected] or call 312-334-2300 with questions. Sign in here.

A community has opened specifically for our PA Section members on SVSConnect. This community is meant to provide a private space for vascular PAs to engage and collaborate with one another. Members will be able to have in depth discussions surrounding important issues including case complications and surgical procedures, research projects, wellness topics and much more. If you haven’t logged into SVSConnect yet, what are you waiting for? All you need are your SVS log in credentials to get started. Email [email protected] or call 312-334-2300 with questions. Sign in here.

A community has opened specifically for our PA Section members on SVSConnect. This community is meant to provide a private space for vascular PAs to engage and collaborate with one another. Members will be able to have in depth discussions surrounding important issues including case complications and surgical procedures, research projects, wellness topics and much more. If you haven’t logged into SVSConnect yet, what are you waiting for? All you need are your SVS log in credentials to get started. Email [email protected] or call 312-334-2300 with questions. Sign in here.

Requirements for starting a vascular surgery training program have been lightened – you no longer need to have a general surgery residency at your institution and faculty requirements are in review. Because of this, SVS members are available to encourage and assist with the formation of new vascular surgery training programs. From 9:30 a.m. to 10:30 a.m. on Friday, June 14, at the Vascular Annual Meeting, an information session will be held for those interested in establishing a vascular training program. If you’re heading to the meeting in June, stop by National Harbor 4 Room at the Gaylord National to hear more about this. Register for VAM today.

Requirements for starting a vascular surgery training program have been lightened – you no longer need to have a general surgery residency at your institution and faculty requirements are in review. Because of this, SVS members are available to encourage and assist with the formation of new vascular surgery training programs. From 9:30 a.m. to 10:30 a.m. on Friday, June 14, at the Vascular Annual Meeting, an information session will be held for those interested in establishing a vascular training program. If you’re heading to the meeting in June, stop by National Harbor 4 Room at the Gaylord National to hear more about this. Register for VAM today.

Requirements for starting a vascular surgery training program have been lightened – you no longer need to have a general surgery residency at your institution and faculty requirements are in review. Because of this, SVS members are available to encourage and assist with the formation of new vascular surgery training programs. From 9:30 a.m. to 10:30 a.m. on Friday, June 14, at the Vascular Annual Meeting, an information session will be held for those interested in establishing a vascular training program. If you’re heading to the meeting in June, stop by National Harbor 4 Room at the Gaylord National to hear more about this. Register for VAM today.

At the Annual Business Meeting, 12 to 1:30 p.m. Saturday, June 15, SVS members (Active, Seniors and/or Distinguished Fellows) will be asked to elect individuals to fill the positions of Secretary and Vice President and then approve the full slate of SVS Officers for 2019-20. The Nominating Committee unanimously identified one person felt to be uniquely qualified to assume the position of Vice President; as in the past, that candidate will be announced at the meeting. Members will select among three highly qualified candidates for Secretary: Keith Calligaro, Michael Conte and Amy Reed. Find information from each of them here. 

At the Annual Business Meeting, 12 to 1:30 p.m. Saturday, June 15, SVS members (Active, Seniors and/or Distinguished Fellows) will be asked to elect individuals to fill the positions of Secretary and Vice President and then approve the full slate of SVS Officers for 2019-20. The Nominating Committee unanimously identified one person felt to be uniquely qualified to assume the position of Vice President; as in the past, that candidate will be announced at the meeting. Members will select among three highly qualified candidates for Secretary: Keith Calligaro, Michael Conte and Amy Reed. Find information from each of them here. 

At the Annual Business Meeting, 12 to 1:30 p.m. Saturday, June 15, SVS members (Active, Seniors and/or Distinguished Fellows) will be asked to elect individuals to fill the positions of Secretary and Vice President and then approve the full slate of SVS Officers for 2019-20. The Nominating Committee unanimously identified one person felt to be uniquely qualified to assume the position of Vice President; as in the past, that candidate will be announced at the meeting. Members will select among three highly qualified candidates for Secretary: Keith Calligaro, Michael Conte and Amy Reed. Find information from each of them here. 

For the first time ever, the SVS Foundation is teaming up with the Society for Vascular Nursing and the Society for Vascular Ultrasound to provide free AAA and peripheral artery disease ultrasound screenings. The event will take place from 8am to 12pm, June 8 at the Medical Faculty Associates Department of Surgery in Washington, DC. Spread the word if you know someone in the DC area who might be interested in attending. Appointments may be scheduled by calling 888-871-3801. View the full details here.

For the first time ever, the SVS Foundation is teaming up with the Society for Vascular Nursing and the Society for Vascular Ultrasound to provide free AAA and peripheral artery disease ultrasound screenings. The event will take place from 8am to 12pm, June 8 at the Medical Faculty Associates Department of Surgery in Washington, DC. Spread the word if you know someone in the DC area who might be interested in attending. Appointments may be scheduled by calling 888-871-3801. View the full details here.

For the first time ever, the SVS Foundation is teaming up with the Society for Vascular Nursing and the Society for Vascular Ultrasound to provide free AAA and peripheral artery disease ultrasound screenings. The event will take place from 8am to 12pm, June 8 at the Medical Faculty Associates Department of Surgery in Washington, DC. Spread the word if you know someone in the DC area who might be interested in attending. Appointments may be scheduled by calling 888-871-3801. View the full details here.

Register today for the Fourth Annual UCLA / SVS Symposium. This year’s program, “A Comprehensive Review and Update of What’s New in Vascular and Endovascular Surgery” will be held Aug. 24 to 26 at the Beverly Hilton, Beverly Hills, Calif. The course, a joint effort of the Division of Vascular and Endovascular Surgery at UCLA and the Society for Vascular Surgery, will offer an in-depth review of the specialty to those preparing to take the vascular board examinations. It will also provide basic didactic education for vascular residents and fellows in training. Read the full details and register here.

Register today for the Fourth Annual UCLA / SVS Symposium. This year’s program, “A Comprehensive Review and Update of What’s New in Vascular and Endovascular Surgery” will be held Aug. 24 to 26 at the Beverly Hilton, Beverly Hills, Calif. The course, a joint effort of the Division of Vascular and Endovascular Surgery at UCLA and the Society for Vascular Surgery, will offer an in-depth review of the specialty to those preparing to take the vascular board examinations. It will also provide basic didactic education for vascular residents and fellows in training. Read the full details and register here.

Register today for the Fourth Annual UCLA / SVS Symposium. This year’s program, “A Comprehensive Review and Update of What’s New in Vascular and Endovascular Surgery” will be held Aug. 24 to 26 at the Beverly Hilton, Beverly Hills, Calif. The course, a joint effort of the Division of Vascular and Endovascular Surgery at UCLA and the Society for Vascular Surgery, will offer an in-depth review of the specialty to those preparing to take the vascular board examinations. It will also provide basic didactic education for vascular residents and fellows in training. Read the full details and register here.

PA programming is set to take place from 1:15 – 5:15pm Thursday, June 13. There will be a PA networking lunch before the section session from 12-1pm, and a PA networking meet-up afterwards at 5:30 in the exhibit hall. The entire Vascular Annual Meeting has been reviewed by the AAPA Review Panel and is compliant with AAPA CME Criteria. This activity is designated for 30 AAPA Category 1 CME credits. PAs should only claim credit commensurate with the extent of their participation. Register for VAM today.

PA programming is set to take place from 1:15 – 5:15pm Thursday, June 13. There will be a PA networking lunch before the section session from 12-1pm, and a PA networking meet-up afterwards at 5:30 in the exhibit hall. The entire Vascular Annual Meeting has been reviewed by the AAPA Review Panel and is compliant with AAPA CME Criteria. This activity is designated for 30 AAPA Category 1 CME credits. PAs should only claim credit commensurate with the extent of their participation. Register for VAM today.

PA programming is set to take place from 1:15 – 5:15pm Thursday, June 13. There will be a PA networking lunch before the section session from 12-1pm, and a PA networking meet-up afterwards at 5:30 in the exhibit hall. The entire Vascular Annual Meeting has been reviewed by the AAPA Review Panel and is compliant with AAPA CME Criteria. This activity is designated for 30 AAPA Category 1 CME credits. PAs should only claim credit commensurate with the extent of their participation. Register for VAM today.

Interventional Chest/Diagnostic Procedures

Complications and economic burden of diagnostic procedures for lung abnormalities in the community setting

The influential National Lung Screening Trial (NLST) reported a 20% reduction in lung cancer-related deaths using low dose CT scan when compared with plain chest radiography (Aberle et al. N Engl J Med. 2011;365[5]:395). Many medical societies responded by recommending screening individuals at high-risk for lung cancer, and community-based lung cancer screening programs were developed across the US. A concerning feature of the study was the rate (23.3%) of false-positive findings after three rounds of screening and the potential for complications secondary to diagnostic invasive procedures.

Pediatric Chest Medicine

microRNAs: A New Biomarker

Biomarkers are essential tools in a clinician’s armamentarium. Biomarkers have multiple uses being indicators of a pathologic or physiologic process. One promising biomarker, now studied across multiple disorders, is microRNA (miRNA).

miRNAs are short (18–22 nucleotide) regulatory RNAs that bind mRNAs and decrease protein translation. miRNAs are generally co-transcribed with neighboring genes or co-transcribed within a cluster of miRNAs (a polycistronic cluster). Over 2,000 miRNAs are listed on miRBase (http://www.mirbase.org/), considered the central repository.

Function and biomarker utility of miRNAs are specific to the cells in which they are expressed. miRNAs isolated from circulating plasma exosomes have been shown to be stable over time, which is key in establishing their utility (Sanz-Rubio, et al. Sci Rep. 2018;8[1]:10306).

miRNAs have been credited with the function of micromanaging the circadian clock and sleep homeostasis in virtually all living organisms (Goodwin, et al. Cell Rep. 2018;23[13]:3776; Mehta, et al. J Mol Biol. 2013;425[19]:3609).

Preliminary work has identified dysregulated miRNAs in patients with obstructive sleep apnea (Li, et al. Medicine (Baltimore). 2017;96[34]:e7917). Exosomal miRNA has been shown to predict and protect against severe bronchopulmonary dysplasia (Lal, et al. JCI Insight. 2018;3[5]. pii: 93994).

Circadian miRNAs in salivary samples were found to have “altered” expression in autistic children with disordered sleep relative to peers with typical sleep (Hicks, et al. PLoS One. 2018;13[7]:e0198288). Collection from salivary samples facilitates multiple timed collection feasible at home and has multiple benefits.

Work on miRNAs, though preliminary, appears promising in providing a much-needed new perspective on pathophysiology and treatment in many disease processes.

Harish Rao, MD

Steering Committee Member

Pulmonary Physiology, Function, and Rehabilitation

Using impulse oscillometry in clinical practice

Impulse oscillometry (iOS) is an effort-independent test that requires minimal cooperation from the patient. It provides measures of respiratory mechanics during normal tidal breathing, including resistance (R), reactance (X), and impedance (Z) (Oostveen E, et al. Eur Respir J. 2003;22[6]:1026).

Airway R is largely, but not entirely, determined by cross-sectional area (Poiseuille’s Law). X is a surrogate for lung elastance, which is the inverse of compliance. Z is the combination of R and X and isn’t used clinically.

There are several benefits to using iOS, as opposed to or in conjunction with standard spirometry. First, iOS yields respiratory function measurements for patients, like the elderly and young children, who cannot provide acceptable and reproducible spirometry (Pezzoli L, et al. Age Ageing. 2003;32[1]:43). Second, it provides a real-world assessment of lung function because R and X values are obtained during tidal breathing. Humans don’t use the forced maneuvers needed for spirometry during normal daily activities, which weakens the correlation of FEV₁ with respiratory symptoms. Forced maneuvers also create artifacts from gas compression and cause small airway closure, which limits inferences made from standard spirometry (Brusasco V, et al. Eur Respir J. 2005;26[5]:948). Lastly, R and X provide information not available from spirometry, and iOS is particularly sensitive for detecting small airway dysfunction (Berger K, et al. Chest. 2015;148[5]:1131).

Clinical and disease-specific indications for iOS are still being established. As discussed above, iOS is appropriate for any patient unable to perform spirometry. As new inhalers designed to deliver medication to the distal airways become available, subtle abnormalities detected via iOS will provide a target for specific therapies (Lipworth B. Ann Allergy Asthma Immunol. 2013;110[4]:233). iOS shows significant promise as a noninvasive assessment for supraglottic diseases, like vocal cord dysfunction, and can quantify changes over time following invasive intervention to relieve upper airway obstruction (Bikov A, et al. Chest. 2015;148[3]:731; Horan T, et al. Chest. 2001:120[1]:69). As their comfort level with interpretation improves, pulmonologists will find iOS is an important tool for disease diagnosis and treatment.

Aaron Holley, MD, FCCP

Steering Committee Member

Pulmonary Vascular Disease

Hemodynamic definition of pulmonary hypertension changed

Many patients worldwide went to bed February 26, 2018, with normal pulmonary pressures and woke up the next morning with pulmonary hypertension (PH). That day, experts met at the World Symposium on PH in Nice, France, and changed the definition of resting PH from a mean pulmonary artery pressure (mPAP) of greater than or equal to 25 mm Hg to a mPAP greater 20 mm Hg (Simmoneau, et al. Eur Respir J. 2019;53:1801913). The First World Health Organization symposium on PH in 1973 established the 25 mm Hg cutoff to distinguish primary PH from what was then considered less severe forms of PH. This definition, acknowledged as arbitrary and conservative at the time, has persisted due to a paucity of data establishing a definitively abnormal mPAP threshold.

Two contemporary findings provide justification for the definition change: (1)Normal mPAP is 14 ± 3.3 mm Hg in healthy subjects (Kovacs, et al. Eur Respir J. 2009;34[4]:888). (2) Patients with mPAP greater than 20 mm Hg suffer worse outcomes compared with control subjects (Maron, et al. Circulation. 2016;133[13]:1240).

Preserving the other hemodynamic criteria for group 1 PH, pulmonary artery wedge pressure less than or equal to 15 mm Hg and pulmonary vascular resistance greater than or equal to 3 Wood units, experts also recommend applying the new definition to all pre-capillary PH, including groups 3, 4, and applicable group 5 diagnoses.

Importantly, new guidelines do not recommend treating PH patients with mPAP 21-24 mm Hg: “A change in the hemodynamic definition of PH due to [pulmonary vascular diseases] does not imply treating these additional patients, but highlights the importance of close monitoring in this population.”

John Kingrey, MD

Steering Committee Member

Thoracic Oncology

Lung Cancer and Women

While the overall incidence of lung cancer (LC) has decreased among both men and women, the decline among men has been steeper compared with women. Further, in women born in the 1950s to 1960s, the incidence has actually increased and cannot be fully explained by sex differences in smoking behavior (Jemal, et al. N Engl J Med. 2018;378:1999). Data suggest that women may be more susceptible to the harmful effects of tobacco and that the biology of LC may be different in women. In addition, LC in nonsmokers is more likely to occur in women.

LC is the leading cause of cancer death in both women and men worldwide, but the dramatic rise in the mortality rate from LC in women was qualified as a “full blown epidemic” in the Surgeon General’s 2001 Women and Smoking report.

The benefits of lung cancer screening (LCS) in the National Lung Screening Trial (NLST) were higher in women than in men and significantly greater in the subset of women (16%) that entered the Nelson trial – reduction in 10-year LC mortality of 61% vs. 26% in men (De Koning, et al. J Thorac Oncol. 2018;13[10]: suppl S185. Abstract PL02.05). A retrospective review of patients diagnosed with LC between 2005 and 2011 showed that only 37% of women vs. 50% of men met LCS criteria (Wang, et al. JAMA 2015;313[8]:853).

Lung cancer needs to be recognized as an important women’s health issue, and there is need for continued attention to sex differences in LC risk, LCS criteria, and outcomes.

Anne Gonzalez, MD, FCCP

Steering Committee Member

Interventional Chest/Diagnostic Procedures

Complications and economic burden of diagnostic procedures for lung abnormalities in the community setting

The influential National Lung Screening Trial (NLST) reported a 20% reduction in lung cancer-related deaths using low dose CT scan when compared with plain chest radiography (Aberle et al. N Engl J Med. 2011;365[5]:395). Many medical societies responded by recommending screening individuals at high-risk for lung cancer, and community-based lung cancer screening programs were developed across the US. A concerning feature of the study was the rate (23.3%) of false-positive findings after three rounds of screening and the potential for complications secondary to diagnostic invasive procedures.

Pediatric Chest Medicine

microRNAs: A New Biomarker

Biomarkers are essential tools in a clinician’s armamentarium. Biomarkers have multiple uses being indicators of a pathologic or physiologic process. One promising biomarker, now studied across multiple disorders, is microRNA (miRNA).

miRNAs are short (18–22 nucleotide) regulatory RNAs that bind mRNAs and decrease protein translation. miRNAs are generally co-transcribed with neighboring genes or co-transcribed within a cluster of miRNAs (a polycistronic cluster). Over 2,000 miRNAs are listed on miRBase (http://www.mirbase.org/), considered the central repository.

Function and biomarker utility of miRNAs are specific to the cells in which they are expressed. miRNAs isolated from circulating plasma exosomes have been shown to be stable over time, which is key in establishing their utility (Sanz-Rubio, et al. Sci Rep. 2018;8[1]:10306).

miRNAs have been credited with the function of micromanaging the circadian clock and sleep homeostasis in virtually all living organisms (Goodwin, et al. Cell Rep. 2018;23[13]:3776; Mehta, et al. J Mol Biol. 2013;425[19]:3609).

Preliminary work has identified dysregulated miRNAs in patients with obstructive sleep apnea (Li, et al. Medicine (Baltimore). 2017;96[34]:e7917). Exosomal miRNA has been shown to predict and protect against severe bronchopulmonary dysplasia (Lal, et al. JCI Insight. 2018;3[5]. pii: 93994).

Circadian miRNAs in salivary samples were found to have “altered” expression in autistic children with disordered sleep relative to peers with typical sleep (Hicks, et al. PLoS One. 2018;13[7]:e0198288). Collection from salivary samples facilitates multiple timed collection feasible at home and has multiple benefits.

Work on miRNAs, though preliminary, appears promising in providing a much-needed new perspective on pathophysiology and treatment in many disease processes.

Harish Rao, MD

Steering Committee Member

Pulmonary Physiology, Function, and Rehabilitation

Using impulse oscillometry in clinical practice

Impulse oscillometry (iOS) is an effort-independent test that requires minimal cooperation from the patient. It provides measures of respiratory mechanics during normal tidal breathing, including resistance (R), reactance (X), and impedance (Z) (Oostveen E, et al. Eur Respir J. 2003;22[6]:1026).

Airway R is largely, but not entirely, determined by cross-sectional area (Poiseuille’s Law). X is a surrogate for lung elastance, which is the inverse of compliance. Z is the combination of R and X and isn’t used clinically.

There are several benefits to using iOS, as opposed to or in conjunction with standard spirometry. First, iOS yields respiratory function measurements for patients, like the elderly and young children, who cannot provide acceptable and reproducible spirometry (Pezzoli L, et al. Age Ageing. 2003;32[1]:43). Second, it provides a real-world assessment of lung function because R and X values are obtained during tidal breathing. Humans don’t use the forced maneuvers needed for spirometry during normal daily activities, which weakens the correlation of FEV₁ with respiratory symptoms. Forced maneuvers also create artifacts from gas compression and cause small airway closure, which limits inferences made from standard spirometry (Brusasco V, et al. Eur Respir J. 2005;26[5]:948). Lastly, R and X provide information not available from spirometry, and iOS is particularly sensitive for detecting small airway dysfunction (Berger K, et al. Chest. 2015;148[5]:1131).

Clinical and disease-specific indications for iOS are still being established. As discussed above, iOS is appropriate for any patient unable to perform spirometry. As new inhalers designed to deliver medication to the distal airways become available, subtle abnormalities detected via iOS will provide a target for specific therapies (Lipworth B. Ann Allergy Asthma Immunol. 2013;110[4]:233). iOS shows significant promise as a noninvasive assessment for supraglottic diseases, like vocal cord dysfunction, and can quantify changes over time following invasive intervention to relieve upper airway obstruction (Bikov A, et al. Chest. 2015;148[3]:731; Horan T, et al. Chest. 2001:120[1]:69). As their comfort level with interpretation improves, pulmonologists will find iOS is an important tool for disease diagnosis and treatment.

Aaron Holley, MD, FCCP

Steering Committee Member

Pulmonary Vascular Disease

Hemodynamic definition of pulmonary hypertension changed

Many patients worldwide went to bed February 26, 2018, with normal pulmonary pressures and woke up the next morning with pulmonary hypertension (PH). That day, experts met at the World Symposium on PH in Nice, France, and changed the definition of resting PH from a mean pulmonary artery pressure (mPAP) of greater than or equal to 25 mm Hg to a mPAP greater 20 mm Hg (Simmoneau, et al. Eur Respir J. 2019;53:1801913). The First World Health Organization symposium on PH in 1973 established the 25 mm Hg cutoff to distinguish primary PH from what was then considered less severe forms of PH. This definition, acknowledged as arbitrary and conservative at the time, has persisted due to a paucity of data establishing a definitively abnormal mPAP threshold.

Two contemporary findings provide justification for the definition change: (1)Normal mPAP is 14 ± 3.3 mm Hg in healthy subjects (Kovacs, et al. Eur Respir J. 2009;34[4]:888). (2) Patients with mPAP greater than 20 mm Hg suffer worse outcomes compared with control subjects (Maron, et al. Circulation. 2016;133[13]:1240).

Preserving the other hemodynamic criteria for group 1 PH, pulmonary artery wedge pressure less than or equal to 15 mm Hg and pulmonary vascular resistance greater than or equal to 3 Wood units, experts also recommend applying the new definition to all pre-capillary PH, including groups 3, 4, and applicable group 5 diagnoses.

Importantly, new guidelines do not recommend treating PH patients with mPAP 21-24 mm Hg: “A change in the hemodynamic definition of PH due to [pulmonary vascular diseases] does not imply treating these additional patients, but highlights the importance of close monitoring in this population.”

John Kingrey, MD

Steering Committee Member

Thoracic Oncology

Lung Cancer and Women

While the overall incidence of lung cancer (LC) has decreased among both men and women, the decline among men has been steeper compared with women. Further, in women born in the 1950s to 1960s, the incidence has actually increased and cannot be fully explained by sex differences in smoking behavior (Jemal, et al. N Engl J Med. 2018;378:1999). Data suggest that women may be more susceptible to the harmful effects of tobacco and that the biology of LC may be different in women. In addition, LC in nonsmokers is more likely to occur in women.

LC is the leading cause of cancer death in both women and men worldwide, but the dramatic rise in the mortality rate from LC in women was qualified as a “full blown epidemic” in the Surgeon General’s 2001 Women and Smoking report.

The benefits of lung cancer screening (LCS) in the National Lung Screening Trial (NLST) were higher in women than in men and significantly greater in the subset of women (16%) that entered the Nelson trial – reduction in 10-year LC mortality of 61% vs. 26% in men (De Koning, et al. J Thorac Oncol. 2018;13[10]: suppl S185. Abstract PL02.05). A retrospective review of patients diagnosed with LC between 2005 and 2011 showed that only 37% of women vs. 50% of men met LCS criteria (Wang, et al. JAMA 2015;313[8]:853).

Lung cancer needs to be recognized as an important women’s health issue, and there is need for continued attention to sex differences in LC risk, LCS criteria, and outcomes.

Anne Gonzalez, MD, FCCP

Steering Committee Member

Interventional Chest/Diagnostic Procedures

Complications and economic burden of diagnostic procedures for lung abnormalities in the community setting

The influential National Lung Screening Trial (NLST) reported a 20% reduction in lung cancer-related deaths using low dose CT scan when compared with plain chest radiography (Aberle et al. N Engl J Med. 2011;365[5]:395). Many medical societies responded by recommending screening individuals at high-risk for lung cancer, and community-based lung cancer screening programs were developed across the US. A concerning feature of the study was the rate (23.3%) of false-positive findings after three rounds of screening and the potential for complications secondary to diagnostic invasive procedures.

Pediatric Chest Medicine

microRNAs: A New Biomarker

Biomarkers are essential tools in a clinician’s armamentarium. Biomarkers have multiple uses being indicators of a pathologic or physiologic process. One promising biomarker, now studied across multiple disorders, is microRNA (miRNA).

miRNAs are short (18–22 nucleotide) regulatory RNAs that bind mRNAs and decrease protein translation. miRNAs are generally co-transcribed with neighboring genes or co-transcribed within a cluster of miRNAs (a polycistronic cluster). Over 2,000 miRNAs are listed on miRBase (http://www.mirbase.org/), considered the central repository.

Function and biomarker utility of miRNAs are specific to the cells in which they are expressed. miRNAs isolated from circulating plasma exosomes have been shown to be stable over time, which is key in establishing their utility (Sanz-Rubio, et al. Sci Rep. 2018;8[1]:10306).

miRNAs have been credited with the function of micromanaging the circadian clock and sleep homeostasis in virtually all living organisms (Goodwin, et al. Cell Rep. 2018;23[13]:3776; Mehta, et al. J Mol Biol. 2013;425[19]:3609).

Preliminary work has identified dysregulated miRNAs in patients with obstructive sleep apnea (Li, et al. Medicine (Baltimore). 2017;96[34]:e7917). Exosomal miRNA has been shown to predict and protect against severe bronchopulmonary dysplasia (Lal, et al. JCI Insight. 2018;3[5]. pii: 93994).

Circadian miRNAs in salivary samples were found to have “altered” expression in autistic children with disordered sleep relative to peers with typical sleep (Hicks, et al. PLoS One. 2018;13[7]:e0198288). Collection from salivary samples facilitates multiple timed collection feasible at home and has multiple benefits.

Work on miRNAs, though preliminary, appears promising in providing a much-needed new perspective on pathophysiology and treatment in many disease processes.

Harish Rao, MD

Steering Committee Member

Pulmonary Physiology, Function, and Rehabilitation

Using impulse oscillometry in clinical practice

Impulse oscillometry (iOS) is an effort-independent test that requires minimal cooperation from the patient. It provides measures of respiratory mechanics during normal tidal breathing, including resistance (R), reactance (X), and impedance (Z) (Oostveen E, et al. Eur Respir J. 2003;22[6]:1026).

Airway R is largely, but not entirely, determined by cross-sectional area (Poiseuille’s Law). X is a surrogate for lung elastance, which is the inverse of compliance. Z is the combination of R and X and isn’t used clinically.

There are several benefits to using iOS, as opposed to or in conjunction with standard spirometry. First, iOS yields respiratory function measurements for patients, like the elderly and young children, who cannot provide acceptable and reproducible spirometry (Pezzoli L, et al. Age Ageing. 2003;32[1]:43). Second, it provides a real-world assessment of lung function because R and X values are obtained during tidal breathing. Humans don’t use the forced maneuvers needed for spirometry during normal daily activities, which weakens the correlation of FEV₁ with respiratory symptoms. Forced maneuvers also create artifacts from gas compression and cause small airway closure, which limits inferences made from standard spirometry (Brusasco V, et al. Eur Respir J. 2005;26[5]:948). Lastly, R and X provide information not available from spirometry, and iOS is particularly sensitive for detecting small airway dysfunction (Berger K, et al. Chest. 2015;148[5]:1131).

Clinical and disease-specific indications for iOS are still being established. As discussed above, iOS is appropriate for any patient unable to perform spirometry. As new inhalers designed to deliver medication to the distal airways become available, subtle abnormalities detected via iOS will provide a target for specific therapies (Lipworth B. Ann Allergy Asthma Immunol. 2013;110[4]:233). iOS shows significant promise as a noninvasive assessment for supraglottic diseases, like vocal cord dysfunction, and can quantify changes over time following invasive intervention to relieve upper airway obstruction (Bikov A, et al. Chest. 2015;148[3]:731; Horan T, et al. Chest. 2001:120[1]:69). As their comfort level with interpretation improves, pulmonologists will find iOS is an important tool for disease diagnosis and treatment.

Aaron Holley, MD, FCCP

Steering Committee Member

Pulmonary Vascular Disease

Hemodynamic definition of pulmonary hypertension changed

Many patients worldwide went to bed February 26, 2018, with normal pulmonary pressures and woke up the next morning with pulmonary hypertension (PH). That day, experts met at the World Symposium on PH in Nice, France, and changed the definition of resting PH from a mean pulmonary artery pressure (mPAP) of greater than or equal to 25 mm Hg to a mPAP greater 20 mm Hg (Simmoneau, et al. Eur Respir J. 2019;53:1801913). The First World Health Organization symposium on PH in 1973 established the 25 mm Hg cutoff to distinguish primary PH from what was then considered less severe forms of PH. This definition, acknowledged as arbitrary and conservative at the time, has persisted due to a paucity of data establishing a definitively abnormal mPAP threshold.

Two contemporary findings provide justification for the definition change: (1)Normal mPAP is 14 ± 3.3 mm Hg in healthy subjects (Kovacs, et al. Eur Respir J. 2009;34[4]:888). (2) Patients with mPAP greater than 20 mm Hg suffer worse outcomes compared with control subjects (Maron, et al. Circulation. 2016;133[13]:1240).

Preserving the other hemodynamic criteria for group 1 PH, pulmonary artery wedge pressure less than or equal to 15 mm Hg and pulmonary vascular resistance greater than or equal to 3 Wood units, experts also recommend applying the new definition to all pre-capillary PH, including groups 3, 4, and applicable group 5 diagnoses.

Importantly, new guidelines do not recommend treating PH patients with mPAP 21-24 mm Hg: “A change in the hemodynamic definition of PH due to [pulmonary vascular diseases] does not imply treating these additional patients, but highlights the importance of close monitoring in this population.”

John Kingrey, MD

Steering Committee Member

Thoracic Oncology

Lung Cancer and Women

While the overall incidence of lung cancer (LC) has decreased among both men and women, the decline among men has been steeper compared with women. Further, in women born in the 1950s to 1960s, the incidence has actually increased and cannot be fully explained by sex differences in smoking behavior (Jemal, et al. N Engl J Med. 2018;378:1999). Data suggest that women may be more susceptible to the harmful effects of tobacco and that the biology of LC may be different in women. In addition, LC in nonsmokers is more likely to occur in women.

LC is the leading cause of cancer death in both women and men worldwide, but the dramatic rise in the mortality rate from LC in women was qualified as a “full blown epidemic” in the Surgeon General’s 2001 Women and Smoking report.

The benefits of lung cancer screening (LCS) in the National Lung Screening Trial (NLST) were higher in women than in men and significantly greater in the subset of women (16%) that entered the Nelson trial – reduction in 10-year LC mortality of 61% vs. 26% in men (De Koning, et al. J Thorac Oncol. 2018;13[10]: suppl S185. Abstract PL02.05). A retrospective review of patients diagnosed with LC between 2005 and 2011 showed that only 37% of women vs. 50% of men met LCS criteria (Wang, et al. JAMA 2015;313[8]:853).

Lung cancer needs to be recognized as an important women’s health issue, and there is need for continued attention to sex differences in LC risk, LCS criteria, and outcomes.

Anne Gonzalez, MD, FCCP

Steering Committee Member

CMS announced in a [press release in mid-March that as it revamped the competitive bidding program for durable medical equipment, it would move to include no invasive ventilation (NIV) in the revamped program, slated to take effect January 1, 2021.

While the implementation date is still more than 18 months in the future, the regulatory timetable for a formal announcement, as well as time for CMS to introduce its revamped bidding process, actually creates a relatively short window for aggressive action to thwart the CMS proposal.

In late November 2018, when CMS was seeking public comment on the idea of such a move, CHEST, NAMDRC and numerous other societies submitted strongly worded comments opposed to the recommendation, citing a wide array of clinical risks associated with such a proposal. The comments also highlighted CMS’ total failure to revamp its own coverage policies, frequently cited by the pulmonary medicine community and the Office of the Inspector General as the primary root cause for significant problems.

Background: Under current law, Medicare is required to pay for certain ventilators under a “frequent and substantial servicing” payment methodology, with payment continuing as long as medical necessity is documented. Nearly 2 decades ago, CMS (then HCFA) sought to circumvent those statutory requirements by declaring that some ventilators are really not ventilators (as FDA classifications indicate) but are actually “respiratory assist devices.” The long-term impact of that unilateral policy decision has been ongoing chaos, as well as flawed coverage policies. For example, it is much more challenging for a physician to order a cheaper bi-level device than to order a ventilator for treatment of “respiratory failure.” As there are no limitations or qualifying criteria tied to “respiratory failure,” the community has responded with the path of least resistance while pleading with CMS to restructure their coverage policies to reflect the standards of care for home mechanical ventilation.

Since 2014, the community has repeatedly tried to convince CMS of the importance, and cost savings, associated with such a revamp, to no avail. Given 5 years of well documented efforts, it is likely that the only genuine solution will be a legislative one that forces CMS to behave in certain ways.

The challenges: There are complicating variables that the clinical community will need to address:

1. If the term “ventilator” is included in any legislative effort, CMS could expand its infamous concept “just because FDA calls a device a ventilator doesn’t make it one.” Using particular CPT or HCPCS codes would open the door for CMS to simply change coding to circumvent legislative intent.

2. If a legislative effort receives serious support, it ought to include specific guidance to CMS to force it to change its coverage policies for home mechanical ventilation to reflect standards of care and state-of-the-art devices.

For example, because devices are designed today to serve a wide range of respiratory issues, one device may be used to provide critical life support for an ALS patient, while that same device could also be used to provide nocturnal or intermittent support for other neuromuscular or COPD patients. Because the durable medical equipment benefit is focused on devices, CMS’ move to change to focus from a device to a patient is questionable.

3. Forcing CMS to move in a particular direction regarding coverage and device usage must be flexible enough to allow for technological and medical innovations; after all, no one wants to recommend legislative policies that would have to be revisited to address potential/likely advances in this field.

Broad strategies: While the durable medical equipment community is also challenging this proposal, they agreed that the medical and patient communities should take the lead. And, in principle, we agree. But implementation of that effort is a bit of a challenge as it requires a significant grassroots effort from concerned physicians, as well as patient groups to contact their legislators in Congress. After all, the worst case scenario is for a Senator to say, “How come I haven’t heard from any constituents about this problem if it is as bad as you say it is?” That is a fair and common refrain, and we must be prepared to engage the broad physician and patient communities to ensure success in this effort.

Once there is formal introduction of a proposal to move this matter forward, there will be outreach to physicians and respiratory therapists across the country to urge support of the legislation. Keep watching for such requests for action!

CMS announced in a [press release in mid-March that as it revamped the competitive bidding program for durable medical equipment, it would move to include no invasive ventilation (NIV) in the revamped program, slated to take effect January 1, 2021.

While the implementation date is still more than 18 months in the future, the regulatory timetable for a formal announcement, as well as time for CMS to introduce its revamped bidding process, actually creates a relatively short window for aggressive action to thwart the CMS proposal.

In late November 2018, when CMS was seeking public comment on the idea of such a move, CHEST, NAMDRC and numerous other societies submitted strongly worded comments opposed to the recommendation, citing a wide array of clinical risks associated with such a proposal. The comments also highlighted CMS’ total failure to revamp its own coverage policies, frequently cited by the pulmonary medicine community and the Office of the Inspector General as the primary root cause for significant problems.

Background: Under current law, Medicare is required to pay for certain ventilators under a “frequent and substantial servicing” payment methodology, with payment continuing as long as medical necessity is documented. Nearly 2 decades ago, CMS (then HCFA) sought to circumvent those statutory requirements by declaring that some ventilators are really not ventilators (as FDA classifications indicate) but are actually “respiratory assist devices.” The long-term impact of that unilateral policy decision has been ongoing chaos, as well as flawed coverage policies. For example, it is much more challenging for a physician to order a cheaper bi-level device than to order a ventilator for treatment of “respiratory failure.” As there are no limitations or qualifying criteria tied to “respiratory failure,” the community has responded with the path of least resistance while pleading with CMS to restructure their coverage policies to reflect the standards of care for home mechanical ventilation.

Since 2014, the community has repeatedly tried to convince CMS of the importance, and cost savings, associated with such a revamp, to no avail. Given 5 years of well documented efforts, it is likely that the only genuine solution will be a legislative one that forces CMS to behave in certain ways.

The challenges: There are complicating variables that the clinical community will need to address:

1. If the term “ventilator” is included in any legislative effort, CMS could expand its infamous concept “just because FDA calls a device a ventilator doesn’t make it one.” Using particular CPT or HCPCS codes would open the door for CMS to simply change coding to circumvent legislative intent.

2. If a legislative effort receives serious support, it ought to include specific guidance to CMS to force it to change its coverage policies for home mechanical ventilation to reflect standards of care and state-of-the-art devices.

For example, because devices are designed today to serve a wide range of respiratory issues, one device may be used to provide critical life support for an ALS patient, while that same device could also be used to provide nocturnal or intermittent support for other neuromuscular or COPD patients. Because the durable medical equipment benefit is focused on devices, CMS’ move to change to focus from a device to a patient is questionable.

3. Forcing CMS to move in a particular direction regarding coverage and device usage must be flexible enough to allow for technological and medical innovations; after all, no one wants to recommend legislative policies that would have to be revisited to address potential/likely advances in this field.

Broad strategies: While the durable medical equipment community is also challenging this proposal, they agreed that the medical and patient communities should take the lead. And, in principle, we agree. But implementation of that effort is a bit of a challenge as it requires a significant grassroots effort from concerned physicians, as well as patient groups to contact their legislators in Congress. After all, the worst case scenario is for a Senator to say, “How come I haven’t heard from any constituents about this problem if it is as bad as you say it is?” That is a fair and common refrain, and we must be prepared to engage the broad physician and patient communities to ensure success in this effort.

Once there is formal introduction of a proposal to move this matter forward, there will be outreach to physicians and respiratory therapists across the country to urge support of the legislation. Keep watching for such requests for action!

CMS announced in a [press release in mid-March that as it revamped the competitive bidding program for durable medical equipment, it would move to include no invasive ventilation (NIV) in the revamped program, slated to take effect January 1, 2021.

While the implementation date is still more than 18 months in the future, the regulatory timetable for a formal announcement, as well as time for CMS to introduce its revamped bidding process, actually creates a relatively short window for aggressive action to thwart the CMS proposal.

In late November 2018, when CMS was seeking public comment on the idea of such a move, CHEST, NAMDRC and numerous other societies submitted strongly worded comments opposed to the recommendation, citing a wide array of clinical risks associated with such a proposal. The comments also highlighted CMS’ total failure to revamp its own coverage policies, frequently cited by the pulmonary medicine community and the Office of the Inspector General as the primary root cause for significant problems.

Background: Under current law, Medicare is required to pay for certain ventilators under a “frequent and substantial servicing” payment methodology, with payment continuing as long as medical necessity is documented. Nearly 2 decades ago, CMS (then HCFA) sought to circumvent those statutory requirements by declaring that some ventilators are really not ventilators (as FDA classifications indicate) but are actually “respiratory assist devices.” The long-term impact of that unilateral policy decision has been ongoing chaos, as well as flawed coverage policies. For example, it is much more challenging for a physician to order a cheaper bi-level device than to order a ventilator for treatment of “respiratory failure.” As there are no limitations or qualifying criteria tied to “respiratory failure,” the community has responded with the path of least resistance while pleading with CMS to restructure their coverage policies to reflect the standards of care for home mechanical ventilation.

Since 2014, the community has repeatedly tried to convince CMS of the importance, and cost savings, associated with such a revamp, to no avail. Given 5 years of well documented efforts, it is likely that the only genuine solution will be a legislative one that forces CMS to behave in certain ways.

The challenges: There are complicating variables that the clinical community will need to address:

1. If the term “ventilator” is included in any legislative effort, CMS could expand its infamous concept “just because FDA calls a device a ventilator doesn’t make it one.” Using particular CPT or HCPCS codes would open the door for CMS to simply change coding to circumvent legislative intent.

2. If a legislative effort receives serious support, it ought to include specific guidance to CMS to force it to change its coverage policies for home mechanical ventilation to reflect standards of care and state-of-the-art devices.

For example, because devices are designed today to serve a wide range of respiratory issues, one device may be used to provide critical life support for an ALS patient, while that same device could also be used to provide nocturnal or intermittent support for other neuromuscular or COPD patients. Because the durable medical equipment benefit is focused on devices, CMS’ move to change to focus from a device to a patient is questionable.

3. Forcing CMS to move in a particular direction regarding coverage and device usage must be flexible enough to allow for technological and medical innovations; after all, no one wants to recommend legislative policies that would have to be revisited to address potential/likely advances in this field.

Broad strategies: While the durable medical equipment community is also challenging this proposal, they agreed that the medical and patient communities should take the lead. And, in principle, we agree. But implementation of that effort is a bit of a challenge as it requires a significant grassroots effort from concerned physicians, as well as patient groups to contact their legislators in Congress. After all, the worst case scenario is for a Senator to say, “How come I haven’t heard from any constituents about this problem if it is as bad as you say it is?” That is a fair and common refrain, and we must be prepared to engage the broad physician and patient communities to ensure success in this effort.

Once there is formal introduction of a proposal to move this matter forward, there will be outreach to physicians and respiratory therapists across the country to urge support of the legislation. Keep watching for such requests for action!

CHEST leadership meets quarterly in person, but the fall and spring meetings include all of the combined committees of CHEST. As the fall meeting takes place during the CHEST Annual Scientific Meeting, the spring meeting takes on a particular importance in providing the impetus of the upcoming year. The meeting spanned from March 27 to March 30. Traditionally, the first day consists of committee meetings, such as the Council of Networks, Training and Transition, Education, Membership, Guideline Oversight, and Professional Standards. On the morning of the second day, the following committees met: Finance, Diversity, and the Governance Committee. The afternoon of the second day was a combined boards meeting with all members of the Board of Trustees and the Board of Regents, where we received updates from each of the committees. In addition, all of the board members underwent professional media training as professional development.

On the 29th, the Foundation Board of Trustees had their meeting, which was attended by several of the members of the Board of Regents (highlights listed below). In the afternoon, we had the biannual meeting of the CHEST Industry Advisory Council, where CHEST leadership meets with our industry partners, working together to anticipate the needs of our members and our patients. The Board of Regents convened on March 30 for our formal board meeting.



Highlights of the Spring Combined Meeting:

CHEST Leadership Committees:

Education Committee: Under the leadership of the Chair, Dr. Alex Niven, the Education Committee has grown in scope and focus with the increasing strength of their subcommittees, including Live Learning, Simulation, Peer Review, Outcomes, Innovations, and Educator Development. The Education Committee is now working to develop a revolving education curriculum to ensure that our members have a solid base at the annual meeting, as well as in online learning. The committee is working to increase coordination with the APCCMPD, as well.

Membership Committee: The Membership Committee reported on several accomplishments during the year, including an increase in nonphysician membership and rolling out several new programs, including automatic membership renewal option and adjusted membership fees for international members and retired members.

Finance Committee: The financial report for the last quarter of the CHEST fiscal year was robust with solid outlook for the year.

Training and Transitions: The T & T Committee has had marked success with a dramatic increase in fellow education programs and learners at the CHEST annual meeting. This year will bring new fellow courses in Pulmonary Nodules and Lung Transplantation. In addition, the committee is also reviewing abstract submissions for trainees at a record pace, with case report submissions exceeding last year’s record number of 1,015 submissions.

Guideline Oversight: There are currently 12 guidelines in development, in addition to the 6 guidelines that were completed last fiscal year. This committee updated us regarding the ongoing development of “living guidelines.”

Scientific Program Committee: Dr. Bill Kelly, chairman of CHEST 2019 in New Orleans, reported on the meeting, including the record number of submissions in all curriculum areas. He updated us regarding the ongoing maintenance of certification credits for the meeting, as well as important new initiatives, such as child care and innovative electronic options for the meeting, designed to make the experience “easy” on attendees in New Orleans - The Big Easy.

CHEST Foundation Board of Trustees: Doreen Addrizzo-Harris, MD, FCCP, President of the Foundation, updated us on the quarterly activities of the foundation and guided the board through some of the novel fundraising opportunities, including the 6th Annual Irv Feldman Poker Night, the Inaugural CHEST Foundation Derby Dinner and Auction in New York, and the Popovich Endowment Dinner and future Gala. The Foundation is sponsoring a number of activities at CHEST in New Orleans, including a Lung Health Experience, Breakfast of Champions, Women & Pulmonary Luncheon, the Young Professionals Reception, and the Foundation Reception.

CHEST Board of Regents (BoR): The Board of Regents, led by Clayton Cowl, MD, FCCP, President of CHEST, had a packed session. The session started off with a unique team building exercise. The Board approved the Master Fellow Award selection that will honor Dr. Darcy Marciniuk. The Digital Strategy Task Force, led by Dr. Chris Carroll, Nicki Augustyn, and Ron Moen, reported on their findings, which led to a lively discussion on how to move forward with an innovative and successful digital plan. A report was also given on the membership recruitment and retention initiative. Finally, the BoR approved a new agreement with PA Consulting to assist in the ongoing CHEST Analytics program.

CHEST leadership meets quarterly in person, but the fall and spring meetings include all of the combined committees of CHEST. As the fall meeting takes place during the CHEST Annual Scientific Meeting, the spring meeting takes on a particular importance in providing the impetus of the upcoming year. The meeting spanned from March 27 to March 30. Traditionally, the first day consists of committee meetings, such as the Council of Networks, Training and Transition, Education, Membership, Guideline Oversight, and Professional Standards. On the morning of the second day, the following committees met: Finance, Diversity, and the Governance Committee. The afternoon of the second day was a combined boards meeting with all members of the Board of Trustees and the Board of Regents, where we received updates from each of the committees. In addition, all of the board members underwent professional media training as professional development.

On the 29th, the Foundation Board of Trustees had their meeting, which was attended by several of the members of the Board of Regents (highlights listed below). In the afternoon, we had the biannual meeting of the CHEST Industry Advisory Council, where CHEST leadership meets with our industry partners, working together to anticipate the needs of our members and our patients. The Board of Regents convened on March 30 for our formal board meeting.



Highlights of the Spring Combined Meeting:

CHEST Leadership Committees:

Education Committee: Under the leadership of the Chair, Dr. Alex Niven, the Education Committee has grown in scope and focus with the increasing strength of their subcommittees, including Live Learning, Simulation, Peer Review, Outcomes, Innovations, and Educator Development. The Education Committee is now working to develop a revolving education curriculum to ensure that our members have a solid base at the annual meeting, as well as in online learning. The committee is working to increase coordination with the APCCMPD, as well.

Membership Committee: The Membership Committee reported on several accomplishments during the year, including an increase in nonphysician membership and rolling out several new programs, including automatic membership renewal option and adjusted membership fees for international members and retired members.

Finance Committee: The financial report for the last quarter of the CHEST fiscal year was robust with solid outlook for the year.

Training and Transitions: The T & T Committee has had marked success with a dramatic increase in fellow education programs and learners at the CHEST annual meeting. This year will bring new fellow courses in Pulmonary Nodules and Lung Transplantation. In addition, the committee is also reviewing abstract submissions for trainees at a record pace, with case report submissions exceeding last year’s record number of 1,015 submissions.

Guideline Oversight: There are currently 12 guidelines in development, in addition to the 6 guidelines that were completed last fiscal year. This committee updated us regarding the ongoing development of “living guidelines.”

Scientific Program Committee: Dr. Bill Kelly, chairman of CHEST 2019 in New Orleans, reported on the meeting, including the record number of submissions in all curriculum areas. He updated us regarding the ongoing maintenance of certification credits for the meeting, as well as important new initiatives, such as child care and innovative electronic options for the meeting, designed to make the experience “easy” on attendees in New Orleans - The Big Easy.

CHEST Foundation Board of Trustees: Doreen Addrizzo-Harris, MD, FCCP, President of the Foundation, updated us on the quarterly activities of the foundation and guided the board through some of the novel fundraising opportunities, including the 6th Annual Irv Feldman Poker Night, the Inaugural CHEST Foundation Derby Dinner and Auction in New York, and the Popovich Endowment Dinner and future Gala. The Foundation is sponsoring a number of activities at CHEST in New Orleans, including a Lung Health Experience, Breakfast of Champions, Women & Pulmonary Luncheon, the Young Professionals Reception, and the Foundation Reception.

CHEST Board of Regents (BoR): The Board of Regents, led by Clayton Cowl, MD, FCCP, President of CHEST, had a packed session. The session started off with a unique team building exercise. The Board approved the Master Fellow Award selection that will honor Dr. Darcy Marciniuk. The Digital Strategy Task Force, led by Dr. Chris Carroll, Nicki Augustyn, and Ron Moen, reported on their findings, which led to a lively discussion on how to move forward with an innovative and successful digital plan. A report was also given on the membership recruitment and retention initiative. Finally, the BoR approved a new agreement with PA Consulting to assist in the ongoing CHEST Analytics program.

CHEST leadership meets quarterly in person, but the fall and spring meetings include all of the combined committees of CHEST. As the fall meeting takes place during the CHEST Annual Scientific Meeting, the spring meeting takes on a particular importance in providing the impetus of the upcoming year. The meeting spanned from March 27 to March 30. Traditionally, the first day consists of committee meetings, such as the Council of Networks, Training and Transition, Education, Membership, Guideline Oversight, and Professional Standards. On the morning of the second day, the following committees met: Finance, Diversity, and the Governance Committee. The afternoon of the second day was a combined boards meeting with all members of the Board of Trustees and the Board of Regents, where we received updates from each of the committees. In addition, all of the board members underwent professional media training as professional development.

On the 29th, the Foundation Board of Trustees had their meeting, which was attended by several of the members of the Board of Regents (highlights listed below). In the afternoon, we had the biannual meeting of the CHEST Industry Advisory Council, where CHEST leadership meets with our industry partners, working together to anticipate the needs of our members and our patients. The Board of Regents convened on March 30 for our formal board meeting.



Highlights of the Spring Combined Meeting:

CHEST Leadership Committees:

Education Committee: Under the leadership of the Chair, Dr. Alex Niven, the Education Committee has grown in scope and focus with the increasing strength of their subcommittees, including Live Learning, Simulation, Peer Review, Outcomes, Innovations, and Educator Development. The Education Committee is now working to develop a revolving education curriculum to ensure that our members have a solid base at the annual meeting, as well as in online learning. The committee is working to increase coordination with the APCCMPD, as well.

Membership Committee: The Membership Committee reported on several accomplishments during the year, including an increase in nonphysician membership and rolling out several new programs, including automatic membership renewal option and adjusted membership fees for international members and retired members.

Finance Committee: The financial report for the last quarter of the CHEST fiscal year was robust with solid outlook for the year.

Training and Transitions: The T & T Committee has had marked success with a dramatic increase in fellow education programs and learners at the CHEST annual meeting. This year will bring new fellow courses in Pulmonary Nodules and Lung Transplantation. In addition, the committee is also reviewing abstract submissions for trainees at a record pace, with case report submissions exceeding last year’s record number of 1,015 submissions.

Guideline Oversight: There are currently 12 guidelines in development, in addition to the 6 guidelines that were completed last fiscal year. This committee updated us regarding the ongoing development of “living guidelines.”

Scientific Program Committee: Dr. Bill Kelly, chairman of CHEST 2019 in New Orleans, reported on the meeting, including the record number of submissions in all curriculum areas. He updated us regarding the ongoing maintenance of certification credits for the meeting, as well as important new initiatives, such as child care and innovative electronic options for the meeting, designed to make the experience “easy” on attendees in New Orleans - The Big Easy.

CHEST Foundation Board of Trustees: Doreen Addrizzo-Harris, MD, FCCP, President of the Foundation, updated us on the quarterly activities of the foundation and guided the board through some of the novel fundraising opportunities, including the 6th Annual Irv Feldman Poker Night, the Inaugural CHEST Foundation Derby Dinner and Auction in New York, and the Popovich Endowment Dinner and future Gala. The Foundation is sponsoring a number of activities at CHEST in New Orleans, including a Lung Health Experience, Breakfast of Champions, Women & Pulmonary Luncheon, the Young Professionals Reception, and the Foundation Reception.

CHEST Board of Regents (BoR): The Board of Regents, led by Clayton Cowl, MD, FCCP, President of CHEST, had a packed session. The session started off with a unique team building exercise. The Board approved the Master Fellow Award selection that will honor Dr. Darcy Marciniuk. The Digital Strategy Task Force, led by Dr. Chris Carroll, Nicki Augustyn, and Ron Moen, reported on their findings, which led to a lively discussion on how to move forward with an innovative and successful digital plan. A report was also given on the membership recruitment and retention initiative. Finally, the BoR approved a new agreement with PA Consulting to assist in the ongoing CHEST Analytics program.