Dyspnea-akathisia Syndrome

December 20, 2013

There’s a recent epidemic in imaging causing many studies to turn up as blurry messes. Could it be that patients aren’t being given the proper prep?

Since my return to hospital-based work a couple of years ago, I’ve become aware of a widespread, perhaps even epidemic, condition lurking in the ER and inpatient populace. I haven’t completely decided what to call it, but I’m currently testing out “dyspnea-akathisia syndrome” to see how that flies. It sounds decently academic and is handily abbreviated (DAS), as seems to be a requirement of all discoveries that catch on in medical jargon.

As the name implies, patients exhibit dyspnea (shown on CTs as respiratory motion-artifact, X-rays as poor inspiratory effort, abdominal sonography as tech notes that imaging was limited by lack of patient compliance with breath-holding, etc.) and/or akathisia (feel free to look it up, but upshot is the patient perceives inability to remain motionless…hence, shown as motion artifact anywhere else you’re trying to image).

Chances are, you’ve already seen cases of DAS, and likely as not attributed it to other factors. There are, after all, mimics: Demented, delirious, or otherwise difficult individuals who aren’t at their best and thus unlikely to hold still nicely or fully follow instructions during their imaging. As far back as my residency, I recall seeing transfers from nursing homes, MVAs, and bar room brawls wherein a crisp, non-limited image (let alone a whole study’s worth of same) was tough to find.

What has me convinced DAS is an epidemic is the dramatic upswing in proportion of cases in which patients are huffing, puffing, tossing, and turning. When last I prowled hospital corridors in a white lab coat adorned with laminated ID, these blurry messes of scans were a small minority of the workload. They are now, at least in the bulk of hospitals I cover, the rule rather than the exception. The change, in less than a decade, has been striking to me.

I would be less suspicious of a new diagnostic entity if these DAS sufferers were uniformly super-sick, with multiple medical problems like COPD and neurodegenerative disorders to account for their issues. But these folks come from all walks of life. I just as routinely see DAS in a 20-something being scanned for generic abdominal pain as I am for a “follow-up pulmonary nodule” case in a septuagenarian. Even in routine “positive PPD” X-rays.

Under other circumstances, I suppose one could blame technology. If, for instance, radiology equipment were routinely falling into disrepair and cost-cutting was resulting in cheaper and shoddier machinery being used, it would be worth considering that the hardware, rather than the wetware, was responsible for such image degradation.

Of course, the opposite is the case; if anything, the past ten years of advances in miracle gizmos should be showing me ever-increasing clarity no matter what patients are doing when in the gantry.

As I’ve shared my observations regarding DAS with a colleague or three, one of the theories counter-proposed was that maybe patients undergoing imaging are no longer routinely being told when to hold still, refrain from breathing for a few seconds, etc. I dismissed this out of hand as being too cynical to be true.

Such basic practices to generate diagnostic quality imaging wouldn’t be allowed to fall by the wayside. Would they?