E4617. Scaling Up Efforts for a Notable Demographic: Challenges and Pitfalls in the Imaging of Patients with Class III Obesity
  1. Nikhil Gupta; Tufts Medical Center
  2. Robert Freund; Tufts Medical Center
  3. Rita Lahoud; Tufts Medical Center
  4. Yilun Zhang; Tufts Medical Center
  5. Daichi Hayashi; Tufts Medical Center
It is estimated that 64% of the United States population is overweight or obese. Patients with class III obesity, defined as BMI greater than 40, are estimated to have a prevalence of 9.2% in the United States, a figure that has been increasing over the past 10 years. Radiologists face numerous unique technical and interpretative challenges when imaging these patients across several modalities. As this population is at higher risk for additional comorbidities and is becoming more prevalent, it is imperative that radiologists understand how to overcome common limitations.

Educational Goals / Teaching Points
Outline the importance of increasing efforts to appropriately image patients with class III obesity. Identify logistical obstacles in image acquisition. Review multimodal diagnostic hurdles and discuss solutions to enable radiologists to make the correct diagnosis.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The exhibit will begin with an introduction to the importance of adequately imaging obese patients. This includes a discussion pertaining to each of the most commonly used imaging modalities, i.e. radiography, fluoroscopy, ultrasound, CT, and MRI. The technical and logistical limitations of image acquisition for each modality will be discussed. Examples include scanner and positioning challenges. This will be followed by a section that outlines commonly encountered diagnostic hurdles and the solutions to overcoming them. An example from ultrasonography is the use of low frequency transducers or tissue harmonic imaging to overcome sound attenuation secondary to subcutaneous fat. Another example from CT is the use of extended FOV reconstruction to mitigate the effects of truncation artifact, an increased band of attenuation along the edge of the image when the imaged body part is partially outside of the FOV.

Patients with class III obesity represent a prominent proportion of patients that undergo imaging in the United States. For Radiologists to provide adequate and valuable care to this population, it is important to understand their unique technical and interpretative challenges and the solutions to overcome them.