Asthma severity is a risk factor for acute hypersensitivity reactions to contrast agents: a large-scale cohort study.

www.chestpubs.org The American College of Chest Physicians (ACCP) has taken concrete steps to provide training in thoracic ultrasonography in the United States. Training in thoracic ultrasonography is a key component in the numerous courses that the college has given to . 2,000 clinicians over the past 7 years. The ACCP has developed a comprehensive critical care ultrasonography training program that includes lung and pleural ultrasonography. This Certifi cate of Completion program requires 7 days of course work, a 20-h Internet training component, and a mandatory 250 image portfolio collection, followed by a hands-on and imagebased examination that includes thoracic ultrasonography. The image portfolio, which is reviewed by the faculty, allows an experienced ultrasonographer to provide meaningful feedback to the learner, thereby increasing skill level. In addition to the national ACCP program, we have developed a local ultrasound training course for fellows. Each summer, 80 fi rst-year pulmonary/critical care fellows from New York City receive an intensive 3-day course in general critical care ultrasonography, including thoracic ultrasonography. Standardized training early in fellowship training ensures that, moving forward, these fellows will disseminate this valuable skill. Finally, we could not agree more that point-of-care bedside thoracic ultrasonography performed by the treating pulmonologist must be integrated with the clinical history and physical examination. In this regard, thoracic ultrasonography is a powerful extension of the physical examination, providing immediate diagnostic and therapeutic benefi t.