This document provides an overview of interpreting chest x-rays. It begins with introducing the normal anatomy seen on chest x-rays and technical aspects to consider. It then discusses an ABCDE approach to interpretation, examining the airways, bones, cardiovascular system, diaphragms, and lungs. Finally, it outlines common patterns of abnormality seen, including alveolar consolidation, interstitial lung disease, atelectasis, nodules/masses, cavities/cysts, and calcification. The document emphasizes the importance of assessing for subtle changes that could indicate underlying pathology.
Chest XRay and other imaging investigations of chest, CT chest, HRCT ChestBishnu Khatiwada
Chest x ray and other imaging investigations of chest, Basics of Chest Xray, PA view, Lateral view, CT chest, HRCT Chest, MRI Chest, USG Chest, PET/CT Chest, V/Q Scan, Silhouette sign, Cervicothoracic sign, Abdominothoracic sign, Golden S sign, Luftsichel sign, Air Bronchogram
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Chest XRay and other imaging investigations of chest, CT chest, HRCT ChestBishnu Khatiwada
Chest x ray and other imaging investigations of chest, Basics of Chest Xray, PA view, Lateral view, CT chest, HRCT Chest, MRI Chest, USG Chest, PET/CT Chest, V/Q Scan, Silhouette sign, Cervicothoracic sign, Abdominothoracic sign, Golden S sign, Luftsichel sign, Air Bronchogram
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. Outline
• Introduction
• Normal CXR- technical aspects
• Normal Anatomy
• Approach to Interpretation
• Patterns of Abnormality
3. Introduction
• The CXR is the most commonly performed
imaging procedure in general Radiology
departments
• Comprises 30 – 50% of studies
• One of the most difficult films to interpret
– For Radiologists
– For you… on-call… at night… on your own!
5. The Normal CXR
• Standard CXR is taken:
– PA – minimal magnification of the heart
– Patient standing
– Full inspiration
• In ill patients, the CXR is usually taken:
– AP – magnifies cardiac shadow
– Often supine – diaphragms higher, lung volumes
lower, pathology often obscured
8. The Lateral CXR
• Purpose:
– To pinpoint location of a lesion seen on PA
– To identify lesions hidden behind the heart on PA
• Left lateral = left side of patient is against
digital plate = standard lateral projection
• Right lateral = performed to assess a lesion in
the right lung (decreases magnification of
lesion)
9. The Lateral CXR
• In practice, lateral radiographs are not routinely
performed any more so you will rarely have to
interpret one
• We occasionally request one ourselves when
reporting a PA chest radiograph, to clarify an
apparent abnormality rather than going straight
to CT
• When there is a definite abnormality on a PA
radiograph that requires further investigation, we
tend to go directly to CT nowadays
10. Additional CXR Views
• Lordotic
– Direction of x-ray beam relative to patient is angled
upwards at 45 degrees
– This projects clavicles above lung apices
– Useful if suspect an apical mass but is obscured by
clavicle
– Also useful if suspect an apparent apical lesion is
actually in a rib or clavicle
• Decubitus
– To confirm the presence of fluid suspected on upright
film (e.g. subpulmonic effusion)
11. Subpulmonic effusion on decubitus film
• The PA film shows an apparently elevated right diaphragm
• On the decubitus view, the effusion flows up along the side of the lung
12. Expiratory CXR
• Makes a pneumothorax appear relatively larger
than on an inspiratory film
• PTx may only visible on expiration film
• When you see the word ‘expiration’ on a CXR you
are almost certainly looking for a pneumothorax
(especially in an exam!)
• Expiratory film is also useful in kids when looking
for air trapping due to an obstructing foreign
body – lung on obstructed side remains expanded
54. Before you start…
1. Check patient label – name, DOB, gender
2. Orientation
– R or L marker (?dextrocardia)
– PA or AP (if not labeled, assume PA)
– Inspiratory or expiratory (if not labeled = insp)
– Erect or supine (again, if not labeled assume
erect)
– Rotated? (clavicles relative to spinous process!)
55. Rotated ED film
One lung field appears whiter,
Difficult to assess cardiac silhouette
Same patient,
better centred CXR
Traumatic diaphragmatic hernia
57. Same image shown the correct way around –
Patient had Kartagener’s Syndrome with situs inversus
58. Before you start…
3. Adequate exposure?
– Should just about be able to see thoracic
vertebrae through heart
• Can’t see them at all? – underexposed, everything too
white
• Vertebrae and disk spaces very clear? – overexposed,
everything too dark
• In over- and under-exposed CXRs, lung pathology is
easily obscured
• This is less of a problem now that we have digital
radiography and automatic exposure control
59. Before you start…
4. Adequate inspiration?
– Count ribs – choose one of these methods
• 9 or 10 ribs posteriorly
• 6 ribs anteriorly (I prefer this one)
– If inspiration is suboptimal, basal lung pathology
may be obscured
63. Airway
• Trachea
– Central?
• Can be pulled by
– lobar collapse
– fibrosis (e.g. old TB)
– lobectomy
• Can be pushed by
– mediastinal mass
– tension pneumothorax
– large pleural effusion
64. Airway
• Trachea
– Narrowed?
• Retrosternal goitre, other mediastinal masses
• Carina
– Splayed?
• Normal carinal angle is ~60 degrees (range 40-75)
• Angle increased by subcarinal lymphadenopathy, left
atrial enlargement
72. Bones
• Destructive lesions – metastases
• Erosion by adjacent tumour, e.g. Pancoast
• Rib fractures
– Sensitivity of CXR is less than 20%
– However, when you see one look carefully for
pneumothorax, haemothorax, lung contusion
• Shoulder dislocation
77. Cardiovascular system
• Heart size <50% of cardiothoracic ration on PA
film
• Generalize cardiomegaly or specific chamber?
• Valve replacement?
• Sternotomy wires?
• Pacemaker? – check for complications if
recently inserted (pneumothorax)
83. Cardiovascular
• Pulmonary vasculature
– Generalized increase in vascular markings
• Left to right shunt
– Focal or unilateral decrease in lung markings
• Westermark’s sign (PE)
– Large central pulmonary arteries with sudden
tapering
• Pulmonary hypertension, e.g. chronic lung disease, PPH
84. Cardiovascular
• Pulmonary vasculature
– Increased size of upper lobe pulmonary veins in
CCF – subtle early CXR sign
• Finally, look BEHIND the heart
– Lung nodule/mass
– Hiatus hernia
– Oesophageal dilatation (tumour, achalasia)
85. Upper lobe venous diversion
- patient with mitral stenosis
Left atrial enlargement
Kerley B lines
88. Diaphragms
• Right higher than left by no more than 2.5 cm
• Larger difference, or L higher than R
– Phrenic nerve palsy e.g. tumour, surgery
– Volume loss in lung e.g. lobar collapse, lobectomy,
pneumonectomy
– Diaphragmatic hernia
– Subpulmonic effusion
89. Diaphragms
• Depressed, flattened diaphragms
– Hyperinflation (asthma, COPD, cystic fibrosis)
• GAS BELOW DIAPHRAGM (erect film)
– Need to be sitting up for at least 20 minutes
• NO gas below diaphragm (no gastric air
bubble)
– Sign of achalasia
• Costophrenic angles - blunted?
– pleural effusion
94. Examine the Lungs
• Are the lungs equal in density?
• One lung too white
– Solitary breast
– Pleural effusion
– Pleural mass (mesothelioma, mets)
– Lobar collapse
– Consolidation
– Pulmonary mass
97. Examine the Lungs
• Are the lungs equal in density?
• Both lungs too dark
– Overexposed film – check if vertebral bodies too
clearly seen
– COPD
• Count ribs (8 or more anteriorly)
• Flattened diaphragms
• Bullae
99. Examine the Lungs
• Are the lungs equal in density?
• Both lungs too white
– Underexposed film
– Pulmonary oedema
– Pulmonary fibrosis (what zones??)
– Miliary shadowing – TB, mets
101. Examine the Lungs
• Are the hemithoraces equal in volume?
– Increased volume
• Tension pneumothorax
• Large effusion
• Expanded lobe (e.g. Klebsiella pneumonia)
102. Examine the Lungs
• Are the hemithoraces equal in volume?
– Decreased volume
• Lobar collapse
• Lobectomy, pneumonectomy
• Fibrothorax (restrictive, thickened pleura secondary to
old TB or empyema)
• Diaphragmatic paralysis or rupture
104. Soft Tissues
• Surgical emphysema – neck and chest
– Trauma
– Surgery
– Chest drain
– Asthma
• When you see surgical emphysema, search
very carefully for a pneumothorax and/or
pneumomediastinum
107. CXR Patterns
• Having identified that the lungs are abnormal,
you now need to decide what the problem is
• Which of the following patterns does the
abnormality fit into?
– Alveolar consolidation
– Interstitial lung disease
– Atelectasis (collapse)
– Nodules and masses
– Cavities and cysts
– Calcification/ossification
108. Alveolar Consolidation
• Signs
– May be localized or diffuse
– Homogeneous, amorphous increased density
– Ill-defined margins
– Air bronchograms
– No volume loss
111. Alveolar Consolidation
• Which lobe is involved?
• Look for absent silhouette:
– Right hemidiaphragm = RLL
– Right heart border = RML
– Left hemidiaphragm = LLL
– Left heart border = lingula (of LUL)
– None – could be upper lobes or apical segments
of lower lobes
112. RUL (above horizontal fissure) and
lingular (obscuring left heart border) pneumonia
Horizontal fissure
120. Atelectasis
• Signs
– Opacification of a lobe
– Volume loss
• Displacement of fissures
• Elevated hemidiaphragm
• Mediastinal displacement
• Tracheal displacement
• Compensatory hyperinflation of opposite lung
121. Atelectasis
• Right upper lobe atelectasis
– Collapses superiorly and medially
– Wedge shaped opacity in right upper zone
– Horizontal fissure displaced upwards
– Oblique fissure displaced anteriorly on lateral CXR
122. Atelectasis
• Left upper lobe atelectasis
– ‘veil’-like opacity in left hemithorax
– Often obliterates left heart border silhouette (as
lingula is in LUL)
– Elevated left hilum
– Oblique fissure displaced anteriorly
123. LUL collapse -
trachea displaced to left
left hilum elevated
left hemidiaphragm elevated
124. Atelectasis
• Right middle lobe atelectasis
– Collapses medially obliterating right heart border
– On lateral, see wedge-shaped opacity anteriorly
– Pulls horizontal fissure downwards
126. Atelectasis
• Lower lobe atelectasis
– Similar appearance on both sides
– Obliterates normal silhouette of hemidiaphragm
– On lateral CXR, see triangular density posteriorly
with increasing opacity of lower thoracic
vertebrae
129. Nodules and Masses
• Nodule is <3cm, mass is >/= 3cm
• Solitary or multiple?
• Solitary – long differential diagnosis e.g.
– Bronchogenic ca, granuloma, hamartoma, met
• Multiple – also long ddx
– Mets, granulomas, rheumatoid nodules,
sarcoidosis
132. Cavities and Cysts
• Cyst = thin wall (< 3mm)
– Fluid or air-filled, or both (air/fluid level)
• Cavity = thicker wall (> 3mm)
– Always contain air +/- air/fluid level
– Usually in an area of consolidation, a mass or a
nodule
137. Final Comments
• Before diving into a CXR, take a step back and
look at the age/gender, any labels on the
image (L/R, erect, AP, expiration), technical
quality
• If you remember your ABCDEs you’re unlikely
to miss any findings