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Findings emphasize superior LUS accuracy for pleural-adjacent conditions and discuss LUS limitations in deeper lesions and restricted acoustic windows, while reaffirming CT’s indispensable role in complex or occult thoracic disease. 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was CT used in the study design for this response?","Question",{"text":63,"@type":64},"LUS and routine portable CXR were performed immediately before CT thorax, and diagnostic metrics were calculated against CT findings as the gold standard.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"Which thoracic pathologies did the authors report as better diagnosed with LUS than with portable CXR?",{"text":68,"@type":64},"LUS significantly outperformed portable CXR for pneumothorax, pleural effusion, consolidation, collapse, and pulmonary edema, particularly when lesions were adjacent to the pleural surface.",{"name":70,"@type":61,"acceptedAnswer":71},"What limitations of lung ultrasound does the author response emphasize?",{"text":72,"@type":64},"LUS is less sensitive for deeper parenchymal lesions surrounded by normally aerated lung, and image acquisition can be difficult in patients with restricted acoustic windows such as obesity, edema, or mechanically ventilated dorsal-zone access 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Limitations, and the Continued Role of Computed Tomography  \nAshraf S Al Tayar1, Hosni A Salem2, Prashant Nasa3  \nKeyword: Bedside lung ultrasound, Critical care ultrasound, Lung ultrasound score, Lung ultrasound, Pneumothorax, Pulmonary edema.  \nIndian Journal of Critical Care Medicine (2025): 10.5005/jp-journals-10071-25109  \nDear Editor,  \nWe thank the authors for their thoughtful and constructive comments on our article on comparative analysis of lung ultrasound (LUS) with chest X-ray (CXR).1 We appreciate their critical appraisal of our work and appreciate the concerns highlighted regarding the optimal use of LUS and computed tomography (CT) of the thorax in critical care practice.  \nAt the outset, it is essential to emphasize a key aspect of the methodology employed in our study. The LUS and routine bedside portable CXR were directly compared with CT thorax, which served as the gold standard. As described in the methods section of the study, all LUS and CXR examinations were performed immediately before CT thorax, and the diagnostic performance metrics were calculated with respect to CT findings asthe standard of truth. This study design facilitated a rigorous and pragmatic head-to-head comparison of the two bedside modalities in the evaluation of various pulmonary pathologies under identical clinical conditions.  \nThe results of our study indicate that LUS significantly outperformed portable CXR in diagnosing five studied pathologies– pneumothorax, pleural effusion, consolidation, collapse, and pulmonary edema. However, these conditions can be accurately assessed when they are adjacent to the pleural surface.2 In various categories, including pleural effusion and consolidation, the sensitivity and positive predictive value of LUS were approximately 100%, reflecting a high-level concordance with CT. Conversely, the routine bedside CXR demonstrated a lower diagnostic accuracy, underscoring the limitations of the portable CXR, which have been widely recognized in the context of critical care imaging.2  \nThe correspondents have appropriately highlighted several limitations of LUS. We fully concur that LUS is less sensitive for deeper parenchymal lesions surrounded by normally aerated lung. This is an inherent limitation of LUS, rooted in the physics of ultrasound rather than the proficiency of the operator.3 Similarly, in conditions with restricted acoustic windows, such as in obese or edematous patients, there can be a difficulty in accessing the dorsal zones of the lung, especially in mechanically ventilated patients. Additionally, the presence of thick dressings, drains, or medical devices can further reduce the image quality and occasionally limit the diagnostic yield. These practical considerations were acknowledged in our discussion and reflect real-world practices in the ICU, where both LUS and portable CXRs face similar constraints when compared to CT scans.1  \n1Department of Acute Medicine, King’s Mill Hospital, Mansfield, United Kingdom  \n2Department of Anaesthesia, Intensive Care and Pain, Faculty of Medicine, Al-Azhar University, Cairo, Egypt  \n3Anaesthesia and Critical Care Medicine, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom Corresponding Author: Prashant Nasa, Anaesthesia and Critical Care Medicine, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom, Phone: +447852862083, e-mail: [dr.prashantnasa@hotmail.com](dr.prashantnasa@hotmail.com)  \nHow to cite this article: AlTayarAS, Salem HA, Nasa P. Author Response: Lung Ultrasound in the Intensive Care Unit: Strengths, Limitations, and the Continued Role of Computed Tomography. Indian J Crit Care Med 2025;29(12):1056–1057 .  \nSource of support: Nil  \nConflict of interest: None  \nWe also agree that in complex polytrauma patients or with suspected occult thoracic pathology, a","cbCaiacIpQKMkDIM","https://ap.wps.com/l/cbCaiacIpQKMkDIM","pdf",177318,"English","# Letter to the Editor – Response to Comments\n## Methodology and comparative design\n## Diagnostic results and key pathologies\n## Limitations of LUS and practical constraints\n## Role of CT in complex cases\n## Advantages of LUS for dynamic monitoring and integration in ICU care","[{\"question\":\"How was CT used in the study design for this response?\",\"answer\":\"LUS and routine portable CXR were performed immediately before CT thorax, and diagnostic metrics were calculated against CT findings as the gold standard.\"},{\"question\":\"Which thoracic pathologies did the authors report as better diagnosed with LUS than with portable CXR?\",\"answer\":\"LUS significantly outperformed portable CXR for pneumothorax, pleural effusion, consolidation, collapse, and pulmonary edema, particularly when lesions were adjacent to the pleural surface.\"},{\"question\":\"What limitations of lung ultrasound does the author response emphasize?\",\"answer\":\"LUS is less sensitive for deeper parenchymal lesions surrounded by normally aerated lung, and image acquisition can be difficult in patients with restricted acoustic windows such as obesity, edema, or mechanically ventilated dorsal-zone access issues, as well as when thick dressings or devices are present.\"}]","Author Response - Lung Ultrasound in the Intensive Care Unit: Strengths, Limitations, and the Continued Role of Computed Tomography | PDF",1790729009]