About

Wallace T. Miller Jr. is an Emeritus Professor and Chief of Radiology at the University of Pennsylvania's Perelman School of Medicine. He holds a B.A. in Chemistry from Williams College, obtained in 1980, and an M.D. from the University of Pennsylvania, earned in 1986. His professional focus is in the field of radiology, with a particular emphasis on the radiographic evaluation of lung diseases, including diffuse interstitial lung disease and infiltrative lung disease. Dr. Miller has contributed to the understanding of thoracic imaging, including the use of high-resolution computed tomography in predicting conditions such as bronchiolitis obliterans syndrome following lung transplantation. His research and publications have explored various aspects of thoracic radiology, including the radiographic, computed tomographic, and magnetic resonance investigation of the mediastinum, as well as the role of nuclear medicine in diagnosing pulmonary embolism. Throughout his career, he has been involved in advancing diagnostic strategies in pulmonary imaging and has contributed to the academic and clinical excellence of the radiology department at the University of Pennsylvania.

Research topics

• Medicine
• Radiology
• Computer science
• Pathology
• Internal medicine

Selected publications

• Frequency of imaging phenotypes of pulmonary interstitial fibrosis

  South African Journal of Radiology · 2025-05-03

  articleOpen access1st authorCorresponding

  Background: Evaluation of diffuse interstitial lung disease (ILD) in thoracic imaging is complicated. Radiologists often use a pattern approach to interpretation; however, they are rarely aware of the statistical frequency of disease presentation. Objectives: To evaluate the relative frequency of causes of fibrotic ILD as a function of imaging patterns. Method: A CT database of 396 cases of fibrotic ILD was amassed from an institutional diffuse lung disease registry and retrospective search of medical records. Three radiologists and one pulmonologist independently and blindly reviewed the CT scans for the distribution of fibrosis, predominant feature and non-pulmonary findings. Results: Peripheral fibrosis was most common (291/396, 73.5%), usually caused by idiopathic pulmonary fibrosis (IPF) and connective tissue diseases-related interstitial lung disease (CTD-ILD) but occasionally by hypersensitivity pneumonitis (HP), idiopathic nonspecific interstitial pneumonia (iNSIP) and asbestosis. Peripheral fibrosis with honeycombing was usually IPF and without honeycombing, was usually CTD-ILD. Peripheral fibrosis with pleural plaques was always asbestosis. Peripheral fibrosis with oesophageal dilatation was usually connective tissue diseases. Consolidative-like peripheral fibrosis was CTD-ILD. Axial fibrosis (61/396, 15.4%) was usually sarcoidosis, HP, CTD-ILD or silicosis. Axial fibrosis with predominantly consolidative-like fibrosis, honeycombing, or reticulation was usually sarcoidosis. Axial fibrosis predominated by ground glass opacity was usually HP or CTD-ILD. Lymph node calcification or short axis > 17 mm increased the probability that axial fibrosis was due to sarcoidosis. The non-specific fibrosis phenotype was uncommon (44/396, 11.1%), usually CTD-ILD (25/44, 57%) but also HP, IPF, iNSIP or asbestosis. Conclusion: Patterns of lung fibrosis provide guidelines to identify the cause. Contribution: A flow diagram that predicts the relative frequency of the causes of 10 patterns of ILD.

  PublisherDOI

• An audit of licenced radiological equipment and personnel in Botswana

  Journal of the Colleges of Medicine of South Africa · 2024-09-26 · 1 citations

  articleOpen access

  Background: The United Nations encourages national audits of diagnostic imaging equipment and personnel. The World Health Organization (WHO) estimates that 20 X-ray and ultrasound units per million people will meet 90% of global imaging needs. This study assessed registered diagnostic imaging resources in Botswana, a high middle-income, sparsely populated African country.Methods: Details of registered diagnostic imaging equipment and personnel were extracted from the Botswana Radiation Protection Inspectorate and the Botswana Health Professions Council databases and stratified by imaging modality, professional category, and by geographical region and healthcare sector. Findings were presented as absolute numbers and resources per million people.Results: Botswana has 130 diagnostic imaging equipment units. General radiography (GR) (n = 79) 60%, mammography (n = 15; 12%), fluoroscopy (n = 13; 10%), computed tomography (n = 13; 10%), magnetic resonance (n = 6; 5%), digital subtraction angiography (n = 3; 2%) and radioisotope (n = 1; 0.7%). General radiography is the only modality where overall public sector resources (n = 44/79, 56%) exceed those of the private sector. Overall GR meet WHO guidelines, while it exceeded WHO guidelines (42–63 units/106 people) in most sparsely populated districts. There are 171 registered radiation workers; 88% (n = 152), radiographers, 9% (n = 15) radiologists and 2% (n = 4) medical physicists. Fifty three per cent of radiographers (n = 80) and 20% of radiologists (n = 3) work in the public sector.Conclusion: This study provides novel insights into the provision of radiological resources to sparsely populated rural communities.Contribution: The study demonstrates a comprehensive analysis of Radiological resources in an upper-middle-income country in Africa, highlighting important data for medium/long term planning towards achieving an equitable imaging access.

  PublisherOA PDFDOI

• Corrigendum: An audit of licenced radiological equipment and personnel in Botswana

  Journal of the Colleges of Medicine of South Africa · 2024-11-15

  erratumOpen access

  [This corrects the article DOI: 10.4102/jcmsa.v2i1.87.].

  PublisherOA PDFDOI

• Computed Tomography of the Head Before Lumbar Puncture in Adults With Suspected Meningitis in High–HIV Prevalence Settings

  Open Forum Infectious Diseases · 2024-09-26 · 3 citations

  articleOpen access

  Background: The role of computed tomography (CT) before lumbar puncture (LP) is unclear, with limited evidence for a causal link between LP and cerebral herniation or for the ability of CT to identify individuals at risk of herniation. The risks of LP delay or deferral are potentially greater in high-HIV prevalence, resource-limited settings; we analyzed data from such a setting to determine the impact of CT on time to LP and treatment, as well as mortality. Methods: Adults with suspected central nervous system (CNS) infection were enrolled prospectively into the Botswana National Meningitis Survey between 2016 and 2019. Inpatient mortality and clinical data including time of treatment initiation and CT were captured from medical records. Associations between preceding CT and outcomes were assessed using logistic regression. Results: LPs were performed in 711 patients with suspected CNS infection; 27% had a CT before LP, and 73% were HIV positive. Time from admission to LP and time from admission to appropriate treatment were significantly longer in patients who had a CT before LP compared with those who did not (2.8 hours and 13.2 hours, respectively). There was some evidence for treatment delays being associated with increased mortality; however, there was no significant difference in mortality between those who had or did not have CT. Conclusions: Patients who had a CT had delays to diagnostic LP and initiation of appropriate treatment; although treatment delays were associated with increased mortality, our observational study could not demonstrate a causal association between delays in diagnosis and treatment introduced by CT and mortality.

  PublisherDOI

• FOXP3+ regulatory T cells are associated with the severity and prognosis of sarcoidosis

  Frontiers in Immunology · 2023-12-20 · 12 citations

  articleOpen access

  Rationale Sarcoidosis is an inflammatory granulomatous disease of unknown etiology with predominant lung involvement. Organ involvement and disease severity, as well as the nature of immune alterations, vary among patients leading to a range of clinical phenotypes and outcomes. Our objective was to evaluate the association of disease course and immune responses in pulmonary sarcoidosis. Methods In this prospective cohort study of 30 subjects, most of whom were followed for one year, we evaluated 14 inflammatory markers in plasma, 13 Treg/T cell flow cytometry markers and 8 parameters of FOXP3 + Treg biology, including suppressive function, epigenetic features and stability. Results We identified a set of 13 immunological parameters that differ in sarcoidosis subjects in comparison with healthy donors. Five of those were inversely correlated with suppressive function of Tregs in sarcoidosis, and six (TNFα, TNFR I and II, sCD25, Ki-67 and number of Tregs) were particularly upregulated or increased in subjects with thoracic lymphadenopathy. Treg suppressive function was significantly lower in patients with thoracic lymphadenopathy, and in patients with higher burdens of pulmonary and systemic symptoms. A combination of five inflammatory markers, Ki-67 expression, Treg function, and lung diffusion capacity evaluated at study entry predicted need for therapy at one year follow-up in 90% of cases. Conclusion Tregs may suppress ongoing inflammation at local and systemic levels, and TNFα, TNFR I and II, sCD25 and Ki-67 emerge as attractive biomarkers for in vivo sarcoid inflammatory activity.

  PublisherOA PDFDOI

• A Validated Model for the Imaging Diagnosis of Cystic Lung Disease

  Open Journal of Radiology · 2023-01-01

  articleOpen access1st authorCorresponding

  Rationale and Objectives: Cystic lung disease may be accurately diagnosed by imaging interpretation of specialist radiologists, without other information. We hypothesized that with minimal training non-specialists could perform similarly to specialist physicians in the diagnosis of cystic lung disease. Methods: 72 cystic lung disease cases and 25 cystic lung disease mimics were obtained from three sources: 1) a prospective acquired diffuse lung disease registry, 2) a retrospective search of medical records and 3) teaching files. Cases were anonymized, randomized and interpreted by 7 diffuse lung disease specialists and 15 non-specialist radiologists and pulmonologists. Clinical information other than age and sex was not provided. Prior to interpretation, non-specialists viewed a short PDF training document explaining cystic lung disease interpretation. Results: Correct first choice diagnosis of 85%-88% may be achieved by high-performing specialist readers and 71%-80% by non-specialists and lower-performing specialists, with mean accuracies in the diagnosis of LAM (91%, p < 0.0001), BHD (93%, p < 0.0001), PLCH (89%, p < 0.0001) and LIP (92%, p < 0.0001). A strategy based on cyst appearance: simple cysts (LAM), peri-septal cysts (BHD), bizarre-shaped cysts (PLCH) and vascular indented cysts (LIP) gave non-specialists accuracies of 90% (p < 0.0001), 94% (p < 0.0001), 92% (p < 0.0001) and 88% (p < 0.0001), respectively, for these diagnoses. Cystic lung abnormalities caused by diseases other than LAM, BHD, PLCH and LIP are rarely accurately diagnosed by imaging alone. Conclusion: With specific but limited training, non-specialist physicians can diagnose cystic lung diseases from CT appearance alone with similar accuracy to specialists, correctly identifying approximately 75% of cases.

  PublisherOA PDFDOI

• Identification and Prognosis of Patients With Interstitial Pneumonia With Autoimmune Features

  JCR Journal of Clinical Rheumatology · 2022-06-11 · 12 citations

  articleOpen access

  BACKGROUND/OBJECTIVE: Patients classified as interstitial pneumonia with autoimmune features (IPAF) have interstitial lung disease (ILD) and features of autoimmunity but do not fulfill criteria for connective tissue diseases (CTDs). Our goal was to identify patients classifiable as IPAF, CTD-ILD, and idiopathic pulmonary fibrosis (IPF) from a preexisting pulmonary cohort and evaluate the prognosis of patients with IPAF. METHODS: We reviewed the medical records of 456 patients from a single-center pulmonary ILD cohort whose diagnoses were previously established by a multidisciplinary panel that did not include rheumatologists. We reclassified patients as IPAF, CTD-ILD, or IPF. We compared transplant-free survival using Kaplan-Meier methods and identified prognostic factors using Cox models. RESULTS: We identified 60 patients with IPAF, 113 with CTD-ILD, and 126 with IPF. Transplant-free survival of IPAF was not statistically significantly different from that of CTD-ILD or IPF. Among IPAF patients, male sex (hazard ratio, 4.58 [1.77-11.87]) was independently associated with worse transplant-free survival. During follow-up, only 10% of IPAF patients were diagnosed with CTD-ILD, most commonly antisynthetase syndrome. CONCLUSION: Despite similar clinical characteristics, most patients with IPAF did not progress to CTD-ILD; those who did often developed antisynthetase syndrome, highlighting the critical importance of comprehensive myositis autoantibody testing in this population. As in other types of ILD, male sex may portend a worse prognosis in IPAF. The routine engagement of rheumatologists in the multidisciplinary evaluation of ILD will help ensure the accurate classification of these patients and help clarify prognostic factors.

  PublisherOA PDFDOI

• A CT Algorithm Can Elevate the Differential Diagnosis of Interstitial Lung Disease by Non-specialists to Equal That of Specialist Thoracic Radiologists

  Academic Radiology · 2021-08-21 · 3 citations

  articleSenior authorCorresponding
  PublisherDOI

• Sporadic coronavirus and human metapneumovirus lower respiratory tract infection in adults: comparison of chest CT findings and correlation with clinical outcomes

  2020-09-07

  articleSenior author

  Coronavirus(CoV) and human metaneumovirus(hMPV) are worldwide causes of lower respiratory tract infection(LRTI) in adults. Chest CT is increasingly used in the diagnosis and management of LRTI. Our aims were to compare chest CT features for LRTI due to sporadic CoV with hMPV and correlate chest CT findings with clinical outcomes. We retrospectively reviewed records of 61 adults with nucleic acid amplification(NAA) assay positive for CoV and 104 adults positive for hMPV over 33 months at 4 community hospitals in the northeast US. A thoracic radiologist reviewed all chest CT images. Inclusion criteria included:1. symptoms of acute LRTI, 2.chest CT within 7 days of positive NAA assay, 3.no other pulmonary infection/lung disease that might interfere with chest CT interpretation. Ground-glass opacities(GGO) were more frequent (p<.05) with hMPV(47/104,45%) than with sporadic CoV(15/61,25%). Multifocal consolidation was more common (p<.05) with hMPV(31/104,30%) than with sporadic CoV(8/61,13%). LRTI without chest CT findings was more common (p<.05) with sporadic CoV (28/61,46%) than with hMPV (16/104,15%). For hMPV, multifocal consolidation was associated(p<.05) with treatment with assisted ventilation(9/30,30%). For hMPV, no other chest CT finding correlated with any studied outcome(new supplementary oxygen at discharge, discharge to skilled facility, hospital re-admission within 30 days). No chest CT finding correlated with any studied outcome for sporadic CoV. With hMPV, healthcare providers should be aware that multifocal consolidation on chest CT often portends treatment with invasive/non-invasive ventilatory support.

  PublisherDOI

• Lower Respiratory Tract Infection with Human Metapneumovirus: Chest CT Imaging Features and Comparison with Other Viruses

  European Journal of Radiology · 2020-04-23 · 22 citations

  articleSenior authorCorresponding
  PublisherDOI

Frequent coauthors

• Andrew L. Kun

  University of New Hampshire

  23 shared

• Warren B. Gefter

  University of Pennsylvania

  20 shared

• Judith M. Aronchick

  University of Pennsylvania

  19 shared

• W B Gefter

  15 shared

• Paul J. Werbos

  13 shared

• Drew A. Torigian

  University of Pennsylvania

  13 shared

• Richard S. Sutton

  13 shared

• DM Epstein

  11 shared

Education

• MD, Perelman School of Medicine

  University of Pennsylvania

  1986

• BA, Undergraduate

  Williams College

  1980