CT

Brain/Head/Neck

Stroke Alert, Step by Step: 

1. CT tech will call reading room with patient name.

2. CT head without contrast first; look for hemorrhage, bleeds, masses - report and document ASPECT score (below)

   1. After CT head is read, contact the ordering provider with the findings, document time findings were communicated in your report.

   2. Ask the ordering provider for patient symptoms, document those in reason for exam

3. CTA Head and Neck second; look for large vessel occlusions (LVO), aneurysm, stenosis, bleeds, etc. 

   1. If a CT perfusion is done, dictate those findings as well. 

4. After CTA/perfusion read, call ordering provider again with findings for both studies and document time findings were communicated in your report. 

Chest

• Bronchopulmonary segments annotated CT: 

  • https://radiopaedia.org/cases/bronchopulmonary-segments-annotated-ct-2?lang=us 

• Thoracic lymph node stations:

  • https://radiopaedia.org/cases/thoracic-lymph-node-stations-annotated-ct?lang=us 

• Fleischner Criteria: 

  • Full page: https://radiopaedia.org/articles/fleischner-society-pulmonary-nodule-recommendations-1?lang=us 

  • Solid nodules

Single

Single solid nodule <6 mm (<100 mm3)

• low-risk patients: no routine follow-up required

• high-risk patients: optional CT at 12 months (particularly with suspicious nodule morphology and/or upper lobe location; see "risk assessment" below)

Solitary solid nodule 6-8 mm (100-250 mm3)

• low-risk patients: CT at 6-12 months, then consider CT at 18-24 months

• high-risk patients: CT at 6-12 months, then CT at 18-24 months

Solitary solid nodule >8 mm (>250 mm3)

• low-risk and high-risk patients: consider CT at 3 months, PET-CT, or tissue sampling

Multiple

Multiple solid nodules <6 mm (<100 mm3)

• low-risk patients: no routine follow-up required

• high-risk patients: optional CT at 12 months

Multiple solid nodules >6 mm (>100 mm3)

• low-risk patients: CT at 3-6 months, then consider CT at 18-24 months

• high-risk patients: CT at 3-6 months, then CT at 18-24 months

When multiple nodules are present, the most suspicious nodule should guide further individualized management.

• Subsolid nodules

Single

Single ground glass nodule <6 mm (<100 mm3)

• no routine follow-up required

Single ground glass nodule ≥6 mm (>100 mm3)

• CT at 6-12 months, then if persistent, CT every 2 years until 5 years

Single part-solid nodule ≥6 mm (>100 mm3)

• CT at 3-6 months, then if persistent and solid component remains <6 mm, annual CT until 5 years

Multiple

Multiple subsolid nodules <6 mm (<100 mm3)

• CT at 3-6 months, then if stable consider CT at 2 and 4 years in high-risk patients

Multiple subsolid nodules ≥6 mm (>100 mm3)

• CT at 3-6 months, then subsequent management based on the most suspicious nodule(s)

• Aorta

  • Ascending thoracic aorta: 

    • Dilatation: >4cm

    • Aneurysm: >5cm

  • Descending thoracic aorta: 

    • Dilatation: >3cm

    • Aneurysm: >4cm

  • Aortic dissection types: 

    • Stanford A: anything involving ascending aorta

    • Standford B: arises distal to right brachiocephalic artery branch, NOT involving the ascending aorta

Pancreas

• Normal pancreatic duct sizes: 

  • https://radiopaedia.org/articles/pancreatic-duct-diameter?lang=us 

  • Head: 

    • 3.5mm (<50y/o)

    • 5mm (>50y/o)

  • Body: 

    • 2.5mm (<50y/o)

    • 3mm (>50y/o)

  • Tail: 

    • 1.5mm (<50y/o)

    • 2mm (>50y/o)

• Cystic Pancreatic Lesions

  • Radiology Assistant (overview): https://radiologyassistant.nl/abdomen/pancreas/pancreas-cystic-lesions

  • Radiopedia (differential w/ page links): https://radiopaedia.org/articles/cystic-lesions-of-the-pancreas-differential?lang=us 

• AAST Pancreatic Trauma Classification

  • Full page: https://radiopaedia.org/articles/pancreatic-trauma-injury-grading?lang=us 

    • Grade I: hematoma with minor contusion or superficial laceration without duct injury

    • Grade II: major contusion or laceration without duct injury

    • Grade III: distal transection or deep parenchymal injury with duct injury

    • Grade IV: proximal transection or deep parenchymal injury involving the ampulla (and/or intrapancreatic common bile duct)

    • Grade V: massive disruption of the pancreatic head ("shattered pancreas")

Kidneys/Ureters/Bladder

Bosniak Classification: 

• Radiology Assistant: https://radiologyassistant.nl/abdomen/kidney/bozniak-2019 

• Radiopedia: 

  • Full page: https://radiopaedia.org/articles/bosniak-classification-system-of-renal-cystic-masses-version-2005?lang=us 

Bosniak I

• benign simple cyst

  • wall ≤2 mm, water density, no septa/calcs/solid components/enhancement

Bosniak II

• benign cyst - "minimally complex"

  • thin <1 mm septa or thin calcifications (not measurable)

  • perceived enhancement, non-enhancing high-attenuation (proteinaceous/hemorrhagic) contents, <3 cm

  • well circumscribed

Bosniak IIF

• minimally complex

  • multiple hairline thin septa or minimally smooth thickened walls or septa

  • perceived but no measurable enhancement of wall or septa

  • calcification can be present and may be thick and nodular

  • generally well marginated

Bosniak III

•  indeterminate cystic mass

  • thickened irregular or smooth walls or septa with measurable enhancement

Bosniak IV

• clearly malignant cystic mass

  • Bosniak III criteria + enhancing soft tissue components adjacent to but independent of wall or septum

Bowel

• Bowel and Mesenteric Trauma: https://radiopaedia.org/articles/bowel-and-mesenteric-trauma?lang=us 

• Normal bowel size (3-6-9 rule): 

  • Small bowel < 3cm

  • Large bowel < 6cm 

  • Appendix < 6mm

  • Cecum < 9cm