Chest Without vs Interstitial Lung Disease vs High Resolution
The only difference in the “Chest Without” and “Interstitial Lung Disease” protocols is the acquisition of expiratory images
Expiratory images do not add anything to the billing side of things. Therefore, technically these studies are billed with the same code as a chest without
The term “High Resolution” is an older term and has been removed from EPIC orders. However, scheduling sometimes still schedules the “CT Chest Interstitial Lung Disease” order as “CT Chest High Resolution” which is why both these entities show up on the protocol worklist. Both of these should be protocolled the same as “Interstitial Lung Disease”.
Low dose does NOT equal “Lung Cancer Screening”. Low dose scans can be done on normal “Chest without” protocols but that doesn’t mean they are in the screening program.
Basic reformations for all chest protocols
Axial soft tissue kernel thin (1-1.5 mm)
Coronal soft tissue 2 mm
Sagittal soft tissue 2 mm
Axial soft tissue (5 mm) and axial lung kernal (B60f) can also be obtained if necessary
Chest Without
Indications
Cancer follow-ups
Infection
Pulmonary nodule
Initial evaluation of lymphadenopathy
Follow-up of aortic size
Acquisition Phase: Noncontrast
Notes
Most common protocol and should be the default unless there is a discrete reason for a different protocol
Chest With
Indications
Abdominopelvic findings which warrant contrast and evaluation of the chest (most common)
Further evaluation of lymphadenopathy following “Chest without”
Differentiation of atelectasis from other lung pathology
Suspected vascular pathology NOT warranting a dedicated vascular examination
Acquisition Phase: 50 second delay or determined by concomitant examination
Esophagram
Indication: Suspected esophageal leak
Acquisition Phase: Varies
Notes
“Post-POEM”: If the patient is post Peroral Endoscopic Myotomy (POEM), perform without and with oral contrast as to not mistake the myotomy clips for a leak
All other leak studies are only post oral contrast (no pre)
Intravenous contrast can be administered if there’s a pressing clinical need
Interstitial Lung Disease (ILD)
Indications
Suspected or known interstitial lung disease (especially initial characterization)
Graft vs Host
History of lung transplant
Small airways disease
Chronic Obstructive Pulmonary Disease (COPD)
Connective Tissue Disease
Acquisition Phase & Reconstructions
Standard inspiratory phase followed by expiratory phase with same parameters
Reconstructions use the same acquisition parameters as the inspiratory phase soft tissue kernel but are spaced 10 mm apart
Notes
Prone images are optional: If prone is on the indication request, then add it to the protocol
Lung Cancer Screening
Indication: Screen for lung cancer
Acquisition Phase: Low dose (kV usually 100 and mAs around 60)
Notes
Ensure that the pack-years are listed in the indication
If the patient doesn’t meet criteria (<30 pack years, outside the 55-80 years old age range), further investigation is required
Low dose does NOT equal “Lung Cancer Screening”. Low dose scans can be done on normal “Chest without” protocols but that doesn’t mean they are in the screening program.
Pulmonary Embolism
Indications
Suspected acute pulmonary embolism
Workup for chronic thromboembolic disease
Acquisition Phase: Dual energy with variable contrast delivery timing typically based on test bolus technique
Notes
Dual energy allows for acquisition of iodine maps and virtual low-kV monoenergetic series
Superior Vena Cava (SVC)
Indication: Suspected/known superior vena cava obstruction
Acquisition Phase: Single phase 90 second delay
Note: Bolus tracked at 100 HU
Tracheomalacia
Indications
Suspected/known tracheomalacia
Abnormality in the central airways
Acquisition Phase: Standard inspiratory phase followed by expiratory phase with same parameters
Notes
Similar to ILD protocol except the the cephalad field of view is higher on both inspiratory and expiratory phases (to get the upper trachea) and the caudad field of view is higher on the expiratory images to limit dose
Reconstructions are volumetric (i.e. not spaced every 10 mm) and include coronal and sagittal planes