Chest

Priority Description
1. P1 High probability of potentially life threatening condition
2. P2 High probability of condition potentially causing significant long term harm
3. P3 Possibility of potentially life threatening condition
4. P4 Possibility of condition potentially causing significant long term harm
5. P5 Unlikely to be life threatening or cause significant long term harm

All routine are reclassified as two-week wait, COVID urgent, COVID semi-urgent, or cancel.

Indication	COVID Cancel	COVID Urgent/Priority Category	Brief description	Slice thickness and reconstruction kernel	Further details of contrast timing/explanation of what the radiographers do	Abbreviation
ENT cancer staging chest		X	CT chest (contrast)	1 mm B30f, 1 mm B70f both 0.7 mm increment.	65 seconds	CT chest + c
Lung cancer staging		X	CT chest and abdomen (contrast)	1 mm B30f, 1 mm B70f both 0.7 mm increment.	65 seconds	CT chest and abdo + c
Nodule on chest x-ray or nodule follow up		X	CT chest limited through nodule (non-contrast)	1 mm B30f, 1 mm B70f both 0.7 mm increment.	No contrast	Limited CT chest
Pulmonary embolus?	See separate chest team guidance		CTPA	1 mm B26f, 1 mm B70f both 0.7 mm increment. Vascular windows: C:200 W:600	ROI placed over main PA monitoring begins after 4 seconds and bolus tracking triggers scan at 140 HU with a delay of 6 seconds. Or Flash CTPA.	CTPA
Interstitial lung disease? Bronchiectasis, rheumatoid arthritis, fibrosis, sarcoidosis, fungal infection, PCP?	X		CT chest volume (non-contrast)	1 mm B30f, 1 mm B70f both 0.7 mm increment.	No contrast	Non-contrast CT chest
Mesothelioma? Empyema/unilateral pleural effusion?		X	CT pleural disease (65 s contrast)	1 mm B30f, 1 mm B70f both 0.7 mm increment.	Scan at 65 seconds post contrast.	CT chest + c
Mesothelioma follow-up		If changes management	CT chest & abdomen (contrast) mesothelioma protocol	1 mm B30f, 1 mm B70f both 0.7 mm increment.	Scan at 65 seconds post contrast.	CT chest and abdo + c
Mediastinal mass		X	CT chest + c	1 mm B30f, 1 mm B70f both 0.7 mm increment.	Scan at 65 seconds post contrast.	CT chest + c
Fungal infection?		X	CT chest (non-contrast)	1 mm B30f, 1 mm B70f both 0.7 mm increment.	No contrast	Non-contrast CT chest
For left atrial ablation	X		CT left atrium (contrast)		Now done by cardiology	CTLA
Post-sternotomy. Infection?		X	CT sternum (65 s contrast)	1 mm B30f, 1 mm B70f both 0.7 mm increment.	65 seconds post contrast.	CT chest + c
For anatomy prior to re-do sternotomy	X	If acute	CT sternum (non-contrast)	1 mm B30f, 1 mm B70f both 0.7 mm increment.	No contrast	Non-contrast CT chest
Pneumothorax? Pneumothorax vs bulla			CT chest volume (non-contrast)	1 mm B30f, 1 mm B70f both 0.7 mm increment.	No contrast	Non-contrast CT chest
Aortic dissection? Aneurysm? Acute aortic syndrome		X	CT angiogram aorta	1 mm B30f, 1 mm B70f both 0.7 mm increment.	Pre contrast aorta followed by cardiac gated CT angiogram or Flash (high pitch) angiogram of the aorta.	Gated CT aorta Flash CT aorta See appendix
Ruptured aortic aneurysm		X	Pre/arterial	1 mm B30f, 1 mm B70f both 0.7 mm increment.	Pre-contrast, angio (bolus tracked)	Angio aorta inc pre con
Post aortic dissection/aneurysm/EVAR repair first follow up		X	CT angiogram aorta with pre-contrast	1 mm B30f, 1 mm B70f both 0.7 mm increment.	Bolus tracking with ROI over descending aorta triggers at 100 HU with 6 second delay	CT aorta pre and angio
Post aortic repair surveillance	X	If first follow-up scan or previous abnormality	CT angiogram aorta or MRI, no pre-contrast	1 mm B30f, 1 mm B70f both 0.7 mm increment.	As above	CT angio aorta
Endoleak?		X	Pre and arterial covering stented aorta. If no leak, but continued sac expansion/type V suspected the 60 second delay	1 mm B30f, 1 mm B70f both 0.7 mm increment.	As above	CT aorta pre and angio (specify which part of aorta)
Acute aortic syndromes		X	Gated CT angiogram aorta	1 mm B30f, 1 mm B70f both 0.7 mm increment.	Pre contrast aorta followed by wide prospective cardiac gated CT angiogram of ascending aorta with CT or Flash CT (high pitch) angiogram of the aorta.	Gated CT angio aorta with pre-contrast
Aortic coarctation?	X		CT angiogram aorta	1 mm B30f, 1 mm B70f both 0.7 mm increment.	Bolus tracking with ROI over descending aorta triggers at 100 HU with 6 second delay	CT aorta
Pre-operative aortic diameter/calcification		X	CT ascending aorta (non-contrast top of arch to mid heart)	1 mm B30f, 1 mm B70f both 0.7 mm increment.	No contrast	CT non-con ascending aorta
Tb?			Indicated for suspected Tb, but uncertain clinical diagnosis, consider contrast if nodal disease is the main query	1 mm slice width, 1 mm increment	Insert text here	CT chest
Tb response to treatment?			Indicated where response is uncertain, consider contrast if nodal disease is the main query	1 mm slice width, 1 mm increment	Insert text here	CT chest
Ocular Tb or other extrapulmonary Tb	X		Consider chest radiograph instead. For example in ocular Tb/Tb uveitis 60% do not have pulmonary Tb and further imaging may not enhance diagnostic pathway as it will not be sensitive for extra pulmonary disease detection and will not have a high negative predictive value for extrapulmonary disease.	N/A	N/A	N/A