Chest: Difference between revisions

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Priority Description<br />
1. P1 High probability of potentially life threatening condition <br />
2. P2 High probability of condition potentially causing significant long term harm <br />
3. P3 Possibility of potentially life threatening condition <br />
4. P4 Possibility of condition potentially causing significant long term harm <br />
5. P5 Unlikely to be life threatening or cause significant long term harm  <br />
<br />
{| class="wikitable"
|-
!Protocol code
!When to use
|-
| ?Ca 2Wk
|| ? Cancer 2ww – use as normal – scan to be scheduled within 2 weeks
|-
| Urgent
|| Urgent – use as normal – scan to be scheduled within 4 weeks
|-
| COVID – Semi Urgent
|| Examination needs performing during next few months
|-
| Routine
|| Do not use during Covid pandemic
|-
| COVID P5 Cancel
|| Examination is P5 exam and will be cancelled and re refer back to clinician
|-
| Cancel
|| Examination to be cancelled due to non-justification of examination only ( not due to COVID)
|-
| On hold
|| Use as normal
|}
All routine are reclassified as above.


{| class="wikitable"
{| class="wikitable"
|-
|-
! Indication
! Indication
! COVID Cancel
! COVID Urgent/Priority Category
! Brief description
! Brief description
! Slice thickness and reconstruction kernel
! Slice thickness and reconstruction kernel
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ENT cancer staging chest
ENT cancer staging chest
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent and add P category-->X
||
||
CT chest (contrast)
CT chest (contrast)
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Lung cancer staging
Lung cancer staging
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent and add P category -->X
||
||
CT chest and abdomen (contrast)
CT chest and abdomen (contrast)
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Nodule on chest x-ray or nodule follow up
Nodule on chest x-ray or nodule follow up
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent and add P category -->X
||
||
CT chest limited through nodule (non-contrast)
CT chest limited through nodule (non-contrast)
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Pulmonary embolus?
Pulmonary embolus?
|| See separate chest team guidance
||
||
||
CTPA
CTPA
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Interstitial lung disease? Bronchiectasis, rheumatoid arthritis, fibrosis, sarcoidosis, fungal infection, PCP?
Interstitial lung disease? Bronchiectasis, rheumatoid arthritis, fibrosis, sarcoidosis, fungal infection, PCP?
|| <!--Put an X after the angled bracket if COVID Cancel -->X
|| <!--Put an X after the angled bracket if COVID Urgent and add P category-->
||
||
CT chest volume (non-contrast)
CT chest volume (non-contrast)
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Mesothelioma? Empyema/unilateral pleural effusion?
Mesothelioma? Empyema/unilateral pleural effusion?
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent and add P category -->X
||
||
CT pleural disease (65 s contrast)
CT pleural disease (65 s contrast)
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Mesothelioma follow-up
Mesothelioma follow-up
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent and add P category-->If changes management
||
||
CT chest &amp; abdomen (contrast) mesothelioma protocol
CT chest &amp; abdomen (contrast) mesothelioma protocol
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Mediastinal mass
Mediastinal mass
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent and add P category-->X
||
||
CT chest + c
CT chest + c
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Fungal infection?
Fungal infection?
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent and add P category-->X
||
||
CT chest (non-contrast)
CT chest (non-contrast)
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For left atrial ablation
For left atrial ablation
|| <!--Put an X after the angled bracket if COVID Cancel -->X
|| <!--Put an X after the angled bracket if COVID Urgent and add P category-->
||
||
CT left atrium (contrast)
CT left atrium (contrast)
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Post-sternotomy. Infection?
Post-sternotomy. Infection?
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent and add P category-->X
||
||
CT sternum (65 s contrast)
CT sternum (65 s contrast)
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For anatomy prior to re-do sternotomy
For anatomy prior to re-do sternotomy
|| <!--Put an X after the angled bracket if COVID Cancel -->X
|| <!--Put an X after the angled bracket if COVID Urgent and add P category-->If acute
||
||
CT sternum (non-contrast)
CT sternum (non-contrast)
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Pneumothorax? Pneumothorax vs bulla
Pneumothorax? Pneumothorax vs bulla
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent and add P category-->
||
||
CT chest volume (non-contrast)
CT chest volume (non-contrast)
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Aortic dissection? Aneurysm? Acute aortic syndrome
Aortic dissection? Aneurysm? Acute aortic syndrome
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent and add P category-->X
||
||
CT angiogram aorta
CT angiogram aorta
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Ruptured aortic aneurysm
Ruptured aortic aneurysm
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent and add P category-->X
||
||
Pre/arterial
Pre/arterial
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Post aortic dissection/aneurysm/EVAR repair first follow up
Post aortic dissection/aneurysm/EVAR repair first follow up
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent and add P category-->X
||
||
CT angiogram aorta with pre-contrast
CT angiogram aorta with pre-contrast
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Post aortic repair surveillance
Post aortic repair surveillance
|| <!--Put an X after the angled bracket if COVID Cancel -->X
|| <!--Put an X after the angled bracket if COVID Urgent and add P category-->If first follow-up scan or previous abnormality
||
||
CT angiogram aorta or MRI, no pre-contrast
CT angiogram aorta or MRI, no pre-contrast
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Endoleak?
Endoleak?
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent and add P category-->X
||
||
Pre and arterial covering stented aorta. If no leak, but continued sac expansion/type V suspected the 60 second delay
Pre and arterial covering stented aorta. If no leak, but continued sac expansion/type V suspected the 60 second delay
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Acute aortic syndromes
Acute aortic syndromes
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent and add P category-->X
||
||
Gated CT angiogram aorta
Gated CT angiogram aorta
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Aortic coarctation?
Aortic coarctation?
|| <!--Put an X after the angled bracket if COVID Cancel -->X
|| <!--Put an X after the angled bracket if COVID Urgent and add P category-->
||
||
CT angiogram aorta
CT angiogram aorta
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Pre-operative aortic diameter/calcification
Pre-operative aortic diameter/calcification
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent and add P category-->X
||
||
CT ascending aorta (non-contrast top of arch to mid heart)
CT ascending aorta (non-contrast top of arch to mid heart)
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Tb?
Tb?
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent and add P category-->
||
||
Indicated for suspected Tb, but uncertain clinical diagnosis, consider contrast if nodal disease is the main query
Indicated for suspected Tb, but uncertain clinical diagnosis, consider contrast if nodal disease is the main query
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Tb response to treatment?
Tb response to treatment?
|| <!--Put an X after the angled bracket if COVID Cancel -->
|| <!--Put an X after the angled bracket if COVID Urgent and add P category-->
||
||
Indicated where response is uncertain, consider contrast if nodal disease is the main query
Indicated where response is uncertain, consider contrast if nodal disease is the main query
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Ocular Tb or other extrapulmonary Tb
Ocular Tb or other extrapulmonary Tb
|| <!--Put an X after the angled bracket if COVID Cancel -->X
|| <!--Put an X after the angled bracket if COVID Urgent and add P category-->
||
||
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.
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.

Latest revision as of 11:03, 3 April 2024

Indication Brief description Slice thickness and reconstruction kernel Further details of contrast timing/explanation of what the radiographers do Abbreviation

ENT cancer staging chest

CT chest (contrast)

1 mm B30f, 1 mm B70f both 0.7 mm increment.

65 seconds

CT chest + c

Lung cancer staging

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

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?

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?

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?

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

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

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?

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

CT left atrium (contrast)

 

Now done by cardiology

CTLA

Post-sternotomy. Infection?

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

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

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

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

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

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?

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

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?

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

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

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