Chest CT for Non-Radiologists. A Practical Guide

178 Pages·2018·9.238 MB·English

by  Mary M. Salvatore, Ronaldo Collo Go, Monica A. Pernia M.

Mary M. Salvatore
Ronaldo Collo Go
Monica A. Pernia M.
Chest CT for
Non-Radiologists
A Practical Guide
123
Chest CT for
Non-Radiologists
Chest CT for the non-radiologist
Mary M. Salvatore
Ronaldo Collo Go
Monica A. Pernia M.
Chest CT for
Non-Radiologists
A Practical Guide
Mary M. Salvatore Ronaldo Collo Go
Radiology Division of Pulmonary, Critical
Icahn School of Medicine at Care, and Sleep Medicine
Mount Sinai Crystal Run Health Care
New York, NY Middletown, NY
USA USA
Monica A. Pernia M.
Internal Medicine
New York Medical College -
Metropolitan Hospital Program
New York, NY
USA
ISBN 978-3-319-89709-7 ISBN 978-3-319-89710-3 (eBook)
https://doi.org/10.1007/978-3-319-89710-3
Library of Congress Control Number: 2018942614
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Preface
“If you can’t explain it simply, you don’t understand it well
enough.”
—Albert Einstein
The purpose of this book is to teach an approach to chest
CT scan review for those who deal with imaging exams on a
regular basis but will not dedicate their career to radiology. It
has been our goal to provide you with a foundation for view-
ing CT scans of the chest, with step-by-step instructions on
how to systematically approach interpretation. This text will
benefit medical students who do not have the opportunity to
study radiology, health care professionals including residents
and fellows who order chest CT scans and use the informa-
tion provided to diagnose and treat patients, and scientists
who are involved in studying pulmonary diseases. We feel
confident that you will enjoy reading this hands-on text and
utilize the information provided to ultimately benefit patients.
Overview of the approach to chest CT review
Review Series Settings Views Specifics
1. Dose Dose NA NA DLP
• 0–200 ok
• >200 Why?
2. Scout Scout Window AP 1. Lines and
400 Lateral tubes
Level 2. Diaphragm
40 3. Scoliosis
v
vi Preface
Review Series Settings Views Specifics
3. Airways Lung Window Axial 1. Trachea
windows 1500 2. RUL bronchus
Level 3. RML
-650 bronchus
4. RLL bronchus
5. LUL bronchus
6. LLL bronchus
4. Lung Standard Window Axial 1. RUL
parenchyma windows 1500 MIP 2. RML
Level 3. RLL
-650 4. LUL
5. LLL
6. Pleura
5. Mediastinum Standard Window Axial 1. Thyroid
windows 400 2. Lymph nodes
Level 3. Heart
40 4. Esophagus
6. Upper Standard Window Axial 1. Liver
abdomen windows 400 2. Spleen
Level 3. Gallbladder
40 4. Pancreas
5. Adrenals
6. Kidneys
7. Bowel
7. Soft tissue Standard Window Axial 1. Breast
windows 400 2. Subcutaneous
Level 3. Muscle
40
8. Osseous Standard Window Axial 1. Spine
structures windows 2000 Sagittal 2. Sternum
Level 3. Ribs
300 4. Shoulders
New York, NY, USA Mary M. Salvatore
Middletown, NY, USA Ronaldo Collo Go
New York, NY, USA Monica A. Pernia M.
Contents
1 Radiation Dose and Imaging Protocols ......... 1
1.1 Radiation Dose .......................... 1
1.2 Imaging Protocols ........................ 3
1.3 ACR Appropriateness Criteria ............. 5
References .................................. 6
2 The Scout Film .............................. 9
2.1 L ines and Tubes Visible on the Scout Film ... 10
2.2 Orthopedic Hardware Assessment .......... 14
2.3 Foreign Body ............................ 16
2.4 Spine Deformity ......................... 16
2.5 Diaphragm .............................. 18
References .................................. 20
3 The Trachea and Bronchi ..................... 23
3.1 Normal Anatomy of Airways............... 23
3.2 Diseases of the Trachea ................... 29
3.3 Diseases of the Bronchi ................... 33
References .................................. 39
4 The Lung Parenchyma ....................... 43
4.1 Introduction ............................. 43
4.2 The Alveoli.............................. 46
4.2.1 Increased Radio Density of Alveoli .. 48
4.2.2 Decreased Radiodensity of Alveoli... 54
4.3 The Interlobular Septa .................... 60
4.3.1 ILD Causes Known and Unknown ... 65
4.4 The Pulmonary Artery .................... 77
References .................................. 82
vii
viii Contents
5 Lung Nodules ............................... 87
5.1 Non-cancerous Lung Nodules .............. 87
5.2 Cancerous Lung Nodules.................. 97
5.3 Pleural Nodules and Plaques............... 104
References .................................. 108
6 The Mediastinum and Pleural ................. 111
6.1 Normal Anatomy and Variants ............. 111
6.2 Lymph Nodes............................ 113
6.3 Anterior Mediastinum .................... 117
6.4 Middle Mediastinum...................... 119
6.5 Posterior Mediastinum .................... 120
6.6 The Heart............................... 121
6.7 Pleural Effusion and Pneumothorax......... 123
6.8 Esophagus............................... 126
References .................................. 129
7 The Upper Abdomen ........................ 131
7.1 A bdominal Organs on Chest CT............ 131
7.2 Liver ................................... 132
7.3 Gallbladder.............................. 135
7.4 Spleen .................................. 137
7.5 Pancreas ................................ 137
7.6 Adrenals ................................ 139
7.7 Kidneys................................. 140
7.8 Bowel .................................. 142
References .................................. 144
8 The Soft Tissues ............................. 147
8.1 Breast on CT ............................ 147
8.2 Subcutaneous Tissue . . . . . . . . . . . . . . . . . . . . . . 152
References .................................. 154
9 The Osseous Structures ....................... 157
9.1 Spine ................................... 157
9.2 Ribs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
9.3 Sternum................................. 164
9.4 Shoulders ............................... 166
References .................................. 167
Concluding Remarks ........................... 169
Index ......................................... 171
Chapter 1
Radiation Dose and Imaging
Protocols
• Is the dose too high?
• Have I optimized ability to make diagnosis?

1.1 Radiation Dose
It is appropriate that the first section of this text should
address the radiation dose because the risk of radiation expo-
sure is a stochastic risk that may be analyzed statistically but
may not be predicted precisely. Therefore, every time a CT
scan is ordered and performed, we must remember there is
risk to the patient, and we should only perform CT when the
risk-benefit ratio supports the exam. In the past CT looked to
© Springer International Publishing AG, part of Springer 1
Nature 2018
M. M. Salvatore et al., Chest CT for Non-Radiologists,
https://doi.org/10.1007/978-3-319-89710-3_1