Chest CT for Non-Radiologists. A Practical Guide PDF
Preview Chest CT for Non-Radiologists. A Practical Guide
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 © Springer International Publishing AG, part of Springer Nature 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of transla- tion, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimi- lar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of pub- lication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Printed on acid-free paper This Springer imprint is published by the registered company Springer International Publishing AG part of Springer Nature. The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland 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
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