Lung |
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Solid pulmonary nodule |
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< 5 mm or < 80 mm3 with no suspicious features (e.g., granulomas, IPLNs) |
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→ Reporting is optional, and no follow-up is required |
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> 5 mm, previously unknown or with suspicious features |
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→ Report and alert the respiratory team |
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5-8 mm → Baseline LDCT and provide an LDCT follow-up schedule |
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5-6 mm: LDCT within one year 6-8 mm: LDCT within three months |
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> 8 mm or > 300 mm3 → Assess the risk of cancer (Brock model) |
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< 10% risk of cancer: baseline LCDT and follow-up LDCT within one year |
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≥ 10% risk of cancer: referral to lung cancer MDT |
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Subsolid pulmonary nodule |
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≥ 5 mm → Report to and alert the respiratory team |
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→ Baseline LDCT and provide a follow-up schedule within three months |
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Stable after ≥ 3 months: assess the risk of cancer (Brock model) |
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< 10% risk of cancer: follow-up LDCT within one year |
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≥ 10% risk of cancer: referral to lung cancer MDT |
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Growing or altered morphology → Referral to lung cancer MDT |
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Pulmonary emboli → Report and urgent referral to the respiratory team |
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ILAs → Report to and alert the respiratory team |
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In the presence of respiratory symptoms, physiological abnormalities, gas transfer abnormalities and extensive CT changes → Referral to the respiratory team/ILD MDT meeting |
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In the presence of risk factors for progression → Follow-up may be appropriate even after exclusion of ILD (the optimal interval for follow-up CT scanning is unknown) |
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Infection/Consolidation |
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→ Report and referral to the respiratory team if not already under their care |
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→ CT reassessment after therapy |
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Emphysema → Report and grade severity |
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Bronchiectasis, atelectasis → Report |
Pleura |
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Pneumothorax (rare) → Report and urgent referral to the medical emergency team |
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Pleural plaques → Report |
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in lung cancer patients: differentiate pleural plaques from pleural metastases |
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in asbestos exposure: assess signs suspicious for mesothelioma |
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Pleural effusion → Report |
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in cardiac patients it may be related to heart failure: trigger an alert |
Mediastinum |
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Pneumomediastinum (rare) → Report and urgent referral to the medical emergency team |
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Mediastinal nodule or mass → Report |
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if presenting suspicious features → Referral to the cardiothoracic surgical team |
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if benign-looking → Suggest annual CT follow-up or MRI characterisation |
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Aorta and pulmonary vessels → Report abnormalities in the context of the patient’s cardiovascular disease |
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Lymphadenopathy → Report |
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if suspicious features or absence of an explaining disease to justify lymphadenopathy → Consider providing a follow-up schedule or suggest further characterisation with PET-CT or biopsy |
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Oesophageal hiatus hernia → Report |
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In the presence of heartburn (confounding symptom) → Referral to gastrointestinal evaluation |
Chest wall |
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Bone |
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‘Do not touch’ lesions → Report but no follow-up required |
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Degenerative bony changes → Report (may cause atypical chest pain) |
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Suspicious bone lesions → Report and trigger an alert |
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Skin, subcutaneous and muscle lesions → Report new or previously undiagnosed lesions |
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Breast → Report new or previously undiagnosed lesions and alert breast team |
Upper abdomen |
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Liver |
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Simple hepatic cysts → Reporting is optional, and no follow-up is required |
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Other focal parenchymal lesions → Report if previously undiagnosed and suggest further evaluation with triple-phase CT or MRI |
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Biliary system |
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Abnormal appearance of the gallbladder wall, biliary obstruction or pneumobilia → Report and suggest further evaluation |
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Gallstones → Reporting is optional, and no follow-up is required |
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Adrenal glands, pancreas, stomach and spleen |
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Any cystic or solid lesions, or splenomegaly → Report and suggest further evaluation if previously undiagnosed |
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Kidneys |
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Simple or minimally complex renal cysts (Bosniak I and II) → Reporting is optional, and no follow-up is required |
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Complex renal cysts → Report and suggest further evaluation |
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Solid renal masses → Report and trigger an alert |
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Peritoneum |
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Nodules, infiltrative masses, haziness, ascites, peritoneal thickening or implants → Report, alert and suggest further evaluation |
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Lymphadenopathy → Report and suggest further evaluation |