Recognizing What to Order - Thoracic Imaging

Question 1

Asthma, suspected pneumonia or pneumothorax?

Answer 1

CXR.

Question 2

COPD worsening with elevated WBC count, pain, associated CAD or CHF?

Answer 2

CXR.

Question 3

Complicated pneumonia?

Answer 3

CXR - Then chest C if pneumonia doesn’t resolve.

Question 4

HIV+; Acute respiratory illness?

Answer 4

CXR - If negative then CT WITHOUT CONTRAST.

Question 5

HIV+; CXR+?

Answer 5

CT chest WITHOUT contrast.

Question 6

Chronic SOB?

Answer 6

CXR - Infiltrative lung disease may be present with a negative CXR - CT WITHOUT contrast.

Question 7

Hemoptysis?

Answer 7

CXR - Then CT WITH CONTRAST.

Question 8

Massive Hemoptysis?

Answer 8

CXR followed by CT WITH contrast.

Question 9

Rib fractures?

Answer 9

CXR - Frontal chest is sufficient to rule OUT pneumothorax, contusion.

Question 10

After insertion of EETT, CVC, PICC, Swan-Ganz catheter, DHT, chest tube?

Answer 10

CXR, portable.

Question 11

Screening for lung metastases from renal cell, testicular, melanoma, head and neck malignancies?

Answer 11

CXR + CT as baseline.

Question 12

Screening for lung metastases from soft tissue or bone sarcomas?

Answer 12

CT chest WITHOUT contrast.

Question 13

Solitary pulmonary nodule, >1cm, low suspicion for cancer?

Answer 13

CT WITHOUT contrast - To detect occult calcifications, fat, bronchus sign, etc.
If indeterminate, consider PET scan.

Question 14

Solitary pulmonary nodule, >1cm, moderate to high clinical suspicion for cancer?

Answer 14

CT WITHOUT contrast - To detect occult calcifications, fat, bronchus sign, etc.
If indeterminate, consider PET scan.

Question 15

Solitary pulmonary nodule,

Answer 15

CT chest WITHOUT contrast.

Question 16

Solitary pulmonary nodule,

Answer 16

CT WITHOUT contrast.

Question 17

Staging for non-small cell lung cancer?

Answer 17

CT WITH contrast - CXR for baseline.

Consider also whole body PET.

Question 18

Staging for small-cell lung cancer?

Answer 18

CXR - Chest CT WITH contrast.

MRI head WITH contrast.

Question 19

Cough, sputum, chest pain, SOB, +/- fever?

Answer 19

CXR.