WlwG Management Protocols Flashcards by WlwG W

Q

Adrenals: Non-adrenal CT, <1cm

A

NFU

All <1cm or non-enhancing = No further scan
1-4cm <10HU on plain = No follow up
Otherwise, 1-2 cm and no cancer history = 12 month CT adrenal
Otherwise = Early CT adrenal

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Q

Adrenals: Non-adrenal CT, non-enhancing

A

NFU

All <1cm or non-enhancing = No further scan
1-4cm <10HU on plain = No follow up
Otherwise, 1-2 cm and no cancer history = 12 month CT adrenal
Otherwise = Early CT adrenal

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Q

Adrenals: Non-adrenal CT, 1-4 cm, <10HU on plain

A

NFU

All <1cm or non-enhancing = No further scan
1-4cm <10HU on plain = No follow up
Otherwise, 1-2 cm and no cancer history = 12 month CT adrenal
Otherwise = Early CT adrenal

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Q

Adrenals: Non-adrenal CT: 1-2 cm, no cancer history, >10HU on plain

A

12 month CT adrenal

All <1cm or non-enhancing = No further scan
1-4cm <10HU on plain = No follow up
Otherwise, 1-2 cm and no cancer history = 12 month CT adrenal
Otherwise = Early CT adrenal

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Q

Adrenals: Non-adrenal CT: 2+cm or >10HU on plain

A

Early CT adrenal

All <1cm or non-enhancing = No further scan
1-4cm <10HU on plain = No follow up
Otherwise, 1-2 cm and no cancer history = 12 month CT adrenal
Otherwise = Early CT adrenal

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Q

Adrenals: CT Adrenals: <1cm

A

NFU

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Q

Adrenals: CT Adrenals: Non-enhancing

A

NFU

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Q

Adrenals: CT Adrenals: 1+cm, <-10HU on plain

A

Myelolipoma, NFU

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Q

Adrenals: CT Adrenals: 1+cm, <10HU on plain

A

Lipid rich adenoma, NFU

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Q

Adrenals: CT Adrenals: 1+cm, >10HU on plain, high washout

A

Lipid poor adenoma, NFU

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Q

Adrenals: CT Adrenals: 1-4 cm, >10HU on plain, low washout

A

Indeterminate, close follow up, consider Bx/PET

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Q

Adrenals: CT Adrenals: 4+cm, no cancer hx

A

Adreno-Cortical Ca, resect

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Q

Adrenals: CT Adrenals: 4+cm, cancer hx

A

Mets, Bx/PET

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Q

Adrenals: CT Adrenals: HU>120

A

Pheochromocytoma

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Q

Adrenals: Follow up CT Adrenals: 1-4cm, stable 1 year, no features of functional adenoma/pheo

A

NFU

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Q

Adrenals: Follow up CT Adrenals: 1-4cm, new or enlarging, no cancer hx

A

Follow up CT, consider resection

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Q

Adrenals: Follow up CT Adrenals: 1-4cm, new or enlarging, cancer hx

A

Mets, Bx/PET

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Q

BIRADS: 0

A

Insufficient scan = do additional views/US

(“RNB 2BC Really normal but to be confirmed” = Repeat, Normal, Benign, 2 year F/U, Biopsy, Cancer)

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Q

BIRADS: 1

A

Completely normal breast

(“RNB 2BC Really normal but to be confirmed” = Repeat, Normal, Benign, 2 year F/U, Biopsy, Cancer)

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Q

BIRADS: 2

A

Complete benign findings (fatty lesion/cyst)

(“RNB 2BC Really normal but to be confirmed” = Repeat, Normal, Benign, 2 year F/U, Biopsy, Cancer)

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Q

BIRADS: 3

A

Benign but 2 years of short-interval follow up (fibroadenoma/cluster of calcs, <2% chance of malignancy)

(“RNB 2BC Really normal but to be confirmed” = Repeat, Normal, Benign, 2 year F/U, Biopsy, Cancer)

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Q

BIRADS: 4

A

BIOPSY as unsure benign/malignant (30% chance of malignancy)

(“RNB 2BC Really normal but to be confirmed” = Repeat, Normal, Benign, 2 year F/U, Biopsy, Cancer)

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Q

BIRADS: 5

A

BIOPSY as likely cancer (95+% chance of malignancy)

(“RNB 2BC Really normal but to be confirmed” = Repeat, Normal, Benign, 2 year F/U, Biopsy, Cancer)

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Q

NIRADS for post-treatment H&N cancer: When to do CT/PET?

A

CT neck and PET-CT at 3 months post treatment
CT neck and chest or PET-CT at 9 months post treatment (6 months after prior scan)

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NIRADS for post-treatment H&N cancer: 0

Incomplete, no prior imaging for comparison

NIRADS for post-treatment H&N cancer: 1

Post-tx changes, no local or LN recurrence = Routine follow up

NIRADS for post-treatment H&N cancer: 2

Non-mass enhancement or LN +ve but no suspicious feature or mild avidity = 3 month CT follow up, consider PET

NIRADS for post-treatment H&N cancer: 3

Mass-like enhancement or LN with suspicious features or high avidity = Biopsy

Lung Fleischner nodules: Exclusions

Under 35 years old, Infn from immunosuppression, Cancer screen, known cancer

Lung Fleischner nodules: Solid/sub-solid/GGO 5mm

NFU

Lung Fleischner nodules: Solid 6-8mm

6-12 mth then 1 yearly

Lung Fleischner nodules: Solid 9+mm

3 mth follow up or PET/CT or biopsy

Lung Fleischner nodules: GGO 6+mm

12 mth then every 2 years

Lung Fleischner nodules: Sub-solid 6+mm

3-6 mth then 1 yearly

Lung-Rads for cancer/cancer screen: Cat 1/2 meaning and management

Lung-Rads for cancer/cancer screen: Cat 3/4A meaning and management

Lung-Rads for cancer/cancer screen: Cat 4B/4X meaning and management

>15mm solid or >8mm solid component sub-solid or spiculation or LN +ve = PET-CT/biopsy

Liver LIRADS Mx: 1

LR1 = Routine follow up (completely benign eg cyst/haemangioma/scarring) LR2 = 6 month follow up (atypical benign eg cirrhosis nodule) LR3 = 3-6 month follow up (indeterminate) LR NC (non-categorizable due to poor scan) = <3 month follow up LR4 = Biopsy (suspicious) LR5 = Treat (very suspicious)

Liver LIRADS Mx: 2

LR1 = Routine follow up (completely benign eg cyst/haemangioma/scarring) LR2 = 6 month follow up (atypical benign eg cirrhosis nodule) LR3 = 3-6 month follow up (indeterminate) LR NC (non-categorizable due to poor scan) = <3 month follow up LR4 = Biopsy (suspicious) LR5 = Treat (very suspicious)

Liver LIRADS Mx: 3

LR1 = Routine follow up (completely benign eg cyst/haemangioma/scarring) LR2 = 6 month follow up (atypical benign eg cirrhosis nodule) LR3 = 3-6 month follow up (indeterminate) LR NC (non-categorizable due to poor scan) = <3 month follow up LR4 = Biopsy (suspicious) LR5 = Treat (very suspicious)

Liver LIRADS Mx: NC

LR1 = Routine follow up (completely benign eg cyst/haemangioma/scarring) LR2 = 6 month follow up (atypical benign eg cirrhosis nodule) LR3 = 3-6 month follow up (indeterminate) LR NC (non-categorizable due to poor scan) = <3 month follow up LR4 = Biopsy (suspicious) LR5 = Treat (very suspicious)

Liver LIRADS Mx: 4

LR1 = Routine follow up (completely benign eg cyst/haemangioma/scarring) LR2 = 6 month follow up (atypical benign eg cirrhosis nodule) LR3 = 3-6 month follow up (indeterminate) LR NC (non-categorizable due to poor scan) = <3 month follow up LR4 = Biopsy (suspicious) LR5 = Treat (very suspicious)

Liver LIRADS Mx: 5

LR1 = Routine follow up (completely benign eg cyst/haemangioma/scarring) LR2 = 6 month follow up (atypical benign eg cirrhosis nodule) LR3 = 3-6 month follow up (indeterminate) LR NC (non-categorizable due to poor scan) = <3 month follow up LR4 = Biopsy (suspicious) LR5 = Treat (very suspicious)

Prostate PIRADS: Based on which sequences?

Based on DWI for PZ, T2 for TZ ("TZ T2")

Prostate PIRADS: 1, meaning and mangement?

P1 = normal/BPH P2 (unlikely) = indeterminate P3 (equivocal) = mild DR or T2-hypo -> Do Dynamic contrast enhancement (DCE): Type 3 curve ie EARLY enhancement is suspicious, hence upgrade to P4 P4 (suspicious) = moderate DR or T2-hypo, <1.5cm and no extra-prostatic extension P5 (very suspicious) = P4 + >1.5 cm or extra-prostatic extension Stage 2/Pirads 4 = within capsule, Stage 3/Pirads 5 = broken through capsule.

Prostate PIRADS: 2, meaning and mangement?

P1 = normal/BPH P2 (unlikely) = indeterminate P3 (equivocal) = mild DR or T2-hypo -> Do Dynamic contrast enhancement (DCE): Type 3 curve ie EARLY enhancement is suspicious, hence upgrade to P4 P4 (suspicious) = moderate DR or T2-hypo, <1.5cm and no extra-prostatic extension P5 (very suspicious) = P4 + >1.5 cm or extra-prostatic extension Stage 2/Pirads 4 = within capsule, Stage 3/Pirads 5 = broken through capsule.

Prostate PIRADS: 3, meaning and mangement?

P1 = normal/BPH P2 (unlikely) = indeterminate P3 (equivocal) = mild DR or T2-hypo -> Do Dynamic contrast enhancement (DCE): Type 3 curve ie EARLY enhancement is suspicious, hence upgrade to P4 P4 (suspicious) = moderate DR or T2-hypo, <1.5cm and no extra-prostatic extension P5 (very suspicious) = P4 + >1.5 cm or extra-prostatic extension Stage 2/Pirads 4 = within capsule, Stage 3/Pirads 5 = broken through capsule.

Prostate PIRADS: 4, meaning and mangement?

P1 = normal/BPH P2 (unlikely) = indeterminate P3 (equivocal) = mild DR or T2-hypo -> Do Dynamic contrast enhancement (DCE): Type 3 curve ie EARLY enhancement is suspicious, hence upgrade to P4 P4 (suspicious) = moderate DR or T2-hypo, <1.5cm and no extra-prostatic extension P5 (very suspicious) = P4 + >1.5 cm or extra-prostatic extension Stage 2/Pirads 4 = within capsule, Stage 3/Pirads 5 = broken through capsule.

Prostate PIRADS: 5, meaning and mangement?

P1 = normal/BPH P2 (unlikely) = indeterminate P3 (equivocal) = mild DR or T2-hypo -> Do Dynamic contrast enhancement (DCE): Type 3 curve ie EARLY enhancement is suspicious, hence upgrade to P4 P4 (suspicious) = moderate DR or T2-hypo, <1.5cm and no extra-prostatic extension P5 (very suspicious) = P4 + >1.5 cm or extra-prostatic extension Stage 2/Pirads 4 = within capsule, Stage 3/Pirads 5 = broken through capsule.

Prostate PIRADS: When to biopsy?

P4 and P5 = Biopsy. P3 depends clinically/PSA etc.

Kidney Bosniak meaning and management: Simple

<20Hu, non-enhancing, no septations/calcs = No follow up (“SFMCE” = Simple, Fine, Multi, Complex, Enhancing)

Kidney Bosniak meaning and management: 2

(<20 Hu or >70 Hu cyst pre-contrast and doesn't fit B2F) = No follow up (“SFMCE” = Simple, Fine, Multi, Complex, Enhancing)

Kidney Bosniak meaning and management: 2F

(3+ cm, or 3+mm thick/4+ number enhancing septations) (“234”) = 6 months then yearly follow up (“SFMCE” = Simple, Fine, Multi, Complex, Enhancing)

Kidney Bosniak meaning and management: 3

(multi-loculated/complex septations/heavy calcifications) = Surgery (“SFMCE” = Simple, Fine, Multi, Complex, Enhancing)

Kidney Bosniak meaning and management: 4

(enhancing >15Hu, ie RCC) = Surgery (“SFMCE” = Simple, Fine, Multi, Complex, Enhancing)

Gallbladder Polyp Management: Points calculation

1-5mm = 1 point 6-9mm = 2 points 1cm or increases by 2mm at follow up = 3 points Risk factors (50+ year old, PSC, Indian, Sessile polyp) = +1 point Disappears at follow up = 0 points

Gallbladder Polyp Management: Management of 0-3 points

0 points = 0 follow up. 1 point = 1x/year f/u. 2 points = 2x/year f/u for first year (ie 6 monthly). 3 points = surgery.

Thyroid TIRADS: Suspicious features

Taller-than-wide, very hypoechoic, solid, irregular margins, micro-calcification, vascular, locally invasive, extra-thyroid extension (“Tall solid black person who fights till bleed”)

Thyroid TIRADS: Mnemonic for management

(“Mnemonic = 1, 2, 2.5, 3, 4, 5, 6, 7”) 1: TR1 no follow up 2: TR2 no follow up 2.5: TR5 x 0.5 cm = follow up 5 years 3: TR4 x 1 cm = follow up 5 years 4: TR3 x 1.5 cm = follow up 5 years 5: TR5 x 1 cm = FNA 6: TR4 x 1.5 cm = FNA 7: TR3 x 2.5 cm = FNA

Endometrium: When to biopsy?

Biopsy if POST-MENOPAUSAL endometrial thickness 5+mm and bleed, or 12+mm if no bleed Pre-menopause: 17+mm is thickened, no fixed guidelines.

AAA Management: 3-3.9cm

3-3.9 cm = US every 2 years, conservative mx (smoking/HTN) 4-5.4 cm = US every 6-12 months, conservative mx (smoking/HTN) 5.5+cm = EVAR or surgical repair Can consider repair if growing 0.5+ cm per 6 months EVAR: Landing zone of >1cm length and <3.2cm wide (not dilated)

AAA Management: 4-5.4cm

3-3.9 cm = US every 2 years, conservative mx (smoking/HTN) 4-5.4 cm = US every 6-12 months, conservative mx (smoking/HTN) 5.5+cm = EVAR or surgical repair Can consider repair if growing 0.5+ cm per 6 months EVAR: Landing zone of >1cm length and <3.2cm wide (not dilated)

AAA Management: 5.5+cm

3-3.9 cm = US every 2 years, conservative mx (smoking/HTN) 4-5.4 cm = US every 6-12 months, conservative mx (smoking/HTN) 5.5+cm = EVAR or surgical repair Can consider repair if growing 0.5+ cm per 6 months EVAR: Landing zone of >1cm length and <3.2cm wide (not dilated)

AAA Management: Growing 0.5+cm per 6 months

3-3.9 cm = US every 2 years, conservative mx (smoking/HTN) 4-5.4 cm = US every 6-12 months, conservative mx (smoking/HTN) 5.5+cm = EVAR or surgical repair Can consider repair if growing 0.5+ cm per 6 months EVAR: Landing zone of >1cm length and <3.2cm wide (not dilated)