Lesson 1Reporting standards for pulmonary nodules (Lung-RADS-compatible structured reports)This section introduces structured reporting frameworks for pulmonary nodules, focusing on Lung-RADS-compatible elements, standardized terminology, risk categories, recommended follow-up intervals, and clear communication of uncertainty and next steps.
Core elements of a nodule CT reportApplying Lung-RADS categories to findingsDocumenting size, type, and growth clearlyStating follow-up intervals and modalitiesCommunicating uncertainty and alternativesLesson 2Location-specific considerations: lobar distribution, proximity to pleura or fissuresThis section reviews how nodule location within the lungs affects differential diagnosis and management, covering lobar distribution, central versus peripheral position, relation to pleura or fissures, and implications for biopsy planning and surgical approach.
Upper versus lower lobe risk differencesCentral, peribronchovascular, and peripheral sitesNodules abutting pleura or fissuresEndobronchial and subsegmental airway nodulesLocation impact on biopsy and resection strategyLesson 3Assessment of growth and volume-doubling time: methods, formulas, and thresholdsThis section explains how to assess nodule growth using serial CT, including linear and volumetric methods, volume-doubling time formulas, thresholds for significant change, and how growth patterns influence management and surveillance intervals.
Choosing baseline and follow-up reference scansLinear versus volumetric growth assessmentCalculating volume-doubling time from volumesThresholds for significant growth or stabilityInterpreting slow, rapid, or absent growthLesson 4Measurement variability and techniques to minimize error (consistent phase, caliper placement, automated volumetry)This section discusses sources of measurement variability in nodule assessment, including technical and reader factors, and presents strategies to minimize error through standardized acquisition, consistent windowing, careful caliper placement, and validated automated volumetry.
Scanner, kernel, and slice thickness effectsImportance of consistent inspiratory phaseBest practices for manual caliper placementStrengths and limits of automated volumetryDocumenting and communicating uncertaintyLesson 5Subsolid nodules: pure ground-glass vs part-solid definitions, clinical implicationsThis section focuses on subsolid nodules, defining pure ground-glass and part-solid types, describing CT appearance, measurement nuances, natural history, malignancy risk, and guideline-based recommendations for surveillance and intervention.
CT definition of pure ground-glass nodulesIdentifying and measuring part-solid nodulesNatural history and indolent adenocarcinomaFollow-up intervals for persistent subsolid nodulesWhen to consider biopsy or surgical resectionLesson 6Internal features: calcification patterns, fat, cavitation, air bronchograms, and relevance to benign vs malignant etiologyThis section examines internal nodule features such as calcification, fat, cavitation, and air bronchograms, describing characteristic CT appearances, typical benign and malignant associations, and how to integrate these signs into overall etiologic assessment.
Benign versus suspicious calcification patternsMacroscopic fat and hamartoma diagnosisCavitation wall thickness and inner contourAir bronchograms within or around nodulesCombining internal features for final impressionLesson 7Limitations of single-phase CT and when contrast or PET/CT adds informationThis section outlines the limitations of single-phase noncontrast CT for nodule characterization and explains when contrast-enhanced CT, dynamic enhancement, or PET/CT provide incremental value for staging, risk stratification, and treatment planning.
Limits of noncontrast single-phase chest CTIndications for contrast-enhanced chest CTRole of dynamic enhancement in nodule workupAppropriate use criteria for FDG PET/CTIntegrating PET/CT with CT morphologyLesson 8CT technique for pulmonary nodule evaluation: acquisition parameters, reconstruction, and importance of thin slicesThis section covers CT technique for pulmonary nodule evaluation, including patient positioning, breath-hold coaching, acquisition parameters, reconstruction kernels, thin-slice imaging, and use of multiplanar and maximum-intensity projections for detection and follow-up.
Patient positioning and breath-hold instructionskVp, mAs, and dose modulation considerationsThin-slice collimation and interval selectionReconstruction kernels and iterative methodsUse of MPR and MIP for nodule detectionLesson 9Associated chest findings: lymphadenopathy, consolidation, emphysema, and prior scarringThis section reviews non-nodular thoracic findings that influence nodule interpretation, including lymphadenopathy, consolidation, emphysema, and scarring, and explains how these patterns modify malignancy risk and guide follow-up or additional testing.
Patterns of mediastinal and hilar lymphadenopathyConsolidation adjacent to or obscuring a noduleEmphysema patterns and lung cancer riskCT features of prior infection and scarringIntegrating background lung disease into riskLesson 10Nodule morphology descriptors: size measurement methods, margin characterization (smooth, spiculated), and attenuation (solid vs subsolid)This section details how to measure nodule size on CT, describe margins, and classify attenuation, emphasizing reproducible techniques, pitfalls in diameter and volumetric assessment, and how morphology informs malignancy probability and management decisions.
Axial, MPR, and volumetric size measurementDefining smooth, lobulated, and spiculated marginsSolid, part-solid, and ground-glass attenuationPitfalls in measuring irregular or juxtavascular nodulesMorphologic patterns linked to malignancy risk
