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Findings of pulmonary infection are common on chest cts

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either in the setting with signs and symptoms

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or in patients who are asymptomatic.

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We come across these findings on lung cancer screening cts

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for many reasons, and it's important for us

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to apply criteria to manage them appropriately.

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So we're gonna talk about how to manage findings

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of infection on a lung cancer screening ct, when

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to use the long RAD zero category and call a patient back

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after they've been treated for presumed pneumonia infection,

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and how to avoid the scenario clinically in your practice

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with the long RADS 2022 update, we tried

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to clarify the recommendations for

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how a radiologist should approach these cases when they see

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infectious or potentially inflammatory abnormalities.

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There are findings that you see on chest CT every day in

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your practice outside of lung cancer screening CT

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that you would ordinarily call infection,

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and it's appropriate to do so in the setting

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of lung cancer screening as well, whether it's a segmental

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or lobar consolidation,

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particularly if it's new since a prior screening CT

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or other chest ct, a large nodule

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with surrounding ground glass

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and cluster of nodules

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as developed in a relatively short timeframe

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of a year from an area that was totally normal,

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it's probably not cancer, it's more likely

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to be infection given the rapid growth rate from none

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to an area of this size of abnormality

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or multiple new nodules which are random

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or peronial in distribution sometimes related

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to the small airways in a patient

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who has small airway disease forms of COPD.

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So you're going to see findings

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of infection on lung cancer screening cts.

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And people often ask, well now what do I do?

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I see this segmental or low bar consolidation

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or this discreet nodule in the middle, or all these nodules.

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How can I say none of this is cancer?

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Well, we apply common principles.

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How quickly did it develop?

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Was there anything in that area before?

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If we have a prior screening ct

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and does this patient have any clinical history which would

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support them being infection?

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Now it may not be in the medical record acutely

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and they may not have seen their primary care physician

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recently, but if they have evidence

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of small airway disease clinically

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and recurrent bounce of aspiration, for example,

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which can give you this lower low micro nodular pattern,

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use those to your advantage.

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When you see these findings

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that you would ordinarily call infection,

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call it a long RAD CT

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with a recommended low dose CT followup in one

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to three months, ideally

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after they've been treated for infection.

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And that treatment for infection can also be empiric even in

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the absence of signs or symptoms.

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So for that approach, if you're reading the CT

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outside the screening setting,

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apply the same findings you would use on those exams

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to screening cts

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and if it obscures a portion of the lung,

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so you can't score it as being normal,

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that means it's a long ran zero consolidation multifocal

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or para bronchial or ground glass or middle

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Lo lingular predominant bronchiectasis with tree

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and bud that we see in the setting of Mac

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or mycobacterium Avium complex infection are all things you

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see in your regular chest CT practice.

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Call these infection, call them a lung RAD zero

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and recommend a followup CT in one

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to three months using the low dose nodule protocol.

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At that time, you'll be able to confirm if it's infection

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that it's cleared, if it is not clear completely,

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or potentially if it's grown.

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It could be a latent sign of a very slowly growing cancer

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and you might want to make sure the patient is recommended

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to see a specialist in your practice.

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Can you avoid this scenario

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of having long rad zero findings for infections?

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Well, there are some things you can do.

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Just like in screening mammography,

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people often schedule next year's annual lung cancer

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screening CT right after they've had the current one.

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So that order has been placed

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by the time the patient comes to you in a year.

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There's no update to that order.

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So if the patient has developed signs

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or symptoms of infections in between, you won't know it.

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It's not going to be on the radiology requisition

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or in the ordering system as a reason for the exam.

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And in that 12 months, patients can develop signs

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and symptoms of infection when they're coming to you

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and they don't know that they should tell you

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that they have these signs

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or symptoms when they're hopping on the CT scanner

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for their screening ct.

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So one thing that you can do is have your imaging

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technologist ask the patient if they have any signs

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or symptoms of infection such as a new cough

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or increased sputum production if they've been feeling lack

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of energy fatigue.

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If something acute has changed with 'em,

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particularly in patients who have a history of COPD,

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that could be evidence of infection.

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And if it's significant, you may want

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to consider deferring the lung cancer screening ct.

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Sometimes you may need

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to consult the patient's referring physician,

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primary care physician, pulmonary medicine physician

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or specialist that may have ordered the lung cancer

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screening exam to resolve this.

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But by asking this question,

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you can avoid having unnecessary lung reds zero examinations

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that require pneumonia treatment

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and then having to call the patient back again.

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So at a point of intervention,

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you can do this if you're doing appointment reminders

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to a patient for their lung cancer screening exam

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or you might be covering logistics of where your facility is

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and how early to arrive in advance of the exam.

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You can also add to your lung cancer screening

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information instructions.

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If you have new signs of symptoms of infection such

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as a new cough or sputum production,

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please contact your referring physician

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as you may have evidence of infection.

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And that may make it difficult for us

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to evaluate your lung cancer screening CT at this time

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so we can communicate directly with our patients through

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that vehicle appointment reminders.

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And we can also ask patients questions when they arrive

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for their CT appointment to help us avoid this conundrum.