Chest CT Reporting Checklist

A systematic approach to comprehensively reviewing the lung parenchyma, airways, pleura, mediastinum, cardiovascular structures, and upper abdomen on routine diagnostic chest CT.

Chest CT is not a single-organ examination. In addition to the lung parenchyma, the airways, pleura, mediastinum, lymph nodes, cardiovascular structures, chest wall, and imaged upper abdomen are all part of the report.

A systematic reading sequence helps prevent mediastinal or upper abdominal findings from being overlooked while attention is concentrated on the lungs. This draft provides a repeatable checklist for routine adult chest CT reporting.

1. Define the protocol and clinical question

☐ Read the indication. Infection, malignancy, nodule follow-up, interstitial disease, trauma, and postoperative assessment require different priorities.

☐ Identify contrast status and phase. Noncontrast, venous phase, or a dedicated angiographic phase determines the limits of vascular and mediastinal interpretation.

☐ Assess inspiration and motion. Poor inspiration may increase dependent opacities and create a false mosaic appearance.

☐ Confirm coverage. The entire thorax from the apices to the costophrenic angles, together with the required upper abdomen, should be included.

☐ Open the prior examination. For changes in nodules, masses, lymph nodes, and pleural fluid, note the date and similarity of technique.

2. Perform a rapid safety survey first

☐ Pneumothorax and large pleural collection. Is there mediastinal shift or cardiac compression suggesting tension physiology?

☐ Obvious aortic or vascular emergency. Within the limits of a routine protocol, do not miss visible signs such as a dissection flap, rupture, or active bleeding.

☐ Large-airway obstruction. Is there a foreign body, mucus plug, or tumor-related obstruction in a main bronchus?

☐ Extensive acute parenchymal process. Dense consolidation, edema, or severe aspiration may alter clinical priority.

☐ Device complication. Quickly check tubes, catheters, drains, and surgical material.

3. Lung window: review the parenchyma systematically

☐ Use a fixed lobar and segmental sequence. Review both lungs from apices to bases on axial images and confirm findings on coronal and sagittal reconstructions.

☐ Nodule and mass. Describe location, size, morphology, margins, attenuation, and change from prior imaging.

☐ Consolidation and ground-glass opacity. Assess distribution, lobular or segmental pattern, air bronchograms, and associated volume loss.

☐ Atelectasis. Interpret possible passive, obstructive, or scar-related appearances together with bronchial patency and pleural disease.

☐ Interstitial findings. Note reticulation, septal thickening, traction bronchiectasis, honeycombing, and distribution; state when routine CT may not substitute for HRCT.

☐ Emphysema and clues to air trapping. Assess type, distribution, and associated bullae; if no expiratory series is available, remain cautious about air-trapping assessment.

☐ Cavity/cyst. Describe wall thickness, contents, surrounding parenchyma, number, and distribution.

4. Airways

☐ Trachea and main bronchi. Assess the lumen, wall, secretions, and extrinsic compression.

☐ Bronchiectasis. Review the bronchoarterial ratio, visibility of peripheral bronchi, wall thickening, and mucus plugging.

☐ Endobronchial lesion. Check for focal narrowing, cutoff, or associated distal atelectasis/consolidation.

☐ Suspected tracheobronchomalacia. State the limitations of a single-phase inspiratory examination; dynamic assessment may be required.

5. Pleura and diaphragm

☐ Pleural fluid. Assess volume, side, loculation, pleural thickening, and adjacent atelectasis.

☐ Pneumothorax. Check for small anterior or basal air collections on multiplanar images.

☐ Pleural nodule/plaque. Note calcification, extent, and suspected invasion.

☐ Diaphragm. Is there elevation, hernia, defect, or focal contour abnormality?

6. Mediastinum, hila, and lymph nodes

☐ Mediastinal compartments. Systematically assess for masses, fluid, air, and distortion of fat planes.

☐ Lymph nodes. State station, short-axis size, morphology, and change from prior imaging, interpreted in the clinical context.

☐ Hila. Review the vessels, lymph nodes, and bronchi together and try to explain any asymmetry.

☐ Esophagus. Is there marked wall thickening, dilatation, hiatal hernia, or alteration of the surrounding fat planes?

☐ Thymus and visible thyroid. Note an obvious mass or nodular enlargement according to age and clinical context.

7. Heart, pericardium, and great vessels

☐ Cardiac size and chambers. Assess obvious enlargement while respecting the measurement limitations of routine nongated CT.

☐ Pericardium. Is there fluid, thickening, or calcification?

☐ Aorta. Assess caliber, atherosclerosis, and visible acute abnormality; when measurements are needed, pay attention to the imaging plane.

☐ Pulmonary arteries. Check the main pulmonary artery caliber and visible filling defects; when appropriate, state that embolism cannot be excluded on a nondedicated examination.

☐ Coronary calcification. Report conspicuous calcification in keeping with image quality, remembering that this is not a substitute for cardiac CT.

8. Chest wall, bones, and upper abdomen

☐ Ribs, sternum, vertebrae, and shoulder girdle. Review bone windows for fracture, destruction, sclerotic foci, or compression deformity.

☐ Soft tissues. Is there an obvious mass or collection in the breasts, axillae, subcutaneous tissues, or muscle planes?

☐ Upper abdomen. Systematically assess the imaged portions of the liver, adrenal glands, spleen, pancreas, and kidneys.

☐ Surgical and radiotherapy changes. Compare with prior images to distinguish expected changes from complications or suspected recurrence.

9. Impression

• Place the finding that answers the main clinical question first.
• For nodules, masses, or other findings that may require surveillance, clearly state measurement, location, and comparison; base follow-up recommendations on the current guideline adopted by your institution and the patient's context.
• State limitations of a nondedicated protocol explicitly only when they are clinically important.
• Make secondary cardiovascular or upper abdominal findings that could alter management visible in the impression.
• Communicate time-sensitive findings directly to the clinical team and document the communication.

Communication of critical findings

10. Commonly overlooked areas

• Tracheal and main bronchial lumina
• Small anterior pneumothorax
• Costophrenic angles and diaphragmatic regions
• Paraesophageal region and hiatal hernia
• Axillary and internal mammary lymph nodes
• Vertebrae and ribs on bone windows
• Adrenal glands and upper abdomen
• Small interval growth of a nodule

11. Example report framework

References

1. ACR Practice Parameter for Communication of Diagnostic Imaging Findings, Revised 2025. Report components and principles for nonroutine/urgent communication. Source (opens in a new tab)
2. ACR-SABI-SPR-STR Practice Parameter for the Performance of Thoracic CT, Revised 2023. Framework for thoracic CT performance, documentation, and quality. Source (opens in a new tab)
3. ACR-SPR Practice Parameter for Performing and Interpreting Diagnostic CT, Revised 2022. General CT interpretation and documentation principles. Source (opens in a new tab)