Chest CT Reporting System: From Lung Windows to the Upper Abdomen
An approach that correctly identifies the protocol, considers pulmonary and mediastinal findings together, and prioritizes incidental findings by clinical importance.
RadPhrases Editorial Team5 min read
REPORTING SYSTEMATICS / CHEST
An approach that correctly identifies the protocol, considers pulmonary and mediastinal findings together, and prioritizes incidental findings by clinical importance.
A chest CT report begins with the protocol
Chest CT is not a single examination. Standard noncontrast CT, contrast-enhanced chest CT, CT pulmonary angiography, aortic protocols, high-resolution CT, and low-dose screening studies answer different clinical questions. Before writing the report, confirm the protocol, contrast phase, inspiratory and expiratory acquisitions, section thickness, and reconstructions, and determine whether they are appropriate for the clinical question.
Assuming the wrong protocol may produce a report that fails to answer the clinical question even when normal anatomy is described correctly. For example, evaluation of the pulmonary arteries on a routine venous-phase chest CT should not be expressed with the same level of certainty as on a properly performed CT pulmonary angiogram.
Suggested window and anatomic sequence
Related calculators
Browse the other checklists, phrase sets, and systematic approaches in this topic.
Scout and coverage. Check the scan range, motion, degree of inspiration, metal artifact, and whether any segment is missing.
Lung windows. Systematically survey every lobe and segment for nodules, consolidation, ground-glass opacity, interstitial abnormality, emphysema, atelectasis, and air trapping.
Airways. Assess the trachea, main bronchi, and, according to the clinical question, more distal airways for narrowing, wall thickening, bronchiectasis, mucus, or endobronchial lesions.
Pleura. Search for effusion, pneumothorax, thickening, plaques, nodules, or collections.
Mediastinum and hila. Assess lymph nodes, mediastinal masses, the esophagus, and the thymic region. When relevant, state lymph-node station, short-axis diameter, and interval change.
Heart and pericardium. Assess cardiac size, coronary and valvular calcifications, and pericardial fluid or thickening within the diagnostic limits of the examination.
Great vessels. Assess the aorta, pulmonary arteries, and systemic veins to the extent permitted by the protocol. Statements about caliber and acute vascular disease must be limited to examinations with appropriate technique.
Chest wall, bones, and soft tissues. Survey the ribs, sternum, vertebrae, shoulder girdles, breast tissue, and axillary regions.
Upper abdomen. Assess the liver, adrenal glands, spleen, and other visualized structures within the phase and coverage limitations of the examination.
One pass is not enough Reviewing a chest CT only on lung windows or only in the axial plane may lead to missed mediastinal, vascular, osseous, and upper abdominal findings. At minimum, lung, soft-tissue, and bone windows and coronal and sagittal reconstructions should be examined in separate passes.
Make pulmonary nodule descriptions reproducible at follow-up
A nodule report should state the side, lobe, and, when possible, segment; solid, subsolid, or ground-glass character; measurement in an appropriate plane; margin characteristics; calcification or fat content; and interval change. When multiple nodules are present, prioritize the dominant or most suspicious lesion that will drive management.
Follow-up recommendations vary according to patient age, malignancy history, immune status, risk profile, nodule type, and current guidelines. Therefore, use recommendations verified against the patient context and the current guideline adopted by the institution rather than a fixed automatic sentence.
Describe parenchymal patterns together with their distribution
Terms such as ground-glass opacity, reticulation, consolidation, or centrilobular nodules may not be sufficient by themselves. Describe upper-versus-lower lung, central-versus-peripheral, peribronchovascular-versus-subpleural, focal-versus-diffuse, and symmetric-versus-asymmetric distribution together with features such as volume loss, traction bronchiectasis, honeycombing, or air trapping.
The report should not become a dictionary of patterns. Details that do not answer the clinical question should be shortened, while interpretations such as infection, edema, interstitial lung disease, or malignancy should be provided in the impression with appropriate clinical context and level of confidence.
Chest CT report template framework
Protocol-specific sections—for example, pulmonary arteries or interstitial lung disease—should be added separately:
INDICATION: [Clinical question] COMPARISON: [Date and examination] TECHNIQUE: [Contrast status/phase, sections, reconstructions, inspiration/expiration, limitations] FINDINGS: Lungs and airways: [Pattern, distribution, nodule, airway findings] Pleura: [Effusion, pneumothorax, thickening] Mediastinum and hila: [Lymph node/mass/esophagus] Heart and pericardium: [Findings within examination scope] Great vessels: [Assessment permitted by the protocol] Chest wall and bones: [Important findings] Upper abdomen: [Important findings on included images] IMPRESSION: 1. [Primary thoracic finding answering the clinical question] 2. [Second important finding or interval change] 3. [Recommendation appropriate to guidelines and patient context, if needed]
Common mistakes
Failing to clarify in the technique section whether the examination is a routine chest CT or CT pulmonary angiogram.
Reviewing the mediastinum, vessels, bones, and upper abdomen only superficially when no finding is seen on lung windows.
Measuring a nodule in a different plane or window on each examination.
Failing to prioritize the management-determining lesion in the impression when multiple nodules are present.
Describing lymph nodes only as “subcentimeter” or “pathologic” without context.
Reporting a parenchymal pattern without its distribution and associated findings.
Making a definitive exclusion statement for vascular structures that cannot be adequately assessed in a routine phase.
Organize the impression for clinical decision-making
Indication-specific messages should come first: findings that establish response or progression in oncologic follow-up, new parenchymal abnormalities when infection is suspected, or embolus location and signs of right-heart strain on a pulmonary embolism protocol. Incidental chronic changes should not obscure the primary question.
For an indeterminate finding, briefly state the level of probability and what additional information could help distinguish the possibilities. Rather than ending the report with a long, uncontrolled differential list, provide the few most likely options and note the need for clinical-radiologic correlation.
Quick pre-sign-off check
Are the protocol and contrast phase correctly documented? Were lung, soft-tissue, and bone windows reviewed separately? Were all lobes and airways surveyed? Were the pleura, lymph nodes, heart and pericardium, great vessels, and upper abdomen assessed? Are nodule or lesion measurements comparable with prior examinations? Does the impression directly answer the indication?
Sources
ACR Practice Parameter for Communication of Diagnostic Imaging Findings (Revised 2025) — Core report components, the impression section, and principles for nonroutine communication. Source (opens in a new tab)
RSNA RadReport Reporting Templates — A resource for standardized, consistent, and comprehensive reporting templates. Source (opens in a new tab)
ESR paper on structured reporting in radiology—update 2023 — Current framework and implementation principles for structured reporting. Source (opens in a new tab)
Structured reporting in radiology: a systematic review — A systematic assessment of the evidence on structured reporting. Source (opens in a new tab)
ACR–SABI–SPR–STR Practice Parameter for the Performance of Thoracic Computed Tomography (CT) — Performance, technical scope, and documentation of chest CT. Source (opens in a new tab)
ACR–SPR Practice Parameter for Performing and Interpreting Diagnostic Computed Tomography — General technical and reporting principles for diagnostic CT. Source (opens in a new tab)
Clinical use note
This content is educational and is not patient-specific medical advice. Every phrase, template, classification result, and recommendation must be verified and adapted by a physician using the complete examination, clinical context, current guidelines, and institutional protocol.
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