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  1. What are the advantages of noncontrast computed tomography (CT) compared with other CT studies?

  2. What are the indications for noncontrast CT with thin-section reconstruction?

  3. When is the use of IV contrast with CT imaging mandatory?

  4. What are the limitations of positron emission tomography (PET)-CT?

  5. What are the main indications for cardiac-CT?

  6. What are the Fleischner Society Guidelines recommendations concerning follow-up of incidental solid pulmonary nodules?

  7. What are the disadvantages of cardiac magnetic resonance with late gadolinium enhancement?

  8. Complementary to two-dimensional echocardiography, transesophageal echocardiography (TEE) is able to provide superior visualization of what cardiac structures?

  9. What calcium score would preclude contrast computed tomography angiography (CTA)?

The overwhelming majority of advanced chest imaging for hospitalized patients is performed by CT, with ultrasound, MRI, and nuclear medicine reserved for specific situations. The evolution of disease processes in the chest over time is central to the diagnostic process necessitating integration between modalities in choosing comparison studies. With the assistance of an experienced radiologist, serial bedside chest radiographs can provide physiologic and pathologic information that may not be available from more advanced imaging that reflects only a single moment in time.

The chief complaint should guide decisions about the extent of medical imaging necessary for the proper diagnosis and treatment of the acute illness. The radiologist reads the patient's body and disease processes much as the clinician completes the history and physical examination with a checklist that will identify both the truly incidental and unrelated findings as well as separate seemingly unrelated findings that complete the picture of the acute illness.

Many patients who require hospitalization for successful care of their acute illness have underlying medical conditions and chronic disease processes. Preexisting heart disease, lung disease, and systemic disease findings help to develop the personalized differential diagnosis for the reporting of the imaging studies whether obtained as radiographs, CT, MRI or any other modality. Diabetes, collagen vascular diseases, chronic obstructive pulmonary disease, atherosclerosis, and suppression of the immune system can lead the radiologist to different conclusions about the significance of particular findings in an individual patient.

Advanced imaging during hospitalization that risks complications in an acutely ill patient, provides suboptimal imaging requiring additional studies, and unnecessarily increases length of stay should be minimized. This chapter will focus on the abnormalities that most frequently require advanced imaging for diagnosis and the common incidental findings that require mandatory follow-up post discharge.

Chest radiography images how lung function (gas exchange and perfusion of oxygenated blood) changes over time. Blood flow is greater to the lower lobes than the upper lobes, and greatest in the right lower lobe, while oxygenation is greater in the upper lobes. Because blood flow is greater to the lung bases, particularly the right lower lobe, hematogenous spread of infection and tumor likely begin in the lung bases. Pulmonary emboli also occur more often in lower lobes. Oxygen-loving mycobacterium organisms prefer the lung apices. Warm cigarette smoke ...

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