1. Image Gallery: Lesion detection on low dose chest CT Sarabjeet Singh, MD Mannudeep K. Kalra, MD *Eugene J. Mark, MD *James Stone, MD James H. Thrall, MD Web Chapter 3 Department of Radiology and *Department of Pathology Massachusetts General Hospital Harvard Medical School, Boston

2. Do you see any abnormal findings in this transverse CT image?

3. Do you see a nodule in right lower lobe, paraseptal emphysema, and centrilobular emphysema?

4. Image AImage BImage C 114 mAs87 mAs40 mAs CTDIvol: 7.7 mGy5.9 mGy2.8 mGy Do you see any additional finding in higher dose images ? nodule in right lower lobe, paraseptal emphysema in the left lung, centrilobular emphysema Image AImage BImage C

5. Do you see any abnormal findings in this transverse CT image?

6. Do you see.. Solid and cystic lesion in left lower lobe abutting the major fissure, ground glass opacity lateral to descending aorta, dependent atelectasis bilaterally?

7. Image AImage BImage C 64 mAs56 mAs23 mAs CTDIvol: 4.4 mGy3.8 mGy1.6 mGy Solid and cystic mass lesion in LLL, ground glass opacity lateral to descending aorta, and dependent atelectasis bilaterally Do you see any additional finding in higher dose images ? Image AImage BImage C

8. Do you see any abnormal findings in this transverse CT image?

9. Do you see multiple peribronchovascular and subpleural nodules consistent with pulmonary sarcoidosis?

10. Multiple peribronchovascular and supleural nodules consistent with pulmonary sarcoidosis Image AImage BImage C 80 mAs69 mAs31 mAs CTDIvol: 5.4 mGy4.7 mGy2.1 mGy Do you see any additional finding in higher dose images ? Image AImage BImage C

11. Do you see any abnormal findings in this transverse CT image?

12. Do you see subpleural opacity in the anterior left upper lobe, right major fissure nodule, and thickened left major fissure?

13. Subpleural opacity in the anterior LUL, right fissural nodule, thickened left major fissure Image AImage BImage C 94 mAs85 mAs35 mAs CTDIvol: 6.4 mGy5.8 mGy2.4 mGy Do you see any additional finding in higher dose images ? Image AImage BImage C

14. Do you see any abnormal findings in this transverse CT image?

15. Do you see paraseptal and bullous emphysema, and nodule in the right upper lobe?

16. Paraseptal and bullous emphysema. Nodule in the right upper lobe. Image AImage BImage C 80 mAs69 mAs31 mAs CTDIvol: 5.4 mGy4.7 mGy2.1 mGy Do you see any additional finding in higher dose images ? Image AImage BImage C

17. Do you see any abnormal findings in this transverse CT image?

18. Do you see patchy air space opacity in the right lower lobe, Multiple right fissural nodules, and right middle lobe non-calcified nodule?

19. Patchy air space opacity in the RLL Right fissural nodules RML nodule 540 mA; 20 mGy270 mA; 10 mGy135 mA; 5.0 mGy 72 mA; 2.7 mGy36 mA; 1.3 mGy Do you see any additional finding in higher dose images ?

20. Do you see any abnormal findings in this transverse CT image?

21. Do you see branching nodular opacities in right middle lobe, patchy consolidation in bilateral lower lobes (right greater than left) and right fissural effusion?

22. 540 mA; 20 mGy 270 mA; 10 mGy135 mA; 5.0 mGy 72 mA; 2.7 mGy36 mA; 1.3 mGy Branching nodular opacities in RML, patchy consolidation in RLL right fissural effusion seen at all dose levels Do you see any additional finding in higher dose images ?

23. Do you see any abnormal findings in this transverse CT image?

24. Do you see mediastinal lymph nodes, and calcified plaques in the ascending and descending thoracic aorta?

25. Mediastinal lymph node, aortic calcification in ascending and descending thoracic aorta Image AImage BImage C 110 mAs80 mAs40 mAs CTDIvol: 7.4 mGy5 mGy3.5 mGy Do you see any additional finding in higher dose images ? Image AImage BImage C

26. Do you see any abnormal findings in this transverse CT image?

27. Do you see left pleural effusion and left fissural effusion.

28. Left pleural effusion and left fissural effusion. Image AImage BImage C 73 mAs52 mAs48 mAs CTDIvol: 4.9 mGy3.5 mGy1.6 mGy Do you see any additional findings on higher dose images Image AImage BImage C

29. Do you see any abnormal findings in this transverse CT image?

30. Do you see calcified and non-calcified mediastinal lymph nodes?

31. Calcified and non-calcified mediastinal lymph nodes Image AImage BImage C 161 mAs106 mAs46 mAs CTDIvol: 10.9 mGy7.2 mGy3.1 mGy Do you see any additional findings on higher dose images? Image AImage BImage C

32. Do you see any abnormal findings in this transverse CT image?

33. Do you see left ventricular apical calcification suggestive of old myocardial infarction in the LAD territory ?

34. Left ventricular apical calcification suggestive of old myocardial infarction in the LAD territory Image AImage BImage C 80 mAs69 mAs31 mAs CTDIvol: 5.4 mGy4.7 mGy2.1 mGy Do you see any additional findings on higher dose images?

35. Do you see any abnormal findings in this transverse CT image?

36. Do you see bilateral pleural effusions with bilateral lower lobe atelectasis, enlarged right atrium and ventricle, and pericardial effusion?

37. B/L pleural effusions with atelectasis, enlarged right atrium and ventricle, pericardial effusion Distinction between pleural effusion and atelectasis is not clear on 20 mAs image. 135 mAs; 10 mGy72 mAs; 5.0 mGy 40 mAs; 2.7 mGy20 mAs; 1.3 mGy

38. Do you see any findings in this transverse CT image?

39. Do you see lytic lesion with sclerotic rim in the head of the left humeral head?

40. 135 mAs; 10 mGy72 mAs; 5.0 mGy 40 mAs; 2.7 mGy20 mAs; 1.3 mGy Do you see any additional findings on higher dose images?

41. Thank You Please contact for any questions Sarabjeet Singh, MD: ssingh6@partners.orgssingh6@partners.org Mannudeep K Kalra, MD: mkalra@partners.orgmkalra@partners.org