Guideline Quick Reference

Essentials

• Separate solid from subsolid nodules.
• Use thin-section CT measurement.
• Risk factors and morphology affect follow-up.
• Does not replace Lung-RADS in screening CT.

Use when

Incidental lung nodule on non-screening CT.

Source

Essentials

• Use only for lung cancer screening programs.
• Standardizes categories and follow-up recommendations.
• Includes updated atypical pulmonary cyst criteria.
• Supports audit and outcome monitoring.

Use when

Low-dose CT lung cancer screening report.

Source

Essentials

• Use only in eligible high-risk patients.
• Assess APHE, washout, capsule and threshold growth.
• Apply diagnostic and treatment response categories.
• Report major observations clearly and consistently.

Use when

Cirrhosis/chronic HBV or eligible HCC-risk population.

Source

Essentials

• Document visualization score.
• Categorize surveillance result.
• Mention limitations that reduce sensitivity.
• Escalate when observation or poor visualization requires it.

Use when

Routine HCC surveillance ultrasound.

Source

Essentials

• Score composition, echogenicity, shape, margins and echogenic foci.
• Assign TR category.
• Use size thresholds for FNA/follow-up.
• Avoid over-biopsy of low-risk nodules.

Use when

Thyroid ultrasound with one or more nodules.

Source

Essentials

• Use standard lexicon for mammography, ultrasound and MRI.
• End every report with final assessment.
• Link assessment to management recommendation.
• Supports audit and outcome monitoring.

Use when

Any breast imaging report.

Source

Essentials

• Use lesion type and morphology.
• Document solid tissue, papillary projections and vascularity.
• Assign O-RADS risk category.
• Management depends on category and clinical context.

Use when

Adnexal lesion on pelvic ultrasound.

Source

Essentials

• Evaluate solid tissue enhancement.
• Use DWI and dynamic contrast features.
• Separate lipid/blood/fibrous content.
• Assign MRI O-RADS category when appropriate.

Use when

Indeterminate adnexal lesion undergoing MRI.

Source

Essentials

• Confirm patient population before applying.
• Use lesion size, imaging features and risk context.
• State if no follow-up is required.
• Avoid unnecessary workup of clearly benign findings.

Use when

Unexpected finding not related to the indication.

Source

Essentials

• Measure non-contrast HU when available.
• Identify macroscopic fat or hemorrhage.
• Use washout/MRI chemical shift when indeterminate.
• Cancer history changes management.

Use when

Adrenal lesion found incidentally on CT/MRI.

Source

Essentials

• Separate cystic from solid lesion.
• Confirm enhancement objectively.
• Use Bosniak framework for cystic masses.
• Macroscopic fat suggests AML but exceptions exist.

Use when

Renal lesion detected on CT/MRI/US.

Source

Essentials

• Use enhancement of wall, septa or nodules.
• Classify cystic renal masses, not solid masses with necrosis.
• MRI can upgrade/downgrade indeterminate CT lesions.
• Management depends on class and patient factors.

Use when

Complex cystic renal mass.

Source

Essentials

• Separate low-risk from high-risk patient.
• Recognize classic cyst, hemangioma and FNH patterns.
• MRI solves many indeterminate CT lesions.
• Known malignancy changes threshold for workup.

Use when

Unexpected liver lesion on CT/US/MRI.

Source

Essentials

• Document cyst size and duct communication.
• Look for mural nodule or main duct dilation.
• Use MRI/MRCP for characterization.
• Recommendations depend on age, size and features.

Use when

Incidental pancreatic cystic lesion.

Source

Essentials

• Benign cyst/calcified granuloma often needs no workup.
• Cancer history changes significance.
• MRI or follow-up can be used for indeterminate lesions.
• Multiple lesions may suggest systemic disease.

Use when

Unexpected splenic lesion.

Source

Essentials

• Correlate symptoms and labs.
• Polyp size/morphology matters.
• Duct dilation should be interpreted with age and cholecystectomy status.
• Obstructive pattern may need MRCP/ERCP pathway.

Use when

Unexpected gallbladder or biliary abnormality.

Source

Essentials

• Menopausal status is essential.
• Simple cysts differ from complex cystic/solid lesions.
• US is often first problem-solving tool.
• MRI helps indeterminate adnexal masses.

Use when

Incidental adnexal lesion on CT/MRI/US.

Source

Essentials

• Assess size and atypical enhancing/solid features.
• Hydrocephalus or symptoms change urgency.
• Most simple pineal cysts are benign incidental findings.
• Use ACR guidance for follow-up decisions.

Use when

Pineal cyst found incidentally.

Source

Essentials

• Include clinical history and scope of exam.
• Correlate with physical/mammographic/MRI finding.
• Use BI-RADS final assessment category.
• Include management recommendation.

Use when

Targeted or survey breast ultrasound report.

Source

Essentials

• Document reaction type and severity.
• Differentiate allergy-like from physiologic reaction.
• Use local premedication policy when indicated.
• Have emergency response pathway ready.

Use when

Before contrast-enhanced CT/MRI in patient with prior reaction.

Source

Essentials

• Check eGFR when policy requires.
• Urgency and diagnostic benefit may outweigh risk.
• Hydration/medication decisions follow local policy.
• Avoid vague recommendation without clinical context.

Use when

Before iodinated contrast or selected gadolinium exams.

Source

Essentials

• Prefer ultrasound/MRI when diagnostic and appropriate.
• Do not delay urgent necessary imaging.
• Use dose optimization for CT/radiography.
• Contrast requires risk-benefit justification.

Use when

Pregnant patient needing diagnostic imaging.

Source

Essentials

• Screen implants/devices before entering Zone IV.
• Clarify MR conditional requirements.
• Orbital metal history needs local pathway.
• Document limitation or cancellation reason.

Use when

Before any MRI exam.

Source

Essentials

• Use the correct eligibility criteria.
• Apply the official lexicon and category definitions.
• Include category-linked management or follow-up.
• Compare with prior studies when relevant.

Use when

Multiparametric prostate MRI for detection, localization and staging support.

Source

Essentials

• Use the correct eligibility criteria.
• Apply the official lexicon and category definitions.
• Include category-linked management or follow-up.
• Compare with prior studies when relevant.

Use when

Post-treatment head and neck CT/MRI/PET reporting.

Source

Essentials

• Use the correct eligibility criteria.
• Apply the official lexicon and category definitions.
• Include category-linked management or follow-up.
• Compare with prior studies when relevant.

Use when

Screening or diagnostic CT colonography reports.

Source

Essentials

• Use the correct eligibility criteria.
• Apply the official lexicon and category definitions.
• Include category-linked management or follow-up.
• Compare with prior studies when relevant.

Use when

Coronary CTA reports for CAD assessment.

Source

Essentials

• Use the correct eligibility criteria.
• Apply the official lexicon and category definitions.
• Include category-linked management or follow-up.
• Compare with prior studies when relevant.

Use when

Local staging of bladder cancer on multiparametric MRI.

Source

Essentials

• Use the correct eligibility criteria.
• Apply the official lexicon and category definitions.
• Include category-linked management or follow-up.
• Compare with prior studies when relevant.

Use when

Unexpected solitary bone lesion in adults.

Source

Essentials

• Use the correct eligibility criteria.
• Apply the official lexicon and category definitions.
• Include category-linked management or follow-up.
• Compare with prior studies when relevant.

Use when

MSK tumor imaging and follow-up communication.

Source

Essentials

• Use the correct eligibility criteria.
• Apply the official lexicon and category definitions.
• Include category-linked management or follow-up.
• Compare with prior studies when relevant.

Use when

Soft tissue tumor MRI/US/CT structured communication.

Source

Essentials

• Use the correct eligibility criteria.
• Apply the official lexicon and category definitions.
• Include category-linked management or follow-up.
• Compare with prior studies when relevant.

Use when

Glioma or treated brain tumor follow-up MRI.

Source

Essentials

• Use the correct eligibility criteria.
• Apply the official lexicon and category definitions.
• Include category-linked management or follow-up.
• Compare with prior studies when relevant.

Use when

Traumatic brain injury CT/MRI reporting.

Source

Essentials

• Use the correct eligibility criteria.
• Apply the official lexicon and category definitions.
• Include category-linked management or follow-up.
• Compare with prior studies when relevant.

Use when

Thyroid nodule ultrasound terminology and teaching.

Source

Essentials

• Confirm the finding is truly incidental.
• Use size, morphology and risk context.
• Avoid unnecessary follow-up for clearly benign findings.
• Mention limitations or need for dedicated imaging when indeterminate.

Use when

Incidental thyroid nodule on neck/chest imaging.

Source

Essentials

• Confirm the finding is truly incidental.
• Use size, morphology and risk context.
• Avoid unnecessary follow-up for clearly benign findings.
• Mention limitations or need for dedicated imaging when indeterminate.

Use when

Unexpected nodal enlargement without known target disease.

Source

Essentials

• Confirm the finding is truly incidental.
• Use size, morphology and risk context.
• Avoid unnecessary follow-up for clearly benign findings.
• Mention limitations or need for dedicated imaging when indeterminate.

Use when

Unexpected vascular abnormality on CT/MRI.

Source

Essentials

• Confirm the finding is truly incidental.
• Use size, morphology and risk context.
• Avoid unnecessary follow-up for clearly benign findings.
• Mention limitations or need for dedicated imaging when indeterminate.

Use when

Unexpected uterine finding on CT/MRI/US.

Source

Essentials

• Confirm the finding is truly incidental.
• Use size, morphology and risk context.
• Avoid unnecessary follow-up for clearly benign findings.
• Mention limitations or need for dedicated imaging when indeterminate.

Use when

Incidental prostate abnormality on CT/MRI.

Source

Essentials

• Confirm the finding is truly incidental.
• Use size, morphology and risk context.
• Avoid unnecessary follow-up for clearly benign findings.
• Mention limitations or need for dedicated imaging when indeterminate.

Use when

Incidental scrotal lesion on US/CT/MRI.

Source

Essentials

• Confirm the finding is truly incidental.
• Use size, morphology and risk context.
• Avoid unnecessary follow-up for clearly benign findings.
• Mention limitations or need for dedicated imaging when indeterminate.

Use when

Unexpected parathyroid-region lesion.

Source

Essentials

• Confirm the finding is truly incidental.
• Use size, morphology and risk context.
• Avoid unnecessary follow-up for clearly benign findings.
• Mention limitations or need for dedicated imaging when indeterminate.

Use when

Incidental sellar/pituitary abnormality.

Source

Essentials

• Confirm the finding is truly incidental.
• Use size, morphology and risk context.
• Avoid unnecessary follow-up for clearly benign findings.
• Mention limitations or need for dedicated imaging when indeterminate.

Use when

Unexpected hepatic steatosis on imaging.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

CT pulmonary angiography report.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

HRCT chest for suspected ILD.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

CT/MRI chest with mediastinal mass.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

CT/US chest pleural abnormality.

Source

Essentials

• Use the correct eligibility criteria.
• Apply the official lexicon and category definitions.
• Include category-linked management or follow-up.
• Compare with prior studies when relevant.

Use when

Dynamic contrast-enhanced breast MRI.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

Screening/diagnostic mammography.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

Image-guided breast biopsy reporting.

Source

Essentials

• Use the correct eligibility criteria.
• Apply the official lexicon and category definitions.
• Include category-linked management or follow-up.
• Compare with prior studies when relevant.

Use when

Post-ablation/TACE/Y90 liver MRI/CT in eligible HCC-risk patients.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

CT/MRI pancreatitis assessment.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

CT/MR enterography for IBD.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

Primary/restaging rectal cancer MRI.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

Prostate mpMRI.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

Acute stroke imaging pathway.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

Brain MRI for metastasis staging/follow-up.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

MRI brain/spine for demyelination.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

Pituitary MRI.

Source

Essentials

• Document risk factors and prior reaction history.
• Follow local policy and emergency readiness.
• Balance diagnostic benefit against patient-specific risk.
• Use the current contrast manual for final decisions.

Use when

Any contrast administration area.

Source

Essentials

• Document risk factors and prior reaction history.
• Follow local policy and emergency readiness.
• Balance diagnostic benefit against patient-specific risk.
• Use the current contrast manual for final decisions.

Use when

Iodinated or gadolinium contrast injection complication.

Source

Essentials

• Document risk factors and prior reaction history.
• Follow local policy and emergency readiness.
• Balance diagnostic benefit against patient-specific risk.
• Use the current contrast manual for final decisions.

Use when

Contrast CT in patient taking metformin.

Source

Essentials

• Document risk factors and prior reaction history.
• Follow local policy and emergency readiness.
• Balance diagnostic benefit against patient-specific risk.
• Use the current contrast manual for final decisions.

Use when

MRI contrast in renal impairment.

Source

Essentials

• Document risk factors and prior reaction history.
• Follow local policy and emergency readiness.
• Balance diagnostic benefit against patient-specific risk.
• Use the current contrast manual for final decisions.

Use when

Pregnant or breastfeeding patient requiring MRI contrast.

Source

Essentials

• Document risk factors and prior reaction history.
• Follow local policy and emergency readiness.
• Balance diagnostic benefit against patient-specific risk.
• Use the current contrast manual for final decisions.

Use when

Breastfeeding patient receiving contrast.

Source

Essentials

• Document risk factors and prior reaction history.
• Follow local policy and emergency readiness.
• Balance diagnostic benefit against patient-specific risk.
• Use the current contrast manual for final decisions.

Use when

Pediatric CT/MRI contrast exam.

Source

Essentials

• Document risk factors and prior reaction history.
• Follow local policy and emergency readiness.
• Balance diagnostic benefit against patient-specific risk.
• Use the current contrast manual for final decisions.

Use when

Contrast-enhanced ultrasound.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

Any pediatric ionizing radiation exam.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

Adult CT/fluoroscopy/nuclear medicine imaging.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

Ovarian/adnexal cyst on ultrasound.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

Thyroid nodule ultrasound.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

Early pregnancy ultrasound.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

Suspected lower extremity DVT.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

Carotid Doppler ultrasound.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

Ultrasound elastography for chronic liver disease.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

Postmenopausal bleeding ultrasound.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

Shoulder pain or suspected cuff tear.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

Bone pain with suspected stress fracture.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

Suspected osteomyelitis.

Source

Essentials

• Confirm the finding is truly incidental.
• Use size, morphology and risk context.
• Avoid unnecessary follow-up for clearly benign findings.
• Mention limitations or need for dedicated imaging when indeterminate.

Use when

Chest CT/MRI with cardiac abnormality.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

Cardiomyopathy or ischemic viability MRI.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

Child with suspected appendicitis.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

Child with UTI or reflux concern.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

Infant DDH screening or risk factors.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

Biopsy, drainage or vascular intervention planning.

Source

Essentials

• Confirm the intended patient population before applying.
• Use standardized language and category where available.
• State the key imaging features driving the recommendation.
• Link the impression to a clear next step when appropriate.

Use when

Any percutaneous image-guided biopsy.

Source