Radiology Working Group Recommendations

A radiology working group with members from the Care Center Network have collaborated to create a recommended protocol for HRCT for imaging those with suspected interstitial lung disease. This document is intended as a guide. 

 Guidelines for Imaging ILD
Click here to view the HRCT protocol. 

Working Group Co-Chair(s): Jonathan Chung, MD, David Lynch, MD

Working Group:
  • Alpa G Desai, M.D.
  • Andrew J. Bierhals, M.D., MPH
  • Hakan Sahin, M.D.
  • Joel Fishman, M.D., Ph.D.
  • Jubal R. Watts, Jr., M.D.
  • Judith L Chezmar, M.D.
  • Katherine A. Kaproth-Joslin, M.D., Ph.D.
  • Kiran Batra, M.D.
  • Lila Pourzand, M.D.
  • Lisa Hood Lancaster, MD
  • Seth Kligerman, M.D.
  • Stephen Hobbs, M.D.
  • Sushilkumar K. Sonavane, M.D.
  • Tadashi L Allen, M.D.
  • Teng Moua, M.D.
  • Warren B. Gefter, M.D., FACR
  • Wendi R Mason, NP

PFF Care Center Network: Recommendations for HRCT Technique

Coach to full inspiration

  • Emphasize importance of holding breath
  • Repeat scans with motion

Volumetric acquisition

Thin section (1-1.5 mm)

Moderate edge-enhancing reconstruction algorithm (e.g. Siemens B45f, GE Bone, Philips D or YB, Toshiba Lung Std.)

Field of view to include only lungs

Coronal and sagittal reconstructions

Routine expiratory CT (contiguous or noncontiguous)

Routine prone CT (noncontiguous)


HRCT report (in suspected pulmonary fibrosis) should contain the following

Clinical information


Exam quality

Fibrotic abnormalities

  • Axial and craniocaudal distribution
  • Presence/Absence of
    • Reticular abnormality
    • Traction bronchiectasis and bronchiolectasis
    • Honeycombing
Non-fibrotic Abnormalities
  • Presence/Absence of
    • Groundglass opacity
    • Mosaic attenuation
    • Air-trapping
    • Nodules/Cysts/Consolidation
    • Emphysema

Ancillary findings

  • Lymph node enlargement (often reactive)
  • Pulmonary arterial enlargement
  • Hiatal hernia
  • Esophageal dilation
  • Pleural abnormality
  • Lung nodules, etc.


  • Imaging UIP classification (e.g. UIP, Probable UIP, indeterminate for UIP, most consistent with a non-IPF diagnosis)
  • Differential diagnosis with level of confidence
  • Change since prior imaging


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