Lung-RADS Calculator v. 2022

Lung Imaging Reporting and Data System (LUNG RADS ®)
A quality assurance tool designed by the American College of Radiology (ACR) to standardize lung cancer screening CT.

Please note: This calculator does not include the "S modifier". Per Lung-RADS® 2022, the S modifier can be added to any categories for clinically significant or potentially clinically significant findings unrelated to lung cancer. This modifier does not affect the follow-up recommendations.

Lung-RADS
Do any of the following apply to the exam?
* Note: Inflammatory/infectious findings may include segmental or lobar consolidation, multiple new nodules (more than six), large solid nodules (≥ 8 mm) appearing in a short interval, and new nodules in certain clinical contexts (eg, immunocompromised patient).
→ Estimated population prevalence: ~1%
→ Recommendation: Comparison to prior chest CT is required. Re-evaluate when the prior scan is available.
→ Estimated population prevalence: ~1%
→ Recommendation: Additional lung cancer screening CT imaging needed.
→ Estimated population prevalence: ~1%
→ Recommendation: Repeat low-dose chest CT in 1-3 month.

Note: Some findings indicative of an infectious or infectious process may not warrant short-term follow-up (eg, tree-in-bud nodules or new < 3 cm ground glass nodules). These nodules may be evaluated using existing size criteria with a Lung-RADS classification and management recommendation based on the most suspicious finding.
Do you want to evaluate nodules or cysts?

Pulmonary Cysts:

How is the cyst's wall?
How is the formation of the cyst?
Does the cyst show any growth?
Does the cyst show any growth?

Not categorized in LUNG-RADS

Thin-walled unilocular cysts are considered benign and are not scored in LUNG-RADS.
Note that fluid-containing cysts may represent an infectious process and are not classified in Lung-RADS unless other concerning features are identified.
If there are multiple cysts may indicate an alternative diagnosis such as Langerhans cell histiocytosis (LCH) or lymphangioleiomyomatosis (LAM) and are not classified in Lung-RADS unless other concerning features are identified.
→ Estimated population prevalence: ~9%
→ Recommendation: 6-month low-dose chest CT screening
→ Estimated population prevalence: ~4%
→ Recommendation: 3-month low-dose chest CT screening. PET/CT may be considered if there is a ≥ 8 mm solid nodule or solid component
→ Estimated population prevalence: ~2%
→ Recommendation: Management depends on clinical evaluation, patient preference, and the probability of malignancy. Options are:
* Referral for further clinical evaluation, and/or:
* Diagnostic chest CT with or without contrast
* Tissue sampling
* PET/CT may be considered if there is a ≥ 8 mm (≥ 268 mm3) solid nodule or solid component

Pulmonary Nodules:

Does the nodule have any of the benign features below?
→ Estimated population prevalence: ~39%
→ Recommendation: 12-month low-dose chest CT screening
→ Estimated population prevalence: ~39%
→ Recommendation: 12-month low-dose chest CT screening

How is the composition of the nodule?
Does the nodule meet any of the following criteria?
Insert the short axis and long axis diameters to calculate the mean.

Error: Mean diameter of the solid component cannot be larger than the total mean diameter.

Is the nodule growing?
→ Estimated population prevalence: ~45%
→ Recommendation: 12-month low-dose chest CT screening
→ Estimated population prevalence: ~45%
→ Recommendation: 12-month low-dose chest CT screening
→ Estimated population prevalence: ~45%
→ Recommendation: 12-month low-dose chest CT screening
→ Estimated population prevalence: ~45%
→ Recommendation: 12-month low-dose chest CT screening
→ Estimated population prevalence: ~45%
→ Recommendation: 12-month low-dose chest CT screening
→ A ground-glass nodule (GGN) that demonstrates growth over multiple screening exams but does not meet the > 1.5 mm threshold increase in size for any 12-month interval may be classified as Lung-RADS 2 until the nodule meets findings criteria of another category, such as developing a solid component
→ Estimated population prevalence: ~45%
→ Recommendation: 12-month low-dose chest CT screening
→ Estimated population prevalence: ~45%
→ Recommendation: 12-month low-dose chest CT screening
→ Estimated population prevalence: ~45%
→ Recommendation: 12-month low-dose chest CT screening
→ Estimated population prevalence: ~9%
→ Recommendation: 6-month low-dose chest CT screening
Attention: Any category 3 or 4 nodules with additional imaging findings that increase the suspicion of lung cancer  (such as spiculation, lymphadenopathy, frank metastatic disease, a GGN that doubles in size in 1 year, etc.), the score should be increased to Category 4X.
→ Estimated population prevalence: ~9%
→ Recommendation: 6-month low-dose chest CT screening
Attention: Any category 3 or 4 nodules with additional imaging findings that increase the suspicion of lung cancer  (such as spiculation, lymphadenopathy, frank metastatic disease, a GGN that doubles in size in 1 year, etc.), the score should be increased to Category 4X.
→ Estimated population prevalence: ~9%
→ Recommendation: 6-month low-dose chest CT screening
Attention: Any category 3 or 4 nodules with additional imaging findings that increase the suspicion of lung cancer  (such as spiculation, lymphadenopathy, frank metastatic disease, a GGN that doubles in size in 1 year, etc.), the score should be increased to Category 4X.
→ Estimated population prevalence: ~9%
→ Recommendation: 6-month low-dose chest CT screening
Attention: Any category 3 or 4 nodules with additional imaging findings that increase the suspicion of lung cancer  (such as spiculation, lymphadenopathy, frank metastatic disease, a GGN that doubles in size in 1 year, etc.), the score should be increased to Category 4X.
→ Estimated population prevalence: ~9%
→ Recommendation: 6-month low-dose chest CT screening
Attention: Any category 3 or 4 nodules with additional imaging findings that increase the suspicion of lung cancer  (such as spiculation, lymphadenopathy, frank metastatic disease, a GGN that doubles in size in 1 year, etc.), the score should be increased to Category 4X.
→ Estimated population prevalence: ~4%
→ Recommendation: 3-month low-dose chest CT screening. PET/CT may be considered if there is a ≥ 8 mm solid nodule or solid component
Attention: Any category 3 or 4 nodules with additional imaging findings that increase the suspicion of lung cancer  (such as spiculation, lymphadenopathy, frank metastatic disease, a GGN that doubles in size in 1 year, etc.), the score should be increased to Category 4X.
→ Estimated population prevalence: ~4%
→ Recommendation: 3-month low-dose chest CT screening. PET/CT may be considered if there is a ≥ 8 mm solid nodule or solid component
Attention: Any category 3 or 4 nodules with additional imaging findings that increase the suspicion of lung cancer  (such as spiculation, lymphadenopathy, frank metastatic disease, a GGN that doubles in size in 1 year, etc.), the score should be increased to Category 4X.
→ Estimated population prevalence: ~4%
→ Recommendation: 3-month low-dose chest CT screening. PET/CT may be considered if there is a ≥ 8 mm solid nodule or solid component
Attention: Any category 3 or 4 nodules with additional imaging findings that increase the suspicion of lung cancer  (such as spiculation, lymphadenopathy, frank metastatic disease, a GGN that doubles in size in 1 year, etc.), the score should be increased to Category 4X.
→ Estimated population prevalence: ~4%
→ Recommendation: 3-month low-dose chest CT screening. PET/CT may be considered if there is a ≥ 8 mm solid nodule or solid component
Attention: Any category 3 or 4 nodules with additional imaging findings that increase the suspicion of lung cancer  (such as spiculation, lymphadenopathy, frank metastatic disease, a GGN that doubles in size in 1 year, etc.), the score should be increased to Category 4X.
→ Estimated population prevalence: ~4%
→ Recommendation: 3-month low-dose chest CT screening. PET/CT may be considered if there is a ≥ 8 mm solid nodule or solid component
Attention: Any category 3 or 4 nodules with additional imaging findings that increase the suspicion of lung cancer  (such as spiculation, lymphadenopathy, frank metastatic disease, a GGN that doubles in size in 1 year, etc.), the score should be increased to Category 4X.
→ Estimated population prevalence: ~4%
→ Recommendation: 3-month low-dose chest CT screening. PET/CT may be considered if there is a ≥ 8 mm solid nodule or solid component
Attention: Any category 3 or 4 nodules with additional imaging findings that increase the suspicion of lung cancer  (such as spiculation, lymphadenopathy, frank metastatic disease, a GGN that doubles in size in 1 year, etc.), the score should be increased to Category 4X.
→ Estimated population prevalence: ~4%
→ Recommendation: 3-month low-dose chest CT screening. PET/CT may be considered if there is a ≥ 8 mm solid nodule or solid component
Attention: Any category 3 or 4 nodules with additional imaging findings that increase the suspicion of lung cancer  (such as spiculation, lymphadenopathy, frank metastatic disease, a GGN that doubles in size in 1 year, etc.), the score should be increased to Category 4X.
→ Estimated population prevalence: ~2%
→ Recommendation: Management depends on clinical evaluation, patient preference, and the probability of malignancy. Options are:
* Referral for further clinical evaluation, and/or:
* Diagnostic chest CT with or without contrast
* Tissue sampling
* PET/CT may be considered if there is a ≥ 8 mm (≥ 268 mm3) solid nodule or solid component
Attention: Any category 3 or 4 nodules with additional imaging findings that increase the suspicion of lung cancer  (such as spiculation, lymphadenopathy, frank metastatic disease, a GGN that doubles in size in 1 year, etc.), the score should be increased to Category 4X.
→ Estimated population prevalence: ~2%
→ Recommendation: Referral for further clinical evaluation
Attention: Any category 3 or 4 nodules with additional imaging findings that increase the suspicion of lung cancer  (such as spiculation, lymphadenopathy, frank metastatic disease, a GGN that doubles in size in 1 year, etc.), the score should be increased to Category 4X.
→ Estimated population prevalence: ~2%
→ Recommendation: Management depends on clinical evaluation, patient preference, and the probability of malignancy. Options are:
* Referral for further clinical evaluation, and/or:
* Diagnostic chest CT with or without contrast
* Tissue sampling
* PET/CT may be considered if there is a ≥ 8 mm (≥ 268 mm3) solid nodule or solid component
Attention: Any category 3 or 4 nodules with additional imaging findings that increase the suspicion of lung cancer  (such as spiculation, lymphadenopathy, frank metastatic disease, a GGN that doubles in size in 1 year, etc.), the score should be increased to Category 4X.
→ Estimated population prevalence: ~2%
→ Recommendation: Management depends on clinical evaluation, patient preference, and the probability of malignancy. Options are:
* Referral for further clinical evaluation, and/or:
* Diagnostic chest CT with or without contrast
* Tissue sampling
* PET/CT may be considered if there is a ≥ 8 mm (≥ 268 mm3) solid nodule or solid component
Attention: Any category 3 or 4 nodules with additional imaging findings that increase the suspicion of lung cancer  (such as spiculation, lymphadenopathy, frank metastatic disease, a GGN that doubles in size in 1 year, etc.), the score should be increased to Category 4X.
→ Estimated population prevalence: ~2%
→ Recommendation: Management depends on clinical evaluation, patient preference, and the probability of malignancy. Options are:
* Referral for further clinical evaluation, and/or:
* Diagnostic chest CT with or without contrast
* Tissue sampling
* PET/CT may be considered if there is a ≥ 8 mm (≥ 268 mm3) solid nodule or solid component
Attention: Any category 3 or 4 nodules with additional imaging findings that increase the suspicion of lung cancer  (such as spiculation, lymphadenopathy, frank metastatic disease, a GGN that doubles in size in 1 year, etc.), the score should be increased to Category 4X.
→ Estimated population prevalence: ~2%
→ Recommendation: Management depends on clinical evaluation, patient preference, and the probability of malignancy. Options are:
* Referral for further clinical evaluation, and/or:
* Diagnostic chest CT with or without contrast
* Tissue sampling
* PET/CT may be considered if there is a ≥ 8 mm (≥ 268 mm3) solid nodule or solid component
Attention: Any category 3 or 4 nodules with additional imaging findings that increase the suspicion of lung cancer  (such as spiculation, lymphadenopathy, frank metastatic disease, a GGN that doubles in size in 1 year, etc.), the score should be increased to Category 4X.
→ Estimated population prevalence: ~2%
→ Recommendation: Management depends on clinical evaluation, patient preference, and the probability of malignancy. Options are:
* Referral for further clinical evaluation, and/or:
* Diagnostic chest CT with or without contrast
* Tissue sampling
* PET/CT may be considered if there is a ≥ 8 mm (≥ 268 mm3) solid nodule or solid component
Attention: Any category 3 or 4 nodules with additional imaging findings that increase the suspicion of lung cancer  (such as spiculation, lymphadenopathy, frank metastatic disease, a GGN that doubles in size in 1 year, etc.), the score should be increased to Category 4X.
→ Estimated population prevalence: ~2%
→ Recommendation: Management depends on clinical evaluation, patient preference, and the probability of malignancy. Options are:
* Referral for further clinical evaluation, and/or:
* Diagnostic chest CT with or without contrast
* Tissue sampling
* PET/CT may be considered if there is a ≥ 8 mm (≥ 268 mm3) solid nodule or solid component
Attention: Any category 3 or 4 nodules with additional imaging findings that increase the suspicion of lung cancer  (such as spiculation, lymphadenopathy, frank metastatic disease, a GGN that doubles in size in 1 year, etc.), the score should be increased to Category 4X.
→ Estimated population prevalence: ~2%
→ Recommendation: Management depends on clinical evaluation, patient preference, and the probability of malignancy. Options are:
* Referral for further clinical evaluation, and/or:
* Diagnostic chest CT with or without contrast
* Tissue sampling Note: Slow-growing nodules may not have increased metabolic activity on PET/CT; therefore, biopsy, if feasible, or surgical evaluation may be the most appropriate management recommendation.
Attention: Any category 3 or 4 nodules with additional imaging findings that increase the suspicion of lung cancer  (such as spiculation, lymphadenopathy, frank metastatic disease, a GGN that doubles in size in 1 year, etc.), the score should be increased to Category 4X.

Click here to visit Lung-RADS 2022 page on ACR's website.

References:
  1. American College of Radiology. Lung CT Screening Reporting and Data System (Lung-RADS) v. 2022
  2. McKee, B. J., Regis, S. M., McKee, A. B., Flacke, S., & Wald, C. (2015). Performance of ACR Lung-RADS in a clinical CT lung screening program. Journal of the American College of Radiology : JACR, 12(3), 273–276. 

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More about the Lung-RADS calculator:

The Lung CT Screening Reporting and Data System (LUNG-RADS) was developed by the American College of Radiology (ACR) in 2014 and last updated in 2022. Its primary goal is to standardize the reporting and management of lung cancer screening with low-dose CT (LDCT). This system is designed to facilitate consistent management recommendations and improve outcomes monitoring for patients undergoing lung cancer screening. The implementation of LUNG-RADS has been associated with a significant reduction in false-positive results and unnecessary follow-up procedures, thereby improving the overall effectiveness of lung cancer screening programs.

Key Updates in LUNG-RADS v2022

LUNG-RADS version 2022 introduces several critical updates to enhance the classification and management of pulmonary nodules detected during lung cancer screening. Released in November 2022, these updates were informed by recent scientific advancements and insights from practicing radiologists. The key changes include new assessment criteria for atypical pulmonary cysts, juxtapleural nodules, and airway-centered nodules. Additionally, the latest version provides clearer guidance on determining nodule growth and introduces stepped management strategies for nodules that are stable or decreasing in size.

The revisions aim to address common clinical scenarios encountered in lung cancer screening, ensuring that radiologists have the latest evidence-based guidance for managing patients. The updated criteria and management recommendations are expected to further reduce the rate of false positives and improve early detection of lung cancer, ultimately contributing to better patient outcomes.

Importance of Standardized Reporting

Standardized reporting through LUNG-RADS is crucial for several reasons. It ensures that all radiologists use a consistent language and approach when evaluating and reporting lung nodules. This consistency enhances the comparability of screening results across different institutions and geographic regions. Moreover, it facilitates more accurate data collection and analysis, which is vital for ongoing research and improvement in lung cancer screening practices.

By adopting LUNG-RADS, healthcare providers can improve communication with patients and other healthcare professionals. This system helps to clearly convey the level of suspicion for lung cancer and the recommended management steps, leading to better-informed decision-making and patient care.

The updates in LUNG-RADS v2022 reflect the ongoing commitment of the ACR to improve lung cancer screening practices. By incorporating the latest scientific evidence and expert consensus, LUNG-RADS continues to evolve, providing radiologists with a robust framework for the accurate assessment and management of pulmonary nodules. This standardized approach is essential for enhancing the effectiveness of lung cancer screening and ultimately improving patient outcomes.

2 Comments

  1. Al Katz says:
    November 7, 2023 at 9:17 am

    I could not resist commenting. Exceptionally well written!

    Reply
  2. Sara R says:
    June 19, 2024 at 7:53 am

    Nicely done. So helpful

    Reply

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