CT Chest Without Contrast — Dictation, Appropriateness, and Dose for Residents

1. The Non-Contrast Chest CT: Nailing the Nodule Follow-Up

Outpatient queue. You see a CT Chest Without Contrast for “pulmonary nodule follow-up.” The prior was an outside hospital CT abdomen from 6 months ago that incidentally caught a 7 mm spiculated nodule in the right lower lobe. The attending expects you to find it, measure it precisely, compare its volume, and apply the correct Fleischner Society criteria in the impression. You know the guidelines exist, but pulling them up and triple-checking the solid vs. subsolid, single vs. multiple logic tree while the list grows is a classic friction point. When I was a resident, I’d measure, dictate the size, and punt the recommendation to the attending. It’s a safe move, but it’s not how you build the confidence to practice independently. Let’s build a better workflow. This guide is part of our commitment to building better tools and references for trainees, which you can find more of in the residents and fellows resource hub.

2. What a CT Chest Without IV Contrast Covers and What Attendings Look For

The non-contrast chest CT is the workhorse for evaluating the lung parenchyma and pleura. Without intravenous contrast, we can’t assess vascular structures like the aorta or pulmonary arteries for acute pathology, nor can we characterize mediastinal mass enhancement. But for the lungs themselves, it’s often the perfect tool. It provides a detailed look at the architecture of the lung tissue, airways, and surrounding structures.

Your attending expects a systematic evaluation that answers these key questions:

• Pulmonary Nodules: What is the size, morphology (solid, subsolid, part-solid), and density of any nodules? Has it changed from the prior? A Fleischner Society recommendation is mandatory.
• Interstitial Lung Disease (ILD): Are there patterns of fibrosis (e.g., honeycombing, reticulation), ground-glass opacities, or mosaic attenuation? Is the distribution suggestive of UIP, NSIP, or another pattern?
• Airways and Emphysema: Is there evidence of bronchiectasis (dilated, non-tapering airways)? What is the emphysema phenotype — centrilobular (smoking-related), panlobular (alpha-1-antitrypsin deficiency), or paraseptal?
• Pleura: Are there effusions, pneumothorax, or pleural thickening/calcification?
• Incidental Findings: Don’t forget to check for coronary artery calcification, thoracic spine degenerative changes, or upper abdominal findings at the lung bases.

3. Radiology Report Template for CT Chest Without IV Contrast

This is a solid starting point for your personal macro. Drop this into your dictation system and modify it as you go. The key is having a consistent structure so you never miss a critical area.

Technique

Non-contrast helical CT of the chest was performed from the lung apices through the lung bases during a single inspiratory breath-hold. Axial images were reconstructed in soft-tissue and lung algorithms. Coronal and sagittal reformations were also created and reviewed.

[Optional: The effective radiation dose for this examination was approximately [X] mSv.]

Findings

Comparison: [Compare to prior CT chest dated MM/DD/YYYY].

Lungs and Airways: The trachea and central airways are patent. The lung parenchyma is clear. There is no focal consolidation, ground-glass opacity, or suspicious pulmonary nodule. No bronchiectasis or honeycombing. No evidence of emphysema.

Pleura: No pleural effusion or pneumothorax. No pleural thickening or calcification.

Mediastinum and Hila: The cardiac silhouette is normal in size. No mediastinal or hilar lymphadenopathy by short-axis criteria. The thyroid gland is unremarkable. The thoracic aorta is normal in caliber, with calcified plaque noted. The esophagus is non-dilated.

Chest Wall and Bones: The visualized osseous structures are intact, with no suspicious lytic or blastic lesions. No acute fracture.

Upper Abdomen: The visualized portions of the liver, spleen, adrenal glands, and kidneys are unremarkable.

Impression

1. No acute cardiopulmonary process.
2. [If nodules are present, describe size, location, and change from prior, then add a Fleischner recommendation. E.g., “Stable 7 mm solid nodule in the right lower lobe, unchanged from prior. Per 2017 Fleischner Society guidelines for a single solid nodule in a low-risk patient, follow-up CT in 12 months is recommended.”]

4. Free Radiology Template Sources

Building your own macro library is a rite of passage. But you don’t have to start from scratch. Before considering any paid tool, you should know that two great free repositories exist, curated by radiologists for radiologists.

• RadReport.org: Maintained by the RSNA, this is a comprehensive library of peer-reviewed templates covering nearly every modality and subspecialty. They are structured, standardized, and a fantastic resource.
• Radiology Templates (AU): This is an excellent, user-friendly site maintained by Australian radiologists. It offers a wide variety of templates that are practical and easy to adapt.

Bookmark them. Use them. They are invaluable resources built by the community.

5. The Next-Level Move: Free-Form Dictation with AI-Powered Structuring

The classic workflow is to fill in the blanks of a static template. It’s safe, but it can feel rigid. Sometimes you just want to look at the images and dictate what you see, especially for a complex case with multiple positive findings. This is where modern tools can change the game.

Instead of clicking through a macro, you can dictate the positive findings in free form—”7 mm solid nodule in the RLL, looks stable from the outside study six months ago. Mild centrilobular emphysema. Coronary artery calcification is moderate.” The AI then parses this, measures against its internal ontologies, and generates a fully structured report. It automatically places the findings in the correct sections and, for things like nodules, can draft the appropriate Fleischner recommendation in the impression. GigHz Precision AI is designed to do exactly this, using ACR and SIR-based templates to ensure your report is clean, comprehensive, and ready for your attending to review.

6. When Should You Order a CT Chest Without IV Contrast? ACR Appropriateness Criteria

The American College of Radiology (ACR) provides evidence-based guidelines to help clinicians choose the right test. For a non-contrast chest CT, the primary indications revolve around lung nodules and diffuse lung disease.

For an Incidentally Detected Indeterminate Pulmonary Nodule, a non-contrast chest CT is almost always the right next step. Whether the nodule was first seen on a chest radiograph, an incomplete CT of the abdomen, or a prior chest CT, this study is rated Usually Appropriate (8/9 or 9/9) for characterizing and following nodules ≥6 mm. For nodules <6 mm, follow-up is often not needed, but if pursued, a non-contrast CT is also Usually Appropriate.

When evaluating suspected or confirmed Diffuse Lung Disease, a non-contrast chest CT is also Usually Appropriate (7/9). Often, this is performed with high-resolution CT (HRCT) thin reconstructions from the same dataset, which provides the fine detail needed to identify patterns like UIP or NSIP. This applies to initial imaging, evaluation of an acute exacerbation, and routine follow-up.

It’s important to distinguish this study from Lung Cancer Screening, which uses a dedicated low-dose CT (LDCT) protocol to minimize radiation exposure. While a non-contrast CT is technically capable, an LDCT is the Usually Appropriate (7/9) study for screening eligible high-risk patients.

For mediastinal masses, suspected pulmonary embolism, or aortic disease, a CT with IV contrast is the appropriate first-line advanced imaging test.

7. How Much Radiation Does a CT Chest Without IV Contrast Deliver?

Patients often ask about radiation, and you should have a confident, simple answer. A standard non-contrast chest CT delivers an effective dose of approximately 3-7 millisieverts (mSv).

To put that in perspective, it’s in the 1-10 mSv tier, which is comparable to the amount of natural background radiation a person receives over several months to a few years. While it’s more than a chest X-ray (~0.1 mSv), it’s a moderate dose and is generally considered a low-risk examination when clinically indicated. Modern scanners use automated dose modulation and iterative reconstruction techniques to keep the dose as low as reasonably achievable (ALARA) while maintaining diagnostic image quality.

Source: Protocol YAML (curated by IR + ACR RRL)

8. CT Chest Without IV Contrast Imaging Protocol — Phases and Reconstructions

The protocol is straightforward but relies on specific reconstructions to be fully diagnostic. The scan itself is a single, quick helical acquisition during an inspiratory breath-hold, covering the chest from the lung apices through the bases. The magic happens in the reconstructions that are generated from this single raw dataset.

Common protocol pitfalls: The most common mistake is not reviewing the dedicated thin-slice (1 mm) lung reconstructions. Small nodules, subtle ground-glass opacities, and early interstitial changes can be completely invisible on the thicker 3 mm soft-tissue windows. Always open the thin-slice lung series and scroll through it carefully on lung windows.

9. The 3-Months-Free Offer for Radiology Residents and Fellows

3+ months free for radiology residents and fellows

Look like a rockstar on your reports. Our goal is to help you transition from simply identifying findings to generating high-quality, attending-level structured reports efficiently. With GigHz Precision AI, you can dictate your positive findings in free form, and the AI generates a structured report using ACR and SIR templates, with the appropriate Clinical Decision Support (CDS) firing automatically.

All we ask is feedback so we can keep improving the product for trainees. The signup is simple. No credit card, no long forms. To apply, just provide three items:

1. Your PGY year (e.g., PGY-2, PGY-4)
2. Your training type (radiology residency or specific fellowship)
3. Your training program / hospital name

Ready to give it a try? You can apply for the residents free-access program here.

10. Frequently Asked Questions

Is GigHz Precision AI HIPAA-compliant?

Yes. The platform is designed for de-identified workflows by default. You dictate findings, not raw PHI. It operates as a “business associate” under HIPAA, and all data is encrypted in transit and at rest, meeting full compliance standards.

Do I need our hospital’s IT department to set this up?

No. It’s a browser-based tool. There is no software to install on hospital machines. It works on the computer in the reading room, your personal laptop, or even the call-room iPad. It’s designed to be independent of hospital IT infrastructure.

Does it work with PowerScribe or other dictation systems?

Yes. It works alongside your existing dictation system, not as a replacement for it. You can dictate into Precision AI, review the structured report it generates, and then copy-paste the final text into your PACS/RIS with a single click.

Can I use my own custom templates?

Yes. While the system comes pre-loaded with ACR and society-backed templates, you can customize them or upload your own preferred templates. The AI will then structure your free-form dictation according to your personalized format.

What happens after my residency or fellowship ends?

The free access is for trainees. After you graduate, you can transition to a standard plan. We offer discounts for recent graduates to help you get started in your first year of practice.