Low-Dose Chest CT Screening Guidelines

Eligibility Criteria

The American College of Radiology recommends annual low-dose CT screening for high-risk individuals aged 55-77 years with at least a 30 pack-year smoking history who currently smoke or have quit within the past 15 years 3, 4
For individuals aged 50-80 with at least 20 pack-years of smoking and additional risk factors, the American College of Radiology suggests low-dose CT screening may be appropriate, though evidence is less conclusive 5
The American College of Radiology does not recommend screening for individuals younger than 50, older than 80, with less than 20 pack-years smoking history, or who quit smoking more than 15 years ago 7
Screening should not be performed in individuals with comorbidities that substantially limit life expectancy or ability to tolerate evaluation of findings or treatment, as recommended by the American College of Radiology 7

The American College of Radiology recommends maintaining a CT dose volume index at ≤3.0 mGy for average-sized patients, with adjustments for larger or smaller patients 1, 2
Images should be optimized to avoid artifacts while maintaining high spatial resolution, according to the American College of Radiology 1
Non-contrast helical studies should be performed with slice thickness ≤2.5 mm (with <1 mm preferred), as suggested by the American Thoracic Society 8

The American College of Radiology recommends that programs develop a dedicated LDCT protocol reviewed annually by supervising radiologists, medical physicists, and radiology technologists 1
Structured reporting systems (such as ACR Lung-RADS) should be used to standardize findings and recommendations, as recommended by the American College of Radiology 1, 2
Programs should implement strategies to determine whether patients have symptoms suggesting lung cancer, directing symptomatic patients to diagnostic testing rather than screening, according to the American College of Radiology 7
Effective counseling and shared decision-making visits should occur prior to screening, including discussion of benefits, harms, and follow-up procedures, as recommended by the American College of Radiology 7, 2

The American College of Radiology recommends that programs develop data collection and reporting tools for quality improvement initiatives 2
Technicians performing screening LDCT scans should be trained in the specific protocol, as suggested by the American Thoracic Society 8
Quality checks using training sets of screening LDCTs can ensure consistent application of structured reporting systems, according to the American Thoracic Society 8
Programs should develop strategies to guide management of non-nodule findings (e.g., coronary calcification, thyroid nodules), as recommended by the American College of Radiology 2

Low-dose CT screening reduces lung cancer mortality by approximately 20% and all-cause mortality by 6.7% in high-risk populations, according to the American College of Radiology 6
Potential harms include false positives leading to unnecessary procedures, radiation exposure, and overdiagnosis of indolent cancers, as noted by the American College of Radiology 6

The American Association of Physicists in Medicine provides a free library of optimized protocols for LDCT screening scans for commonly installed CT scanners, as recommended by the American College of Radiology 1