Viva · Specialty
Chest Viva Questions
Oral-exam style questions and answers on chest for MD, DNB and super-specialty practical examinations. Each answer links back to the playbook or Library entry it was written from.
- What is Lung-RADS and to whom does it apply?
- Lung-RADS is the ACR structured reporting system for low-dose CT lung cancer screening in asymptomatic high-risk adults. It assigns a category based on nodule size, attenuation and interval behaviour, each linked to an estimated malignancy risk and a defined management step. It does not apply to diagnostic CT or to patients with known or suspected lung cancer.
- List the Lung-RADS categories.
- Categories 0 (incomplete), 1 (negative), 2 (benign appearance or behaviour), 3 (probably benign), 4A (suspicious), 4B (very suspicious) and 4X (category 3 or 4 with additional suspicious features), plus the S modifier for significant or potentially significant other findings.
- How is a nodule measured for Lung-RADS?
- As the mean of the long-axis and short-axis diameters on the same image, recorded to one decimal place. For part-solid nodules, the total size and the solid-component size are reported separately, and the solid component determines the category.
- What management follows category 3, 4A and 4B?
- Category 3 gets a 6-month low-dose CT, category 4A a 3-month low-dose CT with PET/CT considered when the solid component is at least 8 mm, and category 4B a diagnostic chest CT with or without contrast, PET/CT and/or tissue sampling.
- What does the 4X category mean?
- A category 3 or 4 nodule that carries additional imaging features or associated findings raising suspicion of malignancy, such as spiculation or associated lymphadenopathy. It is managed as category 4B.
- What did version 2022 change?
- It defined growth as an increase of more than 1.5 mm, allowed stable or decreasing category 3 and 4 nodules to be downgraded to category 2, formalised juxtapleural nodule criteria, and added atypical pulmonary cysts to categories 4A and 4B.
- What is the commonest pitfall when applying Lung-RADS?
- Using it for incidental nodules on diagnostic CT, where Fleischner 2017 criteria apply, and categorising a part-solid nodule by its total diameter instead of its solid component.