How to Read a CT Scan Report - Learn the Sections Relevant to Your Diagnosis

Did you download your CT scan report from your portal and are anxiously waiting contact from your doctor to understand what it means? The complex terminology can be intimidating. How do you find what really matters? We show you how to hone in on the summary section and what those findings mean. https://bit.ly/43fzBFG

In this Episode:

• 03:22 - The Origin of Kellogg Corn Flakes
• 04:56 - Recipe of the Week: Peanut Butter Balls
• 05:20 - Journavx, the First New Oral Pain Medication in 20 Years
• 08:30 - How to Make Sense Out of a CT Scan Report
• 14:58 - Where to Look for the Important Findings - the Impression Section
• 25:37 - Earnest Hemmingway - Silent Support
• 27:02 - Outro

We continue our series, “Everything you always wanted to know about cancer, but didn’t have anyone to ask” with a conversation about how to make sense out of a CT scan report. 

Dr. Matzo goes through an example CT for someone with metastatic prostate cancer. She discusses the different sections and highlights the "Impression" section - the sum of all the important findings. Marianne talks about how radiologists document abnormal but not concerning biology; some are things just to keep an eye on.  She also shared how often things unrelated to the reason for the scan are serendipitously found and treated, like her personal example of a kidney cancer.

Charlie helped highlight how useful it is to download a copy of your reports to share between locations and to facilitate your care. We hope this helps the report feel less threatening and more a tool for you to be involved in your own treatment.

Chapters

• 0:00 Intro
• 3:22 The Origin of Kellogg Corn Flakes
• 4:56 Recipe of the Week: Peanut Butter Balls
• 5:20 Journavx, the First New Oral Pain Medication in 20 Years
• 8:30 How to Make Sense Out of a CT Scan Report
• 14:58 Where to Look for the Important Findings – the Impression Section
• 25:37 Earnest Hemmingway – Silent Support
• 27:02 Outro

Transcript

Hello and welcome to Everyone Dies, a podcast where we talk about serious illness, dying, death, and bereavement. I'm Marianne Matzo, a nurse practitioner, and I use my experience from working as a nurse for 46 years to help answer your questions about what happens at the end of life. And I'm Charlie Navarette, an actor in New York City, and here to offer an every-person viewpoint to our podcast.

We are both here because we believe that the more you know, the better prepared you are to make end-of-life decisions. Additionally, this podcast does not provide medical nor legal advice. Please listen to the complete disclosure at the end of the recording.

Welcome to this week's show. Please relax. Get yourself a handful of something to eat, whatever that envelope is, and drink.

Jelly beans. And thank you. M&Ms.

Yeah. And thank you for spending the next hour with Charlie and me as we continue with our series titled Everything You Always Wanted to Know About Cancer But Didn't Have Anyone to Ask with a conversation about how to make sense out of a CAT scan report. Like the BBC, we see our shows offering entertainment, enlightenment, and education and divide that into three halves to address each of these goals.

Our main topic is in the second half, so feel free to fast forward to that flight of idea-free zone. In the first half, Charlie has our recipe of the week and tells us about a newly improved, non-addicting drug for pain. In the second half, I'm going to continue our series about cancer with information about how to read your CAT scan report.

And in the third half, Charlie has a quote attributed to Ernest Hemingway. So when you say a handful, let's look at M&Ms. A handful of peanut M&Ms or a handful of plain M&Ms, doctor? Or a handful of those little teeny tiny M&Ms.

Teeny? No, no, no, no, no. That's an aberration. Absolutely not.

We need the traditional size. The traditional size. Not the giant ones.

You know they have giant ones now too. What do you mean? How do you? Yeah. What? They're big.

You can go to any store and they have mega M&Ms and they have teeny tiny M&Ms. Okay, I guess I've missed this, you know, cultural leap. Well, you know, if you were in an actual big city, then maybe.

Yeah, there we are. Yeah, it ain't the New York of my ute. So yeah, it's changed a little bit.

So for our first half, we are so glad to have you round tripping with us. It's just like the 60s, only different. This week, Marianne and I are taking you to the state of our birth, Michigan, the home of the Great Lakes, Motown, the automotive industry, and Kellogg's.

No childhood was complete without a trip to Battle Creek, Michigan, to see how cornflakes were made and to have a free sample. This was before the internet, where driving three hours to eat cornflakes was considered the highlight of the summer. Did you get to go? I was just going to ask you, did you? You know what? Absolutely.

I think, I don't remember my sister and I doing that, but I vaguely remember when my brothers were little kids. Yeah, they got all the swell trips. Well, anywho, John Harvey Kellogg and Will Keith Kellogg were brothers from a Seventh-day Adventist family in Battle Creek, Michigan.

They had little education because their parents expected Christ's second coming before they would need it. But John Harvey did manage to get a medical degree. He was a fanatical advocate of what he called biologic living, which involved vegetarianism, no alcohol or tobacco, no tea, coffee, or condiments, and minimal quantities of eggs and dairy products.

Sounds like a fun guy. After a while, this diet was so boring, the brothers experimented with grains, and by accident, one night in 1894, when trying to manufacture an easily digestible form of bread, made cornflakes. John Harvey Kellogg was known to advocate bland foods to prevent lascivious behaviors and tamed the urge to self-pleasure.

He would prescribe cornflakes to stifle sexual desire because they were bland, plain, meat-free, and made of corn. In contrast, our recipe this week is for peanut butter balls, no pun intended, which are simple saucepan cookies that are a snap to make. You can whip them up in 10 minutes for your next funeral repast offering.

These little treats are a big hit with any crowd. Bon Appetite! Now, I don't know if you have heard, but there is a new pain drug in town. This is the first new oral pain medication to receive FDA approval in 20 years.

It contains no opioids and is non-addicting. So, what's all this fuss about Gernovax? Gernovax is made for acute neuropathic type pain. Pain medications can act by blocking the pain pathways, such as anti-inflammatory drugs, that is, for broken bones, sprains, arthritis, muscle injuries.

Topical medications, those you rub on your skin, to block nerves from sending the pain signal to the brain. Those that activate the body's endorphin system, for example opioids, and nerve calming, for example, antidepressants, anti-epileptic drugs, and now Gernovax. Gernovax is for acute pain caused by surgery, accident, or injury.

So, it will be used for short-term pain management. It works as a pain signal blocker at one specific signal called NAV1.8. Think of the nerves as a series of paths with gates on them and the gate that opens and closes to let signals through to send a message to the brain. One gate is called NAV1.8 and it is a voltage-gated sodium channel expressed in peripheral pain-sensing nerve cells called neurons.

Its job is to transmit pain signals, but Gernovax blocks the NAV1.8 gate and won't let the signal through. If the signal can't get through, the brain does not get a message there is pain, and a person does not feel the pain. People need to know it is approved for acute, not chronic pain related to surgery, accident, or injury.

It can be taken twice a day and costs $15.50 per pill. It will likely be useful for peripheral neuropathy and back pain, but it has not yet been tested nor approved for this use. Certain birth control pills may be ineffective if you take Gernovax, and if you're on this drug, don't take food or fluids containing grapefruit.

Please go to our webpage for this week's recipe for peanut butter balls and additional resources for this program. Everyone Dies is offered at no cost, but is not free to produce. Please contribute what you can.

Your tax-deductible gift will go directly to supporting our non-profit journalism so that we can remain accessible to everyone. You can also donate at www.everyonedies.org. That's every, the number one dies, dot org. Or, at our site on Patreon, www.patreon.com, and search for Everyone Dies.

Marianne? CT is short for computed tomography, also known as a CAT scan or a CT scan, which uses a donut-shaped machine to take multiple x-rays from many different angles, creating a 2D cross-sectional slice at one location within the body. These slices are then collected at multiple continual locations and combined through the computer into a detailed 3D image. Now, if you've been diagnosed with cancer, or they think you might have cancer, or any other reason, there's lots of reasons that they might order a CT scan.

Nowadays, they, if you, where you go has a patient portal, you can go into the portal, and your scan is there. And if you haven't yet received a call from your healthcare practitioner to go over it with you, lots of reasons, or you just say, I'm going to print this out, you say, oh my god, I don't even know what any of this means. And then what I see happening is people will post their CT scans on Facebook, and they'll say, can anybody tell me what this means? So I thought, why don't I just tell you how to read one? And then you don't have to post it on Facebook.

So when you get your scan, and what I did is I put a copy of the scan in the show notes. So if you want to, if you're somewhere and you want to follow along with it, you can, but it's not necessary. So there's sections of this report.

First thing it starts out with is the type of the exam. And this section shows date, time, and the type of the exam. For example, it'll say, computed tomography CT of the abdomen and pelvis with intravenous or oral contrast performed January 10, 2022.

So it's just saying, here's what the test is, here's where they looked, and if they used contrast or not. Contrast is a radioactive substance that they'll put in, and they'll kind of shoot it, and you'll feel it kind of, it warms as it goes through your body, and it's able to show a contrast against the organs. The next part of it is the history or reason for the exam.

And this section usually lists the information that your healthcare practitioner has given the radiologist when they ordered your exam. It allows them to explain what symptoms you're having and why they're ordering the radiology test. This helps the radiologist accurately interpret your test and focus the report on the symptoms and your past history.

Sometimes the radiologist can read your exam, will also add information that they find in your chart or forms that are filled out before your imaging test. So in our example, the reason is metastatic prostate cancer. The next part, it says comparison priors.

Sometimes the radiologist will compare the new imaging exam with any previous exams. So if the doctor, whoever ordered it, lists them there, those comparisons will involve exams of the same body area and exam type. It's always a good idea to get any prior imaging exams from other hospitals or facilities and provide them to the radiology department where you're having your test.

Having these older exams can be very helpful to the radiologist. So in our example where it says comparison priors, it says CT of the abdomen and pelvis without and with IV contrast and oral contrast on 10-27-20. So your report, the one you have in your hand, is being compared to that previous exam on 10-27-20.

So if you've had 10 exams, what they do is they take the exam that you have the report about and compare it to the right before it. So you know which one they're comparing it to. Next is findings.

And this section lists what the radiologist saw in each area of the body in the exam. Your radiologist notes whether they think the area to be normal, abnormal, or potentially abnormal. Sometimes an exam covers an area of the body that does not discuss any findings.

This usually means that radiologist looked but did not find any problems to tell your doctor. Some radiologists report things in paragraph form, while others will use reporting style where each organ or region of the body is listed as aligned with the findings. If the radiologist does not see anything concerning, it may say normal or unremarkable.

So in the example that we have in your show notes, it says finding CT thorax. So that's looking at the chest. It's saying the heart is enlarged.

There's coronary artery calcifications. It's saying negative for any lymph problems. So it goes through.

And you can read through all of that. It's a lot of body parts that you may not know what they're talking about. And that's okay because your oncologist or your doctor is going to read through that.

But like many people, they're going to go to the findings, which we'll get to in a minute. So the next part is on the one, the example I gave you is a CT of the abdomen and pelvis. And what it goes through is the size of things and exactly in very detailed words, what exactly was found in the abdomen and pelvis.

So you can go through that and, you know, look up every single word in the dictionary if you want to. But what I'm telling you is that all of that will be further discussed in the impression. So, you know, it's sort of like the difference between reading the whole book and just reading the summary, which is going to give you all the details that you need.

So, and that is all in the impression part. Okay? So you move down your report to your impression part. And it says, so in this section, the radiologist summarizes the findings and reports the most important findings that they see and the possible causes.

And this is called a differential diagnosis for those findings. This section offers the most important information for decision-making. Therefore, it's the most important part of the radiology report for you and your doctor.

For an abnormal finding, the radiologist may recommend other imaging tests that can help better assess the finding or getting a follow-up imaging test to re-look at the findings after a period of time. They might suggest a biopsy. They might suggest correlating the finding with clinical symptoms or lab test results to better understand it if it's an incidental finding and likely no issue or could explain your clinical symptoms.

And many of the findings that a radiologist sees on your scan are incidental and will cause you no harm. I'll tell you from personal story, I had some back and sciatic pain and the doctor that I was seeing said, you should go get a CT just so we can see what's going on with your back. So I went for my CT, and there was an incidental finding of a nodule on my right kidney that, further follow-up, was kidney cancer.

So I went through two years of, it was through COVID, so there was a lot of scans and waiting for going into the hospital because I didn't want to go in the hospital when COVID was brewing and exploding until I had surgery on that. But my incidental finding, and often these like small kind of kidney cancers are found on a CAT scan looking for something else. But what I found ironic is that then nobody focused on the pain that I was having down my leg because we were focused on this kidney cancer, this incidental finding.

So sometimes the incidental findings are great because you find them when things are really teeny tiny and haven't done any harm to you yet. So to go on in the impressions, they might also compare the finding with any other imaging studies that the radiologist is interpreting your test against. So it's important that they have access to those.

So for a potentially abnormal finding, the radiologist may make any of these recommendations. Sometimes the report does not answer the clinical question and more exams are needed. More exams may be necessary to follow up on a suspicious or questionable finding.

So an example of the one that I gave you, the first thing it says is, findings consistent with the interval development of osseous metastatic disease. So what it means is that the cancer in this case has gone into the bone. So that's the first finding.

Second thing they found was non-obstructing right renal calculi. So that means that there's just like some renal stones, kidney stones. The third finding is that they found some enlarged lymph nodes, similar to what they found in previous studies.

Fourth, progression of degenerative changes in the left hip. So they're comparing it to, remember, they're comparing it to the previous CAT scan. So compared to the previous CAT scan, there's changes into that left hip.

It's gotten worse since that last scan in 2020. The fifth finding was fatty changes in the liver, borderline splenic enlargement. Six is coronary artery calcifications.

So there's some, not blockages, but there's some plaque in the coronary arteries. And the seventh, number seven, what they found was non-calcified right middle lobe nodule, suspect peripheral lymph node, reassess on follow-up. So like I said before, the CAT scan can see more stuff.

And this is one of those things that might show up. They're not cancer, but they'll keep an eye on them at each scan to make sure that they're not getting bigger. So at this time, it's not a worry.

We just know it's there. But the important findings is that the cancer has gone into the bone of the right hip is what it's saying, the right hip socket, L3 and L4. And this person has metastatic prostate cancer.

And bone cancer is a typical place for the prostate cancer to metastasize. So in reading it, it's not surprising that where the cancer has moved to is into the bones because that's what prostate cancer does. But what this report is saying is that it has moved there.

So that's how you read a CT report. Actually, in all honesty, you can skip all the stuff above it and go right to the impression and read it through and look at what they're saying is just something that needs to be reassessed at follow-up. But what you're looking for are the words like progression.

So this report has a progression of degenerative changes in the left hip. It's saying the lymph nodes are enlarged, but it also says it's similar to the prior noted study and that they're seeing interval. And when they say interval development, they mean from the previous exam.

So the other CAT scan was in, what did I say, it was in 2020. So when they're comparing that CAT scan to this one, they're saying there's interval development. Osseous is bone metastatic disease.

So I don't know if it's something that, Charlie, you can have questions about. I don't know if you've ever had a CAT scan. But that's how you read to get some understanding about what your CAT scan has to say.

I get it because I have had, now that I'm a little older, I have had to have, in the past several years, two or three CAT scans. So I do know what you're talking about. Okay, I'm good at basically when a doctor explains something to me of repeating it back to him or her just to make sure I understand what is going on.

And I've just seen enough people, friends or just people in discussions who don't do that. Doctor says something, doctor's in a rush. It just goes over people's heads.

So I would suggest that you're the patient. Repeat back what you heard to the doctor just to make sure you understand very clearly what is said to you and what's happening, what you need to do for yourself. Yeah, I mean, ask questions.

Yeah, advocate for yourself. Make sure you know what's going on. If you need to, take somebody with you.

I mean, this is your health. Or you can ask them, you know, do you mind if I record it? Just hit record on your phone. Oh, there we are, yes.

So that then you can play it back. Or when I go to PT, I have Dave come with me and he'll record a video of the exercises that they want me to do so that I can watch them and say, oh yeah, she said put my arm there, whatever. If there is a portal and you can download and print your CT reports and keep them in a folder, that makes it a lot easier.

Because I've been to doctors appointments where they've like, oh, I don't see a copy of that. And it's like, I'll pull it out of my folder. It's like here.

But I'm probably anal when it comes to keeping things organized. You have to take care of yourself. It's not being anal.

It should just be there, available to you. But it's not. And you are Marianne.

You've been doing this for decades, decades. So you know what to do. Most folks don't.

And I found out the hard way. So yeah, folks, what Marianne is saying, make a copy of everything. Keep it all in a nice folder.

Do not lose that damn folder. Make sure you know where it is. Charlie's talking to himself right now about not losing that folder.

For our third half, I have a quote attributed to Ernest Hemingway. In our darkest moments, we don't need solutions or advice. What we yearn for is simply human connection, a quiet presence, a gentle touch.

These small gestures are the anchors that hold us steady when life feels like too much. Please don't try to fix me. Don't take on my pain or push away my shadows.

Just sit beside me as I work through my own inner storms. Be the steady hand I can reach for as I find my way. My pain is mine to carry.

My battles mine to face. But your presence reminds me I'm not alone in this vast, sometimes frightening world. It's a quiet reminder that I am worthy of love, even when I feel broken.

In those dark hours when I lose my way, will you just be here? Not as a rescuer, but as a companion. Hold my hand until the dawn arrives, helping me remember my strength. Your silent support is the most precious gift you can give.

It's a love that helps me remember who I am, even when I forget. Thus ends another episode. Please stay tuned for the continuing saga of Everyone Dies, and thank you for listening.

This is Charlie Navarette, and from British writer E.G. Woodhouse, when he first came to the United States, being in America was like being in heaven without going to all the bother and expense of dying. And I'm Marianne Masso, and we'll see you next week. Remember, every day is a gift.

This podcast does not provide medical advice. All discussion on this podcast, such as treatments, dosages, outcomes, charts, patient profiles, advice, messages, and any other discussion are for informational purposes only, and are not a substitute for professional medical advice or treatment. Always seek the advice of your primary care practitioner or other qualified health providers with any questions that you may have regarding your health.

Never disregard professional medical advice or delay in seeking it because of something you have heard from this podcast. If you think you may have a medical emergency, call your doctor or 911 immediately. Everyone Dies does not recommend or endorse any specific tests, practitioners, products, procedures, opinions, or other information that may be mentioned in this podcast.

Reliance on any information provided in this podcast by persons appearing on this podcast at the invitation of Everyone Dies or by other members is solely at your own risk.