Childhood Interstitial Lung Disease Standardised Operating Procedure – Radiology

This information paper, developed by Lung Foundation Australia in collaboration with chILDRANZ, outlines standardised imaging protocols for radiological assessment of children with suspected or confirmed childhood interstitial lung disease (chILD). The resource provides evidence-based best practice guidance for the use of high-resolution computed tomography (HRCT) to confirm the presence of diffuse parenchymal lung disease, guide site selection for biopsy, and monitor disease progression when clinically justified. It emphasises the need for low-dose, child-specific CT protocols that balance diagnostic image quality with minimal radiation exposure. The protocol includes comprehensive technical recommendations for CT acquisition, including patient preparation, positioning, and scan settings based on age and weight.

The document details how modern multi-detector CT scanners can perform volumetric imaging that captures the entire lung field in a single breath-hold, optimising detection of subtle or localised abnormalities. Instructions are provided for inspiratory and expiratory scan techniques, including alternatives for uncooperative children, such as decubitus imaging. The guide also explains how post-processing techniques such as minimum intensity projections (MinIP) and maximum intensity projections (MaxIP) enhance diagnostic interpretation. Where general anaesthesia is required, a specialised appendix outlines detailed ventilatory and procedural protocols to support optimal imaging and safe sedation practices.

Radiation safety is a critical theme throughout the document, with guidance on dose modulation, collimation, tube current adjustment, and scan pitch to minimise patient risk. Tables provide weight-specific CT parameters, and institutions are encouraged to audit both radiation dose and diagnostic quality routinely. This evidence-informed, co-designed resource is an essential clinical tool for radiologists, paediatric respiratory physicians, and imaging technicians involved in the diagnosis and management of children with childhood interstitial lung disease. By promoting consistent, high-quality imaging, the radiology protocol aims to support timely diagnosis, reduce unnecessary exposure, and improve long-term outcomes for children with complex lung conditions across Australia and New Zealand healthcare systems.