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Awareness and Use of the SAR Adrenal Lexicon
1.
I currently interpret abdominal CT/MRI that includes evaluation of the adrenal glands.
Yes
No
2.
I consent to participate.
Yes
No
3.
Please identify your primary practice setting.
Academic
Community hospital
Community clinic
Mixed academic and community practice
Other (please specify)
4.
Please identify your level/type of training:
Resident
Fellow
General Radiologist
Abdominal Radiologist
Other Radiology subspeciality
5.
How many years have you been in practice?
0-5 years
6-10 years
11-20 years
>20 years
6.
In which province/territory do you currently work?
British Columbia
Alberta
Saskatchewan
Manitoba
Yukon
Northwest Territories
Nunavut
Ontario
Quebec
New Brunswick
Newfoundland and Labrador
Prince Edward Island
Nova Scotia
7.
What percentage of your work comprises abdominal imaging?
0-25%
26-50%
51-75%
>75%
8.
SELECT ONE ANSWER UNLESS OTHERWISE SPECIFIED FOR THE FOLLOWING QUESTIONS.
What size threshold separates an adrenal nodule from an adrenal mass in the SAR lexicon?
Nodule <3 cm (short axis)
Nodule <4 cm (short axis)
Mass ≥3 cm (long axis)
Mass ≥4 cm (short axis)
9.
On unenhanced CT, macroscopic fat in an adrenal lesion is defined as:
Mean attenuation ≤ –5 HU
Mean attenuation ≤ –10 HU
Any region with negative HU
Visual impression only (no numeric threshold)
10.
The lexicon defines heterogeneous lesions as having internal areas of differing attenuation/signal that occupy:
>10% of lesion volume
>20% of lesion volume
>30% of lesion volume
Any amount if visible
11.
On CT, enhancement is:
≥10 HU increase from unenhanced; <10 HU non-enhancing
≥20 HU increase; 10–20 HU equivocal; <10 HU non-enhancing
≥30 HU increase; 10–30 HU equivocal; <10 HU non-enhancing
Any visible increase
12.
The term hyperenhancing is used when the adrenal lesion measures (on contrast imaging):
>97 HU
>110 HU
>130 HU
Must double from baseline
13.
When reporting adrenal lesion size per the lexicon, which axis is used by convention?
Short axis
Long axis
Either; not specified
Volume
14.
When you report CT attenuation (HU) per the lexicon, you should (select all that apply):
Use an ROI covering at least two-thirds of the lesion’s cross-section
Specify the acquisition phase
Avoid including obvious calcification within the ROI
Always include adjacent retroperitoneal fat in the ROI
15.
3.1 cm right adrenal lesion. Unenhanced 18 HU → portal venous 70 HU. Internally uniform. Select all lexicon terms that apply:
Nodule
Mass
Homogenous
Heterogenous
Non-enhancing
Equivocal enhancement
Enhancing
Hyperenhancing
16.
4.2 cm right adrenal lesion containing a dominant focus of macroscopic fat ≤ –20 HU within bulk soft tissue. Select all that apply:
Nodule
Mass
Homogenous
Heterogenous
Contains macroscopic fat
Contains microscopic fat
17.
1.1 cm right adrenal lesion. On opposed-phase (B) vs in-phase (A), clear drop of signal throughout most of the lesion; no history of cancer. Select all that apply:
Nodule
Mass
Homogenous
Heterogenous
18.
The same image is provided. Write one descriptive sentence using lexicon terms to convey inference.
19.
6.2 cm left adrenal lesion. Unenhanced (A) 44 HU → portal venous (B) 139 HU. Select all that apply:
Nodule
Mass
Non-enhancing
Hyperenhancing
Enhancing
20.
The same image is provided. Write one descriptive sentence using
lexicon terms.
21.
Reporting preference (check all you would include in your report for the lesion above):
Axis used for size (long axis)
Phase for HU measurement (e.g., portal venous)
Presence/absence of macroscopic fat with numeric HU if present
Lexicon terms for homogeneity/heterogeneity
22.
Before this survey, had you heard of the SAR Adrenal Lexicon?
Yes
No
Unsure
23.
The lexicon terms are clear and usable in routine reporting.
Strong agree
Agree
Neutral
Disagree
Strongly disagree
24.
I intend to apply the lexicon terms in my adrenal reports over the next 3 months.
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
25.
Main barriers to adoption in your setting (select up to 3):
Not aware of terms
Uncertain definitions
Report templates not aligned
Time pressure
Lack of local consensus
Other (please specify)