Recreational substance abuse causes a broad spectrum of acute and chronic pulmonary injuries through inhalation and intravenous injection. Imaging findings often overlap with infection, pulmonary edema, and other inflammatory lung diseases, particularly when an exposure history is unavailable. This review discusses the mechanisms and characteristic CT imaging patterns of substance abuse-related lung injury (SARLI). Crack lung is an acute pulmonary toxicity syndrome occurring within 48 hours of crack cocaine inhalation and manifests as diffuse bilateral ground-glass opacities with patchy consolidations, or a crazy-paving pattern related to pulmonary edema, diffuse alveolar damage, or alveolar hemorrhage. Cannabis smoking is associated with upper-lobe-predominant paraseptal emphysema, apical bullae, and airway inflammation. E-cigarette or vaping product use-associated lung injury is a diagnosis of exclusion and requires vaping exposure within 90 days prior to abnormal pulmonary imaging for establishing the diagnosis. It most commonly demonstrates an organizing pneumonia pattern, although diffuse alveolar damage and alveolar hemorrhage may occur. Intravenous injection of crushed oral medications can cause excipient lung disease, which has three distinct imaging patterns: diffuse centrilobular micronodules, high-attenuation perihilar and upper lobe predominant fibrotic opacities, and lower-lobe-predominant panlobular emphysema (Ritalin lung). It is often accompanied by right ventricular strain and pulmonary hypertension and can lead to sudden death and long-term deterioration of lung function. Additional complications of drug abuse include aspiration, lobar or bronchopneumonia, septic pulmonary emboli, and barotrauma. Recognition of SARLI patterns within the appropriate clinical and temporal context can help radiologists suggest the correct diagnosis and facilitate timely management.

Fibrotic interstitial lung diseases (fILD) are a heterogeneous group of chronic diseases that require clinical, radiological and pathological correlation for diagnosis and management. In this setting, the role of radiologists is to define the ILD pattern using high-resolution CT (HRCT). These practice guidelines, developed by the Canadian Society of Thoracic Radiology (CSTR) and the Canadian Association of Radiologists (CAR), provide evidence-informed recommendations to assist practicing radiologists in standardizing HRCT acquisition and pattern recognition in fILD. Based on an integration of current evidence and expert consensus, it outlines core knowledge for identifying features of fibrosis and ancillary radiological findings that assist on pattern identification, providing a practical framework to imaging diagnosis. The document includes multidisciplinary correlation for the diagnosis of most common fibrotic ILDs and an updated review of specific clinical diagnoses relevant to the radiology practice.

MRI is a reference-standard modality for an expanding range of clinical questions, yet it remains among the most unevenly distributed technologies in medicine. Portable low- and ultra-low-field MRI, compact permanent-magnet systems that operate without cryogens or need for in-room radiofrequency shielding, have been proposed as a means of extending imaging to settings where fixed scanners are unavailable or cannot be reached safely. A growing evidence base indicates that these systems can address a defined set of high-value clinical questions, including the detection of intracerebral hemorrhage and large ischemic infarcts, the assessment of hydrocephalus, and the monitoring of critically ill patients at the bedside. This article synthesises the technical basis, clinical applications, and equity implications of portable MRI and argues that the technology's equity impact depends less on the device than on how it is implemented and financed. Consistent with the inverse-equity hypothesis, an imaging technology introduced without deliberate design tends to reach advantaged populations first, and may transiently widen the disparities it is intended to reduce. Drawing on implementation science, change management, and financial reasoning, this article reframes portable MRI as a socio-technical intervention whose equitable benefit depends on the coordinated design of three domains: (1) device capability, (2) implementation and organizational change, and (3) sustainable financing matched to local context. The Canadian setting, including remote and Indigenous communities, is used to illustrate both the opportunity and the conditions required to realize the benefits of portable MRI. A deployment framework is proposed to support radiology leaders and health systems.

Retroperitoneal sarcomas (RPS) are a heterogenous family of neoplasms. The Canadian Association of Radiologists Retroperitoneal Sarcoma Working Group was established to provide recommendations for the imaging evaluation and initial workup of suspected RPS in the context of the Canadian healthcare system. The recommendations, which are based on available literature and expert consensus, provide guidance on the imaging pathway, biopsy approach and surveillance for RPS.