Aims and objectives
Surveillance of incidentally detected lung nodules contributes to a significant workload in the radiology department.
Current best practice involves using Flesichner Society recommendations to guide surveillance and management of lung nodules. The revised guidelines incorporate several substantive changes that reflect current thinking on the management of small nodules.
The minimum threshold size for routine follow-up has been increased,
and recommended follow-up intervals are now given as a...
Methods and materials
inorder to demonstrate the potential advantages of compliance with the guidelines to our department,
we performed an audit of all out-patient non-contrast CT Thorax studies performed for surveillance of incidentally detected pulmonary nodules in a two month period.
We then examined how many would have been recommended and performed under the new guideline criteria. Findings were presentedat a departmental journal club.
We discussed the new guidelines and any reservations...
The initial audit revealed 50 patients underwent Non-contrast CT Thorax for surveillance of incidentally detected pulmonary nodules. Had the new criteria been applied to the preceding study reports,
23 of these studies would not have been recommended.
This would represent a 46% reduction in our departmental lung nodule follow up studies and save an entire day’s CT list every 2 months. The discussion around these findings was largely positive and a total of 16 questionnaires were completed (7...
The Fleischner 2017 guidelines offer a less rigorous approach to surveillance of small pulmonary nodules,
which if accepted by radiologists can represent a huge saving in departmental resources as well as reducing undue anxiety,
inconvenience and radiation dose to our patient population. In order for radiologists to change practice they must understand and trust the new guidelines. Some radiologists stated fears of missed pathology and subsequent litigation as a barrier to compliance.
Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017 Heber MacMahon,David P.
Naidich,Jin Mo Goo,Kyung Soo Lee,Ann N.
Mehta,Yoshiharu Ohno,Charles A.
Powell,Mathias Prokop,Geoffrey D.