Ways to Improve Radiologists' Adherence to Fleischner Society Guidelines for Management of Pulmonary Nodules

Purpose: The aim of this study was to assess one institution's experience with radiologists' adherence to the Fleischner Society guidelines for managing pulmonary nodules incidentally detected on CT, which anecdotally was substantially higher than in a recent report. Methods: All chest and abdominal CT scans in the electronic messaging system for communicating unexpected abnormal imaging findings to referring physicians were searched for the terms "lung" or "pulmonary" and "nodule" or "mass." Data were collected regarding patient age, nodule size, and whether the patient was at high risk for malignancy (primarily smoking history) or had evidence of prior or concurrent malignancy. Radiologists' recommendations were then correlated with the Fleischner guidelines for nodule size and patient history. Results: Of the study cohort of 1,412 patients who underwent chest and abdominal CT scans, 420 had new pulmonary nodules. Of these, 205 (48.8%) were excluded because of prior or concurrent malignancies, nodules initially seen on prior CT examinations, ground-glass appearance, or age <40 years. In the remaining 215 patients, the radiologists' recommendations were consistent with the Fleischner guidelines in 82.8%. Conclusions: Radiologists' recommendations for the management of pulmonary nodules incidentally detected on CT adhered to the Fleischner guidelines in 82.8% of cases, more than twice that in a recent report. This difference may reflect various practical departmental attempts to emphasize the importance of the Fleischner guidelines in reducing patient radiation and health care costs.