Original articleFollow-up of Incidental Pulmonary Nodules and the Radiology Report
Section snippets
Background
CT pulmonary angiography is ordered frequently in emergency departments (EDs) to evaluate clinically suspected pulmonary embolus [1]. However, incidental pulmonary nodules that require follow-up are often noted on these examinations [2]. The most widely accepted, evidence-based guidelines for follow-up of incidentally noted pulmonary nodules are the Fleischner Society guidelines [3]. These guidelines use pretest probability of malignancy (on the basis of nodule size, patient age, and presence
Methods
A waiver of the requirement for individual written informed consent was received from the institutional review board of Intermountain Healthcare. We identified 3,500 consecutive CT pulmonary angiographic examinations ordered in the EDs of LDS Hospital and Intermountain Medical Center for suspicion of pulmonary embolus between May 2009 and June 2010 and reported on adherence to Prospective Investigation of Pulmonary Embolism Diagnosis II guidelines in ordering these studies in the ED [7]. At the
Results
Table 1 summarizes the baseline characteristics of the 1,000 patients.
Discussion
Incidental pulmonary nodules are commonly identified on CT scans 2, 9. The 9.9% (99 of 1,000; 95% CI, 8%–12%) incidence of incidental pulmonary nodules that required follow-up in our study of CT pulmonary angiographic examinations ordered in the ED is similar to rates found in previous studies that have examined the rate of incidental findings on chest CT [2].
We found that only 29% (28 of 96; 95% CI, 20%–38%) of pulmonary nodules that required follow-up on the basis of Fleischner Society
Conclusions
Incidental pulmonary nodules are common and are often not followed up appropriately. Although inclusion of a pulmonary nodule in the impression section of a radiology report is helpful, it does not ensure follow-up. Even specific instructions to follow up nodules in radiology reports do not improve the follow-up rate. In the face of ever growing clinician information overload and patient care discontinuity, better systems for appropriate identification and follow-up of incidental findings are
Take-Home Points
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Incidental pulmonary nodules that require follow-up are often noted on chest CT (9.9% [99 of 1,000]; 95% CI, 8%–12%).
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Even when follow-up recommendations are explicitly stated in the radiology report, follow-up remains poor (29% [19 of 65]; 95% CI, 18%–40%).
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However, when nodules are noted only in the findings sections of radiology reports, the nodule follow-up rate is significantly lower (0% [0 of 12]).
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Although our study shows the importance of including findings in the impression section of the
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