Widely accepted guidelines, such as those from the Fleischner Society or American College of Radiology, detail appropriate clinical management of individual patients. Overall, incidental pulmonary nodule findings and management include three core components:
Identification and documentation
According to the Fleischner Society guidelines, the size and shape of a pulmonary nodule are the two primary determinants of cancer risk. Once a nodule that meets the minimum requirements is identified, interpreting providers, often radiologists, should document abnormalities in a consistent way within reports standardized across the organization. Organizations may leverage artificial intelligence (AI) in imaging interpretation to aid in pulmonary nodule detection and documentation. For example, AI can detect lung nodules on the image and propose a recommendation for a radiologist to reject or validate. Additionally, tools exist to auto-populate follow up recommendations based on clinical guidelines.
These abnormalities should then be reported to the ordering provider with clear recommendations for patient’s next steps. The ordering provider should then clearly communicate those findings and the appropriate next steps with the patient. The ordering provider and/or radiologist may also discuss the findings with the patient’s primary provider to help ensure follow up or create a care plan.
Once the patient is notified of their pulmonary nodule, their providers should ensure they receive appropriate follow up. Physicians fail to follow-up on as many as 36% of radiology reports. In order to mitigate gaps, organizations should assign ownership of follow up responsibilities. Many organizations employ navigators who serve a critical role in supporting patient follow up, for example:
- Documenting and tracking patients with incidental pulmonary nodules
- Assisting the patient with administrative functions like scheduling
- Explaining clinical terminology to patients and their care givers
- Communicating with all relevant providers
- Tracking follow-up care and outcomes