Radiologist’s attitudes towards and subsequent compliance with the new Guidelines for management of incidental pulmonary nodules detected on CT images (Fleischner 2017).

Congress:

ECR 2018

Poster Number:

C-0189

Type:

Scientific Exhibit

Keywords:

Lung, CT, Cost-effectiveness, Education, Structured reporting, Outcomes, Patterns of Care

Authors:

M. P. Brassil¹, C. O Rourke¹, C. O Brien¹, J. Feeney²; ¹Dublin/IE, ²Dublin, Dublin/IE

DOI:

10.1594/ecr2018/C-0189

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-0189

Fig. 1: Study Title

Fig. 2: Fleischner Guidelines 2017

Fig. 3: Criteria

Fig. 4: Data Collected

Fig. 5: Online survey of attitudes

Fig. 6: Online survey of attitudes

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 range rather than as a precise time period. We aim to examine attitudes towards the new guidelines and...

Methods and materials

Initially, 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 consultants and residents had regarding change of practice. An anonymous questionnaire examining attitudes towards the...

Results

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 consultants and 9 residents). Despite a number...

Conclusion

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. Others were satisfied with the body of evidence presented and were happy to...

Personal information

References

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. C. Leung,John R. Mayo,Atul C. Mehta,Yoshiharu Ohno,Charles A. Powell,Mathias Prokop,Geoffrey D. Rubin,Cornelia M. Schaefer-Prokop,William D. Travis,Paul E. Van Schil, andAlexander A. Bankier.Radiology2017284:1,228-243