Developing a lung nodule management protocol specifically for cardiac CT: Methodology in the DISCHARGE trial

Area of Science:

• Radiology
• Cardiology
• Pulmonology

Background:

• Lung nodules are often incidentally detected on cardiac CT scans.
• Existing lung nodule management guidelines (Lung-RADS) are designed for dedicated chest CT.
• A specific algorithm is needed for lung nodules found during cardiac CT.

Purpose of the Study:

• To develop and evaluate a modified Lung-RADS algorithm for managing lung nodules incidentally detected on cardiac CT.
• To assess the algorithm's performance within the European DISCHARGE trial.

Main Methods:

• Modification of the Lung-RADS algorithm for cardiac CT indications.
• Inclusion of the modified algorithm in the DISCHARGE trial, a randomized study of 3546 patients across 16 European sites.
• Follow-up of patients for up to four years.

Main Results:

• Key modifications include addressing incomplete lung coverage in cardiac CT, differentiating completion vs. follow-up CTs, excluding cardiac CT findings from lung cancer screening triggers, and adjusting the threshold for probably benign ground glass nodules (≥10 mm).

Conclusions:

• The DISCHARGE trial will provide crucial data on a tailored lung nodule management algorithm for cardiac CT in patients with stable chest pain.
• This methodology paper introduces a novel approach to incidental lung nodule management in a specific clinical context.