Creating an Incidental Pulmonary Nodule Safety-Net Program

Pulmonary nodules are a frequent, incidental finding on CT scans, ranging from up to 8.4% on abdominal scans and up to 48% on CT angiograms. Incidental findings are sometimes disregarded or overshadowed by critical situations and may not be disclosed or documented on discharge. The costs and risks associated with incidental findings are not insignificant, including the risk of a delayed diagnosis of lung cancer. A medical center commitment to prevent overlooked incidental pulmonary nodules led to the development of an incidental pulmonary nodule program. The program, led by an advanced practice nurse, established processes to identify patients with incidental lung nodules on CT scans and developed criteria for further follow-up with the primary care provider and the patient. Improvements with consistent use of Fleischner guidelines in scan reports by radiologists and increased ownership in informing patients of incidental nodules by ED and trauma providers have occurred. As the frequency of chest CT imaging is increasing, the number of incidental nodules identified will also increase. A lung nodule surveillance process would greatly benefit every lung nodule clinic or hospital system for management of pulmonary nodules.