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Updated: Nov 18, 2025

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Radiologist Variation in the Rates of Follow-up Imaging Recommendations Made for Pulmonary Nodules.

Neena Kapoor1, Ronilda Lacson2, Laila Cochon3

  • 1Director of Diversity, Inclusion, and Equity, Department of Radiology, Brigham and Women's Hospital, Quality and Patient Safety Officer, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Journal of the American College of Radiology : JACR
|February 10, 2021
PubMed
Summary

Radiologist variability significantly impacts pulmonary nodule follow-up recommendations. Differences up to 4.3-fold were observed, highlighting the need for standardized guidelines in pulmonary nodule management.

Keywords:
Follow-up recommendationpulmonary noduleradiologist variation

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Area of Science:

  • Radiology
  • Medical Imaging Analysis
  • Natural Language Processing

Background:

  • Pulmonary nodules are common findings on CT scans.
  • Standardized follow-up recommendations are crucial for early detection of lung cancer.
  • Variability in radiologist recommendations can affect patient management.

Purpose of the Study:

  • To determine if patient and radiologist factors influence follow-up recommendation rates for pulmonary nodules.
  • To quantify interradiologist variability in pulmonary nodule follow-up recommendations.

Main Methods:

  • Retrospective analysis of 142,001 chest and abdominal CT reports (2016-2018).
  • Utilized natural language processing (NLP) tools to identify pulmonary nodules and follow-up recommendations.
  • Employed multivariable logistic regression and interradiologist variability analysis.

Main Results:

  • 20.1% of eligible reports included a follow-up recommendation for pulmonary nodules.
  • Male patients and abdominal CTs were associated with lower recommendation rates.
  • Older patients had higher recommendation rates.
  • Significant interradiologist variability (up to 4.3-fold difference) in recommendation probability was observed within subspecialty divisions.

Conclusions:

  • Significant differences exist in pulmonary nodule follow-up recommendation rates among radiologists.
  • Patient demographics and CT type influence recommendations.
  • Standardization of follow-up protocols may be warranted to reduce variability.