Leveraging Artificial Intelligence as a Safety Net for Incidentally Identified Lung Nodules at a Tertiary Center

Artificial intelligence (AI)-powered platforms may be used to ensure that clinically significant lung nodules receive appropriate management. We studied the impact of a commercially available AI natural language processing tool on the detection of clinically significant indeterminate pulmonary nodules (IPNs) based on radiology reports and provision of guideline-consistent care.

All CT scans performed at a single tertiary care center in the outpatient or emergency room setting between February 20, 2024, and March 20, 2024, were processed by the AI natural language processing algorithm. CT radiology reports mentioning a lung nodule or focal indeterminate lesion were flagged. All flagged reports were reviewed by a lung nodule expert 2 weeks after nodule identification. IPNs were classified as "appropriately followed" if follow-up imaging, referral to a nodule clinic, or other guideline-consistent care was ordered. IPNs were classified as "not appropriately followed" if no acknowledgment of the reported nodule was documented in the electronic health record within 2 weeks of being flagged.

The AI software processed 76,507 unique radiology reports, identified 2,585 CT scans with chest imaging, and found 389 IPNs. Review determined that 272 (70%) nodules were appropriately followed, whereas 117 (30%) were not appropriately followed. Of the 117 nodules without documented follow-up, 67 (57%) were more than 8 mm and 24 (20.5%) were more than 15 mm. IPNs that would not have received follow-up in the absence of the AI software generated 43 additional clinical appointments and 3 procedures.

At a large tertiary care center, 30% of clinically significant incidental pulmonary nodules that would have otherwise been missed were brought to the attention of lung nodule clinicians by an AI software, allowing for initiation of appropriate follow-up.