JACR: Rads slow to warm to guidelines for lung nodule management

Source: Siemens Healthcare

Radiology reports are consistent with Fleischner Society guidelines (FSG) for management of CT-detected pulmonary nodules in approximately one-third of cases, according to a study published in the July issue of Journal of American College of Radiology.

The FSG, which were published in 2005, provide a template for lung nodule management on the basis of characteristics such as size, natural edge, opacity, growth rate and patient history. Few studies have examined radiologists’ awareness and compliance with FSG; previous researchers have estimated conformance with guidelines at rates ranging from 0.6 percent to 79 percent, according to background information provided by Ronilda Lacson, MD, PhD, of the Center for Evidence-Based Imaging and department of radiology at Brigham and Women’s Hospital (BWH) in Boston, and colleagues.

Lacson and colleagues devised a retrospective analysis to examine the use of the guidelines in clinical practice. They reviewed data from radiology reports for 1,100 chest and abdominal outpatient and emergency department CT studies performed at BWH between January and June 2010.

They found 315 reports with pulmonary nodules and overall adherence to FSG was 34 percent. The researchers reported nodule size was significantly associated with adherence. Specifically, adherence was highest in the >4-mm to 6-mm nodule group and progressively lower for smaller and larger nodules. According to Lacson and colleagues, this finding might suggest a potential role for decision support systems that could assist radiologists in making recommendations for smaller nodules.

Lacson et al noted that BWH has not adopted a formal policy that requires use of FSG or other guidelines for pulmonary nodule management, nor does the hospital provide decision support or written copies of the guidelines for radiologists. “However, radiologists are able to cut and paste prespecified text containing the FSG in their report, as they deem necessary.” Yet, 85 percent of reports in this study did not cut and paste the recommendations.    

The researchers concluded with recommendations for additional studies to assess reasons for decreased adherence to FSG. “[Interventions] to improve guideline adherence should be facilitated by routine evaluation to determine progress and provide feedback on effectiveness,” they wrote.