Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2019 Jun 1;14(6):349-352.
doi: 10.12788/jhm.3128. Epub 2019 Feb 20.

Follow Up of Incidental High-Risk Pulmonary Nodules on Computed Tomography Pulmonary Angiography at Care Transitions

Janice L Kwan  1   2 , Darya Yermak  2 , Lezlie Markell  2 , Narinder S Paul  3 , Kaveh G Shojania  2   4 , Peter Cram  1   2
Affiliations
Multicenter Study

Follow Up of Incidental High-Risk Pulmonary Nodules on Computed Tomography Pulmonary Angiography at Care Transitions

Janice L Kwan et al. J Hosp Med. .

Abstract

Background: Computed tomography pulmonary angiography (CTPA) detects incidental findings that require follow-up. In just over 50% of cases, those incidental findings are pulmonary nodules. Fleischner guidelines recommend that patients with nodules that have a high risk of malignancy should undergo CT follow-up within 3-12 months.

Objective: We examined the proportion of patients with pulmonary nodules requiring follow up who received repeat imaging within six weeks of the time frame recommended by the radiologist.

Design: This retrospective cohort study included all patients who underwent CTPA in the emergency department and inpatient settings at three teaching hospitals in Toronto, Canada between September 1, 2014, and August 31, 2015. Natural language processing software was applied to a linked radiology information system to identify all CTPAs that contained pulmonary nodules. Using manual review and prespecified exclusion criteria, we generated a cohort with possible new lung malignancy eligible for follow-up imaging; then we reviewed available health records to determine whether follow-up had occurred.

Results: Of the 1,910 CTPAs performed over the study period, 674 (35.3%) contained pulmonary nodules. Of the 259 patients with new nodules eligible for follow-up imaging, 65 received an explicit suggestion for follow-up by radiology (25.1%). Of these 65 patients, 35 (53.8%) did not receive repeat imaging within the recommended time frame. Explicit mention that follow-up was required in the discharge summary (P = .03), attending an outpatient follow-up visit (P < .001), and younger age (P = .03) were associated with receiving timely follow-up imaging.

Conclusions: Over 50% of patients with new high-risk pulmonary nodules detected incidentally on CTPA did not receive timely follow-up imaging.

PubMed Disclaimer

Figures

FIG
FIG
Flowchart of Computed Tomography Pulmonary Angiography (CTPA) Scans Included in the Study Cohort.
See this image and copyright information in PMC

References

    1. Hall WB, Truitt SG, Scheunemann LP, et al. The prevalence of clinically relevant incidental findings on chest computed tomographic angiograms ordered to diagnose pulmonary embolism. Arch Intern Med. 2009;169(21):1961. doi: 10.1001/archinternmed.2009.360. - DOI - PubMed
    1. Macmahon H, Austin JHM, Gamsu G, et al. Guidelines for Management of Small Pulmonary Nodules Detected on CT Scans: A Statement from the Fleischner Society. Radiology. 2005;237(2):395–400. doi: 10.1148/radi-ol.2372041887. - DOI - PubMed
    1. National Academies of Sciences, Engineering, and Medicine . Improving diagnosis in health care. Washington, DC.: 2015.
    1. Blagev DP, Lloyd JF, Conner K, et al. Follow-up of incidental pulmonary nodules and the radiology report. J Am Coll Radiol. 2014;11(4):378–383. doi: 10.1016/j.jacr.2013.08.003. - DOI - PubMed
    1. Callen J, Georgiou A, Li J, Westbrook JI. The safety implications of missed test results for hospitalized patients: a systematic review. BMJ Quality Safety. 2011;20(2):194–199. doi: 10.1136/bmjqs.2010.044339. - DOI - PMC - PubMed

Publication types