title: Factors associated with radiologists' adherence to Fleischner Society guidelines for management of pulmonary nodules.
abstract: OBJECTIVE
  In 2005, the Fleischner Society guidelines (FSG) for managing pulmonary nodules detected on CT scans were published. The aim of this study was to evaluate adherence to the FSG, adjusting for demographic and clinical variables that may contribute to adherence.
  
  
  METHODS
  Radiology reports were randomly obtained for 1,100 chest and abdominal CT scans performed between January and June 2010 in a tertiary hospital's emergency department and outpatient clinics. An automated document retrieval system using natural language processing was used to identify patients with pulmonary nodules from the data set. Features relevant to evaluating variation in adherence to the FSG, including age, sex, race, nodule size, and scan site (eg, the emergency department) and type, were extracted by manual review from reports retrieved using natural language processing. All variables were entered into a logistic regression model.
  
  
  RESULTS
  Three hundred fifteen reports were identified to have pulmonary nodules, 75 of which were for patients with concurrent malignancies or aged < 35 years. Of the remaining 240 reports, 34% of recommendations for pulmonary nodules were adherent to the FSG. Nodule size demonstrated an association with guideline adherence, with adherence highest in the >4-mm to 6-mm nodule group (P = .04) and progressively diminishing for smaller and bigger nodules.
  
  
  CONCLUSIONS
  Pulmonary nodules are prevalent findings on chest and abdominal CT scans. Although most radiologists recommend follow-up imaging for these findings, recommendations for pulmonary nodules were consistent with the FSG in 34% of radiology reports. Nodule size demonstrated an association with guideline adherence, after adjusting for key variables.
authors: Center for Evidence-Based Imaging and Department of Radiology, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts 02445, USA. rlacson@partners.org
authors: Ronilda
authors: R
authors: Lacson
authors: Luciano M
authors: LM
authors: Prevedello
authors: Katherine P
authors: KP
authors: Andriole
authors: Ritu
authors: R
authors: Gill
authors: Jennifer
authors: J
authors: Lenoci-Edwards
authors: Christopher
authors: C
authors: Roy
authors: Tejal K
authors: TK
authors: Gandhi
authors: Ramin
authors: R
authors: Khorasani
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D001900:Boston / Q000453:epidemiology; D019983:Guideline Adherence / Q000706:statistics & numerical data; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011871:Radiology / Q000592:standards; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000592:standards / Q000706:statistics & numerical data