title: The Fate of Patients with Solitary Pulmonary Nodules: Clinical Management and Radiation Exposure Associated.
abstract: BACKGROUND
  The appropriate management of the large number of lung nodules detected during the course of routine medical care presents a challenge. We aimed to evaluate the usual clinical practice in solitary pulmonary nodule (SPN) management and associated radiation exposure.
  
  
  METHODS
  We examined 893 radiology reports of consecutive patients undergoing chest computed tomography (CT) and radiography at two public hospitals in Spain. Information on diagnostic procedures from SPN detection and lung cancer diagnosis was collected prospectively for 18 months.
  
  
  RESULTS
  More than 20% of patients with SPN detected on either chest radiograph (19.8%) or CT (26.1%) underwent no additional interventions and none developed lung cancer (100% negative predictive value). 346 (72.0%) patients with SPN detected on chest radiograph and 254 (61.5%) patients with SPN detected on CT had additional diagnostic tests and were not diagnosed with lung cancer. In patients undergoing follow-up imaging for SPNs detected on CT median number of additional imaging tests was 3.5 and the mean cumulative effective dose was 24.4 mSv; for those detected on chest radiograph the median number of additional imaging tests was 2.8 and the mean cumulative effective dose was 10.3 mSv.
  
  
  CONCLUSIONS
  Patients who did not have additional interventions were not diagnosed of lung cancer. There was an excessive amount of interventions in a high percentage of patients presenting SPN, which was associated with an excess of radiation exposure.
authors.affiliation: Public Health Department, Miguel Hernández University, Alicante, Spain.|CIBER en Epidemiología y Salud Pública, Madrid, Spain.
authors.forename: Blanca
authors.initials: B
authors.lastname: Lumbreras
authors.affiliation: Radiodiagnostic Department, Peset Hospital, Valencia, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Vilar
authors.affiliation: Radiodiagnostic Department, San Juan Hospital, Alicante, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: González-Álvarez
authors.affiliation: Public Health Department, Miguel Hernández University, Alicante, Spain.
authors.forename: Noemí
authors.initials: N
authors.lastname: Gómez-Sáez
authors.affiliation: Radiodiagnostic Department, Peset Hospital, Valencia, Spain.
authors.forename: María L
authors.initials: ML
authors.lastname: Domingo
authors.affiliation: Radiodiagnostic Department, San Juan Hospital, Alicante, Spain.
authors.forename: María F
authors.initials: MF
authors.lastname: Lorente
authors.affiliation: Public Health Department, Miguel Hernández University, Alicante, Spain.|CIBER en Epidemiología y Salud Pública, Madrid, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Pastor-Valero
authors.affiliation: Public Health Department, Miguel Hernández University, Alicante, Spain.|CIBER en Epidemiología y Salud Pública, Madrid, Spain.
authors.forename: Ildefonso
authors.initials: I
authors.lastname: Hernández-Aguado
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008168:Lung / Q000473:pathology / Q000528:radiation effects; D008175:Lung Neoplasms / Q000175:diagnosis / Q000209:etiology; D008297:Male; D049268:Positron-Emission Tomography; D000069079:Radiation Exposure / Q000009:adverse effects*; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis* / Q000209:etiology; D013909:Thorax / Q000473:pathology / Q000528:radiation effects; D014057:Tomography, X-Ray Computed