Purpose: Incidentally discovered pulmonary nodules on computed tomography are common. Executing\r\nappropriate follow-up is challenging. The purpose of this study was to assess the impact of a standardized template\r\nof follow-up recommendations in radiology interpretation reports and an electronic messaging system on the rate of\r\nradiographic follow-up of indeterminate pulmonary nodules identified on computed tomography.\r\nMaterials and methods: This retrospective study examined rates of appropriate follow-up, as defined by the\r\nFleischner Society guidelines, of incidental pulmonary nodules over a seven-month period both before (17 patients;\r\nmean age 62.7 years) and after (72 patients, mean age 61.6 years) the commencement of the quality improvement\r\ninitiatives. Further analysis by risk group, patient and nodule characteristics, notification type and location of imaging\r\nrequest were performed.\r\nResults: There was a trend towards improved time-appropriate follow-up from 35.3% (6/17) to 56.9% (49/72)\r\n[p=0.18]. The largest change was noted in high-risk patients with an improvement from 11.1% (1/9) appropriate follow-\r\nup to 51.4% (18/35) [p=0.06] following the interventions. The largest improvement in on-time follow-up imaging was a\r\nreduction in premature imaging, which decreased from 17.6% (3/17) to 6.9% (5/72) [p=0.18]. Rates of on-time follow-\r\nup after the interventions were similar irrespective of patient age, nodule size or origin of initial imaging request.\r\nConclusions: Ensuring use of a rigorous approach to indeterminate pulmonary nodule reporting reporting that\r\nincludes standardized follow-up recommendations may improve rates of appropriate follow-up.
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