Researchers in the Department of Radiology at Massachusetts General Hospital have identified an approach to improve adherence to evidence-based guidelines for lung nodule follow-up care.
Decision-support tool improves adherence to recommendations for lung nodule follow up
A CT scanner at Massachusetts General Hospital
At the annual meeting of the Radiological Society of North American (RSNA), Mass General researchers presented data with the potential to improve recommendations for follow up of lung nodules. While the majority are benign, some nodules are cancerous. As demonstrated by the National Lung Screening Trial (NLST), surveillance and early treatment can save lives.
To support patients with lung nodules and the referring physicians who care for them, radiologists recommend follow-up imaging and / or procedures depending on the size and appearance of the nodule according to guidelines from the Fleischner Society, an international association of thoracic radiologists. However, researchers noticed considerable variability in compliance with these evidence-based guidelines. To improve concordance, a team of Mass General radiologists developed a point-of-care automated decision-support tool integrated into radiologists' workflow.
A thoracic imaging fellow in the Department of Radiology, Michael Lu, MD and his team then observed that when radiologists used the decision-support tool, 95% of their recommendations were consistent with the guidelines. In the remaining 5% of cases, the radiologist chose to override the tool and recommended more aggressive follow up. Concordance with the guidelines was significantly greater for the study group that used the tool when compared to the study group that did not.
"We found that a point-of-care decision-support tool improves adherence to recommendations for follow up of incidental lung nodules," said Dr. Lu. "It's a framework with profound implications for other evidence-based guidelines in radiology. This may have an impact on cost and patient outcomes."