Abstract Introduction Lung cancer is the leading cause of cancer mortality in the United States. Increased use of CT scans for lung cancer screening has led to more pulmonary nodules being detected and concerns about cumulative radiation exposure with ongoing follow-up. The Fleischner Society’s 2017 guidelines recommend using low-dose CT (3.0 mGy) (LDCT) for pulmonary nodule follow-up. A previous retrospective analysis at Nuvance Health had revealed low compliance (19%) with these recommendations, likely due to insufficient education and lack of a dedicated LDCT order in EMR. Thus, a new order “CT Chest Lung Nodule” was created along with educational efforts targeting primary care providers and pulmonologists. Initiatives included a 10-minute presentation and “CT Chest Scan Guidelines” pamphlet. Also, a CT control room flow chart allowed technicians to convert normal-dose scan requests to low-dose scans when appropriate. We hypothesize that these interventions have increased the adherence to low-dose CT orders for lung nodule follow-up. Methods A retrospective review was conducted of chest CT scans performed from January 2024 to March 2025 with the ICD-10 diagnosis code for pulmonary nodule (R91.1). CT scans performed for multiple indications were excluded. Data was reviewed to determine the proportion of scans correctly ordered and performed as LDCT scans. Results A total of 187 CT scans were identified. Of these, 46 scans (24.6%) were ordered as low-dose, but only 43 (23.0%) were performed as low-dose. Although radiology corrected some incorrect orders (10.2%), 11.8% of scans ordered as low-dose were still performed as normal-dose. Overall, 65.2% of studies were ordered and performed as normal-dose, representing a major deviation from recommendation for low-dose surveillance (p 0.001). Ordering compliance varied by provider. Pulmonologists ordered scans correctly in 61.7% of cases, PCPs in 74.4%, and other providers in 87.1% (p = 0.009). Mean age of patients was 66 years with 53% women. Scans performed using the low-dose protocol delivered a median of 2.5 mGy (1.7-2.7), versus 7.8 mGy (3.3-11.5) for standard-dose scans (p 0.001), with dose-length product 88 mGy-cm (62-96) vs 264 mGy-cm (129-397) (p 0.001). Conclusions There was a modest improvement in CT scans ordered and performed as LDCT for lung nodule follow up after the intervention. However, compliance has remained poor, and surprisingly worse among pulmonologists. Variation in adoption across provider type helps identify potential areas for targeted training in the future and for further optimization. This abstract is funded by: N/A
Qaiser et al. (Fri,) studied this question.