Abstract Introduction Literature indicates that 31% of all chest CT scans reveal an incidental pulmonary nodule (IPN) 4 mm, yet approximately 50% of reported IPNs do not receive appropriate follow-up—representing a missed opportunity for early lung cancer detection. At the Salt Lake City Veterans Affairs Medical Center (SLC VAMC), diagnostic codes are used for follow-up, but no formal tracking system currently exists. Facility data suggest that IPNs are likely underreported within this population. Specifically, in-house radiologists report IPNs in only 0.2% of chest CTs, compared to 10.2% when interpretations are performed by national teleradiologists. Our goal is to increase both the reporting and appropriate follow-up of IPNs at the SLC VAMC. Current efforts are hindered by inconsistent use of diagnostic coding, lack of standardized reporting, and unclear accountability for follow-up. Methods For the initial intervention, our objective is to establish a standardized workflow for IPN reporting and improve diagnostic code accuracy. A structured reporting template will be implemented to guide nodule characterization and ensure follow-up recommendations align with Fleischner Society criteria. To evaluate the impact of this intervention, a retrospective review of chest CT scans and reports will be conducted. Data from pre- and post-intervention periods will be compared, focusing on key metrics such as differences in IPN reporting rates between in-house and teleradiologists, utilization of the standardized reporting template, and completion rates of guideline-recommended follow-up. Results Qualitative data has been collected through multi-site structured interviews and surveys, with responses from 42 sites. Preliminary findings indicate that follow-up is near impossible if IPNs are not reported, underscoring the need for improved and accurate reporting. Additionally, providers expressed a desire for standardized reporting workflows, increased automation, and implementation of tracking systems similar to those used for cancer screening. Quantitative pre-intervention data at the SLC VAMC has been collected and is currently being analyzed. Discussion This project highlights significant variability in the identification and tracking of IPNs. Literature demonstrates that lung cancer is often diagnosed at an advanced stage, and earlier detection is associated with improved survival. Accordingly, quality improvement initiatives aimed at enhancing IPN reporting and follow-up may help improve patient outcomes. This abstract is funded by: none
Raif et al. (Fri,) studied this question.