Targeted Multislice Computed Tomography for Monitoring Likely Benign Pulmonary Incidentalomas: Technique and Clinical Cases

BACKGROUND: Incidental detection of pulmonary nodules remains a common diagnostic challenge in modern clinical practice. According to international guidelines, such findings often require repeated, longterm surveillanceusing followup imaging. Given the growing number of patients who need prolonged monitoring and the necessityto minimize cumulative radiation exposure, optimization of multislice computed tomography (MSCT) protocols hasbecome paramount. The development and implementation of targeted, ultralowdose scanning approaches enablethe acquisition of reproducible and highly informative diagnostic data while substantially reducing radiation dose.This is a key component in managing lowrisk patients and forms the basis for personalized followup strategies thatenhance safety in radiological imaging. OBJECTIVE: to scientifically validate, develop, and evaluate a targeted MSCT protocol for the monitoring of probablybenign pulmonary nodules, and to evaluate its diagnostic performance and radiation exposure against a standardfulldose protocol to determine its clinical utility for routine application. MATERIALS AND METHODS: The study included 92 patients of the Mykolaiv Regional Oncology Center with incidentallydetected solitary pulmonary nodules up to 15 mm requiring dynamic followup. Inclusion criteria were probablybenign morphology and at least one previous followup imaging study. A known oncologic history or imaging suspicion of malignancy served as exclusion criteria.Scanning was performed on a 64slice Revolution Maxima CT scanner (GE, USA) in the supine position during a breathhold. A standard fulldose protocol (A) and a targeted protocol(B) were compared in terms of radiation exposure (CTDIvol, DLP) and diagnostic quality. Nodule dynamics wereassessed using identical reconstruction parameters (slice thickness 1.25 mm, interval 1 mm, lung and mediastinalwindows) with repeated measurements by two independent radiologists. RESULTS: The targeted protocol B reduced DLP by more than eight fold (27.8 vs. 229.5 mGy·cm) and lowered CTDIvolby approximately 40 %, resulting in an 85 % reduction of effective dose, while maintaining high image quality. Atotal of 88 % of nodules remained stable, 7.6 % showed minor changes, and 4.3 % required surgical intervention, alldemonstrating benign histology. Protocol B reliably differentiated stable incidentalomas from lesions requiringintervention, with minimal radiation exposure. CONCLUSIONS: The developed targeted MSCT protocol is safe and effective for dynamic monitoring of probably benignpulmonary nodules. It significantly reduces cumulative radiation exposure without compromising diagnostic accuracy and should be integrated into routine radiological practice.