PURPOSE: To evaluate the incidence, characteristics, and follow-up of incidental solitary pulmonary nodules identified on Coronary CT Angiograms (CCTA) and Electron-Beam CT (EBCT) imaging at a high-volume tertiary-care facility.
METHODS: Retrospective analysis of all inpatient and outpatient CCTA and all inpatient and outpatient EBCT scans performed at Abbott Northwestern Hospital between March 2009 - December 2009. CCTA scans were performed on a Siemens Definition Flash Dual-Source 64-slice, 256-channel scanner. EBCT scans were performed on an Imatron C-150 scanner with 3mm slices. Lung fields were over-read by staff radiologists using a coned-down, limited FOV. Reports were evaluated for identification of pulmonary nodules. Of the patients with identified nodules, an extensive chart review was conducted to determine smoking status, history of previous malignancy, lobar location, nodule characteristics, and any follow-up scans and interventions.
RESULTS: 2338 total scans were performed. 1711 CCTA and 627 EBCT, including both inpatient and outpatient. The median age or patients was 60 and 57% were male. Nodules were identified on 21.1% (494) of all scans with 22.8% (143) on EBCT and 20.5% (351) on CCTA. 25.5% (126) were 4-5mm, 16% (79) were 6-7mm, and 16.4% (81) were ≥8mm. 7.5% (37) had a second nodule 4-5mm and 4.7% (23) had a second nodule ≥6mm.
CONCLUSIONS: Incidental pulmonary nodules are frequently detected on EBCT and CCTA scans, yet a systematic follow-up process was not yet established. This study led to a more uniform reporting of Fleischner Society Guidelines by radiologists and the development of a dedicated, evidence-based pulmonary nodule clinic at Abbott Northwestern Hospital.
CLINICAL IMPLICATIONS: As CCTA and EBCT imaging becomes increasingly prevalent, it creates an opportunity to improve patient care by an evidence-based evaluation of identified nodules earlier.
DISCLOSURE: The following authors have nothing to disclose: Jonathan Hovda, John Lesser, Clark Schumacher, R Michael Bowen
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