• Janice L Kwan, Darya Yermak, Lezlie Markell, Narinder S Paul, Kaveh G Shojania, and Peter Cram.
• Division of General Internal Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.
• J Hosp Med. 2019 Jun 1; 14 (6): 349-352.

BackgroundComputed tomography pulmonary angiography (CTPA) detects incidental findings that require follow-up. In just over 50% of cases, those incidental findings are pulmonary nodules. Fleischner guidelines recommend that patients with nodules that have a high risk of malignancy should undergo CT follow-up within 3-12 months.ObjectiveWe examined the proportion of patients with pulmonary nodules requiring follow up who received repeat imaging within six weeks of the time frame recommended by the radiologist.DesignThis retrospective cohort study included all patients who underwent CTPA in the emergency department and inpatient settings at three teaching hospitals in Toronto, Canada between September 1, 2014, and August 31, 2015. Natural language processing software was applied to a linked radiology information system to identify all CTPAs that contained pulmonary nodules. Using manual review and prespecified exclusion criteria, we generated a cohort with possible new lung malignancy eligible for follow-up imaging; then we reviewed available health records to determine whether follow-up had occurred.ResultsOf the 1,910 CTPAs performed over the study period, 674 (35.3%) contained pulmonary nodules. Of the 259 patients with new nodules eligible for follow-up imaging, 65 received an explicit suggestion for follow-up by radiology (25.1%). Of these 65 patients, 35 (53.8%) did not receive repeat imaging within the recommended time frame. Explicit mention that follow-up was required in the discharge summary (P = .03), attending an outpatient follow-up visit (P < .001), and younger age (P = .03) were associated with receiving timely follow-up imaging.ConclusionsOver 50% of patients with new high-risk pulmonary nodules detected incidentally on CTPA did not receive timely follow-up imaging.

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