Implementation of a Standardized Template for Reporting of Incidental Pulmonary Nodules: Feasibility, Acceptability, and Outcomes

Abstract

Objective: Incidental pulmonary nodules (IPNs) are common. Up to 70% are not followed up according to current guidelines. Follow-up recommendations are based on the characteristics of the patient and the IPN. However, many IPNs are incompletely characterized in CT reports. Structured radiology reports have been shown to reduce missing information. We sought to improve IPN reporting by assessing the feasibility, acceptability, and effectiveness of a structured dictation template to increase the presence of six key nodule descriptors. Methods: We performed a mixed methods, pre- and postimplementation assessment. A template was developed with a multidisciplinary group based on Fleischner Society guidelines. A standardized checklist was used to determine the presence of documented descriptors pre- and postimplementation for sequential radiology reports of patients with an IPN present (n = 400 pre-implementation and n = 400 postimplementation) on a CT performed at the Minneapolis Veterans Affairs Health Care System. We conducted qualitative interviews with radiologists (n = 4) and members of the lung nodule tracking team (n = 2) to elicit their experiences of the template implementation process. Results: The proportion of radiology reports including all six elements increased from 12% to 47% (P