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Radiology. 2010 Apr;255(1):218-24. doi: 10.1148/radiol.09091556.

Compliance with Fleischner Society guidelines for management of small lung nodules: a survey of 834 radiologists.

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  • 1Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA.



To determine the familiarity of radiologists with the Fleischner Society guidelines for management of small lung nodules and to assess whether their decisions for nodule management are consistent with these recommendations.


Institutional review board exemption was granted for this electronic survey, which was sent to a sample of 7000 radiologists randomly selected from the Radiological Society of North America (RSNA) directory. Three clinical scenarios for nodule management were presented. Information about policies and guidelines for nodule management, awareness of published guidelines, and respondent demographics was obtained. Associations between these parameters and management recommendations were assessed by using a chi(2) test. Respondents were also asked about tube current settings for routine chest computed tomographic examinations and those performed solely for nodule follow-up.


Of 834 respondents (response rate, 11.9%), 649 (77.8%) were aware of the Fleischner Society guidelines and 490 (58.8%) worked in practices that employed them or similar guidelines. Management selections were consistent with the Fleischner guidelines in 34.7%-60.8% of responses for the three scenarios. A significantly higher rate of concordance was associated with awareness of the Fleischner guidelines, presence of written policies based on them, a teaching practice setting, practice in a group with at least one member having chest radiology fellowship training, and fewer than 5 years of experience practicing radiology (P < .05 for all associations). The spectrum of tube current settings used was similar between the subgroups of respondents who were aware and those who were unaware of the Fleischner guidelines.


Among survey respondents, there was high awareness and adoption of the Fleischner guidelines, but radiologists showed varying degrees of conformance with these recommendations. Future efforts are necessary to bridge the gap between awareness and implementation of these evidence-based guidelines.

RSNA, 2010

[PubMed - indexed for MEDLINE]
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