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Let's look at this annual lung cancer screening exam

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of a patient who's found to have a new lung nodule.

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Again, as we're scrolling through the images,

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we're looking at the lung parenchyma, both for nodules

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as well as lung disease.

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And we can see this patient has upper lung predominant

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central ular emphysema with areas of low density.

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As we're scrolling through the lungs, you know,

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we're looking both at the periphery of the lung

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where most nodules occur

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and where they're most easily found.

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But we're also paying special attention to look

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around the bronchovascular bundles, the central areas

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of the lung that can be more difficult to find nodules.

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And at first pass it's hard to find small nodules.

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That's why we like to have nodule detection

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AI tools to help us.

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But we also can use our mips.

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So as I put these images into our mips

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and we have the annual screen on the left

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and last year's first baseline screen on the right,

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these are gonna help us find nodules.

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And as we're scrolling on the left here, all

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of a sudden a nodule pops up right here between the vessels.

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We can then go back out of the maps and scroll through that.

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And now it's evident that there is a nodule here.

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And if we look at the same area of the lung

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before being very careful

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to match up the local vessels here we see a central couple

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of vessels, one on top of each other.

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They look about the same location

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before we see this emphysema around that area,

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which we can see here.

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So we wanna make sure we're matching up the

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same anatomic area.

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There was no nodule present in that location at all.

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Measuring this nodule, we can use calipers

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or we can use uh, AI tools that might help us measure.

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But this is a four millimeter solid nodule

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that is new since last year's screen.

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A new four millimeter nodule would make this a

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lung RADS three category.

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And for management, this patient would come back in six

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months for an interval low dose CT to see if it's changed,

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to let you know what happened in this patient.

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They came back and six months later the

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nodule hadn't changed.

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They went back to their annual screening

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and the next year also unchanged

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and they came back yet another year for annual screening.

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So they've gone for several years

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and this nodule has not changed,

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but it was new at the time, which makes it a risk

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for lung cancer at its size.

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We've shown that it's been stable over time

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and this patient will continue annual lung cancer screening,

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CT because we have documented stability.