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Here we have a 61-year-old woman

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with a 25 pack year history of smoking

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who quit smoking 13 years ago

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and comes for her first annual lung cancer screening ct.

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So this is her baseline exam.

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We're scrolling through the lungs.

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We can flip back and forth through MIPS

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to help us find nodules

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and they're a bunch of tiny sub four millimeter nodules,

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which would be lung rads two nodules.

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But as we continue to scroll

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through the lung looking at the fissures,

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we come across a larger nodule.

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So where we have a discreet smoothly marginated nodule,

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it's just barely touching the pleural surface

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with very acute angles.

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We don't want to get unfocused on just one nodule.

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We wanna make sure we cover the entirety

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of the lung parenchyma for nodules.

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So we don't want to miss other findings

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because we get keyed in on a dominant nodule here.

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So I wanna make sure we're very thorough with the rest

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of the exam and we wanna interrogate this

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nodule a little bit more.

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We can see from our nodule detection

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and measurement tool, um,

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it has outlined the volume of the nodule.

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So as a reader I wanna verify that the edges

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that the AI tool has marked for the nodule make sense to me

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as a radiologist.

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They haven't say extended into include the rib

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or an adjacent vessel.

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So I wanna verify the information, not just tru it out

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of the box based on the fact

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that it looks like it's extracted the nodule.

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Well, it's giving me the average diameter, which is

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what we use for the lung RADS category.

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It's giving me the minimum

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and maximum diameter, so 13 by 15 millimeters,

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so average of 14.

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And it also gives us the nodule volume if you're reporting

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nodules in volume and if you're looking at volume doubling

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times by doing that over time.

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So given that this is a 14 millimeter solid nodule on a

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baseline lung cancer screening ct, this is just

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below the size threshold for four B lung rads,

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which is 15 millimeters.

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So this would be a lung RADS four a nodule.

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The recommendation would be to have a follow-up

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CT in three months to check for interval growth.

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The patient, uh, was anxious, uh uh given the size

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of the nodule and the risk of lung cancer.

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They decided they would go on and do a pet CT

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and on the pet CT as we go to the area where the nodule is.

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The activity with the nodule was lower than a background,

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so this was a negative PET scan.

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So we have a 14 millimeter smoothly margin nodule

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with no uptake on PET scan

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that reaffirms those high probability

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of this being a benign lesion.

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This patient subsequently went on to have their interval CT

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that we had recommended be done in three months, as well

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as two annual lung cancer screening CT since that time

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and the nodule has not changed.

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So a good outcome for this patient

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and nodule worrisome by size, PET scan,

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reduces the probability of it being lung cancer

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and then it continues to be stable over time.

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It will be there as this patient continues their screening

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journey and we will continue to make sure it remains stable

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because we know that things happen to patients as they age

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that may change their immune systems

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and that cancers that can stay in check

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for many years can all of a sudden decide to grow

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as those changes happen within a patient over time.

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So we still wanna pay attention to this nodule on every ct.

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We wanna make sure on every subsequent annual CT it's not

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changing in its size, shape, morphology,

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and of course that new nodules are not developing in other

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areas of the lung that might require action.