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© RSNA, 2008

Management of Small (3–5-mm) Pulmonary Nodules at Chest CT: Global Survey of Thoracic Radiologists

Appendix E1

Small Lung Nodule (Ditzel) Survey

We are interested in learning about the current practice patterns of thoracic radiologists regarding management recommendations for 3–5-mm-diameter nodules that are identified on thoracic CT scans in adult patients that are performed as part of clinical practice (outside the research setting).

Please take a few minutes to answer the following questions. You will need to complete all of the questions in order to submit your survey responses.

1. Regarding the detection of solid, noncalcified nodules measuring 3–5 mm in diameter (also referred to as "ditzels") on chest CT scans that are performed in daily clinical practice (not including research studies), does your radiology section or department have a policy to guide radiologists in providing recommendations for their follow-up or management?
   
   a. No, there is no policy in place.
   b. Yes, there is a policy in place. If you answered "yes," please state policy briefly in space below:
2. Please estimate the percentage of all chest CT scans that are performed in adult (>18-year-old) patients in your practice that demonstrate one or more noncalcified nodules measuring 3–5 mm in diameter (select ONE of the following):
   
   a. Less than 25%
   b. 26% to 50%
   c. 51% to 75%
   d. 76% to 100%
3. Please estimate the percentage of clinical (non-research) CT scans that you interpret each day that are obtained solely for follow-up of nodules measuring 3–5 mm in diameter (select ONE of the following):
   
   a. Less than 10%
   b. 10% to 25%
   c. 26% to 50%
   d. 51% to 75%
   e. 76% to 100%

   For each of the four following clinical scenarios, please make a recommendation using ONE of the following options that best simulates the recommendation you would make if you were interpreting the case in your daily practice:

4. In a young patient (<40 years old) with no previous malignancy, an incidental discovery of a ditzel is made at chest CT.
   
   a. Nothing; not mentioned in report.
   b. Nothing; nodule mentioned but no recommendation.
   c. Short-term CT follow-up (3–6 months)
   d. Intermediate CT follow-up (12 months)
   e. Recommend biopsy or surgical resection
   f. Considered malignant or metastatic, no biopsy needed.

5. In a patient more than 40 years of age with no previous malignancy, an incidental discovery of a ditzel is made at chest CT.
   
   a. Nothing; not mentioned in report.
   b. Nothing; nodule mentioned but no recommendation.
   c. Short-term CT follow-up (3–6 months)
   d. Intermediate CT follow-up (12 months)
   e. Recommend biopsy or surgical resection
   f. Considered malignant or metastatic, no biopsy needed.

6. In a patient at high risk for malignancy but with no prior history of malignancy, an incidental discovery of a ditzel is made at chest CT.
   
   a. Nothing; not mentioned in report.
   b. Nothing; nodule mentioned but no recommendation.
   c. Short-term CT follow-up (3–6 months)
   d. Intermediate CT follow-up (12 months)
   e. Recommend biopsy or surgical resection
   f. Considered malignant or metastatic, no biopsy needed.

7. In a patient with a new diagnosis of extrathoracic malignancy, a ditzel is present on a chest CT scan obtained as evaluation for metastatic disease.
   
   a. Nothing; not mentioned in report.
   b. Nothing; nodule mentioned but no recommendation.
   c. Short-term CT follow-up (3–6 months)
   d. Intermediate CT follow-up (12 months)
   e. Recommend biopsy or surgical resection
   f. Considered malignant or metastatic, no biopsy needed.

   Please answer the following questions regarding your background and practice.

8. Number of years of practice in radiology (select ONE of the following):
   
   a. <5 years
   b. 5–10 years
   c. 11–20 years
   d. 21–30 years
   e. >30 years

9. Type of practice:
   
   a. Primarily academic/teaching hospital setting.
   b. Primarily private practice.
   c. Combination of academic and private practice settings.

10. In your practice, which ONE of the following types of CT scanners is MOST commonly used for chest CT scans?
    
    a. Non-helical CT scanner.
    b. Single-detector helical CT scanner.
    c. Multi–detector row (multislice) helical CT scanner.
    d. Electron-beam CT scanner.

11. Is your practice located in an area that is endemic for granulomatous disease (yes or no)?
    
    a. Yes.
    b. No.

12. Of which of the following societies are you a member (select all that apply)?
    
    a. Fleischner Society
    b. Society of Thoracic Radiology (STR)
    c. European Society of Thoracic Imaging (ESTI)
    d. Japanese Society of Thoracic Radiology (JSTR)
    e. Korean Society of Thoracic Radiology (KSR)

    Other thoracic imaging societies (please list):

13. Please name the country in which you practice radiology:

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