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Managing pulmonary nodules

Lung nodules are a common incidental finding on chest scans. They are found in up to 35% of people who have a CT scan or chest X-ray for any reason, and often require follow-up. Most lung nodules are not concerning, but in some cases, they can represent the beginning stages of a lung cancer.

Efficient management of nodules which change over the follow-up period means that lung cancer can be diagnosed at the earliest stage, and that we are then hopefully able to offer curative treatment. This is in line with the aim of the NHS Long Term Plan to diagnose 75% of all cancers at stage 1 or 2.

To assist with prompt diagnosis of cancerous nodules and support patients through the surveillance process, RM Partners has developed and implemented a project to:

  • improve equity in nodule management resources
  • ensure the pathway meets the needs of our diverse patient population
  • support patients to understand their surveillance process and what it might mean for them

The project started with a pathway mapping exercise across the Alliance at all participating Trusts. This involved gaining an understanding of lung nodule management in practice, as well as a listening exercise to hear from patients who had undergone surveillance to better understand their experience of services.

From this, two service-oriented workstreams were developed:

  • an initiative to ensure all our participating Trusts have access to central patient tracking. This will ensure patients are monitored and supported throughout surveillance and improve patient safety by ensuring follow-up is completed.
  • a hub-and-spoke model improving Alliance-wide access to volumetry software, which supports more sensitive measurement of nodule size on imaging.

To support the project, a suite of patient resources was produced:

  • ‘Understanding Lung Nodules’, a patient video which has been translated into seven languages – Arabic, Bengali, Gujarati, Korean, Mandarin, Polish and Punjabi – and made accessible for people with a hearing impairment.
  • A patient leaflet which explains what nodules are, possible causes and treatment
  • A Frequently Asked Questions document designed for use in clinic and to be accessed online across the region by all Trusts, providing more detailed and in-depth information on what patients should expect from the surveillance process and service.

For more information about this Managing pulmonary modules project, please contact Jane Derbyshire, RM Partners project manager (