Fleischner Society Criteria for Pulmonary Nodule Follow-up
Provides evidence-based follow-up recommendations for incidental pulmonary nodules based on size, type, and patient risk factors
- Highest activation tier
- Recommended
- How it is scored
- Scored in code; a stated value is compared only from the structured summary or a supplied value
- Scoring type
- classification
- Care settings
- Emergency department, Inpatient, Outpatient
When it activates
Scribeable activates a calculator from the encounter. The Fleischner Society Criteria for Pulmonary Nodule Follow-up can activate when the transcript or pasted chart context documents any of these:
- Incidental pulmonary nodule
- Lung nodule follow-up planning
- Pulmonary nodule management
- Lung nodule incidentaloma
- CT chest incidental finding
A coded diagnosis can also activate it. ICD-10 prefixes carried by the registry: R91.1.
Inputs the note needs
3 inputs. Each is resolved from the transcript, the pasted chart context and charted labs; at this calculator’s tier a missing input is never requested, and a missing required input keeps the score out of the draft.
| Input | Type | Unit / options | Guidance |
|---|---|---|---|
| Nodule size in mm (average of long and short axes) | exam | ||
| Nodule type: solid, subsolid (part-solid), or ground_glass (pure GGN) | exam | ||
| High-risk patient (smoking history, family history of lung cancer, upper lobe location, emphysema, fibrosis, or other cancer history) | history |
Scoring
Solid nodules: <6mm low-risk=no follow-up, <6mm high-risk=optional 12mo CT. 6-8mm low-risk=CT 6-12mo then 18-24mo, 6-8mm high-risk=CT 6-12mo then 18-24mo. >8mm=CT 3mo, PET/CT, or tissue sampling. Subsolid (part-solid): <6mm=no follow-up. >=6mm=CT 3-6mo then annually for 5 years. Ground-glass: <6mm=no follow-up. >=6mm=CT 6-12mo then every 2 years for 5 years.
Interpretation
These apply to incidental nodules in patients >=35 years without known cancer. Does NOT apply to: cancer screening, known primary cancer, immunocompromised patients, or suspected infection. Key size threshold is 6mm (below = generally benign). Part-solid nodules with solid component >=6mm have higher malignancy risk. Growing nodules (especially volume doubling time <400 days for solid) warrant biopsy or resection. PET/CT most useful for solid nodules >8mm.
Evidence
Sources carried in Scribeable's citation registry for this calculator; guideline version: MacMahon 2017.
- MacMahon H et al. Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images (Fleischner Society 2017)Fleischner Society 2017 · 2017 · Fleischner Society · Consensus · link last verified 2026-03-28
How Scribeable handles it in the note
When an encounter activates the Fleischner Society Criteria for Pulmonary Nodule Follow-up (its highest tier is recommended), Scribeable does not ask you for missing inputs. The score is computed in code from whatever inputs resolve from the transcript, the pasted chart context or charted labs; a computed value is written into the draft only when every required input already resolves.
The score is computed in code from the resolved inputs, not recalled by the language model. A stated Fleischner Society Criteria for Pulmonary Nodule Follow-up value is compared against the computed one when the draft's structured summary carries it; a disagreement found there is flagged to the second drafting pass, which is instructed to correct the score and its interpretation, unless Scribeable has supplied the computed value to that pass, in which case the value the draft writes is checked against the supplied one and a detected difference is shown beside the note for you to adjudicate rather than silently rewritten.
Classified as a staging or classification system: activated strictly, because a wrong stage on the wrong patient is a documentation hazard.
See it activate on your own encounter
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