Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA.
Radiology. 2010 Apr;255(1):218-24. doi: 10.1148/radiol.09091556.
To determine the familiarity of radiologists with the Fleischner Society guidelines for management of small lung nodules and to assess whether their decisions for nodule management are consistent with these recommendations.
Institutional review board exemption was granted for this electronic survey, which was sent to a sample of 7000 radiologists randomly selected from the Radiological Society of North America (RSNA) directory. Three clinical scenarios for nodule management were presented. Information about policies and guidelines for nodule management, awareness of published guidelines, and respondent demographics was obtained. Associations between these parameters and management recommendations were assessed by using a chi(2) test. Respondents were also asked about tube current settings for routine chest computed tomographic examinations and those performed solely for nodule follow-up.
Of 834 respondents (response rate, 11.9%), 649 (77.8%) were aware of the Fleischner Society guidelines and 490 (58.8%) worked in practices that employed them or similar guidelines. Management selections were consistent with the Fleischner guidelines in 34.7%-60.8% of responses for the three scenarios. A significantly higher rate of concordance was associated with awareness of the Fleischner guidelines, presence of written policies based on them, a teaching practice setting, practice in a group with at least one member having chest radiology fellowship training, and fewer than 5 years of experience practicing radiology (P < .05 for all associations). The spectrum of tube current settings used was similar between the subgroups of respondents who were aware and those who were unaware of the Fleischner guidelines.
Among survey respondents, there was high awareness and adoption of the Fleischner guidelines, but radiologists showed varying degrees of conformance with these recommendations. Future efforts are necessary to bridge the gap between awareness and implementation of these evidence-based guidelines.
确定放射科医生对 Fleischner 学会肺部小结节管理指南的熟悉程度，并评估他们对结节管理的决策是否符合这些建议。
本电子调查获得了机构审查委员会的豁免，并向从北美放射学会（RSNA）名录中随机抽取的 7000 名放射科医生样本发送了该调查。提出了三种结节管理的临床情况。获取有关结节管理政策和指南、对已发表指南的认识以及受访者人口统计学信息。使用卡方检验评估这些参数与管理建议之间的关联。还询问了受访者关于常规胸部计算机断层扫描检查和仅用于结节随访的管电流设置。
在 834 名受访者中（回应率为 11.9%），649 名（77.8%）知晓 Fleischner 学会指南，490 名（58.8%）在采用这些指南或类似指南的实践中工作。在三种情况下，34.7%-60.8%的情况下，管理选择与 Fleischner 指南一致。与知晓 Fleischner 指南、存在基于该指南的书面政策、教学实践环境、在至少有一名具有胸部放射学奖学金培训成员的小组实践以及少于 5 年放射科实践经验相关联的一致性更高（所有关联 P <.05）。在知晓和不知晓 Fleischner 指南的受访者亚组之间，管电流设置的范围相似。
在调查受访者中，对 Fleischner 指南的认识和采用程度很高，但放射科医生对这些建议的遵守程度存在差异。未来需要努力缩小这些基于证据的指南的认识与实施之间的差距。
