Pulmonary Nodule Follow-up (Fleischner 2017) — free guideline decision tool

Get CT follow-up advice for incidental pulmonary nodules per the Fleischner Society 2017 guideline, by type, number, size and risk. Instant, browser-side.

Recommendations vary by solid/ground-glass/part-solid type, single vs multiple, size (< 6, 6–8, > 8 mm) and low vs high risk; measured as the average of long and short axes on thin sections.

Decide the follow-up interval and modality for an incidental (non-screening) pulmonary nodule in patients ≥ 35.

Not for known cancer/primary tumour, immunosuppression or lung-cancer screening (use Lung-RADS for screening). Solid nodules < 6 mm in low-risk patients need no routine follow-up. Persistent ground-glass nodules ≥ 6 mm are followed long-term (duration [pending update]). High-risk features include smoking, older age, emphysema/fibrosis, upper-lobe location and family history. Two site rules (not guideline text): low-dose CT from a health-check centre is treated as screening (Lung-RADS), while standard-dose health-check chest CT is treated as incidental (Fleischner); a trailing 5 rounds up (Lung-RADS keeps one decimal, so 5.95 mm counts as 6.0 mm; Fleischner rounds to whole millimetres, so 5.5 mm counts as 6 mm).

For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.

Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.

Inputs: Nodule type Pure ground-glass (GGN), Number Single, Mean diameter = (long axis + short axis) / 2 5.5 mm, Risk (for solid nodules) Low risk → Result: Follow-up advice CT at 6–12 mo（Nodule: Pure ground-glass · single, Mean diameter: 5.5 mm (rounded per Fleischner to 6 mm), Advice: CT at [pending update] to confirm persistence, then follow-up [pending update]） Inputs: Nodule type Part-solid, Number Multiple, Mean diameter = (long axis + short axis) / 2 5.5 mm, Risk (for solid nodules) High risk → Result: Follow-up advice CT at 3–6 mo（Nodule: Part-solid · multiple, Mean diameter: 5.5 mm (rounded per Fleischner to 6 mm), Advice: Follow-up CT [pending update], then manage per the most suspicious nodule）