Lung-RADS: Pushing the Limits

Abstract

Lung-RADS was introduced in 2014 by the American College of Radiology to provide a framework for standardized reporting and management of nodules detected at lung cancer screening CT; this article describes several scenarios that have arisen during implementation of lung cancer screening for which Lung-RADS provides unclear or no guidance, and recommendations are offered on the basis of the authors’ collective experiences. In response to the recommendation of the U.S. Preventive Services Task Force and the coverage decision by the Centers for Medicare and Medicaid Services for lung cancer screening (LCS) computed tomography (CT), the American College of Radiology introduced the Lung CT Screening Reporting and Data System (Lung-RADS) in 2014 to standardize the reporting and management of screening-detected lung nodules. As with many first-edition guidelines, questions arise when such reporting systems are used in daily practice. In this article, a collection of 15 LCS-related scenarios are presented that address situations in which the Lung-RADS guidelines are unclear or situations that are not currently addressed in the Lung-RADS guidelines. For these 15 scenarios, the authors of this article provide the reader with recommendations that are based on their collective experiences, with the hope that future versions of Lung-RADS will provide additional guidance, particularly as more data from widespread LCS are collected and a...