Overview of domain 5
Domain 5 helps you identify the processes needed to ‘find, track and manage’ nodules through their programme, and to consider how it integrates with existing health system services.
Why service delivery matters
Even with the most robust planning, an IPN management programme cannot be effective unless its service delivery pathways are well designed and implemented. There are many approaches to ‘find, track and manage’ nodules, but identifying what works best in your health system is vital to long-term success. Understanding how the programme fits within wider health system services is also needed to avoid ‘losing’ patients.
What this domain covers
Domain 5 guides you through:
Finding IPNs
- Establish a protocol for radiologists to note IPNs on imaging that is appropriate for the programme, including a process to collate incidental findings for the service.
- Triage identified nodules to assess risk accurately and inform follow-up care, including through the use of tools or diagnostic approaches.
- Identify processes for discharging people whose nodules do not meet the risk thresholds.
Tracking people with IPNs
- Identify, leverage and implement navigation services to support service users through the IPN management pathway.
- Implement tracking processes to ensure service users are not ‘lost’ and receive appropriate follow-up care.
Managing care along the pathway
- Establish processes to minimise overmedicalisation while ensuring service users still receive appropriate care.
- Implement periodic reviews to determine the most appropriate course of action for nodule management.
- Identify downstream care for people diagnosed with lung cancer, including transfer protocols where needed.
Integration with other services
- Use existing processes to avoid duplicating care and to streamline provision.
- Identify routes to obtain imaging from other health systems to enable accurate assessment of nodule growth.
- Leverage interdepartmental communication systems to facilitate longitudinal follow-up care.
- Consider how the IPN management programme will integrate with other screening services, if available.
Resources
Pathways for IPN management programmes
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Data governance to facilitate effective IPN management
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The role of patient navigation in IPN management programmes
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Harnessing AI to build an effective and efficient IPN management programme
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An expert's perspective: Dr Luis Raez
Watch videoFurther reading
- BTS guidelines for the investigation and management of pulmonary nodules (British Thoracic Society, 2015)
- BTS quality standards for the investigation and management of pulmonary nodules (British Thoracic Society, 2018)
- Guidelines for management of incidental pulmonary nodules detected on CT images: from the Fleischner Society (MacMahon et al.,2017)
- Incidentally detected indeterminate pulmonary nodule (American College of Radiology)
- Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd edn: evidence-based clinical practice guidelines (Gould et al., 2013)
- Evaluation of pulmonary nodules: clinical practice consensus guidelines for Asia (Bai et al., 2016)
- The Thoracic Society of Australia & New Zealand (TSANZ) practical guide for clinicians in the management of screen- and incidentally-detected nodules (Brims et al., 2025)
- Incidental pulmonary nodules – current guidelines and management [Inzidentelle Lungenrundherde – aktuelle Leitlinien und Management] (Glandorf & Vogel-Claussen, 2024)
- Incidental pulmonary nodules: what should we do in 2026? (Schmid-Bindert et al., 2026)
- ACR Appropriateness Criteria® incidentally detected indeterminate pulmonary nodule (Expert Panel on Thoracic Imaging, 2023)
- Managing incidental findings on thoracic CT: lung findings: a white paper of the ACR Incidental Findings Committee (Munden et al., 2021)
- Initial pulmonary nodule management for the generalist: a brief review (Friesen et al., 2025)
- Management strategies to promote follow-up care for incidental findings: a scoping review (Crable et al., 2021)
- Pulmonary nodule risk calculator (British Thoracic Society)