Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

What is the comparative effectiveness of imaging techniques (e.g. CT scans versus chest X-rays) for monitoring of solitary lung nodules?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Diagnostic CT scans and chest X-ray, tomosynthesis, FDG-PET.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

This review will investigate patients who have a stable pulmonary nodule diagnosed with radiologic imaging.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

N/A

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Improving outcomes and quality of life by better understanding the malignant status of stable lung nodules enabling early diagnosis and intervention.

Describe any health-related risks, side effects, or harms that you are concerned about.

The imaging techniques suggested present risks from increased exposure to radiation and may increase the risk of over-diagnosis and unnecessary invasive follow-up.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Cancer

AHRQ Priority Populations

• Low income groups
• Minority groups

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

Solitary pulmonary nodules are common radiologic findings, with malignant status usually determined by their size and doubling time. Often, further imaging or biopsies are needed, driving increased resource utilization. In addition, with CT screening set to become more frequent in many at risk populations, the incidence of stable lung nodules is expected to increase. With more efficient imaging techniques, we may be able to improve outcomes and quality of life with earlier determination of which nodules are benign and which are malignant.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

THIS TOPIC WAS RECOMMENDED BY A DIVERSE PANEL OF STAKEHOLDERS AS A HIGH PRIORITY QUESTION FOR REVIEW.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

The comparative effectiveness of existing technologies such as CT and chest X-ray is not yet established, nor is the appropriate use of newer techniques such as digital tomosynthesis.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

THE ANSWER TO THIS RESEARCH QUESTION WILL BE DISSEMINATED BY THE EFFECTIVE HEALTH CARE PROGRAM TO CLINICAL PROVIDERS AND POLICY MAKERS WHO WILL BE ABLE TO USE THIS INFORMATION TO MAKE INFORMED TREATMENT AND COVERAGE DECISIONS.

Describe the timeframe in which an answer to your question is needed.

AS SOON AS POSSIBLE TO INFORM INTERESTED STAKEHOLDERS.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Stable lung nodules occur in many different populations, including those representing vulnerable populations.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

THE ANSWER TO THIS RESEARCH QUESTION WILL BE DISSEMINATED BY THE EFFECTIVE HEALTH CARE PROGRAM TO CLINICAL PROVIDERS AND POLICY MAKERS WHO WILL BE ABLE TO USE THIS INFORMATION TO MAKE INFORMED TREATMENT AND COVERAGE DECISIONS.

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program