# Lung-RADS and nodule reporting

Source: https://onco.cc/terms/lung-rads/  
OnCo record `lung-rads` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The scoring systems that turn a screening CT into an action. Each nodule gets a category from the scan, and the category dictates the next step: rescan in a year, rescan in three months, or go to a lung cancer clinic. They exist so that the same scan gets the same answer in every centre.

## Summary

A screening programme that biopsied every shadow would harm more people than it helped, so every programme runs a structured reporting system that maps nodule features to an action. Lung-RADS, the American Lung Imaging Reporting and Data System, categorises the most suspicious nodule on the scan and assigns a follow-up interval or a referral; the NELSON protocol instead measures nodule volume automatically and, for indeterminate nodules, the volume doubling time between scans, referring only those that grow fast enough. The choice matters as much as the eligibility rule: 24.2 percent of low-dose CT screens in the National Lung Screening Trial were called positive, and 96.4 percent of those were false, while NELSON referred only 2.1 percent of participants for a suspicious nodule, and 9.2 percent had one extra scan for an initially indeterminate result. The US Preventive Services Task Force noted in 2021 that most of the trials it reviewed predated current nodule protocols, and that modern protocols should lower the false-positive and invasive-procedure rates below what the trials measured. England's programme runs a national protocol with linked quality assurance standards for exactly this reason, so that a nodule gets the same answer wherever it is scanned.

## Fields

- Kind: Term
- Last checked: 2026-09-25
- Also known as: Lung-RADS; Lung RADS; lung imaging reporting and data system; nodule management protocol; volume doubling time
- Tags: lung

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Lung_cancer_screening
- National Lung Screening Trial Research Team, N Engl J Med 2011: reduced lung-cancer mortality with low-dose computed tomographic screening (53,454 people): https://doi.org/10.1056/nejmoa1102873
- de Koning, N Engl J Med 2020: NELSON, reduced lung-cancer mortality with volume CT screening in a randomised trial (13,195 men and 2,594 women): https://doi.org/10.1056/nejmoa1911793
- Jonas, JAMA 2021: screening for lung cancer with low-dose computed tomography, updated evidence report for the US Preventive Services Task Force (223 publications, 7 randomised trials, 86,486 people): https://doi.org/10.1001/jama.2021.0377
- Br J Hosp Med 2026: how to translate quality standards into good lung cancer screening programmes, the UK experience: https://doi.org/10.31083/bjhm53142

## Connected records

- cancers: [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/)
- technologies: [AI in radiology](https://onco.cc/technologies/radiology-ai-screening/), [CT (computed tomography)](https://onco.cc/technologies/ct/), [Low-dose CT lung screening](https://onco.cc/technologies/low-dose-ct-screening/), [NHS Targeted Lung Health Check (lung cancer screening programme)](https://onco.cc/technologies/nhs-targeted-lung-health-check/)
- terms: [Pack-year](https://onco.cc/terms/pack-year/), [Pulmonary nodule](https://onco.cc/terms/pulmonary-nodule/), [Targeted lung health check](https://onco.cc/terms/targeted-lung-health-check/)

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