Quality statement 1	People with non-calcified pulmonary nodules confirmed on CT have their nodule(s) assessed for risk of malignancy.
Rationale	To ensure patients with non-calcified pulmonary nodules on CT have their nodule(s) assessed for risk of malignancy to guide appropriate use of interval imaging and recommendation for further workup.
Quality measure	Structure: Evidence of local arrangements and written clinical protocols to ensure that people with non-calcified pulmonary nodules confirmed on CT have their nodule(s) assessed for risk of malignancy. Process: Proportion of people with non-calcified pulmonary nodules confirmed on CT who have their nodule(s) assessed for risk of malignancy. Numerator: the number of people with non-calcified pulmonary nodules confirmed on CT who have their nodule(s) assessed for risk of malignancy. Denominator: the number of people with non-calcified pulmonary nodules confirmed on CT.
Description of what the quality statement means for each audience	Service providers: Ensure there are systems in place for people with non-calcified pulmonary nodules confirmed on CT to have their nodule(s) assessed for risk of malignancy and managed according to the latest recommendations. Healthcare professionals: Refer people with non-calcified pulmonary nodules confirmed on CT to services where their nodule(s) are assessed for risk of malignancy and are managed according to the latest recommendations. Commissioners: Ensure they commission services for people with non-calcified pulmonary nodules confirmed on CT to have their nodule(s) assessed for risk of malignancy and be managed according to the latest recommendations. People with non-calcified pulmonary nodules confirmed on CT: Have their nodule(s) assessed for risk of malignancy and are managed according to the latest recommendations.
Relevant existing indicators	Local multidisciplinary team (MDT) minutes/database/audit
National data sources	National Lung Cancer Audit, Society for Cardiothoracic Surgery Thoracic Registry
Source references	BTS Guidelines for the Investigation and Management of Pulmonary Nodules, 20153; NICE Lung Cancer: Diagnosis and Management Guideline, 20114
Other information	BTS Pulmonary Nodule Risk Prediction Calculator https://www.brit-thoracic.org.uk/standards-of-care/guidelines/bts-guidelines-for-the-investigation-and-management-of-pulmonary-nodules/bts-pulmonary-nodule-risk-prediction-calculator/ (to be read in conjunction with the relevant sections of the above guideline). NHS England Service Specification for Thoracic Surgical Services https://www.england.nhs.uk/publication/thoracic-surgery-adults/ NHS England Commissioning Guidance for the Whole Lung Cancer Pathway: https://www.brit-thoracic.org.uk/media/396232/Clinical-Advice-for-the-Provision-of-Lung-Cancer-Services-Aug-2017.pdf https://www.brit-thoracic.org.uk/media/382380/National-Optimal-LUNG-Pathway-Aug-2017.pdf NLCFN Patient Information: https://www.nlcfn.org.uk/patient-information