Quality statement 2	People with solid pulmonary nodules have their nodules assessed by semi-automated volumetry in preference to manual diameter measurements where possible and appropriate (eg, for smaller nodules and for measuring doubling time, when growth not obvious).
Rationale	To ensure patients with solid pulmonary nodules on CT have their nodule(s) assessed by the most accurate method, where possible 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 solid pulmonary nodules have their nodules assessed by semi-automated volumetry in preference to manual diameter measurements where possible and appropriate (smaller nodules and for measuring doubling time, when growth not obvious).
	Process: Proportion of people with solid pulmonary nodules who have their nodule(s) assessed by semi-automated volumetry in preference to manual diameter measurements where possible and appropriate (smaller nodules and for measuring doubling time, when growth not obvious). Numerator: the number of people with solid pulmonary nodules who have their nodules assessed by semi-automated volumetry in preference to manual diameter measurements where possible and appropriate (smaller nodules and for measuring doubling time when growth not obvious). Denominator: the number of people with solid pulmonary nodules confirmed on CT where volumetry is preferable to manual measurements and is possible and appropriate.
Description of what the quality statement means for each audience	Service providers: Ensure there are systems in place that provide nodule assessment by semi-automated volumetry. Healthcare professionals: Refer people with solid pulmonary nodules confirmed on CT to services where they can have their nodules assessed by semi-automated volumetry in preference to manual diameter measurements where possible and appropriate. Commissioners: Ensure they commission services for people with solid pulmonary nodules confirmed on CT to have their nodule(s) assessed by semi-automated volumetry in preference to manual diameter measurements where possible and appropriate. People with solid pulmonary nodules confirmed on CT Have their nodule(s) assessed by semi-automated volumetry in preference to manual diameter measurements where possible and appropriate.
Relevant existing indicators	Local 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 Note: To ensure accuracy of comparative measurements, serial volumetry should be measured using the same CT settings, same software and release version.
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