Optimizing diagnostic outcomes and sustainability in radiological practices: a multicentric study on guideline adherence and incidental findings in elective chest CT scans

Purpose: This multicentric retrospective study aimed to evaluate the diagnostic outcomes, adherence to guideline-based recommendations, and sustainability implications of 280 initial chest CT scans performed without contrast. The scans were conducted at the Radiology Unit of the Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico of Milan and the Radiology Department of Treviglio-Caravaggio Hospital-ASST Bergamo Ovest. The study focused on optimizing patient selection and radiological recommendations to align with evidence-based guidelines. Materials and methods: This retrospective study included 280 patients (mean age 61.68 years; 51.07% women, 48.93% men) who underwent their first chest CT scan without contrast. Diagnostic outcomes were analyzed across different clinical queries. Incidental findings and radiologists’ recommendations were assessed for alignment with Fleischner Society and ACR guidelines. Deviations were categorized as unnecessary imaging suggestions or missed indications. Radiation exposure was quantified using the dose-length product (DLP). Results: Diagnostic outcomes were positive in 54.64% of cases. Incidental findings occurred in 34.64% of cases, with guideline adherence at 81.43%. Deviations included unnecessary imaging in 14.29% and missed follow-up indications in 4.28% of cases. The median DLP was 237.5 mGy·cm (IQR 171.8–320.1). Conclusion: This study highlights significant opportunities to refine patient selection and radiological recommendations through adherence to Fleischner Society and ACR guidelines. By integrating evidence-based practices into routine workflows, the findings advocate for reduced unnecessary imaging, enhanced diagnostic pathways, and sustainable healthcare practices in chest CT imaging.