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Pulmonary nodules

Pulmonary nodules are traditionally defined as ≤30 mm in diameter.  This section is relevant to pulmonary nodules incidentally found on screening or during assessment of another clinical problem.

Emergency department referrals

All urgent cases must be discussed with the on-call Registrar to obtain appropriate prioritisation and treatment. Contact through

  • Caboolture Hospital (07) 5433 8888
  • Redcliffe Hospital (07) 3883 7777
  • Royal Brisbane and Women’s Hospital (07) 3646 8111
  • The Prince Charles Hospital (07) 3139 4000

Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

  • Solid nodule >8 mm in diameter

Category 2

Appointment within 90 days is desirable

  • Solid nodule 6-8 mm (solitary or largest of multiple nodules)
  • Subsolid nodule >10 mm
  • Subsolid (ground glass) lesion with interval growth or development of solid component on serial imaging
  • Part solid nodule of diameter ≥6 mm or where solid component is ≥5 mm (solitary or largest of multiple)
  • Multiple subsolid (ground glass) or part solid nodules <6 mm
  • Multiple nodules of any size in patient with personal history of malignancy

Category 3

Appointment within 365 days is desirable

  • Subsolid (ground glass) nodule 6-10 mm
  • Solid nodule <6mm in high-risk patient (solitary or largest of multiple)

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

  • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Not an exhaustive list

  • Refer to HealthPathways or local guidelines
  • All patients with pulmonary nodules should have a risk assessment for malignancy. Risk increases with
    • Age
    • Smoking status and total consumption
    • Personal history of malignancy
    • Spiculated nodule morphology
  • Nodules <6 mm in low risk people do not require follow up
  • Nodules ≤8 mm could be followed without specialist referral according to the Fleischer Society Guidelines
  • In this case, serial imaging should be performed at the same radiology service ideally on the same equipment

Referral requirements

A referral may be rejected without the following information.

Essential referral information

  • CT chest and details of radiology provider
  • Details and pathology results (if available) of previous malignancies

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can’t order, or the patient can’t afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
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