When choosing a strategy for evaluating patients with lung nodules, clinicians should consider both the probability that the nodule is malignant and the advantages and disadvantages of management strategies. The VA Clinical Model has been validated, is available at no charge, and requires only four simple inputs – smoking status, years since quitting, age, and nodule size in mm or cm. The score generated will place your patient into a risk group (low, intermediate, high) that corresponds to the probability that the nodule is malignant.

VA Clinical Model*

Directions For Use

Fill in the fields in the calculator based on the following key predictors of malignancy:

Enter age from 25 to 85 years old
Enter a value from 0.4 to 3 cm Enter a value from 4 to 30 mm
Former Smoker requires years since stopping to be greater than 0 Years since stopped smoking can not be more than the age minus 10 years
Some fields values are not valid.
Low Risk pCA <5% Consider REVEAL if your patient is uncomfortable with adopting a strategy of surveillance when told that their lung nodule is indeterminate (i.e. not clearly benign).
Intermediate Risk pCA 5-65% Consider REVEAL to minimize the harms of invasively evaluating patients (serial CT scans, non-surgical biopsy, and surgical diagnosis) with benign disease, or to encourage further evaluation to enable earlier diagnosis of malignant nodules.
High Risk pCA >65% Consider REVEAL if your patient is not a suitable candidate for surgery or if they are risk averse about undergoing surgery.

1. MacMahon H, Austin JH, Gamsu G, et al. Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society. Radiology 2005;237(2):395–400

2. Radiology: Volume 284: Number 1—July 2017, radiology.rsna.org 228-243

3. Gould M, et al. Evaluation of Individuals With Pulmonary Nodules: When Is It Lung Cancer? CHEST 2013, e93S -e120s

*with permission from the author, Gould, CHEST, 2007, page 4

All information produced by the VA Clinical Model is provided for educational purposes only. This information should not be used for the diagnosis or treatment of any health problem or disease. This information is not intended to replace clinical judgement or guide individual patient care in any manner.