The goal of this pragmatic clinical trial is to learn whether AI-based personalized digital management can help patients with high-risk pulmonary nodules complete appropriate follow-up care. The study will include adults aged 40 years or older whose pulmonary nodules were identified on chest CT scans already performed at the hospital for clinical care, health examinations, or other reasons. The hospital's AI-based lung nodule evaluation system will be used to identify nodules classified as high risk. Patients who have already completed follow-up or entered an active pulmonary nodule management pathway will not be included.
The main question this study aims to answer is:
\- Does personalized digital management increase the proportion of patients who complete appropriate pulmonary nodule follow-up within 16 weeks after randomization compared with usual care?
Researchers will compare personalized digital management with usual care. Participants will be randomly assigned in a 1:1 ratio to one of the following groups:
* The personalized digital management group will receive individualized information about the pulmonary nodule and recommendations for appropriate follow-up through the hospital's official WeChat account. * The usual care group will not receive the study-specific personalized digital message. Participants in both groups may continue to receive routine clinical care.
Participants will:
* Provide electronic informed consent * Answer a brief questionnaire about pulmonary nodule care received outside the hospital and selected health information, including smoking history * Continue their usual medical care * Allow researchers to review relevant hospital records to determine whether pulmonary nodule follow-up was completed
The study will not arrange an additional initial chest CT solely for research purposes. Appropriate follow-up may include specialist evaluation, follow-up chest CT, PET/CT, tissue sampling, surgery, or a documented clinical decision that no further evaluation is needed. Researchers will also examine subsequent diagnostic procedures, lung cancer diagnoses, treatments, complications, and longer-term clinical outcomes.
Age 40 years or older.
Completion of a chest CT at the study hospital for clinical care, health examination, or another reason.
At least one pulmonary nodule classified as high risk by the Linc model, with a predicted malignancy probability of 75% or greater. The index CT, index nodule, model version, and risk score must be traceable.
Follow-up management for the index nodule has not been completed before randomization, and the participant has not entered a clearly documented active pulmonary nodule management pathway.
Prior or current lung cancer, or ongoing diagnostic evaluation, treatment, postoperative care, or surveillance for the index nodule.
Active malignancy for which the pulmonary nodule should be evaluated or managed as possible metastatic disease or within another established cancer care pathway.
Completion before randomization of a qualifying chest CT, pulmonary nodule specialist or multidisciplinary team evaluation, PET/CT, tissue sampling, surgery or lesion-directed treatment, or verified clinical closure related to the index nodule.
An existing valid order, appointment, referral, or documented active management plan for the index nodule, including active management by thoracic surgery, a pulmonary nodule clinic or multidisciplinary team, oncology, or radiation oncology.
Parallel
Personalized Digital Outreach
BehavioralShortly after randomization, participants receive a study-specific personalized digital message through the hospital's official WeChat account. The message provides understandable information about the participant's AI-classified high-risk pulmonary nodule, explains that a high-risk classification does not establish a diagnosis of lung cancer, and recommends returning to a pulmonary nodule-related specialist for further evaluation. Subsequent imaging, diagnostic procedures, treatment, or observation will be determined by the treating clinician using the official radiology report, prior imaging, and the participant's clinical condition. Message delivery, opening, link clicks, and technical delivery failures will be recorded.
Pulmonary Nodule Follow-up Completion Within 16 Weeks After Randomization
The proportion of all randomized participants who complete at least one qualifying pulmonary nodule follow-up event by Day 112. Qualifying events include: (1) chest CT related to the index nodule; (2) pulmonary nodule specialist or multidisciplinary team evaluation with a documented assessment and management plan; (3) PET/CT; (4) bronchoscopy, percutaneous biopsy, or other tissue sampling; (5) surgery, image-guided ablation, or lesion-directed radiotherapy; or (6) documented clinical closure by a qualified clinician after adequate evaluation. Orders or appointments alone do not count. Patient refusal, loss to follow-up, or death alone do not constitute clinical closure. The denominator includes all randomized participants analyzed according to assigned group. Only hospital records or verified outside-hospital records count as completion.
Follow-up Completion Within 30 Days After Randomization
Proportion of all randomized participants completing at least one qualifying A-F follow-up event, using the same event and evidence rules as the primary outcome.
Time From Recommended Management Due Date to First Follow-up Completion
Difference in days between the first qualifying follow-up event and the prespecified due date. Negative values indicate early completion; positive values indicate delay. Limited to participants with a valid due date.
Time From Index Chest CT to First Follow-up Completion
Days from the index chest CT to the first qualifying A-F event, described within prespecified 3-, 6-, or 12-month management strata.
Lung Cancer Diagnosis
Proportion of all randomized participants meeting the prespecified lung cancer diagnosis standard. Pathologic confirmation is preferred; adjudicated clinical diagnosis is permitted when prespecified criteria are met.
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