Charter Radiology Pulmonary Nodule Clinic

Serving a Specialized Need in the Community

Charter Radiology’s Pulmonary Nodule Clinic detects and evaluates pulmonary nodules, decreasing the number of unnecessary follow-up examinations and, in collaboration with referring physicians (primary care physicians, pulmonologists, and surgeons), helps to create more effective treatment/management plans.

Charter Radiology has always offered the most advanced, low-dose CT imaging for lung screening, and now, with the addition of Charter’s powerful PET/CT technology in our state-of-the-art Clarksville center our patients have another powerful tool for the early detection of lung disease and lung cancer.

Our multidisciplinary team of University-trained radiologists, nuclear medicine physicians, and scientists provides a truly personalized approach to the diagnosis of lung disease. Charter Radiology is ACR accredited and dedicated to providing state-of-the-art medical imaging services with access to the most advanced Imaging technology available.

Lung cancer is a leading cause of cancer-related death in the United States, and 40% of newly diagnosed lung cancer patients have distant metastasis.  Accurate staging and detection of metastases in non-small cell lung cancer (NSCLC) is critical to avoiding ineffective surgery and selecting appropriate treatment.

PET/CT can improve the detection of nodal and distant metastases and change the management plan.

  • Tumor staging with PET/CT immediately before surgery revealed more patients with mediastinal and distant metastatic disease than conventional imaging.
  • Initial PET/CT changed the stage in 29% of NSCLC cases.
  • PET/CT had a medium to high impact on the management plan in 37% of patients when staging lung cancer.


While conventional imaging establishes the presence of solitary pulmonary nodules (SPNs), invasive procedures that involve risk may be required to characterize the lesions.

PET/CT utilization as a diagnostic tool could reduce the number of unnecessary biopsies or thoracotomies on benign SPNs. Nodules that were classified as indeterminate on CT were correctly characterized on PET in over 80% of the cases.

PET should be obtained in the diagnostic work-up of patients with SPN.

PET enables the physician to make a more informed clinical decision. 

The American College of Chest Physicians recommends: In patients with a low-to-moderate pretest probability of malignancy (5% to 65%) and an indeterminate SPN that measures at least 8 mm in diameter, we suggest that functional imaging, preferably with positron emission tomography (PET), should be performed to characterize the nodule.

Medicare recognizes the utility of PET and PET/CT in solitary pulmonary nodule (SPN).

Initial Treatment Strategy

Medicare covers PET scans for characterization of a single pulmonary nodule under the Initial Treatment Strategy of Lung Cancer. For the Initial Treatment Strategy, PET/CT may be used:

  • To determine whether or not the beneficiary is an appropriate candidate for an invasive diagnostic or therapeutic procedure
  • To determine the optimal anatomic location for an invasive procedure

To determine the anatomic extent of the tumor when the recommended anti-tumor treatment reasonably depends on the extent of the tumor.

The Society of Nuclear Medicine and Molecular Imaging (SNMMI) Center of Excellence PET PROS Diagnosis of Pulmonary Nodules:

  • PET and PET/CT are approved by the Centers for Medicare and Medicaid Services (CMS) for the characterization of solitary pulmonary nodules not exceeding 4 cm to determine the likelihood of malignancy. Claims should include evidence of the initial detection of a primary lung nodule, usually by computed tomography.
  • The U.S. Preventive Services Task Force (USPSTF) recently released an updated, final recommendation for CT lung cancer screening that lowers the starting age from 55 to 50 years and adjusts smoking history from 30 pack years to 20 pack years.


When it comes to successfully treating lung cancer, early detection is key. At Charter Radiology, we are committed to detecting lung disease at its earliest and most treatable stage, offering patients low-dose CT lung screening.

Lung screening is a CT scan of the chest to find disease before the symptoms begin. Lung cancer forms in tissues of the lung, usually in the cells lining air passages. The two most common types of this disease are small cell lung cancer and non-small cell lung cancer.

Charter Radiology offers the most advanced, low-dose CT imaging for lung screening. Our state-of-the-art Siemens SOMATOM® Perspective and Definition 128 AS scanner with Safire detectors offers patients the lowest radiation dose in an outpatient center in the region, reducing radiation doses by 60-80%.

Case Studies

Fleischner Society Guidelines for Management of Incidentally Detected Pulmonary Nodules 2017

Figure 1. A. There is spiculated 2.1 cm right upper lobe nodule was seen on the CT scan. B, C. The nodule demonstrated a high metabolic uptake SUV of 7.4, highly suspicious for malignancy. Biopsy showed Non-Small Cell Carcinoma.

WATCH: Video case of multiple CTs and PET/CT pulmonary nodule evaluation:

Metastatic Lung Cancer

Lung Cancer Survivor Testimonial