Radiology reporting standard

Fleischner

The Fleischner Society 2017 guidelines give follow-up recommendations for pulmonary nodules found incidentally on CT in adults, based on nodule type (solid or subsolid), size, number and the patient's risk for lung cancer.

Fleischner through RadVector API Fleischner in RadVector Reporting

Validated packValidated criteria pack (fleischner-2017-r6, validated 2026-10-04); verdicts may be marked usable for output.

At a glance

What Fleischner is

Full name: Fleischner Society 2017 Guidelines for Incidental Pulmonary Nodules
Edition RadVector applies: Fleischner Society 2017
Published by: Fleischner Society (MacMahon H et al., Radiology 2017)
Applies to: Pulmonary nodules found incidentally on CT in adults 35 and older, not for lung cancer screening, known cancer or immunosuppression.
Modality: Chest CT (incidental)

Official source: Fleischner Society 2017 (Radiology)

Fleischner categories

Solid: Single or multiple; under 6 mm, 6 to 8 mm, over 8 mm; low or high risk.
Subsolid: Ground-glass or part-solid, single or multiple, with longer surveillance.
Stability: A solid nodule stable for 2 years, or a subsolid nodule for 5 years, completes surveillance.

A short summary in our own words. Use the official Fleischner documents for the complete criteria.

How RadVector applies it

Fleischner, applied the same way every time.

The same deterministic engine grades Fleischner inside RadVector Reporting and through RadVector API, and a test keeps the two answers identical.

Validated criteria pack: a Fleischner verdict can be marked usable for output.
Applies only to a CT that images the whole chest and is not a screening exam; elsewhere it says Fleischner does not apply and suggests a dedicated chest CT.
Sizes by the mean of the axes in whole millimetres, reads stability and its duration from comparable prior chest CT, and places a known nodule on its surveillance schedule instead of restarting it.
Below age 35 the rows are given for reference as advisory, and the radiologist decides.

Radiologists and imaging centers

RadVector Reporting supplies the Fleischner category and recommendation to the report draft from the radiologist's own findings, cites the guidance applied, and keeps a per-report governance record. The radiologist signs.

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Software teams and AI companies

RadVector API returns the Fleischner verdict with pack version, validation status and a trace id, as JSON or FHIR R4, with a sandbox key and synthetic fixtures to start.

Developer guide

Hospitals and enterprise imaging

One versioned Fleischner implementation across reporting, QA and other AI systems' results, with an audit trail of which pack version graded each report.

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Fleischner questions

Is there an API for the Fleischner criteria?

Yes. RadVector API evaluates an incidental pulmonary nodule against its validated Fleischner 2017 criteria pack and returns the follow-up recommendation with the pack version, validator, validation date and a trace id. The same engine supplies Fleischner recommendations inside RadVector Reporting.

Does RadVector apply Fleischner to lung cancer screening CT?

No. Lung cancer screening CT is governed by Lung-RADS. RadVector applies Fleischner only to incidental nodules on a CT that images the whole chest, in adults without known cancer or immunosuppression.

Other reporting standards

RadVector is clinical decision support for qualified professionals, not a diagnostic device; the radiologist makes the final determination.