In recent years, more than 80% of the patients who come to me for consultation in my specialist’s office have small pulmonary nodules, and the common question is, how do we deal with these small pulmonary nodules? As an attending physician, I must first understand the feelings of these friends who come for consultation; then, I think there are 3 tasks, the first is to study whether the examination method is in place? The next is to analyze the morphological manifestations of the nodules to make a diagnosis; and finally to give some reasonable suggestions to the friends. Around the above 3 tasks, I have also been trying my best to answer these questions from my friends, just do not know what they do after the answer, today, in the prevention and control of avian flu, I hope to interact with my friends who have answered the questions, answer me, how did you act after the consultation? During the consultation, I will analyze the image presentation while constantly communicating verbally with the patient, what we call in medical terminology history taking, the process of understanding the medical history is actually studying the background of the image presentation and sorting out useful information for my final diagnosis. Of course, in the process of asking questions, I also felt that the words “small pulmonary nodule” on the diagnostic imaging report were really painful for the patients, and these pains were a series of questions, such as, “Doctor, is this nodule benign? Or is it something bad, or is it malignant? Doctor what should I do about it? Continue to follow up? How often should I come back for follow-up? Come to you for a follow-up? Or would a local CT or MRI be better? Do I need a PETCT and why is the diagnosis of a small lung nodule so complicated? What should I look for? Is there any specific medicine? And so on. The most common way to find a doctor is to go online. Older friends go online through their children and list out a bunch of specialists, then they run one by one, and when they arrive at the hospital, they register, queue up, consult, check and test again, almost endlessly; some hospitals can’t register, and some numbers are bought by scalpers, causing tension in registration. In some hospitals, there is no registration, and in some cases, the number is bought by scalpers, which makes the registration tight. I counted that before coming to my clinic, friends consulted all of our counterparts in Shanghai, and generally would not tell me who I had seen, and once my opinion did not agree with the doctor in front of me, I would immediately be told who I had seen. It’s a real painful ordeal for the patient. Why are there so many small lung nodules today? There are two main reasons. One is that China’s society and economy have developed and more people are in a position to have regular medical checkups, so there seem to be more small lung nodules than before. The second is that today’s detection technology is high, even chest films are digital chest films, the resolution is much higher than ordinary flat films, and there is also image post-processing technology. More than that, the popularity of CT scanners, especially spiral CT, especially the use and popularity of multi-row spiral CT, has led to a much higher detection rate of small pulmonary nodules, especially those under 5 mm. Of course, there are other reasons, that is, the “production” of small lung nodules has increased, people, close to nature, close contact with certain animals and so on, the chance of infection increased; environmental pollution, toxic and harmful gases, etc.; coupled with the abuse of antibacterial drugs; and immune deficiency or immunosuppressive diseases increased, the formation of small nodules in the lung up. That’s why almost all of those who have come to me in recent years are such small lung nodules with a maximum diameter of less than 3cm, and lately I have found more small nodules of about 3mm! Another situation is that the medical environment has changed and the level of detection of small lung nodules by diagnostic imaging doctors has increased. What is the best way to deal with these small lung nodules? Personally, I think it should be like this, if the imaging data on the malignant manifestation of more, there are indications for surgery should be grasping surgical treatment. If the nodules are benign or malignant, regular follow-up is recommended; if they are benign, follow up once a year below 3cm. If 3cm~5cm can be followed up in 6~9 months, it can also be treated surgically, because the psychological burden of the patient is still heavy during the follow-up, and it is actually still a comprehensive torture. 5cm or more should be treated urgently (this would be out of the scope of this study). This is my opinion for your reference, but the key is how to determine the biological behavior of small pulmonary nodules? In other words, what is the basis for determining its benignity or malignancy? First of all, it is important to pay attention to the CT examination method and the handling of the workstation after the scan, which I have already emphasized in the relevant article and will not repeat here. The purpose of the processing is to show the signs that are valuable for qualitative diagnosis from the best perspective, so that after doing so, the image analysis will be more certain. The reason is that the reliability of the data is low. The reason is that the reliability of the data is low! I always have an uneasy feeling. Many units do not pay enough attention to CT scanning technology, and all patients are scanned in the same way, so when reading and analyzing the film, you will feel that the examination technology is not in place and you are not at ease! What is important in the scanning technique is the layer thickness of the scan, which is the width of the X-ray beam in the Z-axis, and the general principle of this thickness is to be less than half of the smallest diameter of the pulmonary nodule! Of course now the CT scanner, at the end of the scan, you can adjust the layer thickness of the image through the computer, as a patient you should be clear that the so-called check in place and image post-processing are to take up limited resources, especially the doctor’s time, image post-processing are after work computer can be empty, the hard disk to be able to use, so my graduate students generally use noon and evening to do these treatments. The films are all gone now in Shanghai, and it turns out that there are films, but only one film has to be loaded with so many images, so the images on the film are small, and I suggest that the key areas should be enlarged and processed when the film is taken, but despite this, we still have difficulty in doing effective analysis on nodules of less than 5mm, which is a great pity, so sometimes we have to suggest another review at our hospital to be able to It is unfortunate that we sometimes have to recommend another review at our hospital to be able to see the images more confidently. There are many patients who always want a film after a CT scan, not realizing that now this film has no diagnostic value! In fact, if the phone has a good camera function, you can take a picture directly in the phone and show it to the consulting doctor at any time. The CT images scanned to meet the basic technical conditions are good for carefully distinguishing some signs and analyzing the benignity and malignancy to feel secure in your heart. For small lung nodules (maximum diameter of 5 mm or less) MRI can not help because of the imaging principle; PETCT scan will not be more valuable diagnostic information than CT, of course, if you have the conditions, PETCT can be done because it is a whole body scan, there may be additional findings in other parts of the lung, which can help comprehensive thinking.