# Fleischner 2017 incidental solid nodule

Fleischner 2017

Status: LIVE
Price: $0.005 USDC
`GET /api/calc/fleischner_2017`
HTML: https://magentlab.com/docs/fleischner-2017
Markdown: https://magentlab.com/docs/fleischner-2017.md

Not a medical device. Not a diagnosis, dose, or listing recommendation.

## What it computes

Apply the MacMahon 2017 Fleischner Society table for a single solid noncalcified incidental pulmonary nodule and return the published follow-up recommendation from average diameter and caller-assigned high versus low clinical risk.

## When to use

When an agent already has average diameter in millimetres for one solid incidental nodule and a caller-assigned high_risk flag, and needs the 2017 Fleischner solid-solitary row. magent does not read CT. Not Lung-RADS screening. Not subsolid or multiple nodules.

## When not to use

- Not a medical device and not a diagnosis. Not an imaging or biopsy order.
- MacMahon 2017 table for incidental solid solitary noncalcified nodules only. Not subsolid (ground-glass or part-solid) and not multiple nodules.
- Not lung-cancer screening and not Lung-RADS. magent does not measure the nodule or read CT; size_mm is caller-supplied average diameter.
- high_risk is assigned by the caller (for example heavy smoking or other published high-risk features). magent does not compute a risk model.
- Size 1-30 mm is an implementation clamp for a nodule (not a mass). The 2017 guidelines address adults 35 years or older; magent does not take age.

## Formula

```
Single solid noncalcified incidental nodule (MacMahon 2017): size_mm < 6 → no_routine_followup if not high_risk else optional_ct_12_months; 6 <= size_mm <= 8 → ct_6_12_then_consider_18_24 if not high_risk else ct_6_12_then_18_24; size_mm > 8 → consider_ct_3_pet_or_tissue (low or high risk). Not subsolid. Not multiple nodules. Not Lung-RADS screening. magent does not read CT.
```

## Citation

[Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017](https://doi.org/10.1148/radiol.2017161659)
MacMahon H, Naidich DP, Goo JM, Lee KS, Leung ANC, Rajendran K, Travis WD, Bankier AA
Radiology. 2017;284(1):228-243
DOI: [10.1148/radiol.2017161659](https://doi.org/10.1148/radiol.2017161659)

## Worked example

### 5 mm solid nodule, not high risk

Given: `high_risk=false, size_mm=5`

1. size_mm 5 is < 6 → size_band <6
2. high_risk is false → recommendation is no_routine_followup


## Also searched as

- Fleischner 2017
- Fleischner Society nodule guidelines
- incidental pulmonary nodule CT
- MacMahon 2017 Fleischner
- solid nodule follow-up
- Fleischner solid nodule table
- incidental solid pulmonary nodule

## Parameters

- `size_mm` (number, required): Average diameter in millimetres of a single solid noncalcified incidental nodule (1-30). MacMahon 2017 bands: <6, 6-8, and >8. magent does not measure the nodule or read CT.
- `high_risk` (boolean, required): High versus low clinical risk as assigned by the caller (for example heavy smoking or other published high-risk features in MacMahon 2017). true or false. magent does not compute a risk model.

## Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

Method: `POST /api/calc/fleischner_2017`
Max items: 25
Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic)
Status: PREVIEW

- 1 to 25 items. Each item uses the same keys as the GET query parameters.
- POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
- The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
- HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
- Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
- x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request:

```json
{
  "items": [
    {
      "high_risk": "false",
      "size_mm": "5"
    },
    {
      "high_risk": "false",
      "size_mm": "5"
    }
  ]
}
```

Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/fleischner-2017

Example 200:

```json
{
  "count": 2,
  "path": "/api/calc/fleischner_2017",
  "items": [
    {
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "MacMahon H, Naidich DP, Goo JM, Lee KS, Leung ANC, Rajendran K, Travis WD, Bankier AA",
        "doi": "10.1148/radiol.2017161659",
        "id": "macmahon-2017",
        "pmid": "28240562",
        "source": "Radiology. 2017;284(1):228-243",
        "title": "Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017"
      },
      "formula": "fleischner_2017",
      "formula_expression": "Single solid noncalcified incidental nodule (MacMahon 2017): size_mm < 6 → no_routine_followup if not high_risk else optional_ct_12_months; 6 <= size_mm <= 8 → ct_6_12_then_consider_18_24 if not high_risk else ct_6_12_then_18_24; size_mm > 8 → consider_ct_3_pet_or_tissue (low or high risk). Not subsolid. Not multiple nodules. Not Lung-RADS screening. magent does not read CT.",
      "high_risk": false,
      "criteria": [
        {
          "value": 5.0,
          "factor": "size_lt_6",
          "met": true
        },
        {
          "value": 5.0,
          "factor": "size_6_to_8",
          "met": false
        },
        {
          "value": 5.0,
          "factor": "size_gt_8",
          "met": false
        },
        {
          "factor": "high_risk",
          "met": false
        }
      ],
      "recommendation": "no_routine_followup",
      "size_band": "<6"
    },
    {
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "MacMahon H, Naidich DP, Goo JM, Lee KS, Leung ANC, Rajendran K, Travis WD, Bankier AA",
        "doi": "10.1148/radiol.2017161659",
        "id": "macmahon-2017",
        "pmid": "28240562",
        "source": "Radiology. 2017;284(1):228-243",
        "title": "Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017"
      },
      "formula": "fleischner_2017",
      "formula_expression": "Single solid noncalcified incidental nodule (MacMahon 2017): size_mm < 6 → no_routine_followup if not high_risk else optional_ct_12_months; 6 <= size_mm <= 8 → ct_6_12_then_consider_18_24 if not high_risk else ct_6_12_then_18_24; size_mm > 8 → consider_ct_3_pet_or_tissue (low or high risk). Not subsolid. Not multiple nodules. Not Lung-RADS screening. magent does not read CT.",
      "high_risk": false,
      "criteria": [
        {
          "value": 5.0,
          "factor": "size_lt_6",
          "met": true
        },
        {
          "value": 5.0,
          "factor": "size_6_to_8",
          "met": false
        },
        {
          "value": 5.0,
          "factor": "size_gt_8",
          "met": false
        },
        {
          "factor": "high_risk",
          "met": false
        }
      ],
      "recommendation": "no_routine_followup",
      "size_band": "<6"
    }
  ]
}
```

## Response fields

- `formula` (string): fleischner_2017
- `formula_expression` (string): MacMahon 2017 single solid incidental nodule follow-up table
- `size_band` (string): <6, 6-8, or >8 from size_mm. Not a measurement of the nodule.
- `high_risk` (boolean): Echo of the caller-assigned high_risk flag
- `recommendation` (string): no_routine_followup, optional_ct_12_months, ct_6_12_then_consider_18_24, ct_6_12_then_18_24, or consider_ct_3_pet_or_tissue. Not a diagnosis or imaging order.
- `criteria` (array): Tree rows for size_lt_6, size_6_to_8, size_gt_8 (with size_mm value) and high_risk
- `citation` (object): MacMahon 2017 Radiology Fleischner Society citation
- `disclaimer` (string): Not-a-device notice

## Example JSON

Frozen fixture. Not a live lookup.

```json
{
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "MacMahon H, Naidich DP, Goo JM, Lee KS, Leung ANC, Rajendran K, Travis WD, Bankier AA",
    "doi": "10.1148/radiol.2017161659",
    "id": "macmahon-2017",
    "pmid": "28240562",
    "source": "Radiology. 2017;284(1):228-243",
    "title": "Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017"
  },
  "formula": "fleischner_2017",
  "formula_expression": "Single solid noncalcified incidental nodule (MacMahon 2017): size_mm < 6 → no_routine_followup if not high_risk else optional_ct_12_months; 6 <= size_mm <= 8 → ct_6_12_then_consider_18_24 if not high_risk else ct_6_12_then_18_24; size_mm > 8 → consider_ct_3_pet_or_tissue (low or high risk). Not subsolid. Not multiple nodules. Not Lung-RADS screening. magent does not read CT.",
  "high_risk": false,
  "criteria": [
    {
      "value": 5.0,
      "factor": "size_lt_6",
      "met": true
    },
    {
      "value": 5.0,
      "factor": "size_6_to_8",
      "met": false
    },
    {
      "value": 5.0,
      "factor": "size_gt_8",
      "met": false
    },
    {
      "factor": "high_risk",
      "met": false
    }
  ],
  "recommendation": "no_routine_followup",
  "size_band": "<6"
}
```

## Errors

- HTTP 400 `invalid_fleischner_mm`: size_mm must be a number from 1 to 30 (MacMahon 2017 solid nodule average diameter). Returned before settlement; you are not charged.
- HTTP 400 `invalid_flag`: boolean clinical flags must be true or false Returned before settlement; you are not charged.
- HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
- HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
- HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged.

Shared HTTP 402 and 503: https://magentlab.com/docs/payments

## Related tools

- [Mayo SPN](https://magentlab.com/docs/mayo-spn) — Compute the Swensen 1997 Mayo Clinic logistic probability of malignancy for a radiologically indeterminate solitary pulmonary nodule from age, smoking, remote extrathoracic cancer, diameter, spiculation, and upper-lobe location.

## Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s.

- GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall).
- HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote.
- Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering.
- Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional.
- Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402.

- offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront.
- offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization.

- not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search.

Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers).

Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments

Stdio MCP (one process per host): https://magentlab.com/docs/mcp

## Guarantees

- HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON.
- exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
- HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
- Execution is timeout-bounded and concurrency-capped.
- Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.