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Many of our patients either qualify for CT-based lung cancer screening or are incidentally found to harbor small lung nodules on diagnostic workup. To state it mildly, it can be a challenge to know what to do with these. A new study in Radiology looks at the radiographic features of small (< 4 mm) pulmonary nodules among patients who went on to develop lung cancer despite screening “negative.” Features that were most discriminative for future lung cancer included: emphysematous changes, nodule attachment to a vessel, location in the upper lobes, a poor border definition, and concave shape. We hope this will be helpful when screening for malignant potential among our innumerable patients with “indeterminate” lung nodules.