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制定再版物联网辅助评估和管理肺结节中国专家共识，目的为在原基础上通过使“复杂问题简单化、简单问题数字化、数字问题程序化，程序问题体系化”的策略，将肺结节诊治中国共识和亚太指南融入“AI肺结节管理程序”(PNapp 5A)和初评与研判二流程体系，将手工业作坊式诊疗模式提升为达到国家和国际标准的物联网流水作业工程。(1)初评流程，由初诊医师和初评专家执行PNapp 5A的1A~3A程序。1A(Ask，询问)：录入吸烟史、肿瘤家族史、职业粉尘接触史和慢性呼吸系统疾病病史等；2A(Assessment，评估)：应用影像学评估肺结节外观、内涵的良恶性特点和随访变化；3A(Advice，建议)：完成鉴别诊断所需肿瘤标志物、真菌和结核等常规检查。其后PNapp 5A自动反馈智能评估的肺结节恶性风险级别(低、中、高)，然后由初诊医师管理低级风险患者；对中、高度风险患者则建议AI和循环异常细胞等个体化检查，供初评和研判专家会诊参考；高度风险患者则需进入下述程序。(2)研判流程，由研判专家执行PNapp 5A的4A和5A程序。4A(Arrangement，安排)：有活检适应证者，首先顺序选择支气管镜引导(包括支气管内超声或磁导航支气管镜等)的非手术活检；不合适支气管镜检查或者有转移可能者，可考虑经胸壁针吸活检术。不能除外感染者，可考虑经验性抗生素治疗1~2周后复查；肺结节10 mm难以确诊者应考虑为难定性肺结节，建议邀请更有经验的研判专家与AI系统交流互动(人机多学科会诊)会诊提供诊疗意见。5A(Assistance，辅助)：根据组织病理、分子病理和分期、实施术后常规管理，也可参考AI、循环异常细胞和表观遗传等个体化信息，制定个体化防治复发和转移方案，最终实现“名医治未病，大医惠众生”愿景。“,”This study aimed to re-develop an expert consensus on applying the Internet of Things (IoT) as an assistive technology for the assessment and management of pulmonary nodules in China, through a strategy of “ simplifying complex issues, quantifying simple issues, programming quantified issues, and systematizing programmed issues” . The system integrates the Chinese consensus and the Asia-Pacific guidelines into the Pulmonary Nodules Intelligent Assessment and Management Assistant Application (PNapp 5A) and the AI system.It will assist doctors in two processes (the preliminary assessment and clinical judgment of pulmonary nodules), and improve the current handcraft model onto a national and international standardized IoT industrial level.In the initial evaluation (Process 1), the doctors and the experts carry out the consensus guidelines at the first consultation in Step 1A to 3A of PNapp 5A.The 1A, “ Asking” , requires the input of information, including smoking history, family history of tumors, occupational dust exposure history, chronic respiratory disease history, etc.The 2A, “ Assessment” , refers to imaging assessment of the appearance and connotation of pulmonary nodules, as well as their benign and malignant characteristics, and the follow-up observations.In 3A or “ Advice” , upon completion of the routine tests required for PN identification and diagnosis, such as assessment of tumor markers, fungal infections, and tuberculosis, intelligent feedback from PNapp 5A is applied automatically.The cases are assessed and classified into categories of different risks of malignancy: low-, medium-, or high-risk.The doctors manage low-risk patients at the first consultation.In contrast, the experts control medium- and high-risk cases at the initial evaluation, and carry out personalized tests, such as AI analysis and circulating abnormal cells detection, as alternatives for the patients and the consultants.High-risk cases are subjected to the following steps.In the clinical judgment (Process 2), each patient is allocated to an expert to execute the 4A and 5A in PNapp.The 4A, “ Arrangement” , indicates differentiated interventions: for cases with biopsy indications, a non-surgical biopsy such as bronchoscopy, endobronchial ultrasound, or electromagnetic navigation bronchoscopy, should be selected, according to local conditions; for those unsuitable for biopsies and having possible metastasis, a transthoracic needle aspiration is recommended; for those suspected of infections, antibiotic treatment followed by re-examination one to two weeks later should be considered; if the pulmonary nodules measure <10 mm in diameter, follow-ups should be arranged according to the guidelines; if the pulmonary nodules measure ≥10 mm in diameter and are still not diagnosed (difficult indeterminate nodules), a superior expert should be involved, or consultation should be arranged with the AI system (human-machine multidisciplinary consultation, MDT). The 5A, “ Assistance” , refers to the routine postoperative management based on the pathological results and staging, or a personalized management plan considering AI analysis, circulating abnormal cells, and epigenetics, to prevent recurrence and control metastasis.This consensus is expected to develop the vision of “ the famous treat the pro, the genius help the myriads” .