This session will provide an overview of guideline recommendations for pulmonary nodule management (including the new 2017 Fleischner Society guidelines), the limited clinical data upon which guidelines are based, and strategies for optimizing pulmonary nodule management given the frequent uncertainty in optimal management approach. I will review the data for pulmonary nodule management recommendations and demonstrate the overall lack of evidence upon which pulmonary nodule guidelines are based. I will discuss strategies for managing the uncertainty that exists in pulmonary nodule management, including shared decision-making, local systems resource availability, and dedicated pulmonary nodule clinics. I will review the data for how these strategies may be implemented to improve pulmonary nodule outcomes.