News | Lung Imaging | July 17, 2020

Improving Lung Cancer CT Screening Performance in Real-world Settings

Focusing on lung cancer screening subjects less likely to remain in a program -- those with negative low-dose CT exams and those who still smoke — improves that program's cost-effectiveness, while maximizing societal benefits

"Our study demonstrates that a real-world lung cancer screening can perform similar to randomized controlled trials in regard to important performance metrics," the UPenn authors of this AJR article concluded. Image courtesy of American Journal of Roentgenology (AJR)

"Our study demonstrates that a real-world lung cancer screening can perform similar to randomized controlled trials in regard to important performance metrics," the UPenn authors of this AJR article concluded. Image courtesy of American Journal of Roentgenology (AJR)

July 17, 2020 — An online first accepted manuscript published in ARRS' American Journal of Roentgenology (AJR) finds that focusing on lung cancer screening (LCS) subjects less likely to remain in the program — those with negative low-dose computed tomography (LDCT) exams and those who still smoke — can improve that program's cost-effectiveness and maximize its societal benefits.

For people with a long history of smoking, LDCT LCS has been shown to decrease mortality; however, adherence to an LCS program remains significantly lower than in randomized controlled trials.

To assess real-world LDCT LCS performance and factors predictive of adherence to recommendations, three radiologists from the University of Pennsylvania's Perelman School of Medicine retrospectively recorded patient demographics, smoking history and behavior changes, Lung-RADS category, PPV and NPV, and adherence to screening recommendations for 260 subjects returning for follow-up LDCT from 2014 to 2019.

Forty-three subjects (16.5%) had positive scans, of which 28/260 (10.8%) were Lung-RADS category 3, 8/260 (3.1%) were 4A, 6/260 (2.3%) were 4B, and 2/260 (0.8%) were 4X.

Four subjects were diagnosed with cancer: 3 lung, 1 metastatic melanoma.

Meanwhile, 143/260 (55%) subjects were current smokers at baseline, and 121/260 (46.5%) were current smokers during the last round of LCS.

Both LCS sensitivity and NPV were 100%, while specificity was 84.8% and PPV was 9.3%.

Overall adherence was 43%, though it increased progressively the higher the Lung-RADS category. Additionally, adherence was higher in former vs. current smokers (50% vs. 36.2%; p = 0.002). Ultimately, there were only two significant independent predictors of adherence: having smoked previously and a positive (? 3) Lung-RADS category.

"Our study demonstrates that a real-world LCS can perform similar to randomized controlled trials in regard to important performance metrics," concluded first author Eduardo J. Mortani Barbosa, Jr.

Acknowledging that an economic incentive, such as an insurance premium reduction, could improve LCS adherence, Barbosa, Jr. et al. added that multimodal communication (i.e., face-to-face discussions with radiologists, letters from referring providers, reminders via electronic health records) should be investigated and incentivized.

"Such communications should emphasize that a negative LCS exam does not confer immunity to future lung cancer development," the authors of this AJR article noted, "and that continued participation in LCS, combined with smoking cessation, is essential to accrue the maximum benefits of mortality reduction amongst persons with substantial smoking history."

For more information: www.arrs.org

Related Content

PSMA PET/CT accurately detects recurrent prostate cancer in 67-year-old man. 18F-DCFPyL-PSMA PET/CT shows extensive, intensely PSMA-avid local recurrence in prostate (bottom row; solid arrow) in keeping with the known tumor recurrence in the prostate. Right: PET shows extensive, intensely PSMA-avid local recurrence in prostate (top row; solid arrow) and a solitary bone metastasis in left rib 2 (bottom row; dotted arrow). Image courtesy of Ur Metser, et al.

PSMA PET/CT accurately detects recurrent prostate cancer in 67-year-old man. 18F-DCFPyL-PSMA PET/CT shows extensive, intensely PSMA-avid local recurrence in prostate (bottom row; solid arrow) in keeping with the known tumor recurrence in the prostate. Right: PET shows extensive, intensely PSMA-avid local recurrence in prostate (top row; solid arrow) and a solitary bone metastasis in left rib 2 (bottom row; dotted arrow). Image courtesy of Ur Metser, et al.

News | PET-CT | July 16, 2020
July 16, 2020 — New research confirms the high impact of...
Total-body dynamic 18F-FDG PET imaging with the uEXPLORER scanner allows us to monitor the spatiotemporal distribution of glucose concentration in metastatic tumors in the entire body (a). As compared to a typical clinical standardized uptake value image (b), the parametric image of FDG influx rate (Ki) can achieve higher lesion-to-background (e.g., the liver) contrast. In addition to glucose metabolism imaging by Ki, total-body dynamic PET also enables multiparametric characterization of tumors and organs

Total-body dynamic 18F-FDG PET imaging with the uEXPLORER scanner allows us to monitor the spatiotemporal distribution of glucose concentration in metastatic tumors in the entire body (a). As compared to a typical clinical standardized uptake value image (b), the parametric image of FDG influx rate (Ki) can achieve higher lesion-to-background (e.g., the liver) contrast. In addition to glucose metabolism imaging by Ki, total-body dynamic PET also enables multiparametric characterization of tumors and organs using additional physiologically important parameters, for example, glucose transport rate K1 (d), across the entire body. Image courtesy of G.B. Wang, M. Parikh, L. Nardo, et al., University of California Davis, Calif.

News | PET Imaging | July 16, 2020
July 16, 2020 — Results from the first...
Breathe Easy Bus from CHI Memorial in Chattanooga, TN. Image courtesy of CHI Memorial in Chattanooga, TN

Breathe Easy Bus from CHI Memorial in Chattanooga, TN. Image courtesy of CHI Memorial in Chattanooga, TN

News | Lung Imaging | July 15, 2020
June 15, 2020 — A mobile platform for lung cancer screening
The Mindways Solid phantom with volume of interest in the quality assurance phantom (red circles, left side). A participant's noncontrast-enhanced axial CT (right side) with volume of interest (yellow circles) in the trabecular bone compartment of three vertebrae for bone mineral density measurements. Image courtesy of Radiological Society of North America

The Mindways Solid phantom with volume of interest in the quality assurance phantom (red circles, left side). A participant's noncontrast-enhanced axial CT (right side) with volume of interest (yellow circles) in the trabecular bone compartment of three vertebrae for bone mineral density measurements. Image courtesy of Radiological Society of North America

News | Cardiac Imaging | July 15, 2020
July 15, 2020 — ...
Infervision's newly FDA approved CT lung AI application sets a new standard
News | Artificial Intelligence | July 10, 2020
July 10, 2020 — Infervision announced U.S.
Artificial intelligence (AI)-assisted software was used to identify inflammatory tissues in lung and automatically segment inflammatory lesions. Three-dimensional image shows regions of COVID-19 pneumonia in lung through AI postprocessing. Image courtesy of the American Journal of Roentgenology (AJR)

Artificial intelligence (AI)-assisted software was used to identify inflammatory tissues in lung and automatically segment inflammatory lesions. Three-dimensional image shows regions of COVID-19 pneumonia in lung through AI postprocessing. Image courtesy of the American Journal of Roentgenology (AJR)

News | Coronavirus (COVID-19) | July 10, 2020
July 10, 2020 — An open-access Ameri
A lung CT of a COVID-19 patient, showing ground-glass opacities in the lung from COVID pneumonia. Image courtesy of John Kim.

A lung CT of a COVID-19 patient, showing ground-glass opacities in the lung from COVID pneumonia. Image courtesy of John Kim.

News | Coronavirus (COVID-19) | July 09, 2020
July 9, 2020 — With increased lung CT exam paradigms being used in the current...
World's largest radiation oncology meeting will offer full conference on interactive platform October 25-28, 2020
News | ASTRO | July 09, 2020
July 9, 2020 — Registration opens today for the American Society for Radiation Oncology's (...
Simulation finds starting at age 30 with MRI and mammography to be the preferred strategy; starting at 25 prevented marginally more deaths, but with more testing and emotional stress

Getty Images

News | Breast Imaging | July 09, 2020
July 9, 2020 — Chest radiation is used to treat children with Hodgkin and non-Hodgkin lymphoma as well as lung metast