News | June 07, 2013

Lung Cancer Screening Study Demonstrates Need for Acceleration of Chest CT Scan Comparison

Current PACS systems not well-equipped to support radiologists for high-volume comparisons of deformable anatomy in chest CT scans

June 7, 2013 — Blackford Analysis announced that recent studies on the use of low-dose computed tomography (CT) scans to screen for lung cancer present a strong case for the ability to accelerate comparative analysis of CT scans.

Recently published in the Journal of the American College of Radiology [1], initial data from a free, high volume, low-dose CT lung cancer screening program at the Lahey Hospital and Medical Center showed that free screening can be profitable for the healthcare provider.

This study follows the National Lung Cancer Screening Trial [2], which showed in 2011 that participants at high risk of developing lung cancer screened with low-dose CT had a 20 percent lower risk of dying from the condition than those screened with chest X-rays. Analysis of the initial round of screening published this year in the New England Journal of Medicine [3] showed low-dose CT diagnosed more early-stage lung cancers than chest X-ray and a similar number of late-stage cancers, resulting in increased follow-up diagnostic and therapeutic procedures. The American Cancer Society, the National Comprehensive Cancer Network and the American College of Chest Physicians all recently recommended low-dose CT for lung cancer screening.

However, the challenge of comparative reading of serial chest CT scans for positive lung screening findings is not currently well supported by the picture archiving and communication systems (PACS) used by radiologists. Matching lung nodule locations, which are the most common positive screening finding in low-dose chest CT studies, consumes the majority of radiologist reading time. Comparative reading of a current chest CT with one or more priors takes around 10 minutes.

“Matching lung nodule locations across studies is difficult due to different breath hold volumes in each exam,” said Ben Panter, CEO, Blackford Analysis. “The manual scrolling and synchronization of current and prior CTs in today’s PACS systems make it time-consuming for radiologists to detect changes in lung nodules in serial exams. If a national low-dose CT lung cancer screening program were implemented, this could significantly increase radiologist workload.”

Designed to be integrated into any PACS system, the Blackford software suite enables near-instant registration of volumes in current and prior tomographic scans, including those from different modalities, such as CT, magnetic resonance imaging (MRI) and positron emission tomography (PET). The Blackford suite of navigational tools provide radiologists with an average time-saving of over 50 percent when matching lung nodule location across current and prior chest CT scans.

“With the recent interest in lung cancer screening following publication of the National Lung Screening Trial in the New England Journal of Medicine, we have seen an increase in the numbers of patients requiring serial CT scans to monitor small lung nodules for potential growth,” said Matthew A. Barish M.D., FACR, clinical associate professor of radiology; director, Body Imaging; director, Body MRI; Stony Brook Medicine. “The process of manually matching each nodule across multiple studies normally requires considerable time and effort, and leaves uncertainty that each nodule has been accurately assessed. However, Blackford’s PACS integrated lung registration technology automatically matches nodule locations across studies with a single click, substantially reducing the time it takes to interpret these studies and improves reader confidence.”

With Blackford, a PACS system automatically registers each new study volume with all relevant prior study volumes for the same patient. Results are instantly available to the radiologist, enabling comparative interpretation of cross-sectional studies, such as the ability to instantly see the same location in all compared studies with a single click, or to reformat a view of one exam for like-for-like, side-by-side comparison with another.

“Using a PACS system that has been integrated with Blackford software, a radiologist has the ability to instantly match lung nodule locations across chest CTs,” said Panter. “Deformable registration is a complex process and presents a significant challenge for PACS vendors seeking to develop their own solution — Blackford solves this problem by providing a ready-made and cost-effective solution for any system.”

For more information:


1. McKee BJ, McKee AB, Flacke S, Lamb CR, Hesketh PJ, Wald C. Initial Experience With a Free, High-Volume, Low-Dose CT Lung Cancer Screening Program. Journal of the American College of Radiology. Epub 26 April 2013. doi:10.1016/j.jacr.2013.02.015

2. National Lung Screening Trial Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011;365:395-409.

3. National Lung Screening Trial Research Team. Results of Initial Low-Dose Computed Tomography Screening for Lung Cancer. N Engl J Med 2013;368:1980-91.

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