Jessica DuBois-Maahs

CHICAGO - Widespread adoption of low-dose CT for lung screening may be more effective at catching early-stage lung cancer.

Lung cancers are aggressive, and treatment at an advanced stage can be challenging. While diagnosing lung cancer early is considered the key to effective treatment, the high cost of screening means fewer patients are eligible for early detection. For high-risk patients, low-dose CT scans may play a role in making screenings more accessible, said Caroline Chiles, speaking at a session at RSNA 2013.

“I think that we are on the cusp of changing screening for lung cancer,” Chiles said. “We have enough evidence to show that LDCT [for] lung cancer screening in 2013 is a good starting point,” Chiles said. “It is a preventative health intervention that is cost effective.”

Out of the 43.4 million current smokers and 47.3 million former smokers in the U.S., many are not eligible for lung cancer screening under current programs, said Chiles, a professor in the Department of Radiology at Wake Forest University Baptist Medical Center. She said this eligibility conundrum stems from the current procedure's high cost for late-stage lung cancer screening - $142,750 per patient. Low-Dose CT scans, on the other hand, are estimated to cost about $68,000 per quality-adjusted life year.

Early-stage lung cancer accounted for about half of the cancers detected by CT scans in a two-year study period, according to a U.S. study funded in part by the National Lung Screening Trial. In contrast, only 24 percent of the cancers detected by chest X-rays were early stage. “The better we understand lung cancer screening, the more we can estimate its costs,” she said.

But to identify more early-stage, localized lung cancer, the current eligibility requirements for lung cancer screening need to change, Chiles said. The odds of surviving lung cancer are better if the cancer is detected earlier, before it has spread to lymph nodes or distant sites. In 2013, 57 percent of patients screened were found to have late stage lung cancer, which revealed a systematic screening problem.

“The goal of lung cancer screening is to shift that 57 percent of patients to a more localized version of the disease,” Chiles said. “We want to close the gap between cases diagnosed and deaths.”

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Low-dose CT for Lung Cancer Screening Should Be Expanded

CHICAGO - National registries may be the new frontier in recording and reporting radiation dosage, as facilities sign on to compare and make improvements.

Kalpana Kanal, PhD, medical physicist at the University of Washington, explained at RSNA 2013 the significant role national dosage comparisons are playing in the radiology field. These data warehouses are helping imaging professionals track radiation dosage amounts. Without a national dosage average, comparing a facility's dosage to the 801 total facilities and 6.7 million exams using a national registry may help improve a patient's standard of care.

As medical professionals are concerned about how their respective dosage amount compares to the national average, registries can naturally allow for a detailed comparison. “It sets some benchmark on what would be the national level of common exam types,” Kanal said. “It's comparing your median values to that of other facilities.”

Kanal focused her attention on the American College of Radiology's National Radiology Data Registry (NRDR), which houses data from several other groups including the Colonography Registry (CT), the Dose Index Registry (DIR), and the General Radiology Improvement Database (GRID).

How do registries such as these work? A medical facility signs a participation agreement, registers on the national registry's website, downloads software to transmit their dosage data and configures scanners to transmit data, according to Kanal. Besides the initial setup, no personnel is required to be a part of the system.

The intention behind registries is a cyclic, data-driven improvement process. Each facility and physician submits their dosage data, and they receive periodic national benchmarking reports, allowing them to analyze their results and develop and implement a possible improvement plan. Kanal said tracking certain types of data can “empower facilities,” as the guiding principle behind these systems is allowing professionals to monitor and track their facility’s improvements.

But even with access to a litany of national averages, facilities are still encountering some challenges. Registries do not collect individual dosage amounts or a patient's identifiable information, making national comparability difficult among patients that vary in size. To alleviate some of the comparability problem, Kanal said physicians should make sure their dosage amounts are accurately recorded. She said mapping out the dosage amounts and frequency allotted for each patient will help facilities more accurately track data.

For registry participants, a semi-annual feedback report is uploaded every six months and is available to all its users. In the January through June 2013 report, for example, 431 facilities received feedback on their adult patients and 410 on their pediatric patients. The report breaks the data down in six vertical columns for easy reference.  Users can also view the nation's top 20 exams, allowing the viewer to see the median Computed Tomography Dose Index (CTDI) volume, and determine where the user should improve the dosage value. “The [registries are] very established,” Kanal said. “In general, they [are] doing very well.”

CHICAGO - National registries are allowing facilities to monitor and improve radiation dose.

Dose Registries Gaining Ground

Slideshows

From digital broadband MR to internet-based image sharing platform, several exciting new products were on display at RSNA 2013. Here’s a sampling. 

Author | Jessica DuBois-Maahs

Articles

Low-dose CT for Lung Cancer Screening Should Be Expanded

Dose Registries Gaining Ground

RSNA 2013 Slideshow: On the Exhibit Floor