Lung Cancer Screening with Computer Aided Detection Chest Radiography: Design and Results of a Randomized, Controlled Trial

Abstract

IntroductionThe sensitivity of CT based lung cancer screening for the detection of early lung cancer is balanced by the high number of benign lung nodules identified, the unknown consequences of radiation from the test, and the potential costs of a CT based screening program. CAD chest radiography may improve the sensitivity of standard chest radiography while minimizing the risks of CT based screening.MethodsStudy subjects were age 40–75 years with 10+ pack-years of smoking and/or an additional risk for developing lung cancer. Subjects were randomized to receive a PA view chest radiograph or placebo control (went through the process of being imaged but were not imaged). Images were reviewed first without then with the assistance of CAD. Actionable nodules were reported and additional evaluation was tracked. The primary outcome was the rate of developing symptomatic advanced stage lung cancer.Results1,424 subjects were enrolled. 710 received a CAD chest radiograph, 29 of whom were found to have an actionable lung nodule on prevalence screening. Of the 15 subjects who had a chest CT performed for additional evaluation, a lung nodule was confirmed in 4, 2 of which represented lung cancer. Both of the cancers were seen by the radiologist unaided and were identified by the CAD chest radiograph. The cumulative incidence of symptomatic advanced lung cancer was 0.42 cases per 100 person-years in the control arm; there were no events in the screening arm.ConclusionsFurther evaluation is necessary to determine if CAD chest radiography has a role as a lung cancer screening tool.ClinicalTrials.gov identifier NCT01663155

The effect of computer-aided detection markers on visual search and reader performance during concurrent reading of CT colonography

“…A wide variety of CAD systems are currently utilised across a range of modalities, including mammography [1], thoracic imaging [2] and computed tomography colonography (CTC) [3,4]. In CTC, CAD has been shown to improve both readers' perpatient and per-polyp sensitivity [3][4][5].…”

Quality of Life and Healthcare Use in a Randomized Controlled Lung Cancer Screening Study

“…The results suggested that additional evaluation of CAD chest radiography was necessary to determine if it had a role in the CT lung cancer screening era. Please see the publication for additional details (3). Note that the results presented here do not overlap with the results that have been published.…”

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“…The finding of the present study was analogous with Mazzone et al (2013). 13 Sashidhar et al (2002) 14 observed the findings of emphysema in clinically undiagnosed and asymptomatic smokers and reported that chest scans and pulmonary function test may be useful in an early diagnosis of damage in smokers as well as in group of asymptomatic smokers. Eisner et al (2011) 15 reported the beneficial role of advance techniques for early detection of disease especially in chest abnormalities and indicated their advantages and disadvantages in reference to the radiation dose.…”