Lung Cancer Screening with Low-Dose Chest CT: Current Issues

Abstract

C om pute d tom ogra phy offers m a ny advanta ges over routine radiogra phs in screening for lung cancer, and it is cle a r tha t low-dose spira l C T scre e ning ca n m ore fre que ntly find conside ra bly sm a lle r lung ca nce rs tha n pre vious de te ction tools. R e ce ntly, inve stiga tors ha ve pe rform e d low-dose spira l C T scanning for scre ening of lung cancer, and have suggested that C T screening can depict lung cancers at smaller sizes and at earlier stages. W ith te chnologica l a dvances in spira l C T scanners, the de tection rate of sm all nonca lcified pulm onary nodules ha s m a rke dly incre a se d, with highe r ra te s note d with thinne r collim a tion of C T sca nning. U nfortuna te ly, the m a jority of the se ha ve prove d to be be nign, i.e . fa lse positive re sults. If, e ve n in part, C T fe a ture s could be found to pre dict be nign nodule s without follow-up, the false -positive ra te would be reduced, and conse que ntly, the cost, em otional stress, radiation dose, m orbidity and m orta lity a ssocia te d w ith inte rve ntiona l proce dure s would also be reduced. There have been several studies trying to establish reliable C T features for benign lesions in sm a ll pulm ona ry nodule s a nd to de te rm ine the ir outcom e . Although the se e fforts ha ve not com ple te ly resolved the issue of false positive results, it is expected that lessons will be learnt on how to manage these small nodules through e xperie nce with scre ening in the nea r future. Because pulmonary nodules on C T are much more common in Korea than in western countries, the management algorithm for screening C T-detected nodules should be m odified a ccording to diffe rent circum stances, with conse nsus am ong related physicians and radiologists. In a ddition, to e nha nce pa tient care and a void m isunde rsta nding of inhe re nt lim ita tion of C T scre e ning by the screening subjects, physicians, hospital managers as well a s radiologists should provide proper inform a tion re garding C T screening to the screenees.

Variation in Utilization of Computed Tomography Imaging at Tertiary Pediatric Hospitals

“…4,5 Finally, false-positive results from CT scanning can lead to increased patient morbidity. 6,7 Several reports examining pediatric CT scanning for particular indications, including head trauma and appendicitis, suggest that variability across hospitals exists and is in part due to differences in institutional practice, availability of CT, and lack of protocol-driven decision-making on when to image. [8][9][10][11][12] An assessment of the variability in the rate of CT scanning inclusive of all body regions and indications is useful to evaluate if differences in CT imaging rates are due to institutional factors, such as case-mix or hospital volume.…”

Overuse of CT and MRI in paediatric emergency departments

“…25 CT overuse may also result in prolonged length of stay due to additional evaluation of incidental findings, 27 and false-positive results. 28 MRI has the obvious benefit of avoiding radiation exposure, but the disadvantages of higher cost, less availability than CT and also MRI may not be tolerated in young children (especially under age 5). 29 Although, Feed and swaddle MRI is feasible without sedation up to 6 months of age.…”

Radiological Report of Pilot Study for the Korean Lung Cancer Screening (K-LUCAS) Project: Feasibility of Implementing Lung Imaging Reporting and Data System

“…According to the 2015 World Health Organization database, a total of 40847 tuberculosis cases were recorded in Korea, where the incidence of tuberculosis of 80 per 100000 individuals is much higher than that in the U.S. (3.2 per 100000) ( 7 ). Because of the high prevalence of tuberculosis in Korea, pulmonary nodules found on screening are much more in numbers compared with those found in Western populations ( 8 ). In this pilot study, 11.7% participants were diagnosed with old pulmonary tuberculosis using LDCT.…”