International sharing of best practices may improve quantitative imaging quality for low-dose CT for small nodules.
By James L. Mulshine, MD
Posted: February 2018
It is heartening to learn of the decision by thought leaders to begin the process of initiating European implementation of lung cancer screening.1 With this effort, the opportunity exists to off er potentially life-saving cancer detection services to cohorts that are at the highest risk for developing lung cancer. In addition, because so many European countries have already been conducting CT screening research efforts, there are many positive models of screening success to inform the process of optimizing screening across Europe. In addition, many European screening sites have also implemented high quality tobacco-cessation programs as an integral part of their tobacco health efforts. Success from these complementary efforts can serve as a template to be scaled, as required, to ensure that maximal smoking-cessation benefit is achieved in conjunction with CT screening implementation.
One example of a screening resource that may be shared internationally to address quality issues with quantitative imaging in the screening setting is the Quantitative Imaging Biomarker Alliance Small Pulmonary Nodule Profile.2 This is a document that describes a process to acquire a low-dose CT screening image that contains sufficient image quality to allow reliable measurement of the volume of pulmonary nodules of interest. Th is image-quality process employs an inexpensive precision-engineered phantom to test the image-acquisition process of the CT imaging platform used for the screening study. Th e acquired phantom image is analyzed by an automated cloud-based analysis resource that, within 5 minutes, completes a targeted analysis to determine if the imaging process is sufficiently robust to allow reliable measurement of relevant pulmonary nodules.
Discussions about this and other opportunities for international collaboration with lung cancer screening implementation were discussed at the recent IASLC 18th World Conference on Lung Cancer in Yokohama, Japan. The new European Union position statement on lung cancer screening and the expected outcome report from the Dutch-Belgian Lung Cancer Screening trial (NELSON) study will undoubtedly frame further important discussions regarding lung cancer screening to be covered at the IASLC 19th World Conference on Lung Cancer, in Toronto, Canada. ✦
About the Author: Dr. Mulshine is Acting Dean of the Graduate College and Professor in the Department of Internal Medicine, Rush Medical College, and Vice President for Research at Rush University Medical Center.
1. Oudkerk MD, Deveraij A, Vliegenthart R, et al. EU Position Statement on Lung C ancer Screening. Lancet Oncol. 2017;18(12):e754- e766.
2. Rydzak CE, Armato SG, Avila RS, et al. Quality assurance and quantitative imaging biomarkers in low-dose CT lung cancer screening. Br J Radiol. 2017 Oct 27:20170401. doi: 10.1259/ bjr.20170401. [Epub ahead of print] PMID:28830225.