Tag: lung cancer screening

Better Lung Screening Strategies

Posted on by Brian Casey

In our last issue, we discussed how CT lung cancer screening is falling short, mostly because so many eligible people still aren’t getting screened. In this issue, we offer strategies for fixing the problem, based on studies published last week in JACR. 

A lung cancer diagnosis was once thought of as a death sentence, as it was usually diagnosed at a late stage.

  • But that dynamic has changed with low-dose CT screening, which detects cancers small enough to be effectively treated – as was the case with Pope Leo XIV earlier this month. 

But uptake of LDCT screening has been slow, with U.S. screening rates below 20% for eligible people – compared to nearly 80% for mammography. 

  • The new JACR articles include three studies that cover a range of relevant topics in screening, from boosting participation rates to ensuring quality in screening programs. 

In the first study, researchers described their LungCheck program for boosting LDCT rates. 

  • LungCheck focuses on outreach to primary care providers with educational materials and meetings that explain screening eligibility criteria, as well as patient navigators for follow-up and scheduling and EHR modifications to capture eligible people.

Across 5.9k people, LungCheck led to almost 3X higher odds of an eligible person getting LDCT screening at academic centers (OR = 2.67), and almost 5X at federally qualified health centers (OR = 4.53).

The second JACR study specifically addresses outreach to Hispanics, a traditionally underserved population for LDCT screening. 

  • Researchers analyzed the effectiveness of their Empower LCS program, which included a culturally adapted decision aid, provider notifications, and patient text reminders. 

While the sample size of 60 patients was small, there were significantly higher ordering rates for patients in Empower LCS at four months than usual care (50% vs. 13%), as well as more lung screening discussions (40% vs. 17%). 

  • There was a trend toward greater completion of LDCT screening exams, but the difference wasn’t statistically significant, probably due to the small sample size (30% vs. 13%, p = 0.117). 

In the third paper, researchers assessed how well the ACR’s Lung Cancer Screening Registry mapped to IASLC quality measures.

  • While 69% of IASLC measures mapped to registry data, 31% didn’t line up, especially data on patient entry, treatment, and wait times. 

The Takeaway

The new JACR studies show the promising advances being made to boost CT lung cancer screening participation, while also helping imaging facilities improve the quality of their service. All that’s left to do is to put these promising ideas into broader practice.

One-Stop CT Chest Screening

Posted on by Brian Casey

Could opportunistic screening be driving the evolution of low-dose CT from a screening test just for lung cancer into a broader one-stop exam for multiple chest pathologies? A new study in JACR suggests as much – and provides a blueprint for how to do it. 

There’s no question LDCT lung cancer screening is gaining traction around the world. But as screening programs are starting, clinicians are finding that CT scans can detect far more than just lung cancer. 

  • Emphysema, commonly associated with COPD, is one such condition, as it goes hand-in-hand with lung cancer in people with long smoking histories. Another is coronary artery calcium (CAC), a known risk factor for cardiovascular disease. 

In the new study, researchers wanted to investigate the prevalence of COPD and CAC in their LDCT screening program covering three hospitals in the NewYork-Presbyterian system. 

  • In addition to documenting prevalence rates, they wanted to connect clinical outcomes to social determinants of health, which have been demonstrated to affect patient care. 

They tracked results from 2.4k people who got baseline LDCT scans from 2015 to 2022, finding…

  • Emphysema was detected in 77% of patients, and CAC in 65%.
  • 87% of patients with emphysema had no previous diagnosis.
  • The proportion of patients getting pulmonary care after their LDCT scan increased (from 24% to 46%), as did the rate of those getting cardiovascular care (from 43% to 63%).  
  • Lower household income was associated with 57% higher adjusted odds of emphysema, and food insecurity with 52% higher odds. 
  • No social determinants of health were associated with CAC burden.

It’s worth noting that the study did not use any IT tools to classify COPD and CAC, like AI image analysis or longitudinal tracking and reporting. 

  • It’s entirely possible that the results could be even more promising given the plethora of algorithms that have become available for opportunistic screening applications. 

The Takeaway

The new study on incidental CAC and emphysema findings on LDCT exams shows that lung screening has the potential for opportunistic disease detection even if you don’t have fancy AI algorithms at your disposal. All you need are radiologists and clinical staff dedicated to providing better patient care. 

Expanding CT Lung Screening at WCLC 2026

Posted on by Brian Casey

Low-dose CT lung cancer screening appears set to be the next major population-based cancer screening exam. But much work remains to make LDCT screening available to as many eligible people as possible while optimizing scanning protocols.

That’s according to sessions at IASLC’s World Conference on Lung Cancer (WCLC 2026), which just wrapped up in Seoul, South Korea. 

  • WCLC 2026 sessions ranged from expanding scanning to people at high risk but without smoking histories to using AI to not only detect and characterize lung nodules but to predict future cancer risk.

Some of the key findings from WCLC 2026 included…

  • Australia started its national LDCT screening program in 2025, and researchers expect a national-level stage shift to earlier diagnosis. At a 50% participation rate, stage I diagnoses should grow from 32% currently to 42% for women and 43% for men. 
  • The Ready to Screen (R2S) trial in Australia found that of 1.7k eligible screening candidates surveyed, 85% “definitely” intended to get screened and 26% said they had already received an LDCT scan. 
  • Taiwan’s national screening program showed that – at least in East Asia – people with a family history of lung cancer should be screened. Of 2.8k cancers detected, there was a 74% higher detection rate in those with family histories versus smoking histories (18 vs. 10 cancers per 1k screened), with more early-stage cancers detected (92% vs. 83%).
  • An LDCT screening program in China screened 6.7k people – including those with risk factors besides smoking – finding a 56% lung cancer mortality reduction.  
  • French clinicians successfully added smoking cessation therapy to their LDCT program, with 88% screening attendance and participants 44% less likely to smoke.
  • MIT’s Sybil AI algorithm was more accurate than Lung-RADS in predicting one-year cancer risk from suspicious nodules, with higher AUC when applied to two large lung screening trials (NLST and P-IELCAP). 
  • Researchers found that applying Sybil to coronary artery calcium scans could also predict lung cancer risk for both smokers and non-smokers over a 15-year follow-up period.
  • Researchers used Softek Illuminate’s Illuminate AI software for identifying incidental pulmonary nodules as a complement to an LDCT screening program, finding that the algorithm discovered more lung cancer cases than conventional screening. 

The Takeaway

This week’s WCLC 2026 sessions point out the rapid progress being made around the world in expanding access to LDCT lung cancer screening – as well as the role that AI-based software tools can play in making screening more effective and more widely accessible. 

CT Lung Screening Variation

Posted on by Brian Casey

Adoption of low-dose CT lung cancer screening is growing, and that’s a good thing. But rising LDCT utilization is also creating new challenges, illustrated by a new study in JACR that found high variability in radiologist interpretations. 

CT lung screening participation rates are rising, from single digits a decade ago to 19% in a recent survey. 

  • But there’s still a long way to go to get lung screening to the roughly 75% participation rate seen with breast cancer screening. 

One barrier to getting more people screened is false positives, which can cause patient anxiety and trigger a cascade of additional exams and procedures to work up suspicious findings. 

  • A major contributor to false positives may be variability in how radiologists read CT scans, so the JACR researchers investigated how interpretations for the same images changed between imaging specialists. 

Researchers looked at interpretations made by 1.4k radiologists, each of whom read a minimum of 50 LDCT screening exams (a total of 200k exams), then calculated false-positive rates for both baseline and follow-up exams. Researchers found…

  • High variability in false-positive rates, from 11% to 22%.
  • In random pairs of radiologists, on average, one radiologist would have twice the odds of making a false-positive call as the other. 
  • Radiologists with false-positive rates higher than the median rate also unsurprisingly had higher sensitivity than those below the median (97% vs. 92%).

What’s causing the variation? It could be because some radiologists use image interpretation patterns that increase false positives but also catch more cancers. 

  • In statistical terms, researchers found that for baseline screens read by radiologists who were below the median false-positive rate, they would have about 100 fewer false-positive screens for one fewer true-positive cancer. 

Radiologist variability could be reduced through programs to standardize screening interpretation, such as those implemented in mammography screening.

  • These could include support tools, automated feedback systems, educational interventions, and targeted double reading.

The Takeaway

The new findings on radiologist variability in reading CT lung cancer screening exams illustrate the delicate balance between detecting more cancer at the risk of producing additional false positives. Is the tradeoff worth it? We think we know how most patients would feel.

Lung Cancer Mystery in Non-Smokers

Posted on by Brian Casey

One of the emerging mysteries around lung cancer is why it occurs so often in people who don’t smoke – particularly in Asia. A new paper in JAMA Network Open investigates the phenomenon by presenting results from South Korea indicating that established screening criteria would have missed nearly two-thirds of lung cancer patients.

From its earliest days, CT lung screening has been targeted at heavy smokers who have the greatest chance of developing lung cancer.

  • Risk-based criteria determine who should be screened, usually based on some metric of smoking history (such as the USPSTF’s 20-pack-year threshold).

But many countries that have had national lung screening programs in place for a while – mostly in Asia – are learning that lung cancer also occurs in people who have never smoked at all. 

  • Whether and how to screen these individuals has become the subject of debate. 

In the current study, researchers from South Korea examined 89.9k patients who were diagnosed with lung cancer from 2013 to 2018, just before the country started its national lung screening program in 2019. 

  • Researchers focused on whether patients would have been eligible for screening under established criteria, such as from the USPSTF, ACS, and NCCN.

Among people diagnosed with lung cancer…

  • 65% would not have been eligible for lung screening under international guidelines. 
  • 44% had no smoking history. 
  • Screening eligibility differed sharply by sex, with men eligible at far higher rates than women (57% vs. 2.3%).
  • Smokers who weren’t eligible for screening had 5% lower rates of all-cause mortality and 4% lower lung cancer-specific mortality than smokers who were.
  • People who had never smoked had 14% lower rates of both all-cause and lung cancer-specific mortality. 

The data point out an interesting dilemma inherent in CT lung cancer screening, which from the outset was set up to be risk-based rather than population-based like mammography to avoid many of screening’s downsides, like overdiagnosis.

  • But that approach is missing many people who would otherwise benefit from screening, especially as we learn more about the elevated risk among many non-smoking populations, such as East Asian women.

The Takeaway

The new study shows momentum building toward broader CT lung cancer screening criteria that go beyond smoking status. The question is how quickly such criteria are adopted, and whether they gain traction outside of Asia, where recognition of lung cancer among non-smokers is growing.

The Danger of Incidental Findings in CT Lung Screening

Posted on by Brian Casey

CT lung cancer screening is gaining momentum around the world, but one of the challenges providers face is how to manage incidental findings. It’s especially important given that a new study in JAMA Network Open suggests that incidental findings on screening exams are associated with a higher risk of cancer occurring outside the lung. 

Incidental findings are suspicious areas discovered outside the target region being imaged, and are especially a concern with cancer screening exams.

  • Incidental findings turn out to be normal most of the time, but pathology occurs often enough that most clinicians agree they’re worth investigating. 

The problem is that many providers don’t have a robust system in place for alerting referring physicians to incidental findings and ensuring that patients get the follow-up exams they need.

The new study addresses incidental findings within the context of CT lung cancer screening, specifically in the National Lung Screening Trial, the landmark study that established low-dose CT’s lifesaving benefit.

  • It’s an important question, because chasing down a large number of benign incidental findings would be a resource-intensive task that could alter the cost-benefit ratio of lung screening.

Researchers analyzed significant incidental findings unrelated to lung cancer in 26.4k people across three rounds of LDCT screening who were followed for a year, revealing…

  • Cancer findings outside the lung occurred in 6.8% of people, and 13% of them had multiple cancers. 
  • Patients with significant incidental findings had a higher absolute risk of being diagnosed with extrapulmonary cancer within a year (16 per 1k participants). 
  • Study participants with incidental findings tended to be slightly older (62 vs. 61 years) and more likely to have a history of smoking-related disease (69% vs. 66%).

The findings confirm that having a plan to manage incidental findings should be an important part of any CT lung cancer screening program, especially given previous research showing that 23% of deaths in NLST were due to cancers outside the lung. 

  • In fact, an effective incidental finding program could enhance LDCT screening’s value, especially given that people eligible for screening have heavy smoking histories.

The Takeaway

The new study shows that incidental findings on CT lung screening exams are common and serious enough to warrant further investigation. Screening programs that are able to do so effectively will deliver even more value to their patients than lung screening alone.

Lung Cancer in Non-Smokers Creates Questions

Posted on by Brian Casey

Behind the growing enthusiasm for CT lung cancer screening is a nagging question – should we be screening people who have never smoked too? It’s a dilemma that’s addressed in a new paper in Radiology that offers some insight.

CT lung screening is the only major cancer screening test that’s exclusively targeted at high-risk individuals, essentially people who have smoked long enough to meet inclusion criteria.

  • Other cancer screening exams – for breast, colorectal, and cervical cancer– are offered to broader segments of the population, with age typically the only qualifying factor.

But lung cancer still occurs in people who have never smoked, who account for 10-25% of lung cancer cases, the fifth most common cause of cancer mortality globally.

  • For example, East Asian women, even those who have never smoked, seem to have higher lung cancer incidence rates, indicating a genetic risk factor that’s still not fully understood. 

The new Radiology paper reviews the state of knowledge regarding lung cancer in people who have never smoked, and examines whether the phenomenon’s prevalence calls for a rethinking of how CT lung cancer screening is offered. 

The authors explain that lung cancer in non-smokers…

  • Can be caused by environmental factors like workplace exposure, air pollution, genetic susceptibility, and exposure to second-hand smoke (20-26% higher risk for spousal exposure).  
  • Has a different carcinogenesis mechanism than lung cancer in smokers, and tends to be more slow-growing.
  • Has different characteristics than cancer in smokers, being overwhelmingly dominated by adenocarcinoma (90%). 

So with this knowledge in hand, should current U.S. and European lung cancer screening guidelines be changed? 

  • Japan is already conducting mass lung screening regardless of smoking history, while China’s guidelines include people who have never smoked but have other risk factors like occupational exposure.

But broader screening could lead to higher rates of overdiagnosis and overtreatment, and early studies from Asia have found screening had little effect on overall mortality in non-smokers. 

  • That led the Radiology authors to conclude that, at present, it’s probably not advisable to begin screening people who have never smoked until more research is conducted.

The Takeaway

The new paper on CT lung cancer screening of people who have never smoked is more than just an interesting thought experiment. It surfaces an issue that’s been percolating as risk-based lung screening gains momentum, and that ultimately may require a completely different approach to lung screening from what’s been used to date.

CT Lung Screening Leads RSNA’s First Day

Posted on by Brian Casey

Day 1 of RSNA 2025 is in the books, and new research into CT lung cancer screening dominated the scientific sessions at Chicago’s McCormick Place.

Lung cancer screening is drawing attention as screening programs go into effect internationally.

  • In the U.S., lung screening is hampered by low completion rates (18-19%), but providers are finding that participation can be improved with aggressive identification and outreach to eligible patients.

Some highlights from Sunday (with handy session numbers to help you follow along) include…

  • The ScreenLungNet AI model predicted three-year lung cancer risk from CT lung screening scans with AUCs from 0.93-0.94 (S4-SSCH02-1).
  • In a study of 2.6k patients with lung cancer, only 36% met 2021 USPSTF lung cancer screening criteria, and just 5% actually got screened. Only 23% had data on their smoking history in the EMR (S4-SSCH02-2).
  • Risk assessment scores were used to perform CT lung screening of lower-risk people every two years rather than annually, reducing screening’s harms without missing many cancers (S4-SSCH02-4).
  • Compared to the landmark NLST study, a real-world CT lung screening program had fewer benign surgeries (12% vs. 18%), lower complication rates (24% vs. 32%), and better recurrence-free survival (HR = 0.60) (S4-SSCH02-5).
  • CT radiation dose was reduced 51% and contrast iodine use 61% through a triple-optimized protocol that included 80-kVp scanning, GE HealthCare’s TrueFidelity deep learning reconstruction, and low-iodine adaptive contrast injection (S2-SSCA01-1).
  • Using AI for automated patient positioning and scan range in CT exams cut positioning time 41% with 10-13% lower radiation dose and no discernible impact on image quality (S4-SSIN01-1).
  • Measures of adiposity acquired opportunistically from coronary artery calcium CT scans using HeartLung Technologies’ AI-CVD algorithm predicted adults at risk of diabetes in a study of 2.9k people (S5-SSCA02-6). 
  • The Promedius AI algorithm for osteoporosis assessment of chest radiographs had an AUC of 0.84 in a study of 1k adults from three countries (M3-SSCH03-1).
  • A real-world study of 2.1k patients found that DeepTek’s chest X-ray AI algorithm had an AUROC of 0.95 for detecting any of 13 clinically significant findings (M3-SSCH03-2).
  • Researchers presented a feasibility study of a compression-free spectral DBT mammography system, finding spatial resolution close to state-of-the-art systems (S4-SSPH02-6).
  • Researchers presented their protocol for MRI scanning of patients with cardiac implanted electronic devices. Over 10 years they scanned 7.3k patients with no major adverse events (S5-SSCA02-1).
  • Adding MRI data to a multimodal transformer AI model improved its ability to predict five-year breast cancer risk in intermediate- and high-risk women (S2-SSBR01-6).

The Takeaway

RSNA 2025 is off to a great start. Be sure to check back with Thursday’s newsletter for more radiology news from Chicago, and follow along on our social media channels for ongoing video updates. 

Next-Generation AI Platform Redefines Radiology Workflow Standards

Posted on by Partner Content

AI is no longer being viewed as a diagnostic aid but as essential medical infrastructure. Nowhere is that more apparent than in lung screening, with Germany and other European Union countries increasingly embedding AI into their lung cancer screening guidelines and pilot programs.

This evolution will be on display at RSNA 2025, where Coreline Soft will introduce its groundbreaking chest AI platform AVIEW 2.0.

  • The solution demonstrates how unified AI automation is fundamentally transforming radiology workflows and elevating diagnostic precision across pulmonary, cardiac, and airway pathologies.

AVIEW 2.0 represents a paradigm shift from task-specific tools to an integrated diagnostic ecosystem. 

  • The platform seamlessly combines lung-cancer screening (LCS), coronary-artery calcium (CAC) scoring, and COPD quantification into a single, continuous analytical pipeline. 

Clinical validation shows radiologists using AVIEW 2.0 achieve 89% increase in case throughput and 60% reduction in interpretation time compared to the previous generation. 

  • This effectively consolidates multi-disease CT assessment into one streamlined, automated workflow.

AVIEW’s clinical foundation extends far beyond pilot studies. The platform has processed over 2.5M cases across 19 countries, establishing itself as a proven solution in diverse healthcare ecosystems. 

  • Most notably, AVIEW has been selected as the AI platform for major government-led lung cancer screening pilots and programs in Germany, France, and Italy.

Beyond Europe, AVIEW solutions are already integrated into major U.S. medical centers, where their clinical reliability has been independently validated in real-world settings…

  • UMass Memorial Medical Center has deployed the system as an integrated platform for LCS, CAC, and COPD diagnosis, supporting full-spectrum thoracic screening in daily radiology operations.
  • Temple Lung Center, 3DR Labs, and ImageCare Radiology have incorporated AVIEW products into their research and diagnostic environments – each adapting AI functions to site-specific workflows and physician preferences.

SOL Radiology, a fast-growing radiologist-owned practice serving communities across California and Illinois, has deployed AVIEW LCS Plus across its outpatient centers and hospital network, leveraging the platform for high-confidence nodule detection, rapid turnaround, and integrated COPD/CAC assessment. 

  • The group reports significant gains in diagnostic efficiency and consistency within one week of implementation, supporting its vision for technology-driven, high-quality community radiology.

With national-scale validation in Europe, clinical adoption across top-tier U.S. institutions, and 2.5M cases processed globally, Coreline Soft is positioning AVIEW 2.0 as the new benchmark for AI-driven thoracic imaging – where efficiency, accuracy, and scalability converge.

The Takeaway

Coreline Soft will conduct an end-to-end AI workflow demonstration in the “Radiology Reimagined” demo zone at RSNA 2025, using real-world clinical scenarios. With AVIEW and HUB, the full pathway – from triage and interpretation to reporting and quality management – will be validated against standards such as IHE and FHIR, allowing attendees to experience integrated flow firsthand. Learn more or book an appointment on Coreline Soft’s website.

RadNet’s UK Lung Cancer Screening Acquisition

Posted on by Jake Fishman

RadNet advanced its AI-led cancer screening strategy, acquiring a 75% stake in Heart & Lung Health, a UK-based teleradiology network with a direct connection to the NHS’ lung cancer screening program.

Heart & Lung Health (HLH) has a network of over 70 cardiothoracic radiologists, and provides teleradiology reporting services for the NHS and a variety of UK hospitals and academic institutions.

Acquiring a UK telerad company might seem out of character for RadNet, which has historically focused its M&A on US-based imaging centers (and more recently global AI developers), only mentioned Europe once in its 2021 annual report, and exited the teleradiology business in 2020. However…

  • HLH is the leading reporting provider for NHS England Targeted Lung Health Check (TLHC), an AI-enabled lung cancer screening pilot program that might pave the way for a UK-wide program. 
  • TLHC requires all radiologists to use AI with their LDCT screening interpretations, suggesting that AI might also be required in a future UK-wide program.
  • HLH uses RadNet’s Aidence subsidiary’s lung cancer AI tools, and HLH will work with Aidence to further develop its solutions.

The Takeaway

RadNet started 2022 by acquiring two major cancer screening AI companies (Aidence and Quantib), which combined with its DeepHealth breast cancer AI business to support its ambitious new strategy to become a population-scale cancer screening leader. 

That goal might have seemed like a longshot to some, given AI’s uncertain path forward and RadNet’s geographic concentration in just seven US states. However, last week’s HLH acquisition showed that RadNet remains very committed to AI-driven cancer screening leadership, and its strategy might not be as geographically-challenged as some initially thought.

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