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Lung Cancer |

Learning Curve for Low-Dose Chest Computed Tomography Interpretation During the Implementation of a Lung Cancer Screening Program

Richa Sharma*, MD; Mark Yoder, MD; Palmi Shah, MD; Edward Hong, MD; Michael Liptay, MD; James Mulshine, MD
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Rush University Medical Center, Chicago, IL


Chest. 2012;142(4_MeetingAbstracts):632A. doi:10.1378/chest.1390880
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Abstract

SESSION TYPE: Lung Cancer Posters I

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Low dose chest computed tomography (CT) will likely be utilized more frequently for lung cancer screening in upcoming years. CT interpretations from early and late time points during implementation of a lung cancer screening program were compared and the effect of discrepancies on clinical follow-up were assessed.

METHODS: A retrospective review of the first 100 subjects enrolled in a lung cancer screening study was performed. The interpretation of the on-site radiologist was compared to that of a study center radiologist, and discrepancies in nodule size and number and coronary artery calcification (CAC) score were compared between the first 50 subjects (early group) and second group of 50 subjects (late group). The effect of discrepancies on recommended follow-up was determined.

RESULTS: A total of 158 nodules were detected. The on-site radiologist detected 134 nodules, and the study center radiologist detected 103 nodules. The on-site radiologist missed 20 nodules in the early group and 4 nodules in the late group. The average diameter of missed nodules was 3.22 mm (range 1 - 6.75 mm). The average size measurement difference between the on-site and study center radiologists was 0.5 mm (range 0 - 8.5 mm). The average size measurement difference was 0.72 mm in the early group and 0.39 mm in the late group. Nine discrepancies in follow-up recommendations occurred, none due to a missed nodule or size measurement difference. The average discrepancy in CAC score was 0.44 (range 0 - 5). There was no significant difference between the scores of the early and late groups.

CONCLUSIONS: A learning curve was noted in detection and measurement of nodules, but not for CAC scoring, during the implementation of a lung cancer screening program. Differences in CT interpretations were small and did not result in clinical management errors.

CLINICAL IMPLICATIONS: A learning curve should be anticipated during implementation of a lung cancer screening program. Secondary review of CT interpretations during this phase may be useful to improve accuracy.

DISCLOSURE: The following authors have nothing to disclose: Richa Sharma, Mark Yoder, Palmi Shah, Edward Hong, Michael Liptay, James Mulshine

Many professional societies consider lung cancer screening to be research at this point.

Rush University Medical Center, Chicago, IL

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