Low-dose CT: technique, reading methods and image interpretation

Abstract The National Lung Cancer Screening Trial has recently demonstrated that screening of high-risk populations with the use of low-dose computed tomography (LDCT) reduces lung cancer mortality[1]. Based on this encouraging result, the National Comprehensive Cancer Network guidelines recommended LDCT for selected patients at high risk of lung cancer[2]. This suggests that an increasing number of CT screening examinations will be performed. The LDCT technique is relatively simple but some CT parameters are important and should be accurately defined in order to achieve good diagnostic quality and minimize the delivered dose. In addition, LDCT examinations are not as easy to read as they may initially appear; different approaches and tools are available for nodule detection and measurement. Moreover, the management of positive results can be a complex process and can differ significantly from routine clinical practice. Therefore this paper deals with the LDCT technique, reading methods and interpretation in lung cancer screening, particularly for those radiologists who have little experience of the technique.

[1]  Jin Hwan Kim,et al.  Comparison of standard- and low-radiation-dose CT for quantification of emphysema. , 2007, AJR. American journal of roentgenology.

[2]  David Spizarny,et al.  Final results of the Lung Screening Study, a randomized feasibility study of spiral CT versus chest X-ray screening for lung cancer. , 2005, Lung cancer.

[3]  G. Bastarrika,et al.  Low-dose Volumetric Computed Tomography for Quantification of Emphysema in Asymptomatic Smokers Participating in an Early Lung Cancer Detection Trial , 2009, Journal of thoracic imaging.

[4]  Mathias Prokop,et al.  Pulmonary ground-glass nodules: increase in mass as an early indicator of growth. , 2010, Radiology.

[5]  Rebecca M. Lindell,et al.  Five-year lung cancer screening experience: CT appearance, growth rate, location, and histologic features of 61 lung cancers. , 2007, Radiology.

[6]  D. Lynch,et al.  The National Lung Screening Trial: overview and study design. , 2011, Radiology.

[7]  G. Veronesi,et al.  Extrapulmonary malignancies detected at lung cancer screening. , 2011, Radiology.

[8]  H. Tonami,et al.  Fluorine-18-FDG PET imaging is negative in bronchioloalveolar lung carcinoma. , 1998, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[9]  L. Washington,et al.  Inherent variability of CT lung nodule measurements in vivo using semiautomated volumetric measurements. , 2006, AJR. American journal of roentgenology.

[10]  K. S. Lee,et al.  Localized form of bronchioloalveolar carcinoma: FDG PET findings. , 1998, AJR. American journal of roentgenology.

[11]  Karin A. Herrmann,et al.  Mehrschicht-Spiral-CT der Lunge: Multiplanare Rekonstruktionen und Maximum-Intensitäts-Projektionen in der Detektion von Lungenrundherden , 2001 .

[12]  W. Heindel,et al.  Screening for early lung cancer with low-dose spiral computed tomography: results of annual follow-up examinations in asymptomatic smokers , 2004, European Radiology.

[13]  H. Ohmatsu,et al.  Detection failures in spiral CT screening for lung cancer: analysis of CT findings. , 1999, Radiology.

[14]  Wendy J. Post,et al.  Volumetric measurement of pulmonary nodules at low-dose chest CT: effect of reconstruction setting on measurement variability , 2009, European Radiology.

[15]  S. Armato,et al.  Lung cancers missed at low-dose helical CT screening in a general population: comparison of clinical, histopathologic, and imaging findings. , 2002, Radiology.

[16]  Utilidad de la reconstrucción de proyección de máxima intensidad para la lectura de los estudios realizados en un programa de detección precoz de cáncer de pulmón por tomografía computarizada multicorte de baja dosis de radiación , 2008 .

[17]  Ming-Ting Wu,et al.  Coronary arterial calcification on low-dose ungated MDCT for lung cancer screening: concordance study with dedicated cardiac CT. , 2008, AJR. American journal of roentgenology.

[18]  B. Nan,et al.  Pulmonary nodule volumetric measurement variability as a function of CT slice thickness and nodule morphology. , 2007, AJR. American journal of roentgenology.

[19]  Binsheng Zhao,et al.  Small pulmonary nodules: volumetrically determined growth rates based on CT evaluation. , 2000, Radiology.

[20]  Thomas Boehm,et al.  Effect of slab thickness on the CT detection of pulmonary nodules: use of sliding thin-slab maximum intensity projection and volume rendering. , 2009, AJR. American journal of roentgenology.

[21]  H Rusinek,et al.  Pulmonary nodule detection: low-dose versus conventional CT. , 1998, Radiology.

[22]  Myrna C B Godoy,et al.  Subsolid pulmonary nodules and the spectrum of peripheral adenocarcinomas of the lung: recommended interim guidelines for assessment and management. , 2009, Radiology.

[23]  Yang Xue-ning.  International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society International Multidisciplinary Classification of Lung Adenocarcinoma , 2011 .

[24]  J. Goo,et al.  Volumetric measurement of synthetic lung nodules with multi-detector row CT: effect of various image reconstruction parameters and segmentation thresholds on measurement accuracy. , 2005, Radiology.

[25]  Dianna D. Cody,et al.  Estimated radiation dose associated with low-dose chest CT of average-size participants in the National Lung Screening Trial. , 2011, AJR. American journal of roentgenology.

[26]  Hironobu Ohmatsu,et al.  Screening for lung cancer with low-dose helical computed tomography: anti-lung cancer association project. , 2002, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[27]  B. Ginneken,et al.  A comparison of six software packages for evaluation of solid lung nodules using semi-automated volumetry: What is the minimum increase in size to detect growth in repeated CT examinations , 2009, European Radiology.

[28]  W. Heindel,et al.  Detection of pulmonary nodules at multirow-detector CT: effectiveness of double reading to improve sensitivity at standard-dose and low-dose chest CT , 2004, European Radiology.

[29]  Margrit Betke,et al.  Small pulmonary nodules: volume measurement at chest CT--phantom study. , 2003, Radiology.

[30]  G. Pelosi,et al.  Difficulties encountered managing nodules detected during a computed tomography lung cancer screening program. , 2008, The Journal of thoracic and cardiovascular surgery.

[31]  M. Prokop,et al.  Lung nodule volumetry: segmentation algorithms within the same software package cannot be used interchangeably , 2010, European Radiology.

[32]  Mark Tann,et al.  Volumetric growth rate of stage I lung cancer prior to treatment: serial CT scanning. , 2002, Radiology.

[33]  K. Bae,et al.  Automated detection of pulmonary nodules on CT images: effect of section thickness and reconstruction interval--initial results. , 2005, Radiology.

[34]  M. Revel,et al.  Are two-dimensional CT measurements of small noncalcified pulmonary nodules reliable? , 2004, Radiology.

[35]  Ying Wang,et al.  Smooth or attached solid indeterminate nodules detected at baseline CT screening in the NELSON study: cancer risk during 1 year of follow-up. , 2009, Radiology.

[36]  C. Gatsonis,et al.  Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening , 2012 .

[37]  Y. Shimizu,et al.  Positron Emission Tomography in Relation to Noguchi’s Classification for Diagnosis of Peripheral Non-Small-Cell Lung Cancer 2 cm or Less in Size , 2007, World Journal of Surgery.

[38]  K. Marten,et al.  Computer-assisted detection of pulmonary nodules: performance evaluation of an expert knowledge-based detection system in consensus reading with experienced and inexperienced chest radiologists , 2004, European Radiology.

[39]  G. Pelosi,et al.  Role of positron emission tomography scanning in the management of lung nodules detected at baseline computed tomography screening. , 2007, The Annals of thoracic surgery.

[40]  C I Henschke,et al.  Does 2-year stability imply that pulmonary nodules are benign? , 1997, AJR. American journal of roentgenology.

[41]  M. Reiser,et al.  [Multidetector-row CT of the lungs: Multiplanar reconstructions and maximum intensity projections for the detection of pulmonary nodules]. , 2001, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[42]  Masahiro Tsuboi,et al.  International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society International Multidisciplinary Classification of Lung Adenocarcinoma , 2011, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[43]  H Rusinek,et al.  Variables Affecting Pulmonary Nodule Detection with Computed Tomography: Evaluation with Three‐Dimensional Computer Simulation , 1993, Journal of thoracic imaging.

[44]  O. Miettinen,et al.  CT screening for lung cancer: frequency and significance of part-solid and nonsolid nodules. , 2002, AJR. American journal of roentgenology.

[45]  H. D. de Koning,et al.  No benefit for consensus double reading at baseline screening for lung cancer with the use of semiautomated volumetry software. , 2012, Radiology.

[46]  Y. Shim,et al.  Persistent pulmonary nodular ground-glass opacity at thin-section CT: histopathologic comparisons. , 2007, Radiology.

[47]  Mathias Prokop,et al.  Pulmonary nodules detected at lung cancer screening: interobserver variability of semiautomated volume measurements. , 2006, Radiology.

[48]  Rebecca M. Lindell,et al.  5-year lung cancer screening experience: growth curves of 18 lung cancers compared to histologic type, CT attenuation, stage, survival, and size. , 2009, Chest.

[49]  A. Jankowski,et al.  Pulmonary nodule detection on MDCT images: evaluation of diagnostic performance using thin axial images, maximum intensity projections, and computer-assisted detection , 2007, European Radiology.

[50]  M. Chung,et al.  Ultra-Low-Dose MDCT of the Chest: Influence on Automated Lung Nodule Detection , 2008, Korean journal of radiology.

[51]  G. Chatellier,et al.  Pulmonary nodules: preliminary experience with three-dimensional evaluation. , 2004, Radiology.

[52]  S. Swensen,et al.  Lung cancer screening with CT: Mayo Clinic experience. , 2003, Radiology.

[53]  M. Wahidi,et al.  Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition). , 2007, Chest.

[54]  Kyung Soo Lee,et al.  Coronary calcium screening using low-dose lung cancer screening: effectiveness of MDCT with retrospective reconstruction. , 2008, AJR. American journal of roentgenology.

[55]  Paul J Nietert,et al.  Imprecision in automated volume measurements of pulmonary nodules and its effect on the level of uncertainty in volume doubling time estimation. , 2009, Chest.

[56]  Kyle J Myers,et al.  Noncalcified lung nodules: volumetric assessment with thoracic CT. , 2009, Radiology.

[57]  F. Fischbach,et al.  Detection of pulmonary nodules by multislice computed tomography: improved detection rate with reduced slice thickness , 2003, European Radiology.

[58]  D. Xu,et al.  Nodule management protocol of the NELSON randomised lung cancer screening trial. , 2006, Lung cancer.

[59]  G. Veronesi,et al.  Evolution of emphysema in relation to smoking , 2010, European Radiology.

[60]  W. Heindel,et al.  Volumetric measurements of pulmonary nodules at multi-row detector CT: in vivo reproducibility , 2003, European Radiology.

[61]  H Nakata,et al.  Evolution of peripheral lung adenocarcinomas: CT findings correlated with histology and tumor doubling time. , 2000, AJR. American journal of roentgenology.

[62]  O. Miettinen,et al.  Early Lung Cancer Action Project: overall design and findings from baseline screening , 1999, The Lancet.

[63]  Hironobu Ohmatsu,et al.  Progression of Focal Pure Ground-Glass Opacity Detected by Low-Dose Helical Computed Tomography Screening for Lung Cancer , 2004, Journal of computer assisted tomography.

[64]  Harry J de Koning,et al.  Identification of chronic obstructive pulmonary disease in lung cancer screening computed tomographic scans. , 2011, JAMA.

[65]  K. Marten,et al.  Inadequacy of manual measurements compared to automated CT volumetry in assessment of treatment response of pulmonary metastases using RECIST criteria , 2006, European Radiology.

[66]  Ken Kodama,et al.  Natural history of pure ground-glass opacity after long-term follow-up of more than 2 years. , 2002, The Annals of thoracic surgery.

[67]  Anthony J. Sherbondy,et al.  Pulmonary nodules on multi-detector row CT scans: performance comparison of radiologists and computer-aided detection. , 2005, Radiology.

[68]  S. Ferretti,et al.  Evolution of lung nodules < or =5 mm detected with low-dose CT in asymptomatic smokers. , 2007, The British journal of radiology.

[69]  S. Armato,et al.  Lung cancer: performance of automated lung nodule detection applied to cancers missed in a CT screening program. , 2002, Radiology.

[70]  A. Aisen,et al.  Effect of varying CT section width on volumetric measurement of lung tumors and application of compensatory equations. , 2003, Radiology.

[71]  Gilles Chatellier,et al.  Software volumetric evaluation of doubling times for differentiating benign versus malignant pulmonary nodules. , 2006, AJR. American journal of roentgenology.

[72]  Ravi Menezes,et al.  CT screening for lung cancer: implication of lung biopsy recommendations. , 2012, AJR. American journal of roentgenology.

[73]  Masumi Kadoya,et al.  Indeterminate solitary pulmonary nodules revealed at population-based CT screening of the lung: using first follow-up diagnostic CT to differentiate benign and malignant lesions. , 2003, AJR. American journal of roentgenology.

[74]  K. Marten,et al.  Flat Panel Detector-Based Volumetric CT: Prototype Evaluation with Volumetry of Small Artificial Nodules in a Pulmonary Phantom , 2004, Journal of thoracic imaging.

[75]  D K Owens,et al.  Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis. , 2001, JAMA.

[76]  N J Wald,et al.  UK Lung Screen (UKLS) nodule management protocol: modelling of a single screen randomised controlled trial of low-dose CT screening for lung cancer , 2011, Thorax.

[77]  P. D. Domínguez Echávarri,et al.  [Usefulness of maximum intensity projections in low-radiation multislice CT lung cancer screening]. , 2008, Radiologia.

[78]  Harry J de Koning,et al.  Comparing coronary artery calcium and thoracic aorta calcium for prediction of all-cause mortality and cardiovascular events on low-dose non-gated computed tomography in a high-risk population of heavy smokers. , 2010, Atherosclerosis.

[79]  G. Battista,et al.  Three-dimensional analysis of pulmonary nodules: variability of semiautomated volume measurements between different versions of the same software , 2010, La radiologia medica.

[80]  Jonathan Goldin,et al.  Accuracy of PET/CT in characterization of solitary pulmonary lesions. , 2007, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[81]  F. Fazio,et al.  Early lung-cancer detection with spiral CT and positron emission tomography in heavy smokers: 2-year results , 2003, The Lancet.

[82]  T. Naruke,et al.  Evaluation of F-18 fluorodeoxyglucose (FDG) PET scanning for pulmonary nodules less than 3 cm in diameter, with special reference to the CT images. , 2004, Lung cancer.

[83]  Rhodri Hayward,et al.  Screening , 2008, The Lancet.