Formal radiology guidelines for CT lung cancer screening needed

Formalized radiology guidelines for CT screening for lung cancer are needed due to the dearth of uniformity in screening practices reported by U.S. academic medical centers, according to a research letter published online Dec. 9 in JAMA Internal Medicine.

Following the results of the National Lung Screening Trial (NLST), several organizations have published clinical practice guidelines (CPGs) for lung cancer screening. While they emphasize the clinical aspects of CT screening, there is only a small focus on technical and logistical considerations.

Phillip M. Boiselle, MD, of Beth Israel Deaconess Medical Center in Boston, and colleagues surveyed leading academic medical centers in order to determine current screening practices. The survey was distributed via email to thoracic radiology division chiefs at those centers.

Nineteen recipients completed the survey, 15 of which have a current CT screening program. Eleven of the 15 active screening sites use the NLST entry criteria, one uses expanded selection criteria, and the other three provide screening to any patients who have participated in shared decision making with a clinical physician. Eleven of the sites require a referral from a clinical physician.

The estimated radiation dose used was less than 1 mSv at five sites, 1-2 mSv at seven sites, and 2-3 mSv at two sites. One respondent did not know the dose. Fourteen sites included a smoking cessation program, and these programs were mandatory for current smokers at three sites.

Given the survey’s results, the letter’s authors thus contend that more formalized radiology guidelines are needed for CT screening for lung cancer. “Such guidelines should place primary emphasis on the technical and logistical aspects of screening that are not covered by currently available CPGs,” wrote Boiselle and colleagues. “These issues will be addressed in a practice guideline for radiologists that is being developed jointly by the American College of Radiology and the Society of Thoracic Radiology,” they concluded.