Siemens’ syngo
lung CAD offers capabilities for the detection of
solid pulmonary nodules in thoracic CT studies as
well as CAD workflow
enhancements.
Progressive
clinicians are working with vendors to fine-tune CAD
applications for lung imaging. Even as the tool can help
radiologists detect more lung nodules, it’s only one
item in a complete imaging toolset. But there’s a
Catch-22: More radiologists need to use it to help prove
its value, but ease of use has to improve to encourage
more radiologists to use it.
Lung CAD is “not a
shot in the dark or a flash in the pan,” says David
Naidich, MD, professor of radiology and medicine at the
New York University School of Medicine & Hospitals
Center in New York City. He uses syngo Lung CAD from
Siemens Medical Solutions. Lung CAD has been making
“very steady progress,” he says.
Overall, lung
CAD can aid imaging, decrease false negative findings,
offers high sensitivity and has brought a 26 percent
reduction in missed actionable nodules.
“As the
technology got better and better in CT, generating huge
datasets, the concept that computers would be an
additional means of interpretation became very
attractive,” Naidich says. That has turned out to be a
very complex set of problems for the computer to
solve.
Naidich doesn’t see CAD as an independent,
stand-alone tool, even though it is designed to be just
that. CAD isn’t used to detect nodules—which can
determine whether a patient requires surgery—but also to
characterize, conduct volumetric assessment, and look at
contour and density to match scans later to see whether
nodules have changed. Coupling CT and CAD allows for
more accurate judgment in lung cancer cases, he
says.
To facilitate a smooth workflow, study data
are streamed to Siemens Leonardo workstations. But,
Naidich hopes to soon see CAD integrated into PACS
configurations. “When you work on two separate systems,
you have to go back and forth. It would be easier if the
tools were available right from the get-go.” That ease
of use would translate, Naidich says, to physicians
using CAD more often and more appreciation of its value.
“Until [physicians] really are using CAD, they don’t
fully sense that it’s a relatively simple idea. The
information you’re getting is not onerous. As long as
the device doesn’t overload you, it is truly positioned
to only show you things you want to see for
reassurance.”
Edwin van Beek, MD, PhD,
radiologist at the University of Iowa Hospitals and
Clinics in Iowa City, has been working with EDDA
Technologies to boost the user friendliness of its IQQA
Chest Enterprise software—requiring fewer clicks and
offering more automation. The facility conducts research
on lung nodules, so the partnership was a good
fit.
Since implementing IQQA Chest Enterprise
from EDDA Technologies 18 months ago, the software is
used for annual follow-up on all lung cancer patients.
The teaching facility is fortunate in that its residents
already double-read all chest x-rays. A review found
that of 214 cases, CAD was the only thing that caught a
finding in 19 cases. Of those 19 cases, 16 were true
positives and three were false positives. Those
are very good results considering that it takes about 20
seconds to run a chest x-ray through CAD.
A
review of residents’ usage has shown that CAD helped
them pick up 20 percent more nodules; for senior
radiologists, that percentage is closer to 5
percent.
Skeptical
interest
During a talk van Beek gave in June, he noticed a lot of
skepticism but, at the same time, more interest in CAD
than in recent years. Growth in the use of CAD depends
on reimbursement, he says. Currently, there is a
tracking code for CAD but “if there’s no reimbursement,
people are not going to make the investment.” But, he
feels that knowing that he’s done everything he can
gives him peace of mind. The issue of missed or delayed
diagnosis weighs on radiologists, however. “I have no
problems sleeping at night, and I think a lot of people
see it in a fairly similar way.”
Freiburg
University Hospital in Hamburg, Germany, is one of the
largest academic teaching hospitals in Europe with 1,600
beds and 1,150 physicians. The department of radiology
employs 35 radiologists and 65 radiologic technologists,
and an MR research section staffs 50 physicists. The
team performs about 500 exams a day.
The facility
implemented X-ray Lung Nodule Analysis (xLNA)—EDDA’s
IQQA Chest Enterprise as marketed by Philips Medical
Systems—in May, says Elmar Kotter, MD, senior
radiologist. Although research has established CAD’s
value with lung CT, its value with chest x-rays is still
under evaluation, he says. Kotter has studied results
from the use of xLNA and found encouraging results that
he submitted for publication in Investigative Radiology.
CAD needs to be very fast and integrated into
radiologists’ daily workflow, Kotter points out. He has
found that xLNA is simple to integrate with PACS and is
easy to learn.
Patricia Shapiro, MD, of
Southcoast Medical Imaging, Savannah, Ga., has been
using lung CAD from Riverain for about six months. After
going all-digital years ago and implementing CAD for
mammography almost two years ago, implementing lung CAD
was pretty seamless, she says.
The facility
implemented lung CAD because, as a multispecialty group,
primary-care physicians read their own chest x-rays. “We
were interested in doing this as a way to provide an
additional tool to primary-care doctors.” While it has
proved to be very helpful for primary-care providers,
lung CAD hasn’t made as big an impact with radiologists
yet, she says. “As lung CAD algorithms improve with
time, it will make more difference to radiologists.”
Meanwhile, CAD has value right now in her view if it
encourages primary-care physicians to take a second and
third look at chest x-rays.
In the
future
Debate continues about whether CAD is a valid tool,
Naidich says, and clinical evaluation has necessitated a
large-scale, randomized, multi-facility study. “If the
answer is that lung cancer screening is an important
clinical tool in its own right, that would have
tremendous impact on whether CAD to detect lung nodules
would be something people want.” Study results are
expected some time in 2008.
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