Results of the National Lung Screening Trial (NLST) released last November showed that early detection of lung cancer can save lives. Low-dose helical computed tomography (CT) scans showed bigger gains than the chest X-ray but not without concern. Cost, accessibility, radiation dose and false-positives are risks to be considered when using CT as a screening tool.

Over the next few years, researchers, physicians and hospitals will start to develop screening protocols, which will likely recommend CT scans. In the meantime, it’s important for hospital administrators to look closely at their current X-ray equipment today and consider ways to make it more effective for lung cancer detection.

Most lung cancers, early- and late-stage, are detected using a traditional chest X-ray due in large part to the frequent use of the chest X-ray. Surprisingly, one out of every 500 to 1,000 chest X-rays reveals an unexpected lung nodule. Today, 40 percent of hospitals in the U.S. don’t have access to a spiral CT scanner. Particularly in rural communities, hospitals do not necessarily have the budget to make the capital equipment investment of one million dollars for a low-dose helical CT machine.

Riverain Medical’s SoftView suppresses ribs and clavicles on chest X-rays for a clear view of soft lung tissue.

At this time, a chest X-ray costs around $45, while a CT scan is typically over $300. This represents a six time differential for the patient. To compound the cost issue, Medicare and third-party insurance payers do not reimburse for CT or chest X-rays as a screening tool. Outside formal, endorsed screening programs with well-established protocols, an augmented chest X-ray is an attractive tool to aid in the fight against lung cancer.

Today, hospitals have access to enterprise-wide CAD and bone suppression software that works in concert with a chest X-ray, helping radiologists detect cancer at its earliest and most treatable stage. This serves as an important step to fighting lung cancer.

Chest X-rays are an underutilized source of information. Some hospitals are finding that by upgrading existing X-ray equipment with Enhanced Chest Imaging technology, they can significantly improve the sensitivity of chest X-rays and their ability to detect abnormalities, including lung cancer.

Two of the newest chest X-ray innovations are bone suppression and Computer Aided Detection (CAD) technologies that work in tandem with chest X-rays. Bone suppression technologies, such as Riverain Medical’s SoftView, suppresses the ribs and clavicles on every chest X-ray giving the radiologist a clear view of the soft tissue in the lungs, resulting in improved detection of lung nodules. Since lung cancer can be obscured by the bone, the technology enables the radiologist to see the lung, without any obstruction. Multi-reader, multi-case reader studies have shown the use of SoftView can improve the detection of lung nodules.

Riverain’s OnGuard processes the chest X-ray and marks lung nodules that may be lung cancer.

Enhancing chest X-rays can have additional clinical benefits. Riverain’s Enhanced Chest Imaging technology has been proven to help physicians diagnose pneumonia. In addition, clinical research is underway to evaluate the benefits of Enhanced Chest Imaging in detecting change over time on a chest X-ray, detecting tuberculosis and verifying line and tube placement.

Most radiologists agree that the chest X-ray is a ubiquitous technology that will continue to be an important tool in detecting lung cancer far into the future. By enhancing the chest X-ray, administrators will be making a long-term investment in their hospital’s technology infrastructure that makes a difference.

Steve Worrell is the Chief Technology Officer of Riverain Medical and a pioneer in the development of advanced visualization technologies for mammography and chest X-ray.