The field of lung imaging continues to grow, as exemplified by the enthusiasm at International Workshop on Pulmonary Functional Imaging and the September 2013 issue of Journal of Thoracic Imaging dedicated to quantitative CT.
UW Radiology, under the direction of Dr. Mark Schiebler, recently hosted the 6th IWPFI in Madison this July, which brought together researchers and clinicians from across the globe to discuss state-of-the-art techniques in pulmonary functional imaging.
With newer generation CT and MRI scanners, new molecular imaging techniques, and new software, functional imaging of the lung is increasingly being used in research studies. Quantitative CT is being investigated in patients with chronic obstructive lung disease and pulmonary fibrosis. Pulmonary MRI with hyperpolarized gases can be combined with new perfusion sequences to study asthma, cystic fibrosis, and other airway diseases.
However, the clinical utility or feasibility of these techniques in general practice remains unclear. Furthermore, differences in hardware and software across manufacturers can affect quantitative measurements, making multicenter studies difficult. Nevertheless, this field continues to grow as exemplified by the enthusiasm at IWPFI and the September 2013 issue of Journal of Thoracic Imaging dedicated to quantitative CT.
Another exciting development in thoracic imaging is the recent publication of the National Lung Screening Trial (NLST), a study of approximately 55,000 current and former smokers comparing low-dose helical CT (LDCT) to chest radiography with the goal of reducing mortality from lung carcinoma. The trial showed that annual screening with LDCT, as compared to chest radiography, resulted in a 20% reduction in lung cancer specific mortality as compared to chest radiography, which has been confirmed to be no better than not screening at all.
The U.S. Preventive Services Task Force (USPSTF) recently released draft guidelines recommending annual LDCT screening for current and former smokers age 55-79 years with no previous history of lung cancer. Former smokers must have quit within the past 15 years. USPSTF gave this a grade B recommendation, which means that CMS and third-party payers will be required to cover this test under the Affordable Care Act should the draft guidelines be adopted.
UW Radiology currently has a self-pay lung cancer screening program in place developed in response to earlier guidelines issued by several professional societies following publication of NLST. We anticipate this becoming a covered service in the near future, available to all of our eligible patients.
New developments in functional lung imaging and lung cancer screening continue to make thoracic imaging an exciting field in radiology. We look forward to new technologies allowing us to integrate functional imaging into our clinical practice.
— Jeffrey Kanne
Chief of Thoracic Imaging