How patients and providers benefit from CT lung cancer screeningPosted on: 11.01.18
Lung cancer is a leading cause of cancer deaths. One reason is that the signs and symptoms don’t present themselves until the disease has already progressed. By taking advantage of low-dose CT lung cancer screenings, high-risk patients can reduce their chances of dying from lung cancer by as much as 20%.
Screening eligibility requirements
Under the Medicare and Medicaid guidelines, a patient must meet the following criteria:
- Be between the ages of 55 and 77
- Be asymptomatic of lung cancer
- Have a tobacco smoking history of at least a one pack per day for 30 years or 2 packs per day for 15 years
- Be a current smoker or former smoker who has quit within the last 15 years
Patients who satisfy the eligibility requirements will meet with a qualified health professional for a lung cancer screening counseling session. The session is designed to result in a share-making decision about the patient’s upcoming test results.
If anything suspicious is found, the patient and healthcare professional will develop a treatment route to pursue. If it comes back normal, there’s always the recommendation that the patient continues to get the scan on an annual basis until they no longer meet the eligibility requirements.
What happens during the screening test?
The test itself is quite simple. It’s essentially a chest CT-scan that does not require any preparation. After answering a few screening questions, the patient will lay down on the scanner and hold their breath for ten seconds during the scan. There is no IV or contrast administration needed.
The screening is a significant benefit to the patient. Although they’re considered high risk due to their lifestyle, they’re also asymptomatic at the moment. In the event of a positive result, the identification of lung cancer at any stage before it shows signs or symptoms offers the patient a higher chance of survival.
Patient and Facility Benefits
The benefit to the patient and the effect on their survival rate are most important, but there are additional benefits to the facility that provides the screening service. As they continue to serve the community and identify people early in their cancer journey, the facility is continually establishing themselves as a lung cancer treatment center.
The earlier a patient begins treatment, the higher their survival rate…and the better the statistics for the hospital. In the age of Google, when families are searching for a treatment facility, those with higher survival rates will be looked upon more favorably.
It also provides a financial benefit for the facility. From a business perspective, the lung cancer screenings and diagnostic CTs don’t generate a tremendous amount of revenue, but the treatment, radiation therapy, surgery, and chemotherapy utilize a broad spectrum of services at your facility.
Outsourced CT Imaging
If your facility is reaching maximum capacity for CT imaging, or does not currently offer on-site CT, there is the option of outsourcing it to a mobile provider like DMS. As an extension of your facility, DMS can provide their state-of-the-art equipment at your location to perform the screenings and ultimately complement your efforts.
It’s a worthwhile service for your patients and the community, and it financially supports your organization without putting the extra burden on your staff. For more information on DMS and how they can help support your efforts, visit their website.
World Lung Cancer Day – August 1stPosted on: 07.26.18
This upcoming Wednesday, August 1st, is World Lung Cancer Day. As healthcare providers, we feel that it is important to help raise awareness of the disease and discuss what can be done to combat it.
According to the American Cancer Society, lung cancer is the second most common cancer in both men and women – second only to prostate and breast and prostate cancer. With over 234,000 new cases of lung cancer being diagnosed each year, the chances of developing the disease are 1 in 15 for men and 1 in 17 for women. With statistics like these, it is important that we know what symptoms to look for and what we can do to prevent it.
Signs & Symptoms
Unfortunately, the majority of people that develop lung cancer are asymptomatic, or do not have any signs or symptoms, before the cancer starts to spread. Some individuals do experience early symptoms that help to detect the cancer before it spreads but it is not as often as the medical community would like. Some of the most common symptoms of lung cancer are:
- Shortness of breath
- Persistent cough that lingers or gets worse over time
- Cough that produces a bloody or concerning looking phlegm
- Consistently feeling tired or weak
- Loss of weight or appetite
- Chronic respiratory infections – bronchitis, pneumonia, etc.…
There is hope thanks to advances in technology and medicine. As detection methods are improving, so are the odds of overcoming early stage lung cancer. One of the best screening tools out there is a low dose CT (LDCT) lung cancer screening.
What is a low dose CT lung cancer screening?
LDCT lung cancer screening is exactly as it sounds – a CT or CAT scan involving a minimal amount of radiation. The exam itself takes only a few seconds while most of the time spent at the imaging facility is either registering at the front desk or walking back to the CT department. Luckily, there is no need to have an IV or contrast injected as part of the routine screening exam.
Can anyone have a LDCT lung cancer screening?
Right now, to qualify for a LDCT screening exam, there are a few criteria that must be met. Keep in mind, newer healthcare procedures tend to evolve over time and this is what the American Cancer Society currently recommends (all criteria must be met):
- Be a current smoker or have quit within the past 15 years
- Have a 30+ pack year smoking history: This equation for this is: (# of years smoked) x (# of cigarettes per day) = pack years
- Example: (15 years of smoking) x (2 packs per day) = 30 pack years
- Received counseling to quit smoking if they are current smokers
- Have been informed by their physician regarding the potential benefits, limitations and harms associated with LDCT screenings
- Have a facility where they can go to receive LDCT screenings and treatment
Digirad and DMS Health Technologies are available to help your facility or clinic establish a LDCT screening program. Don’t have a CT scanner? No worries, we can help with that.
There are many resources out there on lung cancer, smoking cessation, patient and family support. A few great places to start are:
Why you should rethink PET/CT imaging for prostate cancerPosted on: 06.28.18
The large majority of the nuclear imaging community would be quick to point out that PET/CT imaging with either 18Fluorodeoxyglucose (18FDG), or Sodium 18Fluoride (NaF18), is not effective in prostate cancer diagnosis. In fact, it’s not even approved for initial prostate treatment strategy.
With oncology imaging, most other cancers are green-lighted for both initial and subsequent treatment strategies. Prostate imaging, however, is only approved in the latter.
Radiopharmaceuticals and diagnosis
Because prostate cancer is a slow growing, less aggressive disease, the common sugar-based FDG is not an effective agent for diagnosis, but it can be used appropriately to identify metastasis in the body during subsequent treatment.
Sodium 18Fluoride (NaF18), has been used in bone imaging and was previously covered through the National Oncologic Pet Registry (NOPR). However, when the radiopharmaceutical reimbursement was discontinued in December 2017, it lost some of its popularity among physicians. Based on the NOPR study results, coverage is expected to be addressed in the future.
While prostate cancer is consistently one of the top three cancers in the nation, there are very few effective imaging solutions. Blood work, specifically through monitoring the prostate-specific antigen (PSA) level, delivers the majority of diagnoses. Any deviation from normal is an indicator, and may lead to surgery, cryotherapy, or radiation, as necessary.
One new radiopharmaceutical, two benefits
The relative newcomer to prostate cancer detection is Axumin (18F-Fluciclovine), which is indicated for PET imaging in men with suspected prostate cancer recurrence based on elevated PSA levels following prior treatment (chemical recurrence). By continuously monitoring PSA levels following treatment, Axumin can be used as soon as PSA levels begin trending upward leading to quicker detection.
Other imaging methods rely on physical changes in the body, whereas Axumin detects changes on the physiological level, which can develop weeks, even months earlier than physical changes. It ultimately presents a huge opportunity to fill the void in prostate imaging solutions.
An Axumin PET scan accurately identifies the cellular activity and location of a reoccurrence. While 18FDG is ideal for soft tissue, and NaF18 for bone imaging, Axumin offers the best of both worlds. Imaging studies show skeletal mass and metastasis throughout the body, including the prostate bed. When using Axumin, the imaging process begins right away and there is little to no bladder uptake visualized, whereas the traditional method of imaging with 18FDG typically has a great deal of bladder uptake. This bladder uptake, in some cases, obscures residual prostate cancer that may be in the prostate bed or regional lymph nodes.
The challenge with Axumin is its availability. It is currently available from only a handful of radiopharmacies throughout the U.S. and is only produced on certain days, with doses available during a short window of time. However, additional manufacturing sites are planned for 2018.
The role of PET/CT with pulmonary nodule workups: what you need to knowPosted on: 05.25.18
The two most common approaches after identifying a solitary pulmonary nodule are the wait-and-see approach, or to move straight to a biopsy. While medically sound, both of these paths present risks for the patient that could be solved with a PET/CT scan.
It’s a common misconception in nuclear medicine that a patient must have a cancer diagnosis before a PET/CT scan can be ordered. While this is generally true, many physicians are not aware that a solitary pulmonary nodule that measures less than 4cm qualifies for a PET scan without a prior cancer-confirming biopsy.
Avoiding Unnecessary Risks
Lung nodules are typically discovered via chest x-ray or CT and available guidelines for nodule management are generally based on nodule size or changes.
The wait-and-see approach is a standard recommendation for nodules under 4cm. The patient is given CT scan and then rescanned on a pre-determined schedule (every six or 12 months). This approach works well if the risk is in-fact low, but for patients who do have metabolically active nodules, this approach can have serious consequences. Properly identifying and diagnosing the cancer early can have a far-reaching impact on their long-term prognosis. Waiting to see if the nodule gets worse costs valuable time.
However, the reason most physicians chose the wait-and-see approach is that the alternative, a lung biopsy, also presents risks. For small nodules that may or may not be growing, many doctors decide that waiting is safer than subjecting the patient to a potentially unnecessary invasive medical procedure. Lung biopsies are a vital diagnostic tool, but they bring with them the risk of infection, collapsed lungs, bleeding in the lung, etc.
Gaining Clarity with PET/CT
The central issue physicians deal with in these situations is how to deal with the unknown and juggle the risks associated with both paths. With PET/CT imaging, you have a much clearer picture of what is actually happening within the nodules. Having this vital information makes the decision much easier and drastically reduces the risk for the patient.
For nodules that are not metabolically active during the PET/CT scan, it’s not recommended to follow up with a biopsy. So patients avoid the risks of an unnecessary procedure. However, if the nodule positively reacts to the radiotracer, further investigation and a biopsy are strongly recommended. Knowing this sooner, rather than later, saves the patient valuable time.
Additionally, in the new “value-based” culture we operate in, investing in a single PET/CT scan could save the healthcare system tens of thousands of dollars in unnecessary scans, biopsies, or advanced cancer treatments. It’s the right thing for the patient, and the system. That is precisely why Medicare covers it.
PET/CT vs. CT
In the wait-and-see approach, most physicians recommend having a series of follow-up CT scans. While CT scans are effective, PET/CT is more accurate than CT alone for characterizing pulmonary nodules, resulting in fewer equivocal findings and higher specificity. Low to intermediate risk nodules ≥ 8 mm should be evaluated by PET/CT, whereas high-risk nodules should be biopsied or excised.
In over 80% of indeterminate CT scans, PET/CT correctly characterizes lung nodules. Statistically speaking, PET/CT is far superior to CT in terms of diagnostic accuracy in solitary pulmonary nodule characterization. PET/CT is 97% sensitive, has an 85% specificity value, a 92% negative predictive value (NPV) and a 93% positive predictive value (PPV). Overall, PET/CT imaging provides 92% accuracy when diagnosing SPNs.
The Society of Nuclear Medicine recommends that FDG PET/CT exams should be routinely obtained in the diagnostic work-up of solitary pulmonary nodules. Imaging will improve health care outcomes, mostly by avoiding futile surgeries in low-risk patients and enabling curative surgeries in high-risk patients.
PET/CT is approved by CMS for characterization of solitary pulmonary nodules not exceeding 4 cm to determine the likelihood of malignancy. Claims should include evidence of the initial detection of a primary lung nodule, usually by computed tomography. SPNs recommended with a PET/CT follow up using ICD 10 code R91.1
Although the Fleischner Society generally recommends a wait-and-see approach for nodules under 8cm, the under 4cm requirement for PET scan approval is causing many physicians to reevaluate their care strategy. PET/CT scans are a useful screening tool that clarifies where the patient actually stands.