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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.

Smoking stigma present or not, innovations to improve the commonly late and missed diagnosis of lung cancer could change the lives of the hundreds of thousands of Americans diagnosed each year.   

According to the American Cancer Society, an estimated 222,520 patients will be diagnosed with lung cancer in 2010 and more than 150,000 will lose their battle to the disease.¹ More people will die from lung cancer this year than breast, colon and prostate cancers combined.²

Lung cancer awareness, funding

 While lung cancer is the leading cancer killer, it falls short on funding, research and early detection screening programs. In fact, lung cancer continues to be the least funded in dollars per death of the four major cancers. Table 1 represents the research dollars spent by the Department of Defense, the Centers for Disease Control and Prevention and the National Institute of Health in 2009 per death for respective types of cancers.³

As well, lung cancer continues to be plagued by the stigma associated with smoking, yet cigarette smoking is only one of the risks associated with lung cancer. Approximately 15 percent of lung cancer patients are non-smokers.⁴ Only through activism and associated funding have devastating diseases seen dramatic improvements in the effectiveness of treatments and benefits of early detection.

The need for early detection

The five-year survival rate of a lung cancer patient is 15 percent, according to the Lung Cancer Alliance.⁵ Only 16 percent of lung cancer is diagnosed at the earliest and most treatable stage.⁶ Detection at an early stage is difficult. Symptoms--persistent cough, chest pain or shortness of breath--aren't commonly present until the cancer has grown to a significant size. In fact, the detection of early stage lung cancer is typically a result of a non-symptomatic patient receiving a chest X-ray or CT scan for an issue unrelated to lung cancer.

Most early- and late-stage lung cancers are detected using a traditional chest X-ray due in large part to the frequent use of the chest X-ray. One out of every 500 to 1,000 chest X-rays reveals an unexpected lung nodule.⁷ While CT scans can detect smaller lesions than a traditional chest X-ray, the prevalence of CT is far less than chest X-ray and the risks to the patient far greater. Issues relating to CT scans received national spotlight in recent years as new findings highlighted the risks of exposure to higher doses of radiation. Advances in new technologies allow chest X-rays to be more effective and practical for detecting lung cancer in its earliest stages.

Soft tissue images: seeing beyond the bone

Data has shown that 81 percent of missed lung cancers were partially obscured by ribs and clavicles.⁸  New technologies are now available that lead to increased visibility of soft tissue in a chest X-ray (offered by Fuji, GE Healthcare and Riverain Medical). The bone suppressed, soft tissue image can be obtained through both hardware and software solutions.

Before and after: Riverain Medical's SoftView technology uses advanced algorithms to suppress the bone in chest X-ray images without requiring dedicated hardware or exposing the patient to additional radiation. images/courtesy of Riverain Medical

Data demonstrates that radiologists who use Riverain Medical's OnGuard CAD technology for chest X-rays can improve the detection of nodules and detect up to 50 percent of missed nodules.

CAD technology

Computer-aided detection (CAD) is a widely-used tool in mammography, breast MRI, virtual colonoscopy, chest X-rays and lung CT. CAD technologies work as a second set of eyes to indicate areas that warrant a closer look. Chest X-ray and lung CT CAD have shown radiologists with these tools can result in improved detection rates of lung cancer and the ability to detect lung cancer earlier.¹¹

Early barriers to the adoption of chest CAD (i.e., false-positive rates and workflow) are being overcome by algorithm improvements along with full, seamless integration into existing PACS reading workstations.

On the horizon

Blood biomarker and breathalyzer technologies also show promise to detect lung cancer. These non-invasive breakthroughs analyze biomarkers in a person's blood and particles in the breath to detect the presence of lung cancer cells.

Studies have shown that with the early detection of lung cancer, five-year survivability rates can triple.⁹ Today's technologies make this early detection a reality. Imaging technologies used to aid in lung cancer detection are able to assist your healthcare organization to make a difference in the fight against lung cancer.

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.