Lung-cancer screening using CT (computed tomography)
Massachusetts General Hospital Imaging now offers CT (computed tomography) lung-cancer screening, on a self-pay basis, for individuals meeting specific criteria.
A small nodule discovered by CT in the left lung (A)
enlarged on followup CT scan (B) and was found to
be an adenocarcinoma at surgery.
Massachusetts General Hospital Imaging provides lung-cancer screening using low-radiation-dose CT (computed tomography) at Mass General Imaging – Chelsea, Mass General West Imaging – Waltham, and Mass General Imaging - Worcester. No matter which facility you come to, our staff places priority on making your journey through the imaging process comfortable, safe, and successful. All images are read by a radiologist with specialty expertise in the area of the body being studied.
Lung-cancer screening overview
- A large scientific study recently showed that lung-cancer screening using CT technology resulted in a significant reduction in deaths among patients who met specific criteria.
- National medical societies such as the American Cancer Society are working on official guidelines for who should receive lung-cancer screening and when they should receive it.
- Until such guidelines are available, Mass General Imaging is providing lung-cancer screening to patients who meet the criteria that were used in the study:
- Current or former smoker between 55 and 74 years of age.
- History of at least 30 “pack years” of smoking. (A pack year equals the number of packs smoked per day times the number of years the patient smoked; two packs a day for 10 years equals 20 pack years.)
- No history of any cancer within the past five years.
- Former smokers must have quit within the past 15 years
- A physician referral is required.
- The service is provided on a self-pay basis; the fee is $350, payable at the time of the exam.
- Lung-cancer screening does not involve the use of contrast.
- Lung-cancer screening carries a low radiation dose.
- Patients and referring physicians should be aware that lung-cancer screening has a high rate of false positive results, which may lead to followup exams, additional cost, additional radiation exposure and patient anxiety. It is important that a responsible health care provider manage follow up care for patients with a positive finding.
Lung-cancer screening in depth
On July 6, 2011, the New England Journal of Medicine published results from the National Lung Cancer Screening Trial (NLST) conducted by the National Cancer Institute (NCI) and the American College of Radiology Imaging Network (ACRIN). This study, the only randomized control trial of lung-cancer screening that has been completed, included more than 50,000 patients.
The results demonstrated a mortality benefit of 20 percent when CT is used to screen high-risk patients for early lung cancer. In other words, 20 percent fewer deaths were reported during the study among a group of patients who received CT scanning of the chest versus a control group of patients who did not.
National medical societies such as the American Cancer Society are now developing guidelines for screening programs, but none are currently available. In the meantime, Mass General Imaging recommends using the inclusion criteria used in the National Lung Cancer Screening Trial, as outlined above.
Until official guidelines are available, insurance companies will not cover lung-cancer screening, so the service is being offered on a self-pay basis. The total fee of $350 will be due at the time of the exam. If the initial exam uncovers something that requires followup, the patient’s insurance should cover additional exams.
Active smokers undergoing screening CT should enter a smoking cessation program. Screening is not an alternative to smoking cessation.
Radiation dose reduction
In accordance with Mass General Imaging’s commitment to reducing radiation exposure, lung-cancer screening will be a low-dose CT exam, with a radiation dose of around 1.5 mSv (millisieverts), equivalent to approximately half of the naturally occurring background radiation that a person receives living for one year at sea level.
Although low-dose CT screening for lung cancer in high risk groups has been shown to have a definite benefit in saving lives, there is a negative aspect: The number of false-positive studies is high. For example, indeterminate lung nodules, which could be cancer but are small, will require followup in order to determine if they grow, indicating a likely cancer. Larger nodules may require biopsy by means of an invasive procedure to establish the diagnosis. Some of these nodules will be proven not to be cancer.
What should I expect BEFORE my CT lung-cancer screening?
- Medications: It is important for you to keep to your regular medication schedule. Please take all the medications that have been prescribed to you by your doctor. Just let our staff know what medications you have taken prior to your test.
- Food and drink: There are no restrictions on food and drink.
- When to arrive: Please arrive 15 minutes before your scheduled appointment time.
- What to wear: You should dress in comfortable clothing. It might be necessary for you to change into a hospital gown if there is metal in your clothing, such as a bra or zipper, within the area of interest of your study. If you are wearing jewelry or anything else that might interfere with your scan, we will ask you to remove it. The CT scan is conducted in a very secure environment. It is best, however, if you leave valuable items at home.
What will I experience DURING my CT lung-cancer screening?
- Scanning: Your CT technologist will bring you into the CT scan room where you will lie down on the patient table. The technologist positions your body so that the area you are having scanned is in the middle of the large doughnut-shaped scanner ring which holds the x-ray tube and an electronic detector. The technologist leaves the room, but is in full view and communication with you through the observation window in the adjoining room.
The scanner does not touch you, nor do you feel the x-rays. It does make some noise and the table you are lying on may move slightly to make adjustments for a better view. It is important for you to lie very still and at some points, you may be asked to briefly hold your breath as the picture is taken. During the scan, a thin beam of x-ray is focused on a specific part of your body. The x-ray tube moves very rapidly around this area, enabling multiple images to be made from different angles to create a cross-sectional picture. The x-ray beam information goes to the electronic detector and then into a computer, which analyzes the information and constructs an image for the radiologist to interpret.
- Length of scan: Most examinations last approximately 15 minutes in total, and the actual scanning only takes about a minute.
What should I expect AFTER my CT lung-cancer screening?
- Instructions: You have no restrictions after having a CT scan and can go about your normal activities.
- Exam results: All CT scans are read by a Mass General radiologist specialty trained in CT imaging and dedicated to the specific area of interest for your study. Rapid results are essential not only for your peace-of-mind, but also for your physician to begin planning your treatment immediately, if necessary. After the scan has been read the results are sent to your physician, who will discuss them with you.
Research shows a clear benefit for CT lung-cancer screening among individuals who meet strict criteria. Patients and referrers should understand both the benefit and the potential for false positive results.
Find scheduling information for patients and referring physicians.
Mass General offers specialty-trained radiologists, leading-edge technology and a caring staff that's committed to patient safety and comfort.
Every scan at Mass General Imaging is read by a radiologist with specialty training in the area of the body being studied.