1. The lung cancer mortality rate is high, and medical expenses for the treatment of lung cancer are care).. Total number of patients .[r]
Trang 1Can Radiographers Serve as Primary Screeners of
Low‐dose Computed Tomography for the
Diagnosis of Lung Cancer?
Presenter
Tomohiro Arai, R.T., Ph.D ,
Email address: depository.of.mail@gmail.com
24th August, 2019: Vietnam Association of Radiological Technologists
To promote the widespread acceptance
Welcome!
Consider the following issues.
To promote the widespread acceptance
of low‐dose lung cancer CT screening
1. What is the most effective screening program?
Page ・ 2
2. How should dose be managed?
3. How should accuracy and image quality be
managed?
Trang 2National medical care expenditures (2011: excluding dental
27,812.9 billion yen
Current status 1: Deaths from lung cancer
and medical expenses
The leading cause of death
1. The lung cancer mortality rate is high, and medical
expenses for the treatment of lung cancer arecare)
Total number of patients with malignant neoplasms 1,957,000 patients
General medical care expenditures (for malignant neoplasms)
3,183.1 billion yen
Number of patients with lung cancer 138,000 patients
Colon
Lung
expenses for the treatment of lung cancer are
increasing.
Page ・ 3
Medical care expenditures for lung cancer 381.1 billion yen
Medical care expenditures for lung cancer (per capita) 2,761,600 yen
Medical expense of Early detection (VATS） 976,263 yen
Breast
Prostat
e
※ VATS : Video Assisted Thoracic Surgery
if lung cancer can be
found at an early stage.
The Accreditation Council recognizes and publicizes medical professionals have
specialized education, training and experience related to Lung Cancer CT Screening
Approach of the Accreditation Council
for Lung Cancer CT Screening
To guarantee lung cancer CT screening at a certain accuracy
or higher at anytime and anywhere in Japan.
Technologies and Abilities required for
Accredited…
Page ・ 4
RT
Doctor
For the purpose of fostering and producing human resources with skills,
the lung cancer CT screening certification mechanism was established
■ Constant quality control of CT
■ "The ability to see" which becomes the
reading assistance of the doctor
Trang 3Number of certified RT for Lung Cancer CT Screening
Chubu
R.T = 127 Kinki
R.T = 317
K & Oki
Kanto R.T = 438
Page ・ 5
A total of 1453 Radiological Technologists have been certified “license in low‐
dose lung cancer CT screening” in approximately 10 years based on the test
results
Kyusyu & Okinawa
R.T = 166
Chugoku & Shikoku R.T = 438
Information
This report was published as an activity of
the Accreditation Council for Lung Cancer CT Screening.
Page ・ 6
Publication：Journal of X‐Ray Science and Technology Date ：2018．7.22
Impact Factor 2018：1.381
Trang 4■ The basic requirements for technologists to perform the
examination were licensure and at least 2 years of clinical
Requirements for the exam
examination were licensure and at least 2 years of clinical
experience as a radiographer.
• Score of >60% is needed for the
written
examination
Criteria of judgment (pass/fail)
Page ・ 7
examination
• Detection sensitivity of "true positive” (TP) must be
>0.90
• Az value in the area under the receiver operating characteristic curve of >0.90
Abnormal finding
detection test
1 Basic of CT A Basic of CT scanner
B Basic of CT image
Standard questions of written test
2 Management techniques of CT
A Image quality control
B Dose management
C CT Exposure
3 Inspection technology of lung
A
Basic knowledge of certified technologist of lung cancer CT screening
B Practice of lung cancer CT
Page ・ 8
3
cancer CT screening B examination g
C Accuracy management of lung
cancer CT examination
4 Basic knowledge of chest image
diagnosis
A Chest image anatomy
B Chest disease
Trang 5Abnormal findings detection method
‐ CT image viewer for test ‐
If lung nodule is identified =
TP (True Positive)
×
×
Page ・ 9
1 Display slices are changed by scrolling the mouse.
2 The mouse is also used to mark the locations showing
abnormal findings.
3 Image data for the next patient is loaded by clicking [Next
Patient] after image interpretation for the current patient is
completed.
If lung nodule is suspected in a region where lung nodule is not present = FP (False Positive)
Overall structure of the abnormal findings detection test system
Abnormal findings
detection test
Counting and scoring
of test results Clinical images Correct answer
data
Examinees
100 to 150 examinees
Test system Counting system
TP (True Positive) or
Page ・ 10
<1> 100 client systems are connected to one server system.
<2> Suspicious lung nodules are detected by the examinee.
<3> Counting and analysis are performed immediately after the test is completed.
Test results Counting results
FP (False Positive) for clinical cases
Trang 6n.s.
** : p < 0.01
* : p < 0.05
n.s.: no significant difference
n.s.
Avg. Value
Page ・ 11
**
**
Classification of experience years
n.s.
n.s.
Result of Abnormal findings detection test
** : p < 0.01
* : p < 0.05
n.s.: no significant difference
**
Avg. Value
0.922
Avg. Value 0.930
Avg. Value 0.937
Avg. Value 0.937
Page ・ 12
**
**
Classification of experience years
Trang 7n.s. n.s.
**
*
Result of Abnormal findings detection test
** : p < 0.01
* : p < 0.05
n.s.: no significant difference
Avg. Value
Avg. Value
0.365
Page ・ 13
**
n.s.
Classification of experience years
Relationship between years of experience and performance of CT used
RT acquire reading ability from the work environment
• Output only the necessary range using film
Transition of business configuration of CT
Multi slice CT (64‐row detectors )
• In single‐slice, once a lesion is recognized on a thick‐slice image,
thin‐slice images are obtained again.
Multi slice CT (16‐row detectors )
Single Slice CT
Page ・ 14
Analog output by film
Years of clinical
Digital output by PACS system
• Shorter imaging times with the use of multiple rows of
CT detectors
• Providing images with Thin Slice has become routine.
Simplify the work of checking the image
Trang 8■ From the test analysis of resluts
Witten test
Conclusion
• the written test tended to be higher with less experience.
Abnormal finding detection test
• the abnormal finding detection test improved with the number
of years of experience.
■ Future of education system
Page ・ 15
■ To maintain the standards of certified RTs, it is necessary to eliminate
biases in knowledge by assessing the balance between the foundation
and clinical knowledge and to review the educational method.
■ We believe that training and practice with CAD is indispensable to
maintain the standards of certified Radiological Technologists