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Chest Imaging

E2910. Development and Implementation of a Lung Cancer Screening Program: A Resident-Driven Initiative

Buckley J,  Stowell J,  Reid S. Truman Medical Center, Kansas City, MO

Address correspondence to J. Buckley (jenniferrbuckley@gmail.com)

Background Information: Despite a significant reduction in incidence, lung cancer remains the third-most common cancer and is number one in cancer mortality. Detecting lung cancer prior to the onset of symptoms is vital to decreasing mortality. In 2011, results from the National Lung Screening Trial demonstrated a significant decrease in mortality from lung cancer via annual low-dose CT chest examination. In response to this data, multiple agencies, including the Center for Medicare and Medicaid Services (CMS), have issued recommendations supporting screening in high-risk patients. These recommendations led to the creation of hospital-based, multidisciplinary lung cancer screening programs (LCSPs). These programs benefit patients by defining appropriate eligibility criteria for referring clinicians, standardizing reporting between radiologists, and creating management pathways for positive findings. Furthermore, these programs also benefit the hospital by ensuring adherence to additional criteria required for reimbursement, particularly by CMS. A review of the utilization of low-dose CT screening examinations at our urban hospital showed a significant number of examinations were ordered or reported inappropriately, leading to inappropriate follow-up and preventing reimbursement. As residents, we used published recommendations to implement a multidisciplinary LCSP that successfully adhered to CMS eligibility and reimbursement criteria.

Educational Goals/Teaching Points: The goal of our exhibit is to review rationale for lung cancer screening, including potential benefits and harms. We will discuss the article entitled, “Ten Pillars of Lung Cancer Screening: Rational and Logistics of a Lung Cancer Screening Program” (RadioGraphics 2015; 35:1890–1908), and how the authors created an LCSP in our urban hospital. We will define current CMS reimbursement criteria as well as common reasons for nonreimbursement. We will explore how the implementation of key changes in current practice improved both success of screening and number of reimbursable examinations. Participants will understand Lung-Reporting and Data System (RADS) ratings and standardized reporting methods. We will also provide guidance for residents interested in developing a LCSP at their own institution.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: Multiple radiologic factors are tied to the reimbursement of lung cancer screening. These include the technical aspects of image acquisition, methods of evaluation of lung nodules and other findings, as well as standardized reporting. Lung-RADS is a quality assurance tool developed by the American College of Radiology to assign a rating to lung cancer screening examinations that dictates recommendations for follow-up. A review of Lung-RADS ratings, with representative examples, will be provided in this exhibit, with specific emphasis on standardized reporting and the influence this has on reimbursement.

Conclusion: Lung cancer screening via annual low-dose CT chest examination has been proven to reduce mortality in high-risk patients. Residents at our urban hospital were able to successfully implement a multidisciplinary LCSP. An understanding of the CMS eligibility and reimbursement criteria, including standardized reporting techniques, were integral to our success. Following a similar approach, residents at other hospitals can successfully implement a LCSP.