A lung screening programme using low-dose CT (LDCT) requires a reading radiologist to dedicate a significant amount of time to the task. Should a national lung screening programme be launched, the number of radiologists reading lung screening CTs would - in terms of current working practices- need to increase, especially if the reading protocol involved more than one reader with consensus and arbitration, as is the case with many current or recently concluded lung cancer screening trials [1-4]. One possible method of circumventing the increase...

Study design and case selection The UK Lung Screen (UKLS) pilot trial is a randomised control trial that has been underway since 2011, randomising 4000 subjects (2000 in each arm) aged between 50 and 75 years to either screening with LDCT or no screening [5]. Over a 20-week period between November 2011 and April 2012, the LDCT studies of 290 consecutive participants in the LDCT arm of the UKLS were read prospectively for this study. All LDCT scans were performed at two participating sites. Classification...

Reference standard Eighty-one (27.9%) of the 290 CT studies did not contain any nodules. The reference standard consisted of 599 nodules in the remaining 209 (72.1%) CT studies. Figure 1 illustrates the frequency of the number of reference standard nodules per scan. The majority of scans had one (74/209,35.4%), two (48/209, 23.0%) or three (45/209, 21.5%) nodules. The median number of reference standard nodules per scan was one, with a range of 0 to 18 nodules. 567/599 (94.7%) of the reference standard nodules were solid....

The importance of a high rate of nodule detection- i.e. high sensitivity- is underscored by the fact that most failures in lung cancer diagnosis are due to errors of detection rather than interpretation [6,7]. Considering this in isolation, any CT screening programme would want readers with the highest possible sensitivity. In this context, data from our study suggests that radiographers cannot be considered ideal first readers for lung screening, since their performance in the majority of cases was statistically significantly lower than that of the...

1. van Klaveren RJ, Oudkerk M, Prokop M, et al. Management of lung nodules detected by volume CT scanning. N Engl J Med 2009; 361:2221-2229 2. Pedersen JH, Ashraf H, Dirksen A, et al. The Danish randomized lung cancer CT screening trial--overall design and results of the prevalence round. J Thorac Oncol 2009; 4:608-614 3. Lopes PA, Picozzi G, Mascalchi M, et al. Design, recruitment and baseline results of the ITALUNG trial for lung cancer screening with low-dose CT. Lung Cancer 2009; 64:34-40 4. Pastorino...

Arjun Nair, Thoracic Imaging Fellow, Royal Brompton Hospital, London, UK. Email: [email protected] Nicholas J Screaton, Consultant Radiologist and Clinical Director, Radiology Services, Papworth Hospital, Cambridge, UK. John A Holemans, Lead Consultant Cardiothoracic Radiologist, Liverpool Heart and Chest Hospital, Liverpool, UK. Diane Jones, Superintendent Radiographer, Liverpool Heart and Chest Hospital, Liverpool, UK. Leigh Clements, Superintendent Radiographer, Papworth Hospital, Cambridge, UK. David R Baldwin, Consultant Respiratory Physician and Honorary Associate Professor, University of Nottingham Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals, Nottingham, UK. Professor...