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Lee, Kim, Kim, Park, Yi, and Jeong: Korean Society of Thoracic Radiology Guideline for Lung Cancer Screening with Low-Dose CT
Chest Radiology

Journal of the Korean Society of Radiology 2012; 67(5): 349-365.

Published online: 30 November 2012

DOI: https://doi.org/10.3348/jksr.2012.67.5.349

Korean Society of Thoracic Radiology Guideline for Lung Cancer Screening with Low-Dose CT

Hyun Ju Lee, MD1, Jin Hwan Kim, MD2, Yoon Kyung Kim, MD3, Chang Min Park, MD1, Chin A Yi, MD4, Yeon Joo Jeong, MD5

1Department of Radiology, Seoul National University Hospital, Seoul, Korea.

2Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea.

3Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea.

4Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

5Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Korea.

Corresponding author: Jin-Hwan Kim, MD. Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon 301-721, Korea. Tel. 82-42-280-7838, Fax. 82-42-253-0061, michelan@cnu.ac.kr

Received 8 August 2012       Accepted 23 October 2012

Copyright © 2012 The Korean Society of Radiology

Abstract

The National Lung Screening Trial (NLST), a nation-wide randomized controlled trial involving more than 50,000 current and former heavy smokers ages 55 to 74, compared the effects of two screening procedures (low-dose helical CT and standard chest radiography) on lung cancer mortality and found 20 percent fewer lung cancer deaths among trial participants screened with low-dose CT. Korean Society of Thoracic Radiology (KSTR) planned to establish an effective guideline for lung cancer screening with low-dose CT to improve health of Korean people and to reduce harms from misuse of lung cancer screening with low-dose CT. KSTR guideline for lung cancer screening with low-dose CT established based on objective medical evidences obtained by NLST.

Keywords: Screening, Lung Cancer, Low-Dose CT, Korean Society of Thoracic Radiology, Guideline

Figures and Tables

Fig. 1

Estimated New Cancer Cases and Cancer Deaths in the United States (2010).

A. Estimated New Cancer Cases in the United States. Lung cancer is the second most common cancer in the States being second only to prostate cancer in men and breast cancer in women (from reference 4).
B. Estimated New Cancer Deaths in the United States (2010). Lung cancer is the leading cause of cancer death in both men (29%) and women (26%). The statistical data shows that lung cancer causes the death of 157300 people every year in the United States (from reference 4).
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Fig. 2

Age-Standardized Death Rates of Cancers in the Korea (2011). Lung cancer becomes the major causes of cancer death from 1999. Lung cancer causes the largest number of cancer deaths in the Korea, accounts for more deaths than stomach cancer and hepatocellular carcinoma (from reference 5).

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Table 1

KSTR Guideline for Lung Cancer Screening with Low-Dose CT (1)

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Table 2

KSTR Guideline for Lung Cancer Screening with Low-Dose CT (2)

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Note.-KSTR = Korean Society of Thoracic Radiology, LDCT = low-dose computed tomography, NLST = National Lung Screening Trial

Table 3

Pulmonary Nodule Classification Detected on Screening CT

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Note.-*The nodule size was defined as the average of length and width.

†Interval growth of nodules was defined as follows: a diameter change ≥ 50% in nodules ≤ 5 mm; a diameter change ≥ 30% in nodules of 5-9 mm in size; a diameter change ≥ 20% in nodules ≥ 10 mm in size.

‡The definition of "solid portion growth" in part-solid nodule was as follows: a solid part diameter change ≥ 50% in the case of solid portion ≤ 5 mm; a solid part diameter change ≥ 30% in the case of solid portion of 5-9 mm in size; a solid part diameter change ≥ 20% in the case of solid portion ≥ 10 mm in size.

Table 4

Management Protocol according to Nodule Classification

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Note.-*Management protocol covers both the baseline-detected nodules and the interval-detected nodules.

†Solid nodules can be considered benign (Category 1) if they are stable over at least 2 years' follow-up period irrespective of their size. In the case of part-solid nodules or pure ground-glass nodules, there has been no sufficient evidence to determine any specific follow-up duration to confirm their benignity, yet.

Table 5

CT Acquisition Parameters (NLST)

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Note.-NLST = National Lung Screening Trial

Table 6

CT Acquisition Parameters (KSTR)

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Note.-BMI = body mass index, KSTR = Korean Society of Thoracic Radiology, MDCT = multidetector CT

Table 7

Quality Control Tests for CT

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Table 8

Performance Evaluation of CT Using Phantom

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Note.-HU = Hounsfield unit, ROI = region of interest

Table 9

Quality Control in CT: Clinical Image Quality Assessment

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Table 10

Radiologic Data Reporting System

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Note.-LAD = left anterior descending, LCX = left circumflex, RCA = right coronary artery

Notes

This work was supported by the 2012 KSTR Research Grant funded by the Korean Society of Thoracic Radiology.

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