Examination: Low Dose CT Lung-Cancer Screening

Purpose of the test: UAB Hospital is now offering lung cancer screening using low-radiation CT (computed tomography) technology. Research shows a clear benefit for CT lung-cancer screening among individuals who meet strict criteria. Patients and referring physicians should understand both the benefits and the potential for false positive results.

Among heavy smokers, heart disease and lung cancer are the major causes of death.  A recent, large randomized control trial of lung-cancer screening, conducted by the National Cancer Institute included more than 50,000 patients and showed that annual chest CT screening can detect lung cancer sooner, and can reduce the death rate from lung cancer by 20% in high risk smokers older than 55 years.

In our judgment the individuals that may benefit from annual CT screening are:

1. Age = 55-77 years
2. Cigarette consumption > 30/pack years
3. Current smoker, or quit < 15 years ago

Benefits of screening:

  • Detection of lung nodules that may be cancers, before symptoms appear leading to early treatment.
  • Detection of significant coronary artery calcification, which may indicate higher risk for heart disease.

Potential disadvantages:

  • Many lung nodules detected from the CT are not cancers, and additional follow up CT examinations and/or other tests will be necessary to determine the presence of cancer.

Do I need a referral: Lung cancer screening chest CT requires referral from a physician, to ensure proper participant selection, as well as any necessary follow-up.  All patients must be referred for the study by a physician after a shared decision making appointment. It is important that a responsible healthcare provider manage follow up care for patients with a positive finding.  The patient and the referring physician must complete a lung-cancer screening form either by:

  1. UAB physicians – the online order form in Cerner
  2. Non-UAB physician download the form below and fax the completed form to UAB Radiology at the Kirklin Clinic (205) 731-6479.

About the CT exam: In accordance with UAB’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. The exam does not require contrast. Like mammography, CT screening should be performed annually. Currently, CT screening for lung cancer is covered by Medicare and many private insurers. If the CT is abnormal, subsequent care may be covered by your insurance.

How to prepare: We require that you have a personal physician that can manage any additional testing and follow up if an abnormality is found in the CT. The screening will not be performed without the contact information of a physician to whom the test results can be communicated. Since smokers have a higher likelihood of lung infections, and infection can result in abnormalities in the CT, which can mimic cancer, we recommend that the CT be delayed for 3-4 weeks if you had a fever, new cough or any change in sputum production during the past 2 weeks.

What to expect:  When you contact us, we will determine your suitability for the screening, that you do not have symptoms/signs suggestive of a recent lung infection, and that you have a personal physician (see above). The Physician’s office should send us the request for the CT. Then you will be given an appointment for the CT. It may be possible to perform the CT on the same day of request. No special preparation is required for the CT. You will be asked to lie on the CT table.  The CT technologist will determine the length of time to complete the scan (usually less than 20 seconds), and will coach you to take a deep breath, and hold the breath during the scan.  Once you understand the procedure, the CT examination will be performed.

After the examination: Two radiologists will review the CT. A written report will be sent to your personal physician and placed on the UAB patient portal. The report will describe any abnormalities found in the scan, and if they are suspicious for cancer, include clear and specific recommendations for subsequent follow up. If desired, you can discuss the CT report with your physician and/or radiologist. The CT will be reported by chest radiologists who have considerable experience in diagnosing lung cancer and heart disease.

To schedule an appointment:
Call UAB Radiology Scheduling at the Kirklin Clinic. (205) 731-9380
Referring physician can fax the Lung-Cancer Screening form to (205) 731-6479

Download Lung Cancer Screening form

Active smokers undergoing screening CT should enter a “smoking cessation program”.
Screening is not an alternative to smoking cessation.