Lung-RADS has evolved to meet the needs of both patients and radiologists in providing lifesaving care. With Lung-RADS, we are able to more accurately detect, classify, and manage cancer in its earliest, most treatable stage,” says Jared D. Christensen, MD, MBA, director of the Duke University Lung Cancer Screening (LCS) Program, vice chair and associate professor of radiology at Duke University Medical Center, and chair of the ACR Lung CT Screening Reporting & Data System (Lung-RADS®) Committee.
Lung-RADS is a quality assurance tool designed to standardize LCS CT reporting and management recommendations, reduce confusion in LCS CT interpretations, and facilitate outcomes monitoring. A complete lexicon of LCS CT terms, classification, and follow-up guidance standardizes the language used in reports. The Bulletin recently caught up with Christensen about the latest updates to the Lung-RADS tool.
What is the goal of Lung-RADS?
The ultimate goal of Lung-RADS is to identify findings that may represent lung cancer and provide appropriate and timely management guidance to reduce lung cancer mortality. Achieving this goal is a multifocal approach that involves engagement by patients, referring physicians, and radiologists.
How is lung cancer research tied to Lung-RADS?
The accuracy and overall benefit of Lung-RADS is directly tied to research. We encourage ACR members who have an interest in lung cancer to explore questions around screening and the impact on patient outcomes. It is all about data. For instance, the new criteria for atypical pulmonary cysts and juxtapleural nodules are predicated on available research. The strongest and most reliable recommendations come from evidence-based data. In the absence of such data, we rely upon expert consensus to inform best practices.
What is new with Lung-RADS 2022?
Lung-RADS 2022 makes some significant updates to our classification system. We have added new classification criteria for atypical pulmonary cysts. Up to 6% of all lung cancers have an associated cystic component, and cystic lesions were difficult to categorize in version 1.1. We have also expanded management criteria for juxtapleural nodules — version 1.1 applied only to perifissural nodules that met specific shape and size criteria. However, new research suggests we can apply similar criteria to all nodules along the pleural surface. There are several other updates that provide clarity to the system, including additional guidance for endobronchial nodules, stepped management criteria for follow-up of suspicious nodules, and guidance on how to handle interval diagnostic CTs in screening. Finally, we plan to release a text and image-based Lung-RADS atlas that will illustrate how to apply Lung-RADS in clinical practice. Whenever we make changes, we strive to balance potentially increased complexity with the overall benefits of patient care. As a committee, we have attempted to keep things as simple as possible to facilitate adoption.
Why are these updates important?
Much like with other image-based systems or tools, Lung-RADS provides a standardized way to communicate and report findings with evidence-based management recommendations. Although most nodules are benign, we want to capture suspicious nodules that could represent lung cancer and facilitate early treatment. We believe the updates in Lung-RADS 2022 help accomplish that objective. Simply put, low-dose CT screening saves lives by reducing lung cancer mortality.
What are the secrets to your success?
The ACR Lung-RADS Committee is very diverse — representing diversity in experience and in practice, with both community and academic programs represented, as well as in gender, race, and ethnicity. Over the past three years, the committee has grown along these parameters to bring to the table the most robust expertise and perspectives around LCS. Such diversity results in better outcomes.
What should ACR members take away from this?
I would love all ACR members to recognize that the Lung-RADS system has been developed to benefit patients — it saves lives. For radiologists, it helps us provide better and more timely care. I would also stress that while CMS no longer requires reporting to the National LCS Registry, the ACR strongly encourages programs to continue registry participation — because data from the registry help inform future Lung-RADS updates. We need radiologist engagement to ensure continued progress in LCS.