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Screening for Early Lung Cancer, Chronic Obstructive Pulmonary Disease, and Cardiovascular Disease (the Big-3) Using Low-dose Chest Computed Tomography

Current Evidence and Technical Considerations

Heuvelmans, Marjolein A. MD, PhD*; Vonder, Marleen PhD*; Rook, Mieneke MD, PhD*; Groen, Harry J.M. MD, PhD; De Bock, Geertruida H. MD, PhD; Xie, Xueqian MD, PhD§; Ijzerman, Maarten J. PhD*,∥,¶; Vliegenthart, Rozemarijn MD, PhD*,#; Oudkerk, Matthijs MD, PhD*

doi: 10.1097/RTI.0000000000000379
Screening and Lung Nodule Management

Lung cancer, chronic obstructive pulmonary disease, and cardiovascular disease are highly prevalent in the general population and expected to cause most deaths by 2050. For these “Big-3,” treatment might cure, delay, or stop the progression of disease at a very early stage. Lung nodule growth rate (a biomarker for lung cancer), emphysema/air trapping (a biomarker for chronic obstructive pulmonary disease), and coronary artery calcification (a biomarker for cardiovascular disease) are imaging biomarkers of early stages of the Big-3 that can be acquired with low-dose computed tomography (CT). We hypothesize that a (combined) low-dose CT examination for detection of all 3 diseases may significantly improve the cost-effectiveness of screening in the future. We review the current evidence of the imaging biomarkers for the detection of the Big-3 diseases and present the potential health economic potential of Big-3 screening. Furthermore, we review the low-dose CT protocols to acquire these biomarkers and describe the technical considerations when combining the CT protocols for the different biomarkers.

*Center for Medical Imaging North-East Netherlands (CMI-NEN), University Medical Center Groningen, University of Groningen

Departments of #Radiology

Pulmonary Diseases

Epidemiology, University Medical Center Groningen, University of Groningen, Groningen

Department of Health Technology & Services Research, University of Twente, Enschede, The Netherlands

§Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

University of Melbourne and Victorian Comprehensive Cancer Center, Melbourne, Vic., Australia

M.A.H. and M.V. contributed equally.

The authors declare no conflicts of interest.

Correspondence to: Matthijs Oudkerk, MD, PhD, Center for Medical Imaging—North East Netherlands, University Medical Center Groningen, University of Groningen, Hanzeplein 1, EB45, Groningen 9713 GZ, The Netherlands (e-mail:

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