Software May Improve Chest X-Ray Detection of Lung Cancer, Shows Early Promise for Pneumonia

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CHICAGO, Nov 30, 2011 (BUSINESS WIRE) — Sophisticated yet simple-to-use software enhancements to standard chest X-rays may significantly improve early detection of hard-to-find lung cancers and pneumonia, when there are more treatment options, according to three studies being presented at the 97th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA), Nov. 27 through Dec. 2 in Chicago. The software does not require additional tests or radiation exposure for the patient and requires no new equipment, space or staff. It immediately enhances images captured using existing X-ray machines.

OnGuard(TM) 5.2, computer-aided detection (CAD) software manufactured by Riverain Technologies, uses pattern recognition and machine learning technologies to suppress the rib and clavicle bones that often obscure lung abnormalities, and circles areas that may be a lung tumor. This new version of the software, an update of OnGuard 5.1, has improved accuracy and received PMA supplement approval from the Food and Drug Administration (FDA) this month. It can enhance any conventional chest X-ray captured by any system.

CAD with Bone Suppression Detected 75 Percent of Lung Cancers

In a University of Chicago Medical Center study of 88 confirmed lung cancers, OnGuard 5.2 identified 25 percent more lung cancers than radiologists found when reviewing the same X-rays without OnGuard.

“Without OnGuard, experienced radiologists found 60 percent of the lung cancers and radiology residents found 40 percent, which is much higher than it would have been clinically because the radiologists were looking very specifically for subtle cancer,” said Heber MacMahon, M.B., professor of radiology and director of thoracic imaging at the University of Chicago Medical Center. “By comparison, OnGuard accurately marked 75 percent of the cancers.”

Lung cancer is the leading cause of cancer death in the United States, claiming more lives than breast, colon and prostate cancer combined, according to the American Cancer Society. Early detection greatly improves the chances of survival but most cancers are found in late stages, on images captured for other medical reasons. X-ray is the most common imaging test.

“This software is a ready-made, easy-to-adopt solution to instantly improve chest X-rays in the detection of lung disease on images that already are being captured,” said Steve Worrell, chief technology officer for Riverain Technologies.

“You don’t want to miss a cancer, and this system offers a much clearer view,” Dr. MacMahon said. “I envision this technology being run on all chest X-rays, certainly for all adults ages 35 and up.”

OnGuard’s built-in bone suppression technology helps radiologists detect commonly missed cancers in the upper chest, according to Dr. MacMahon. “The majority of cancers missed on chest X-ray are in the upper lobes and can be obscured by clavicles and ribs — cancer likes to live there,” he said. “The best examples of cancers being found by bone suppression are in the upper lobes.”

The company’s SoftView(R) product also gives radiologists the option of a bone-suppressed X-ray image with no CAD markings.

Chest CAD Detects Lung Cancers Previously Missed by X-ray

Related research by the University of Maryland Medical Center being presented at this year’s RSNA meeting found that even the prior version of OnGuard (5.1) accurately identified 49 percent of lung cancers that previously had been missed by radiologists using standard X-ray alone.

In the study of 297 total cases including 82 previously missed lung cancers, OnGuard also accurately identified several of the hardest-to-find cancers. The software detected more than one-third of the missed cancers classified by expert thoracic radiologists as “subtle” and one-quarter that were “very subtle.”

“Our goal is to detect early lung cancer when the patient can be cured,” said Charles White, M.D., professor of radiology and medicine and vice chairman of radiology at University of Maryland Medical Center in Baltimore. “OnGuard is a tool for radiologists to aid in not overlooking subtle findings that could be lung cancer.”

Software Also May Improve Detection of Pneumonia

Another study using OnGuard 5.1 found that it significantly improved radiologists’ ability to identify pneumonia in at-risk patients. The software has not yet been reviewed by the FDA for the detection of pneumonia.

“Pneumonia often begins as nodules that can appear very early and be very difficult to see,” said Robert C. Gilkeson, M.D., professor of radiology and vice chairman of clinical research, University Hospitals (UH) Case Medical Center in Cleveland. “In this retrospective study, CAD improved detection of pneumonia in patients by 10 percent.”

Early detection of pneumonia can be essential to successful treatment and even survival for those with weakened immune systems. All of the patients in this study had low white blood cell counts (neutropenia) and fevers.

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