Guest Post by: Chris Wood, CEO of RevealDX
Improvements in early cancer detection have historically contributed more to mortality reduction than drugs designed to treat later stage disease. This is the case with Lung Cancer, which is the biggest cancer killer, taking more lives than the next three cancers combined. In the last 20 years, however, a medical imaging exam called CT has been shown it can detect cancer in its earliest stages. The question that remains is who should get screened.
CT Screening of Smokers (who are at most risk)
Numerous studies, dating back as far as 1999 have proven that Low Dose CT (LDCT) can be used effectively to screen for Lung Cancer in smokers, and in 2023, I-ELCAP published an especially compelling article showing that the 20 year survival rate for current or former smokers enrolled in annual screening and diagnosed with a first primary lung cancer was over 80%. This is essentially a cure, but even though a cure for many patients is available, screening compliance is only about 16% and only 27% of patients with Lung Cancer are diagnosed at an early stage. So if you are (or were) a smoker, you should check the American Cancer Society Guidelines to see if you should get screened.
CT Screening of Patients with Other Risk Factors
25% of cases worldwide and the 50% in East Asia occur in “never smokers” but mass screening is impractical and prohibitively expensive, so the search is on for risk factors that might justify expansion of Lung Cancer screening outside smokers. A recent study found key factors linked with Lung Cancer in Never Smokers included female sex, rheumatoid arthritis, and exposure to pollution, but there is no consensus yet if lung cancer screening should be expanded to patients beyond those who have smoked.
Opportunistic Screening of Patients Receiving CT Scans
As it turns out, we have a massive opportunity to catch early cancers in patients because lung nodules are frequently found by Radiologists when reading Chest CT exams that are ordered for reasons other than screening. For example, a Chest CT might be ordered because of a severe cough. Frequently, this person would be a smoker, so even though they are not being technically “screened” for cancer, that is essentially what happens. As it turns out, patients who are sent for Chest CT exams are at elevated risk for lung cancer.
The Output from a Chest CT Scan
The majority of Chest CTs show no possible signs of cancer, but approximately 40 percent are deemed suspicious for Lung Cancer due to the presence of a lung nodule. In the US alone, we find over 10,000 nodules every day. Because there is a small chance that a nodule could be cancerous, all nodules should be tracked until they are deemed stable (about 2 years) and can be safely assumed to be benign.
Finding and Tracking More Nodules is Not Always the Best Solution
On the surface, the solution may seem simple: we need to find more lung nodules. But when we increase the number of nodules requiring triage and tracking, it leads to increased costs, patient anxiety and unnecessary interventions for benign nodules, overwhelming existing nodule management programs, and making it harder to identify true malignancies.
An AI Based Solution
Nodule detection paired with improved AI-based characterization of nodules (CADx) promises earlier diagnosis of lung cancer, while simultaneously unburdening beleaguered nurse navigators by shrinking their dashboards and allowing them to be laser focused on the patients that need them most.
CADx analyzes lung nodules using advanced radiomics and artificial intelligence to assess three dimensional nodule features such as shape, texture and surrounding tissue which are invisible to the human eye. Because the technology is augmentative, not just assistive, CADx tools are currently reimbursed by Medicare (and some private payors) using code 0721T and 0722T. While these codes are somewhat generic, the ACR has produced a Clinical Coding Example for Lung Nodule CADx, giving providers some assurance that billing for this CADx function is appropriate.
More screening and better nodule management can, in turn, lead to increased early lung cancer detection and better patient outcomes. Through the combination of its augmentative technology and revenue generation, CADx is helping to achieve diagnosis early enough to perform a curative surgical procedure in more patients. This positive effect on program efficiency can result in decreased marginal program costs, making screening and nodule programs self-sustainable. It is our hope as an industry that we can continue to work together with payors and providers to reduce the loss of life caused by the biggest cancer killer.
About Chris Wood
Chris Wood is CEO of RevealDx, a leading radiomics company delivering the market’s first secured radiology AI reimbursement in Germany, with significant U.S. market impact having received official FDA clearance in early 2026. Reveal Dx is a Seattle-based software company with a breakthrough AI-assisted technology that is set to dramatically transform lung cancer related radiology practices.
