As part of the Healthy Chest Initiative at Philadelphia-based Temple Health, radiologists and physicians are using one low-dose CT scan to identify three common chest morbidities. The strategy aims to diagnose conditions at an earlier stage and enable more personalized treatment options.
Integrated with Coreline AI software, the scan flags for lung cancer, chronic obstructive pulmonary disease and coronary artery calcifications, according to a Temple Health news release shared with Becker's.
The three-in-one scan is offered at five locations across the system with expanded hours for easier accessibility, according to the Temple Health website.
Gerard Criner, MD, director of the Temple Lung Center and chair and professor of thoracic medicine and surgery at Temple University's Lewis Katz School of Medicine, spoke to Becker's about the clinical and financial benefits of the screening initiative.
Editor's note: Responses have been lightly edited for clarity and length.
Question: How was the Healthy Chest Initiative first established?
Dr. Gerard Criner: About four and a half years ago, we made a major systemwide change to expand lung cancer screening. That meant developing a program to increase availability, improve access and educate both providers and patients on the importance of lung cancer screening with a low-dose CT scan.
In most cases, only about 8% to 12% of eligible patients actually get screened, and the numbers are even worse for women and minorities. Eligible patients — they're over the age of 50 and have smoked 20 pack-years — are part of a group where lung cancer is underdiagnosed and undertreated. As a result, these patients often present at later stages.
Studies have shown that about 70% of patients undergoing lung cancer screening will have some radiographic abnormality on their CT scan. If we're already doing a CT scan to look for cancer, it makes sense to recognize and act on other abnormal findings to improve patient health. That way, we get more value out of the radiation exposure.
Q: How has AI integration affected the screening's operational workflows?
GC: The goal is to improve the recognition and treatment of diseases that might otherwise go unnoticed or undertreated, but scaling these efforts is challenging because you can't manually flag every individual finding in a radiology report. So, we structured our radiology reports to capture these abnormalities. With AI-based imaging programs we can flag individual findings at scale.
Every CT scan is processed through a secondary pathway beyond the standard radiologist read. AI software scans the images for lung nodules, emphysema, the quantitative degree of emphysema, interstitial lung disease and coronary artery calcification. These findings are then reviewed by coordinators in Temple Health's Chest Initiative lung cancer screening program. If we identify additional clinically relevant information, we notify the primary provider and the patient.
Q: Have you seen any measurable outcomes since beginning the initiative?
GC: We've gone from about 10 scans a month to 400 scans a month, with a goal of reaching 1,000 scans a month. That's our major focus: expanding screening that has been shown to reduce lung cancer mortality by 20%.
We're also hopeful that we can demonstrate a similar impact with the early diagnosis of other diseases like chronic obstructive pulmonary disease, interstitial lung disease, or unsuspected coronary artery calcification, ultimately making a meaningful difference in patient outcomes.
Q: What actionable steps does Temple Health take to encourage patient engagement in the Temple Healthy Chest Initiative and lung cancer screenings?
GC: One of the biggest challenges with any lung cancer screening program is just getting patients to come in the first time. But like other screenings — breast cancer, colon cancer — it needs to be done annually, and that's not always easy for people.
That's why screening has to be scheduled at a time that works for them, not just when it's convenient for us. A lot of people work and can't take time off, so we have to make it accessible.
Q: The Temple Healthy Chest Initiative emphasizes the role of nurse navigators. Could you elaborate on the importance of this approach?
GC: The use of navigators in the program is key. If you're generating more patient information, it's crucial to have reliable follow-up on the most important aspects. You need to ensure the right people, whether it's the patient, their primary doctor, or other providers, are properly informed, and that everything is accurately reported in the clinical record. The most important thing is organizing the data and making sure it's acted upon.
Q: Can you touch on the financial benefits of implementing a three-in-one screening initiative?
GC: While there's certainly an element of altruism, we also have to pay the bills. Part of that comes from identifying patients who may need additional therapies that weren't previously recognized.
If you look at lung cancer screening, only about 2% of scans detect lung nodules that result in lung cancer, the downstream revenue from that alone isn't very attractive. However, if you consider the comorbidities that can also be detected during these scans, that applies to about 70% of patients.
If you really capture and act on these comorbid conditions, that can be significant. We're now identifying about four to five patients per month who could benefit from procedures that tend to be more reimbursable, and that kind of downstream revenue can help sustain the program.