Breathing Easy

The premiere of Lung-RADS promises aid to radiologists creating lung cancer screening programs.

Breathing Easy, Lung-RADS

The first edition of lung-rads is out and ready to help practices implement their own programs. Ella A. Kazerooni, MD, MS, chair of the ACR Committee on Lung Cancer Screening, and Mythreyi Bhargavan-Chatfield, PhD, leader of the ACR Lung-RADS team, explain what you can expect from the atlas and why it’s important for practices to adopt.


Q: Could you tell us a little about Lung-RADS?

A: Kazerooni: Lung-RADS is a tool for standardizing the reporting and management of abnormal findings on lung cancer screening CT examinations and preparing for practice audits and benchmarking. It was strongly modeled after the success of BI-RADS®.

Bhargavan-Chatfield: The goal of Lung-RADS is to reduce ambiguity for clinicians who refer patients to radiologists. The tool, if effective, should minimize false positives and unnecessary biopsies.

Q: Why did the ACR create Lung-RADS?

A: Kazerooni: We’re providing a tool that radiologists critically need. We’re on the precipice of widespread lung cancer screening in clinical practice. When the USPSTF gave the screening a B grade recommendation in December 2013, this meant insurers would be required to cover it under the Affordable Care Act (ACA) beginning in January 2015. CMS is not covered by the same terms of the ACA, and we are hopeful that CMS will also cover this procedure. Therefore, this is something radiologists will need all over the country soon. Without a tool like this, there could be much more heterogeneity in the way that lung cancer screening CT exams are interpreted and in the subsequent tests that are recommended.

Q: How was Lung-RADS developed?

A: Bhargavan-Chatfield: Lung-RADS was created with the efforts of a disparate committee of lung cancer researchers from places such as the National Lung Cancer Screening Trial, the Lahey Clinic, and the International Early Lung and Cardiac Action Program. The committee worked together to synthesize available evidence and arrive at a consensus as to how radiologists should categorize their findings.  This committee brings together national experts who have been working on lung cancer screening for years, and it was important to include everyone’s perspective so that we would have a robust standard that everyone would be able and willing to use.

Q: How often will Lung-RADS be updated?

A: Bhargavan-Chatfield: Lung-RADS will continue to be updated and revised as new evidence emerges. Since lung cancer screening evidence is being published at a fairly high rate, we expect frequent updates in the early years of Lung-RADS. The committee will determine which emerging evidence is valuable enough to warrant an update to Lung-RADS, balancing the need for a stable standard with accuracy in reporting on radiologic findings.

Q: Why is it important that imaging specialists use Lung-RADS?

A: Kazerooni:
Screening is applied to a large swath of the population, in this case, older smokers, who are at a high risk for cancer. As a result, screening is rolling out to a large number of practices and patients very quickly. Radiologists need the tools to practice to consistent and high standards — otherwise, there could be widespread variation in practice, resulting in poor quality, unnecessary testing and procedures, and failure to achieve the kind of results seen in the National Lung Screening Trial.

Another important component of Lung-RADS is guidance on a practice audit. In the longer Lung-RADS document, which will be published by early 2015, there will be instructions on the types of data a practice needs to collect to participate in one of the ACR’s National Radiology Data Registries that we’re developing on lung cancer screening. So by using the updated version of Lung-RADS, practices will be able to benchmark themselves to other practices in their region or even nationally in terms of positive screening rates, callback rates for additional imaging, and lung cancer diagnosis rates. This will help practices and radiologists understand Lung-RADS, learn to use it better, and standardize reporting even more than just using the Assessment Category table that is now published.

Q: Where can you access Lung-RADS?

A: Bhargavan-Chatfield: Right now, version 1.0 is available. As of press time, it exists as a PDF document and contains the assessment categories and management recommendations for each assessment. You can access the document for free by visiting

Read about a Texas practice’s successful screening program in the latest Imaging 3.0 case study at


JACR® articles: “Performance of ACR Lung-RADS in a Clinical CT Lung Cancer Screening Program” (available at and “Experience with a CT Screening Program for Individuals at High Risk for Developing Lung Cancer” (available at

The ACR Practice Parameters and Technical Standards for Lung Cancer Screening CT, available at

The ACR Lung Cancer Screening Resources page, which has information on ACR lung cancer screening center status, CT lung cancer screening, smoking cessation, and clinical research on lung cancer screening. Available at



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