According to David Faller, general manager of CAD Business in Kodak's Health Group, the only affordable way to test large populations for lung cancer at the current time is by chest x-ray, which can miss small or difficult to find lesions behind ribs.

Although CT scans solve these problems, they take up to 20 minutes to perform, more than an hour to analyze, and are too expensive and time-consuming to be used in the general population.

Faller said Kodak's new product enhances a normal x-ray in under a minute, allowing radiologists to see if there are "areas of interest" that require more extensive work-up. While there are other x-ray/CAD screening tools on the market, Faller said the Kodak system was faster, could be added to current equipment, and analyzes images in a way that allows radiologists to integrate the additional pictures into their normal workflow.

"Using CAD on digital chest x-rays could help physicians determine the most appropriate patients to refer for the more expensive and labor-intensive CT lung scan," said Faller. "The procedure has the potential to make CT scans more practical for early lung cancer detection and improve patient care."

He added that insurance companies will not pay for CT scans as lung cancer screening tools because of their high number of false positives, but since x-ray/CAD screening procedures for other conditions already have a reimbursement code (0152T) associated with them, he was hopeful that Kodak's new lung cancer tool would eventually be covered as well.

Mohit Ghose, vice-president for public affairs for health plan trade group America's Health Insurance Plans (AHIP), was more cautious.

"The essential first step for bringing a product to market in the United States is getting FDA approval; but this does not guarantee that physicians will use it or insurers will cover it," said Ghose. "When it comes to using technology in screening, there are many other procedures and reviews involved. There are two things that drive coverage of any procedure.

The most important is a sizeable body of medical evidence that shows that the new product provides the best level of intervention for a particular disorder. When it comes to screening procedures, the United States Preventive Services Task Force is one of the major scientific groups that reviews technologies as they come to market and determines whether they can viably screen for a particular condition."

Ghose added,"If the medical community approves Kodak's system, the insurance community will evaluate it for coverage."

The new tool was designed as a second reader that would reduce the amount of human labor needed to obtain a more useful image. It processes and analyzes PA/AP digital chest x-rays and highlights the location of suspected nodules by circling findings on a copy of the original picture.

It is automatic, so no additional human interaction is required, and the images are routed to an independent CAD server for analysis so there is no impact on a radiology department's normal workflow or productivity.

Kodak is testing the system in China, and it will be marketed there in early 2007, along with CAD-enhanced full-field digital mammography systems that can integrate with GE and Siemens mammography machines and a CAD improvement for bone mineral density testing that can analyze a digital x-ray of a woman's hand. Kodak plans to bring all three products to the United States as soon as possible, company representatives said.

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