Optimization of low dose CT for lung cancer screening: finding the best balance between radiation risk and performance in terms of image quality and success rate of computer aided detection

Lung cancer causes a large mortality, worldwide and in Flanders, with 3822 cases in 2016. The only technique with proven mortality reduction is lung cancer screening (LKS) with CT scans. In 2020, a mortality reduction of 26% (men) and 41% (women) was measured in the Dutch-Belgian "NELSON" study. The Flemish 'Task Force Lung Cancer Screening' therefore brings together experts to design and subsequently support an LKS program for population groups where this improvement can be continued. All (expected) questions from the responsible Flemish government must be answered. With this project, radiologists and physicists from the Task Force want to find adequate answers to the following questions: what is the radiation risk associated with the CT scans? Can imaging be optimized for even lower X-ray doses? How are computer algorithms for detecting and measuring cancers performing? The greatest challenge is to develop new test methods in a world with rapidly changing technology - e.g. artificial intelligence. Three university groups will combine their expertise with (1) risk assessment, (2) evaluation of clinical image quality and (3) computer-aided detection and characterization of cancer. All new techniques and test criteria will be bundled in a unique test protocol to assess and optimize the quality of each CT protocol or computer algorithm for LKS.