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Cancer Imaging

Open Access

The impact of radiologists’ expertise on screen result decisions in CT lung cancer screening

  • MA Heuvelmans1Email author,
  • M Oudkerk1,
  • PA de Jong2,
  • WPTM Mali2,
  • HJM Groen3 and
  • R Vliegenthart1
Cancer Imaging201414(Suppl 1):P19

Published: 9 October 2014


To evaluate the impact of radiological expertise on screen result decisions made in a CT lung cancer screening trial.


In the Dutch-Belgian randomized lung cancer screening trial (NELSON), the baseline CT screen result was based on the lung nodule with largest volume. According to the protocol, nodule volume<50mm3, 50-500mm3 and >500mm3 led to a negative, indeterminate and positive screen result, respectively. The protocol, however, allowed radiologists to manually adjust screen result in case of high suspicion of benign or malignant nodule nature. In this study, all participants whose baseline CT result was based on a solid nodule were included. Adjustments by radiologists at baseline were evaluated. Histology was the reference for diagnosis, or, to confirm benignity, stability on subsequent CT scans.


3,268 participants (2,759 male, median age 58.0-years) were included. In 189 participants (5.8%) the initial baseline screen result was adjusted by the radiologist. Adjustment was downwards from positive or indeterminate to negative in two and 118 participants, respectively, and from positive to indeterminate in 64 participants. None of these nodules turned out malignant. In five participants (2.6%) the screen result was adjusted upwards from negative to indeterminate (N=1) or indeterminate to positive (N=4); two nodules (40%) were malignant.


In about one-in-twenty cases of baseline lung cancer screening, nodules were reclassified by the radiologist (97.4% downwards), leading to reduction of false-positive and false-negative screen results.

Authors’ Affiliations

Center for Medical Imaging – North East Netherlands, Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
Department of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands


© Heuvelmans et al; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.