Low dose CT scans for the NLCSP will be imaging a large proportion of the body - the thoracic region including parts of the lower neck and parts of the upper abdomen – and it is anticipated that there will be incidental/additional findings in the scans. It is estimated that about 10% of cases will contain at least one noteworthy finding so it is important to bear in mind that simple lesions that are considered benign or have little clinical consequence to the patient (for example a simple renal cyst or a simple liver cyst) are unlikely to be reported on the scans.  

However, with additional findings considered to be relevant to the patient either immediately or for their long-term health, these will be considered actionable findings and appropriate recommendations will be noted in the report. Examples include coronary artery calcification of the aortic valve and interstitial abnormalities which may suggest that the patient is developing pulmonary fibrosis.  

Referrers with a full patient history and awareness of current clinical management of any pre-existing conditions will decide on further actions taking into consideration the recommendations made in the report.  

A specific example - calcification in the coronary arteries 

Calcification in the coronary arteries is related to atherosclerotic plaque and is likely to be reported in the lung cancer screening cohort. Calcification increases the risk factors for cardiovascular events, cardiovascular related mortality and all-cause mortality and is often under reported on most CT scans.  

The radiologist will provide a visual interpretation of the degree of calcification, reported as either mild, moderate or severe. Based on the severity of the calcium, recommendations could include consideration of lifestyle modification or potentially instituting pharmacological therapy and further evaluation.