What is the difference in accuracy and x-ray dose between low-dose screening computed tomography (CT) and conventional contrast-enhanced CT?
Julian Dobranowski: If we look at what the purpose of the CT scan is… If the purpose is looking only at the structures within the lungs, then there is no difference in accuracy between low-dose CT and conventional CT. If, however, we want to rule out disease within the mediastinum or in hilar areas, then yes, there is a difference because that is the trade-off. With low-dose CT, we see the lungs clearly; with high-dose CT or conventional CT, we see all the other structures as well as the lung structures.
If you have a patient that has a clinical problem, you have to balance what information you want from that examination. For example, patients that have had early-stage lung cancer and have been treated successfully are followed with low-dose CT, because we know that that is where the money is, that is where we are going to have problems. If, however, the patient becomes symptomatic and has considerable symptoms suspicious of tumor recurrence, then we would do a conventional CT scan looking for nodal disease or distal spread.