Spanish HTA report: radiological bone suppression technology for the detection of lung cancer

In Spain, lung cancer represents 16% of all cancers in men, while it represents 7% of all cancers in women. The most critical factor causing lung cancer is smoking. Due to the fact that the symptoms are usually late, lung cancer is often diagnosed in advanced stages. The main decisions regarding treatment are made by clearly distinguishing small cell carcinomas and those that do not correspond to this type.

The analysed technology suppresses the chest bone with X-ray images using an algorithm of advanced image processing software accompanied by a recognition pattern. The process begins with the normalization of the image in a way that all the acquisition variables are compatible with a standard format. These variables include the range of gray scale, pixel size, image, contrast, sharpness and even acquisition noise. With an estimation of the bone image, the appropriate scale adjusted for the use of high resolution and the image of the soft tissues is formed by subtracting the image of the bone to the obtained normalized radiological image.

The objective of the report was to assess effectiveness, safety and indications of the procedure. The report is not an economic analysis, nor an expert opinion. The authors performed a search of the literature without temporal restrictions, searching databases such as Medline, CRD (HTA, NHS EED, DARE), Cochrane Collaboration, National Guidelines Clearing House, EuroScan, seeking for systematic reviews, clinical practice guidelines and clinical trials.

Six (6) studies of medium-low quality were identified. The evidence found shows an improvement in the detection rate compared to conventional X-rays, although the data are not conclusive. The false positive rate is similar in both cases, but the sensitivity seems to be higher using this procedure (compared to traditional X-ray imaging). The sensitivity of the analysed technique for significantly increases when the results are analysed with specific software. The use of this software has implications for the training of specialists. On the other hand, no evidence was found on indications that would benefit from the use of this technology.

The authors concluded the report emphasizing the need for publications of the ongoing clinical trials, as well as the need for economic analysis, in order to bring proper conclusions regarding this technology. Finally, they recommend that the use of bone suppression should be monitored in routine practice and its utility should be determined on the basis of data on final outcomes.

See the report in Spanish (with summaries in English and Basque) here.

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