Relative Survival Rate

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2 5X Su r vi val Th r ou gh Ear l y Det ect i on Cancer Stage I II III IV Relative Survival Rate 55,2% 28% 8% 2%

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4 90% TIME AND COST IS W AITING IN LINE

5 OBJ ECTIVES Reduce Screening Time By Reduce Screening Cost By Improve Survival Probability

6 PROGRESS SO FA R

7 SENSITIVITY AND SPECIFICITY FOR LUNG CANCER: Summary of 19 Published Papers from 7 Countries Actor Sensitivity Specificity Population Year Country Notes Paper Title CAD 35% USA Lung cancers missed on chest radiographs: results obtained with a commercial computer-aided detection program CAD 61% Netherland 2.4 False positives per CXR Computer-aided detection of lung cancer on chest radiographs: effect on observer performance CAD 70% 50% 2011USA Sensitivity and specificity of a CAD solution for lung nodule detection on chest radiograph with CTA correlation CAD 76% China 2 False positives per CXR Assessing the use of digital radiography and a real-time interactive pulmonary nodule analysis system for large population lung cancer screening CAD EpiSight XR 2004Japan AUC 98.6% Improved detection of lung nodules on chest radiographs using a commercial computer-aided diagnosis system CAD Riverain v % USA The effect of computer-aided detection on radiologist performance in the detection of lung cancers previously missed on a chest radiograph CAD Riverain v % 32% USA A Comparison of Computer-Aided Detection (CAD) Effectiveness in Pulmonary Nodule Identification Using Different Methods of Bone Suppression in Chest Radiographs CAD Riverain v % 58% Germany Computer-aided Detection Fidelity of Pulmonary Nodules in Chest Radiograph Physician 29% 96% Netherland Detection of lung cancer on the chest radiograph: a study on observer performance. Radiologist 52% 305, Japan squamous cell carcinoma Limiation of Annual Screening Chest Radiography for the Diagnosis of Lung Cancer Radiologist 50% 305, Japan small cell carcinoma Limiation of Annual Screening Chest Radiography for the Diagnosis of Lung Cancer Radiologist 36% 90% Netherland Detection of lung cancer on the chest radiograph: a study on observer performance. Radiologist 20% to 60% 87% to 95% Netherland Detection of lung cancer on the chest radiograph: impact of previous films, clinical information, double reading, and dual reading Radiologist 28% 93% 2003Netherland High Kappa The limited detection of lung cancer on chest X-rays Radiologist 2004Japan AUC 92.4% Improved detection of lung nodules on chest radiographs using a commercial computer-aided diagnosis system Radiologist 63.8% 98.1% USA Evaluation of a real-time interactive pulmonary nodule analysis system on chest digital radiographic images: a prospective study Radiologist 78% 97% Japan Sensitivity and specificity of lung cancer screening using chest low-dose computed tomography Radiologist 33% 95% France Performance of chest radiograph and CT scan for lung cancer screening in asbestos-exposed workers Radiologist 53.80% India Stage III-A Only The importance of 18F-FDG PET/CT, CT and X-rays in detecting primary stage III A lung cancer and the incidence of extra thoracic metastases Radiologist 63% Netherland 0.23 False positives per CXR Computer-aided detection of lung cancer on chest radiographs: effect on observer performance Radiologist 62.3% China False positives per CXR Assessing the use of digital radiography and a real-time interactive pulmonary nodule analysis system for large population lung cancer screening Radiologist 84% Korea 0.17 False positives per CXR Computer-aided detection of malignant lung nodules on chest radiographs: effect on observers' performance Radiologist 44.0% USA AUC 38% The effect of computer-aided detection on radiologist performance in the detection of lung cancers previously missed on a chest radiograph Radiologist 65% 39% 2015UK The value of digital tomosynthesis of the chest as a problem-solving tool for suspected pulmonary nodules and hilar lesions detected on chest radiography Radiologist (CT) 89% 93% Japan Sensitivity and specificity of lung cancer screening using chest low-dose computed tomography Radiologist (CT) 83% 78% France Performance of chest radiograph and CT scan for lung cancer screening in asbestos-exposed workers Radiologist (CT) 92.00% India Stage III-A Only The importance of 18F-FDG PET/CT, CT and X-rays in detecting primary stage III A lung cancer and the incidence of extra thoracic metastases Radiologist (Resident) 49% Netherland 0.45 False positives per CXR Computer-aided detection of lung cancer on chest radiographs: effect on observer performance Radiologist + CAD 77.3% China False positives per CXR Assessing the use of digital radiography and a real-time interactive pulmonary nodule analysis system for large population lung cancer screening Radiologist + CAD 87% Korea 0.19 False positives per CXR Computer-aided detection of malignant lung nodules on chest radiographs: effect on observers' performance Radiologist + CAD 50.0% USA AUC 43% The effect of computer-aided detection on radiologist performance in the detection of lung cancers previously missed on a chest radiograph Radiologist + CAD EDDA IQQA 92.7% 96.2% USA Evaluation of a real-time interactive pulmonary nodule analysis system on chest digital radiographic images: a prospective study Test: Flexible Bronchoscopy 88% 2007USA 34% for peripheral nodules Initial diagnosis of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition) Test: Sputum Cytology 66% 99% 2007USA Initial diagnosis of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition)

8 For PA Lung Cancer Detection Sensitivity and Specificity Physician Radiology Residents Radiologists Commercial CADs 29% 49% 55% 62% 66% 96% 90% % 47% 99% Ou r s : % 73 (Preliminary results; final results in Sep) Free, Open-Source Sputum Cytology ****

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