No patient left behind with the detection of incidental nodules in Wellstar health systems
screening program
screening program
Customer story ∙ By Philips ∙ Featuring Wellstar Health System, Marietta, GA ∙ July, 2023 ∙ 6 min read
“If there’s anything that keeps me up at night, it’s ‘Are we missing anyone?’ I sleep better at night now knowing that we have a true system that reminds us and tracks those folks in their journey along the incidental nodule and lung screening pathway.” says Dr. Bill Mayfield, a thoracic surgeon and Chief Surgical Officer at Wellstar Health System in Marietta, Georgia.
Wellstar uses Philips Lung Cancer Orchestrator* to support its care team in identifying incidental pulmonary nodules early. The system finds and brings cases into a work queue for follow-up, so that the team can refer concerning findings to a multidisciplinary team, meaning that no patient is left behind in the process.
Customer story at a glance
Dr. Bill Mayfield talks about the Wellstar experience using Lung Cancer Orchestrator to aid early detection of lung cancer
Design, manage and scale lung cancer care with Lung Cancer Orchestrator
Wellstar has nine hospitals and also runs one of the largest lung cancer screening and lung nodule detection programs in the country. Despite the size of its program, until the past few years even Wellstar had no formal system to identify incidental nodules and place them into a patient management tool that tracks each step of the patient journey from early detection to treatment.
Before Wellstar had Lung Cancer Orchestrator, the hospital team saw itself as just like that of every other hospital in the United States. Says Dr. Mayfield, “That is, we have very talented radiologists who read all these CT scans and X-rays and have lots of findings, maybe a dozen findings in every report. And every once in a while, there will be a tiny pulmonary nodule mentioned in one of those reports. If the primary care physician or the person who ordered the test did not review in detail every line of the report, then occasionally some of these pulmonary nodules would just not be addressed or be missed. There was no formal follow-up program for incidental pulmonary nodules, so we recognized that as an issue and decided to create a program to identify these pulmonary nodules, bring them into a central place where we could work on them and then, if need be, treat them.”
Until Wellstar had Lung Cancer Orchestrator, it had no way to systematically review reports in the PACS to aid in the identification of incidental nodules. With Lung Cancer Orchestrator, the team has been able to create terms in a natural language processing engine. Every 24 hours the engine pulls forward the reports of patients who potentially have incidental pulmonary nodules and places those reports into a work queue. The team then reviews the reports for pertinent findings. Any concerning findings are referred to a multidisciplinary team of thoracic surgeon, pulmonologist, medical oncologist and radiation oncologist to manage those nodules.
“Anyone who's been practicing pulmonary medicine or thoracic surgery for more than five years will tell you that they will occasionally see a patient with a lung cancer, maybe an advanced stage lung cancer. You go back and you look three, four or five years into previous studies, and sure enough, there is that tiny pulmonary nodule that was either overlooked or identified but not followed up on.”
“An early detection program with Lung Cancer Orchestrator allows us to identify patients early, reduce the burden of lung cancer care on a family and reduce the cost of care.”
Dr. Bill Mayfield
Chief Surgical Officer Wellstar Health System Marietta, Georgia
Detecting lung cancer when it’s most curable, and also addressing disparities to care
Incidental pulmonary nodules are nodules that are seen on images of the chest (CT scans, chest X-rays, pulmonary angiograms, carotid angiograms and aortograms) and are findings in the lung in a study that was done for another purpose. Wellstar performs 100,000 images of the chest a year for reasons other than imaging the chest, and by using Philips Lung Cancer Orchestrator the team has discovered and treated about 90 lung cancers and ten other types of cancers.
Dr. Mayfield points out that 55% of the patients who have been identified through the incidental pulmonary nodule program so far have stage one or two lung cancer, which is highly curable through minimally invasive surgery. That’s quite a contrast to the much greater burden faced by patients who have stage three or four lung cancer and are treated with chemotherapy and radiation therapy.
Of those 90 patients identified, 45% would not have qualified for lung cancer screening under the United States Preventive Services Task Force criteria because of lack of known risk factors. “An early detection program with Lung Cancer Orchestrator allows us to identify patients early, reduce the burden of lung cancer care on a family and reduce the cost of care,” he says.
The lung nodule program represents an important safety net for patients because the team is able to identify, follow up and treat lung nodules that might otherwise have been missed, and in patients who don’t always have access to care through a primary care physician. At Wellstar, 80% of the patients that are brought into the Lung Cancer Orchestrator had their CT scans done in the emergency room. Dr. Mayfield says, “If you look at the US census data, that population has a higher proportion of lower socioeconomic status, lower education, lower income and lower access to health care. We identify problems in those patients who otherwise might have been identified by a primary care physician. Since they don’t have access to that, we actually provide that access to care.”
What Wellstar has learned along the way in partnering to create this solution for early detection of lung cancer
Dr. Mayfield says, “The interface is very beautiful and the workflow is intuitive. Medicine tends to lag behind some other industries in the adoption and creation of technology. We look to industry to really partner with us, and to understand the pebble in our shoe--the challenges we have--and help us develop the solutions required to solve our problems. We have been working for Philips in designing and implementing Lung Cancer Orchestrator, and we have found them to be superb partners. Philips is uniquely qualified to create a program like this because they own the imaging side and they have great software writers and research folks. We are uniquely positioned to work with Philips because we have one of the largest lung screening programs and early incidental nodule programs in the country. So the marriage of those two has been perfect.”
Lung Cancer Orchestrator supports the efforts of a dedicated team. Dr. Mayfield points out that success always requires people dedicated to detecting and treating lung cancer as early as possible.
“Our team here at Wellstar is passionate about finding lung cancer, and we find a new lung cancer in our pulmonary nodule program every ten days. It's what keeps us going.“
Dr. Bill Mayfield
Chief Surgical Officer Wellstar Health System Marietta, Georgia
Looking into the future of early detection and lung cancer care with prognostication, robotics, and genomics
Dr. Mayfield sees several themes emerging over the next ten years, including the application of artificial intelligence to not only nodule detection, but also prognostication. He asks, “How effective could it be that we had an algorithm running in the background for every CT scan of the chest that not only gave us a report of what was on that CT, but what the probability is that that patient will develop lung cancer in the next five years? The ability to prognosticate whether there's a pulmonary nodule or not would be huge.”
He also sees great potential in robotic-assisted thoracic surgery to be minimally invasive and highly effective. The addition of molecules that allow clinicians to visualize cancers and the metastatic disease in the chest is also very promising, as is the use of genomics and the ability to detect circulating tumor DNA, RNA and exosomes in the circulation in very, very early stage lung cancer. “Perhaps in 10 or 20 years you won't even get imaging to detect your lung cancer or have to go to an imaging center,” he says.
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Disclaimer:
* Lung Cancer Orchestrator bundle (includes Lung Cancer Screening Manager and Incidental Nodule Manager) is supporting screening programs as well as incidental pulmonary nodule management.
This video reflects the opinion of the interviewee, not Philips. Results from customer experiences are not predictive of experiences in other cases. Results in other experiences may vary.
Lung Cancer Orchestrator is not intended for diagnosis or treatment selection and not a medical device.
