Lung cancer remains the leading cause of cancer-related mortality globally. It is the 5th most common cancer and the leading cause of cancer-related deaths in Australia.
Despite advances in systemic therapies and surgical techniques, prognosis remains poor when diagnosis occurs at an advanced stage. Radiology is central in transforming this landscape, supporting earlier detection, accurate staging, and effective restaging to guide precision treatment.
Radiological imaging underpins the multidisciplinary approach to lung cancer management, from initial screening through to therapeutic monitoring and post-treatment surveillance.
Lung Cancer Screening
Early detection significantly improves survival. The National Lung Cancer Screening Program (NLCSP) for high-risk asymptomatic populations (e.g. smokers aged 50–70 with 30 pack-year history) aims to reduce lung cancer mortality by up to 20–25% through the use of Low-Dose CT.
- Offers excellent sensitivity for small, asymptomatic pulmonary nodules
- Enables volumetric assessment and nodule tracking over time
- Carries a low radiation burden, making regular screening feasible
Nodule Evaluation and Risk Stratification
As part of the NLCSP, Radiologists must apply structured reporting systems (i.e. PanCan baseline assessment or Lung-RADS nodule categorisation) to guide follow-up recommendations, reduce false positives and improve personalised screening approaches.
Staging Lung Cancer
Once a suspicious lesion is identified, accurate staging is essential for determining resectability, treatment modality, and prognosis. Radiological staging follows TNM criteria (Tumour, Node, Metastasis).
Contrast-Enhanced Chest CT
- First-line modality for evaluating tumour size, local invasion (T stage), and regional lymphadenopathy (N stage)
- Also assesses for pleural involvement and satellite nodules
PET-CT (FDG PET)
- Integral in staging Non-Small Cell Lung Cancer (NSCLC) and Small Cell Lung Cancer (SCLC) when curative treatment is being considered
- Superior for detecting metabolically active nodal and distant metastatic disease
- Guides biopsy targets and mediastinal staging strategies
- Helpful in evaluating a solitary pulmonary nodule unsuitable for biopsy, or pathological characterisation has failed
MRI of the Brain
- Recommended for patients with stage III/IV disease or neurological symptoms.
- Essential in staging small-cell lung cancer due to its high metastatic propensity to the CNS
Restaging and Response Assessment
With immunotherapy and targeted treatments reshaping the therapeutic landscape, medical practitioners adapt to evolving tumour response patterns and progression patterns.
CT (Serial Imaging)
- Remains the cornerstone for monitoring treatment response
- RECIST 1.1 criteria guide objective assessment of measurable disease
- Atypical response patterns (e.g., pseudoprogression in immunotherapy) demand careful radiological interpretation and sometimes PET correlation
PET-CT
- Offers functional insight beyond morphology
- Useful in evaluating residual metabolic activity after chemoradiotherapy or in indeterminate post-treatment changes
- Helps differentiate scar tissue or necrosis from viable tumour
MRI (CNS Surveillance)
- Critical in monitoring treated brain metastases and identifying new lesions
- Advanced sequences (e.g., perfusion, spectroscopy) aid in differentiating progression from radiation necrosis
Conclusion
Radiology is not merely diagnostic in lung cancer; it is integral to clinical decision-making. From LDCT screening, which identifies disease at a curable stage, to advanced PET-CT and MRI, which guide precision oncology, imaging drives personalised treatment strategies.
As the National Lung Cancer Screening program evolves, the collaboration between radiology and clinical specialities will only deepen, supporting smarter, more tailored lung cancer care Australia-wide.
Why Choose Qscan Radiology Clinics for Your Lung Cancer Imaging Needs?
Qscan is a trusted name in medical imaging, offering x-ray services, Low Dose CT, PET-CT and MRI. We use advanced technology and skilled radiographers and radiologists. This helps us provide clear and high-quality images for accurate diagnosis and treatment planning.
Qscan has many locations offering easy access to expert imaging services. Our team is committed to delivering the best care with minimal wait times and accurate results.
For more information about the NLCSP, please contact your local Business Development Manager by emailing [email protected]