Original article
General thoracic
Mobile Lung Screening: Should We All Get on the Bus?

Presented at the Sixty-sixth Annual Meeting of the Southern Thoracic Surgical Association, Marco Island, FL, Nov 6-9, 2019.
https://doi.org/10.1016/j.athoracsur.2020.03.093Get rights and content

Background

Despite favorable recommendations, national lung screening adoption remains low (2% to 3%). Patients living in rural areas have additional challenges, including access to lung screening programs. We initiated a mobile lung screening program to serve the rural patients at risk. This is what we learned from this 12-month feasibility project.

Methods

Utilizing a multidisciplinary approach, we began an 8-month design and build schedule. This was the first build of this type. The operational team included a radiology technician, nurse practitioner, driver with a commercial driver’s license, and program developer. Specialized software was used for data mining. Downstream revenue projections were based on previously published Medicare claims data. Generally accepted accounting principles were used.

Results

The prototype bus was delivered January 2018. During the 12-month feasibility period, we performed 548 low-dose lung screenings at 104 sites. Mean patient age was 62 years, mean pack-years of smoking was 41; 258 (47%) were male. Five lung cancers were found in addition to a type B thymoma. Financially, we exceeded the break-even analysis by 28%. The 5-year pro forma using 1 year of actual data and 4 additional years of projected data demonstrated a net present value of 1 million, internal rate of return of 34.6%, and profitability index of 2.2—all highly dependent on downstream revenue.

Conclusions

Although challenges exist, a commercially viable bus and a financially sound mobile program can be developed. However, without a centralized approach for incidental findings, the downstream revenue may be at risk as well as the financial viability of the project.

Section snippets

Patients and Methods

A quick search for a commercially available mobile lung screening vehicle that fit our geographic needs revealed none existed. Computed tomography (CT) scanners are a sensitive, complex electrical machine that require climate control and a level environment to operate. Historically, they have been placed in tractor trailers and parked on level concrete slabs connected to external power supplies. We needed mobility, self-leveling, independent power, climate control, patient comfort, and

Results

The prototype bus was delivered to Chattanooga in January 2018 (Figure 2). It was taken to a certified automated truck scale for verification of its weight. Fully loaded, the bus weighed 27,900 lbs. That was 400 lbs over the GVWR. It was returned to Medical Coaches where the cabinets were replaced with a lighter material. Nonessential equipment like a rear ladder, trailer hitch, and handicap lift were removed. The final weight was reduced to 26,820 lbs. This modification along with training of

Comment

Mobile lung screening is not new, it dates back to 1996 in Japan when Sone and associates12 utilized a CT scanner in a van. They were able to perform more than 13,000 scans for more than 5000 patients from 1996 to 1998. Ten-year survival was calculated to be 86.2% for deaths from lung cancer.12 The Levine Cancer Center has also started a mobile lung cancer screening program centered around a very specific population at risk in North Carolina.

Late stage cancer treatment is known to be expensive

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