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Let's talk a little bit about what makes

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a lung cancer screening CT a Lung Reds category four x.

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We'll look at the definition of category four X nodules

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or examinations and some examples of what could be included.

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The lung RADS four X category is defined as any

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category three or four, a lung nodule

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with additional features of the nodule

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or other imaging findings

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that increase the suspicion of malignancy.

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It recognizes that the radiologist's prediction malignancy

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integrates more features than are easily incorporated into

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the lung rat's interpretation schema.

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In fact, research studies have shown

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that the radiologist's probability

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of lung cancer in a nodule is an important factor in the

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final diagnosis of lung cancer.

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So when we do lung rads, we're looking at nodule size.

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We're looking at density, solid part,

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solid nonsolid cystic components,

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but we know there are other features there, such

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as speculation

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or eccentric shape, loation, other features

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that you may want to apply.

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And when the radiologist integrates all those features

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together, it's a pretty good predictor

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of a nodule being lung cancer by upgrading category three

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or four A nodules to four x, it gives patients

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with those nodules the same followup recommendation

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as four B, which is otherwise the highest classification,

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and is the same diagnostic assessment management

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that's recommended in four x nodules.

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This importantly allows radiologist discretion both at

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looking at the nodule

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and other findings on the lung cancer screening CT

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that may indicate a patient has lung cancer.

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So when we think about examples of long rads fourex,

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it may be features of the nodule

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or it may be other findings on the chest CT features

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of the nodule, such as speculation cavitation

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or nodule doubling time

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of a nonsolid ground glass nodule may make the radiologist

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think there's something more going on here than

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what I'm getting from the lung rads

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interpretation schema itself.

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And then there may be other findings on the chest ct.

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And let's not forget that chest cts have been done

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for many decades where many clinical indications,

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and we see these cts every day in our practices.

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There might be enlarged lymph nodes,

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there could be a pleural effusion,

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there could be pleural thickening

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or evidence of metastases on the chest ct,

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whether it's in the lower neck, the thorax,

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or even the upper abdomen.

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So there's a lot of anatomy to cover,

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and some of the findings in the other organs can help

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increase the probability of malignancy

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beyond just the features of the nodule itself.

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We also know that sometimes you can have small

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adenocarcinomas of the lung that metastasize early,

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so finding a liver metastasis or a bone metastasis

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or a large lymph nodes might be an important factor

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in a nodules.

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Otherwise small, it might be only a category three

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or four, a nodule being upcoded to a category four XI.