External Quality Assurance (EQA) platforms are essential for the cost-effectiveness of any Lung Cancer Screening (LCS) program. iDNA’s online EQA platform – codeveloped with the digital education company Alledaags – serves as a comprehensive training and assessment course for radiologists performing the CT readings in LCS programmes. The EQA is embedded in a digital learning environment and assists radiologists in testing their LCS background knowledge, as well as their ability to register pulmonary nodules and deciding on the referral strategy (negative, indeterminate or positive). In the EQA platform we have incorporated the latest developments in LCS and nodule evaluation management through the Nelson+ nodule management protocol.

The LCS background information in our EQA platform is divided in several chapters. It discusses the basic principles of LCS, like participant selection of individuals who are at high risk for developing lung cancer, technical aspects like the settings of the CT systems used in LCS, the latest scientific findings on lung nodule characteristics, as well as the Nelson+ protocol, which incorporates the latest nodule evaluation management protocols and participant referral strategies.

The platform has an integrated quality control by assessing the learning curve of users after completing every chapter. To progress to the practical training of the CT reading cases, a user is required to reach a pre-determined performance threshold.

In our online DICOM viewer application, the user of the platform gets to assess real life (de-identified) CT scans of a LCS participant. In this viewer, the user can scroll through the image slice-by-slice, as a radiologist normally would in a radiological reading station. When scrolling though the scan, nodules can be selected, of which the volume is automatically calculated by the integrated CAD system and the nodule characteristics can be entered for every nodule found. When the user is done assessing the scan, he or she can enter the CT reading result and the subsequent referral strategy. The platform is also capable of providing direct feedback to users concerning any missed findings or incorrect CT reading results.