MeiLan K. Han, MD, MS, on When to Order Imaging to Identify Patients At Risk for Disease Progression to COPD — And When to Not

Imaging may help in identifying early COPD. But is performing a CT scan worth it? In this video, MeiLan K. Han, MD, MS, explains the decision-making process she takes to determine the risk/reward of performing imaging for the identification of COPD, calling it a "delicate balance." It is a topic she presented about during ATS 2020 Virtual. 

MeiLan K. Han, MD, MS, is a professor of internal medicine in the Division of Pulmonary and Critical Care at the University of Michigan in Ann Arbor, Michigan. 

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Hi, my name is MeiLan Han. I’m a professor of pulmonary medicine at the University of Michigan in Ann Arbor. Much of my research is focused on understanding how imaging metrics can help us understand COPD and, hopefully, even predict patients that will be at risk for more rapid disease progression. But I think it’s a bit of a balance and I often get asked about, “Well, is it worth doing the CT scan just to get that information?” And that’s something that we’re really trying to explore, and the balance and the tipping point for that is going to be changing. One issue is that the CT scanners that we have are getting more and more sensitive with lower and lower doses of radiation. As we move into these next‑generation scanners, the risk for the patient is going to drop.

The other thing is that we are starting to get imaging more and more for other reasons. For instance, lung cancer screening is now something that’s covered by CMS. More and more patients are seeking to get lung cancer screening. We’re going to have more and more patients with imaging available, and the risk to getting CT scans is going to continue to drop.

But would I, for instance, get a CT scan right now on someone new to my practice, I’ve got lung function, just to have the CT scan? And I think the answer to that right now is no. If I have the imaging, I definitely use it. It definitely helps inform some of my decision‑making.

If I have any questions, though, about whether for instance a patient might qualify for endobronchial valve placement that we can do with bronchoscopy or lung volume reduction surgery, which is a more traditional surgical procedure, in those cases, I do need to have the imaging to understand the extent of emphysema vs small airways disease in addition to location.

I think the reasons to get imaging in patients whether it’s for lung cancer screening or looking to see if they would qualify for advanced procedures are increasing. But right now, I wouldn't get the CT scan outside of that unless perhaps there was some diagnostic uncertainty.

Having said that, if I do have it, I definitely use it. Ultimately, my hope is that as we start developing new therapies for COPD that the pharmaceutical industry in particular will start incorporating imaging. Because it’s really only then when we have an evidence basis that—for instance, patients with one particular subtype CT abnormality or a certain extensive CT abnormality—qualifies for, say, a particular therapy that the utility for imaging and the push to potentially expose patients to the radiation becomes more clear.

Like I said, right now, it is a balance. If I have a strong reason to get CT scans, I do. Again, if it’s a patient that would qualify for advanced therapies or needs lung cancer screening, I definitely get it and use it. But right now, I think we need to gather more evidence to see if we should be using imaging more routinely in patients outside of those patients.