- The Washington Times - Thursday, October 4, 2001

The cancer nodule in the patient's left lung is a blurry gray polka dot that is barely visible on the screen even though it is marked by a bright white circle.The nodule may be vague, but the image and the circle together represent an important step forward in the battle for early detection of a cancer that claims more American lives than any other some 178,000 new cases each year, leading to about 160,000 deaths, according to the American Cancer Society.
The disease is so deadly largely because of the difficulties of finding cancer traces early enough for treatment to begin in time to prevent the cancer from spreading. Intervention in later, more critical, stages is seldom effective enough for a cure.
It's a race against time because most cancers of any kind take five years before they are detectable in any form, says Dr. Matthew Freedman, associate professor at Georgetown University Medical Center, an imaging wizard whose formal title is clinical director of imaging science and information systems in the center's Department of Radiology.
Dr. Freedman has worked for the better part of a decade in conjunction with the Rockville firm responsible for creating a machine that spots deviant tissue otherwise likely to be missed on X-ray film even by skilled radiologists and puts rings around suspicious areas in the process.
The trademarked RapidScreen RS-2000, a computer-aided detection (CAD) system, is a product of Deus Technologies. It digitizes and analyzes chest X-rays well enough to have won U.S. Food and Drug Administration approval in July following a six-month clinical research project led by Dr. Freedman, who is a consultant for Deus.
The company says the device, which is about the size and shape of a copying machine, can detect up to 14 percent more lung cancers than are found by more conventional means.
Research Corp., which has done high-tech research and development for clients such as the National Aeronautics and Space Administration and the National Institutes of Health, wanted its initial product in the area of digital radiography to be something truly needed in the medical field.
One reason such a machine hasn't been developed for lung cancer before now, he suggests, is because of "a mind-set that says if you smoke and get lung cancer, it's your fault. An educational process needs to be done."
Dr. Freedman agrees. Thirty percent of lung-cancer patients are nonsmokers, he says, noting that the figure is as high as 50 percent in Japan.

The RapidScreen doesn't come cheap. Its cost at present is $170,000, but the price is expected to drop as demand grows. The more sales, the faster the company is compensated for the total costs of research, said by Dr. Freedman to be "in the hundreds of thousands of dollars."
To date, only Georgetown Medical Center and University of Maryland Medical Systems in Baltimore have them installed. The Maryland institution is evaluating the machine prior to purchase. Georgetown has had a machine in active use for only two weeks. Deus provided grant funds to the hospital and supplied it with a machine on a permanent basis with the understanding that patients would not be charged directly for its use under their insurance plans. Dr. Freedman is adjusting the machine for different-size X-ray film before it goes into routine use.
"You will select which patients should have this done routinely. For example, you might say everyone over age 40 or 35. Everyone who smokes might qualify. I don't know yet," he says.
The clinical trials done at the hospital used blind testing on X-ray films of past patients, some of whom had cancer and some of whom did not. Dr. Freedman employed 15 radiologists throughout the Washington area for the project, working with 80 cases of lung cancer and 160 non-cancer cases. In nearly every instance, the radiologists were able to detect a nodule with an average size of 15 millimeters (three-fifths of an inch) that previously had been overlooked. That is the size, he says, that radiologists most often miss, as has been shown in two studies.
False positives exist, he says, but not to an alarming degree.

Physicians use the system by reviewing chest radiographs (X-rays) and making an initial interpretation. The X-ray film then is loaded onto the RapidScreen's vertical scanner. The physician punches a code on the keyboard that sends a signal for the software to do its work, and in a matter of minutes, a digitized image is seen on a monitor, indicating whether any cancer nodules are present.
"Eventually, the film will be acquired digitally and will be reprinted digitally, thereby speeding the process," he says.
Dr. Freedman was using the machine one recent afternoon to see whether it could be adapted for detecting tuberculosis, which he calls "the worst scourge worldwide. There is great need for a system like this for TB."
Meanwhile, he says, "If we could get this machine implemented widely, a half-million small lung cancers could be found around the world each year that should be curable. At present, most lung cancers can't be cured."
The company's Web site, www.deustech.com, asserts that lung cancer can be found in one out of 200 nonsmokers and one out of 100 smokers and that 85 percent of early-stage cancers can be treated successfully.
Dr. Freedman flags smokers with a dire warning: "Remember, you are at risk 15 years after stopping if you have smoked heavily. And a moderate smoker, even one using filtered cigarettes, is at risk smoking just 20 packs a year for 20 years."
RapidScreen RS-2000 represents a new frontier in medicine, he notes. "This is just the start of this field, and Deus obviously hopes and expects to be one of the leaders. In about 10 years from now, everything a radiologist will do will be interacting with a computer."
It's no wonder, he muses, that the name Deus Latin for God was chosen. He calls the present era "one of the most exciting in radiology. Over the next 10 years, detection methods will change dramatically, and not just in lung cancer. We will have imaging methods related to a person's genetic makeup. Whenever you are given an MRI , it is reasonable to think that medicine given you in the process will relate to your particular genetic makeup because the medicines interacting with each person will show a different imagery."
A Brooklyn-born medical doctor who also has a master's degree in business, Dr. Freedman has been at Georgetown since 1987. His interest in radiology stems from his time in the U.S. Public Health Service, when he first realized he had a special skill in the field, and from what he says is a talent for visual spatialization.
"It's seeing things and knowing how to look at basically ambiguous things and make a structure out of it. Everything you look at in the world is somewhat ambiguous. I've been working in visually related things as far back as I can remember. My favorite place in Washington is the Corcoran Gallery of Art because it has the most innovative art in the city."



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