Lung cancer is no longer solely a smoker’s disease or commonly only found in the elderly. Due to pollution levels, occupational exposure, and changes in lifestyle diseases in India, we are seeing increased rates of lung cancer in both non-smokers and younger persons as well. Early diagnosis is the ideal means to cut down mortality, but we still do not have an established program on scale with the population to screen for lung cancer with low dose CT scan.The reasons being cost effectiveness for now and India being an Tuberculosis endemic country.
Newer technology like CBCT (Cone Beam Computed Tomography) is causing us to revisit our methods of early lung cancer diagnosis with greater accuracy.
What Is CBCT, and how does it work?
CBCT is a new imaging technology that takes 3D images of lungs and adjacent structures with great accuracy. The only difference from CT is that it uses a cone-shaped, as opposed to fan-shaped beam, to take an image of a specified area in one rotation, and that it does this in fewer rotations. As a result, CBCT has the benefits of faster scans, less radiation, and clearer higher-resolution images.
CBCT was initially developed for use in dental and orthopedic settings, but is starting use by pulmonologists, particularly useful in bronchoscopic procedures, lung nodule localisation, and early detection of lung cancer. With CBCT we are able to ascertain real time whether our tools we use for lung biopsy are well within the suspected lung nodule.
Why India needs a technological shift
The majority of lung cancer patients in India continue to be diagnosed at advanced stages of disease – this is mainly due to a combination of factors including: the presentation of symptoms not occurring until disease is advanced, individuals sometimes taking (too) long to seek medical advice, and also owing to limited high precision imaging in numerous locations across the country. Conventional X-rays and even standard CT scans may not find smaller nodules or early lesions. With integration of AI into image reading the chances of missing it is less common.
CBCT, especially when combined with robotic bronchoscopy or navigational bronchoscopy, allows for high precision access to small peripheral lung nodules located in potentially difficult locations to access with standard tools. By bronchoscopic methods it also has the advantage of staging the lung cancer concurrently which helps in instituting quicker curative therapy. This is particularly important with non-smokers, where by tumors often present in outer regions of the lung, which are difficult to access with conventional tools.
The benefits of CBCT for lung cancer diagnosis
Greater accuracy: CBCT obtains real-time 3D pictures during procedures, enabling clinicians to accurately define tumours and biopsy nodules as small as millimetres.
Lower radiation: Patients are exposed less using CBCT compared to exposure during traditional CT scan, this is critical for patients who require serial imaging.
Outpatient-friendly: CBCT could be used in minimally invasive outpatient procedures and could prevent the need for surgical biopsy in cases.
Faster: The scan takes seconds, there is limited discomfort for the patient and fewer resources used at hospitals.
What’s next: Access and awareness
As CBCT has changed the landscape of lung cancer management, in all health care systems and contexts throughout India, access to the patient has never been a greater challenge.Technology involves upfront finances, training, and complex integration into regular workflows in pulmonology and oncology. Leading hospitals, cancer centres have already begun to incorporate CBCT within their procedures as the gold standard, particularly in the case of suspected early-stage lung cancers and indeterminate nodules.
Improved awareness among general physicians, pulmonologists, and radiologists will also lead to more timely referrals and improved usage of CBCT in cases with clinical suspicion.
Conclusion
CBCT is not simply another imaging modality — it is the future of precision pulmonology in India. As the burden of lung cancer increases and early detection is crucial, implementing tools like CBCT in the standard diagnostic pathway provides a unique opportunity to improve outcomes dramatically.
The future of lung cancer in India along with all cancers relies on awareness, accessibility and acceptance. In India, we can break the chains of lung cancer from detection of disease in the late stages of the illness with death as the only outcome, and shift the process to a paradigm of early detection and intervention which saves lives.