title: Geographic variation in radiologist capacity and widespread implementation of lung cancer CT screening.
abstract: BACKGROUND
  Newly released United States Preventive Services Task Force (USPSTF) recommendations for lung cancer screening are expected to increase demand for low-dose computed tomography scanning, but health system capacity constraints might threaten the scale-up of screening.
  
  
  OBJECTIVE
  To estimate the prevalence of capacity constraints in the radiologist workforce and resulting potential disparities in access to lung cancer screening.
  
  
  METHODS
  We combined information from health interview surveys to estimate the numbers of smokers who meet the USPSTF eligibility criteria, and information from administrative datasets to estimate the numbers of radiologists and the numbers of scans they currently interpret in Health Service Areas (HSAs) nationwide. We estimated and mapped the prevalence of capacity constrained HSAs - those having a greater than 5% or greater than 25% projected increase in scans over current levels from scaling up screening - and used descriptive statistics and logistic regressions to identify HSA characteristics associated with capacity constraints.
  
  
  RESULTS
  Scaling up lung cancer screening would increase imaging procedures by an average of 4% across HSAs. Of the 9.6 million eligible smokers, 1,023,943 lived in HSAs with increases of at least 5%. HSAs that were rural, with many eligible smokers, and disproportionately Hispanic or low-income smokers had significantly higher odds of facing capacity constraints.
  
  
  CONCLUSIONS
  Disparities in access to lung cancer screening appear likely unless policy makers target HSAs with few radiologists for additional resources. Radiologists should be able to absorb the workload imposed by lung cancer screening in most areas of the country.
authors.affiliation: Department of Health Studies, Program in the Economics of Cancer, University of Chicago, Chicago IL fsmiel@uchicago.edu.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Smieliauskas
authors.affiliation: Section of Thoracic Radiology, Department of Radiology, University of Chicago, Chicago IL.
authors.forename: Heber
authors.initials: H
authors.lastname: MacMahon
authors.affiliation: Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago IL.
authors.forename: Ravi
authors.initials: R
authors.lastname: Salgia
authors.affiliation: Section of Hospital Medicine, Department of Medicine, Program in the Economics of Cancer, University of Chicago, Chicago IL.
authors.forename: Ya-Chen Tina
authors.initials: YC
authors.lastname: Shih
mesh_terms: D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000600:supply & distribution*; D011871:Radiology; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014481:United States; D000078329:Workforce; D016526:Workload
keywords: CT scan; cancer screening; health care capacity; lung cancer; radiologists