Early diagnosis can dramatically improve the clinical outcome of cancer and other lifethreatening diseases. Patients with lung cancer often die within one year after the onset of clinical symptoms, so screening and early detection can play a crucial role in saving a patient's life [1].

Low-dose CT scanning is an accepted diagnostic technique, but has relatively high false positive rates for small nodule detection. Even though a recent article suggests that low-dose CT lung screening could be cost-effective [2], it is not always sufficiently widely available for screening of large patient populations. A number of studies suggest that digital radiography, further enhanced by computer-aided detection and dose reduction refinements, could provide a more cost-effective tool [3-5].

This article presents initial experience with a real-time interactive diagnostic analysis system for digital chest radiography at the Carver College of Medicine/Iowa Hospitals and Clinics (Figure 1). The University of Iowa Hospitals and Clinics also houses the Holden Comprehensive Cancer Center and is affiliated with the Iowa City Veterans Affairs Medical Center and other local institutions and practitioners. It is the only public medical school in Iowa.

Located in Iowa City, a community of about 60,000, the University of Iowa health sciences campus includes the colleges of Medicine, Dentistry, Nursing, Pharmacy and Public Health, and University of Iowa Hospitals and Clinics, one of the nation's largest university-owned teaching hospitals.

Serving a catchment area with a population of over four million, the University of Iowa Hospitals and Clinics is the only tertiary healthcare facility in a radius of 200 miles, and is one of the few major trauma centers. It deals with some 800,000 outpatient visits and more than 41,000 admissions per year. In addition, the faculty and staff provide clinical services at 249 outreach clinics in 62 Iowa communities. These provide specialized services including care for children with special needs, high-risk infant follow-up, genetic counseling and prenatal health care.

The University of Iowa also has extensive telemedicine and teleradiology services, which provide outreach care via telecommunications technology. Affiliated regional medical education centers provide clinical care, community-based experience for medical students and coordinate residency programs.

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