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Administrative codes for LCS may capture tests prompted by signs\/symptoms.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Objective<\/jats:title>\n            <jats:p>To validate an automated algorithm that identifies LCS among asymptomatic patients.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Design<\/jats:title>\n            <jats:p>In this cross-sectional study, an algorithm was iteratively developed to identify outpatient low-dose chest CT scans via Current Procedural Terminology (CPT) codes, search free text of radiology orders for screening terms and signs\/symptoms (e.g., cough), and classify scans as screening or not.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Participants<\/jats:title>\n            <jats:p>National population-based sample of 4503 adults ages 65\u201380 in Veterans Health Affairs primary care, with detailed smoking history to identify LCS-eligible individuals (30\u2009+\u2009pack-years, current tobacco use, or quit\u2009&lt;\u200915\u00a0years prior).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Main Measures<\/jats:title>\n            <jats:p>Algorithm specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) relative to manual chart review (gold standard) on 100% of screening scans and\u2009&gt;\u200910% random sample of non-screening scans.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Key Results<\/jats:title>\n            <jats:p>Chart review was conducted on <jats:italic>n<\/jats:italic>\u2009=\u2009335 scans. The final algorithm could not classify 22% of scans, of which 73% were non-screening; these were excluded from primary analyses. Among 842 LCS-eligible individuals, the algorithm demonstrated 97% sensitivity (95%CI 91\u201399%) and 79% specificity (58\u201393%). Only 69% (61\u201377%) of scans classified as LCS via administrative codes were truly screening, compared to 95% of those classified as screening via the algorithm (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Algorithm performance was similar regardless of LCS eligibility, with 90% PPV (84\u201394%) and 93% NPV (86\u201397%) in the overall population regardless of tobacco cigarette history.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>An automated algorithm can accurately identify screening versus diagnostic chest imaging, a necessary step to unbiased analyses of LCS in non-randomized settings. Studies should assess the accuracy of administrative codes for LCS in other health systems.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s11606-025-09429-2","type":"journal-article","created":{"date-parts":[[2025,2,25]],"date-time":"2025-02-25T16:51:53Z","timestamp":1740502313000},"page":"1306-1314","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Novel Automated Algorithm to Identify Lung Cancer Screening from Free Text of Radiology Orders"],"prefix":"10.1007","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4880-7658","authenticated-orcid":false,"given":"Alison S.","family":"Rustagi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marzieh","family":"Vali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis J.","family":"Graham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily N.","family":"Lum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher G.","family":"Slatore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salomeh","family":"Keyhani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,2,25]]},"reference":[{"issue":"5","key":"9429_CR1","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1056\/NEJMoa1102873","volume":"365","author":"The National Lung Screening Trial Research Team","year":"2011","unstructured":"The National Lung Screening Trial Research Team. 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