That's a tough five minutes. These were really terrific session and I appreciate the opportunity to be able to speak and I particularly appreciate the opportunity to have the last word with these panelists. Something I rarely get. I also just want to point out that there were four sessions today and there were four of these sum up talks and if you noticed three of the four did not have slides even though we were all promised slides by the panelists ahead of time only one person got the slides and I have to point out that that was the surgeon in the group which gives you some insight into why it's beneficial to have a surgeon around. They can do some things that the rest of us just can't get done. So starting at that point I want to talk a little bit about each of the sessions and give some thoughts about it. The first was was Professor Tamamagi and quality indicators. Wow that was a major effort on his part and he and Andrea who helped him enormously. This is not an easy task to put this together to do the literature review to get 20 plus academicians to fill out these forms to hound them to make sure they did it to get it back and then to send it back again for the next round and get it done. This is really a lot of work and to their credit they were able to get this done and put together I think something that's going to be very useful. These are important indicators. I think this will improve quality in screening. We have to monitor the programs and it was particularly important that he said he didn't give thresholds for what it should be yet. That's that was important. He's just identifying the things that we all felt were important to monitor and I think the next step will be to start figuring out how we use this how we compare sites what we expect in different countries. So there's a lot of work to be done but this really sets a wonderful groundwork for what we're going to be doing in the future. So again that was really a tremendous effort and was part of the early diagnosis committee that Rudolph heads or is Annette. So really terrific work and a great product from this meeting. The next was the talk on chest x-rays and to my amazement I find myself agreeing with Christine Berg on this topic. It's something that rarely happens but but I you know I have a very different maybe it's not so different. You know I knew that Berlin who was the NCI director of the deputy director of the NCI for those three original randomized control trials chest x-ray the Mayo Hopkins and Memorial and it was a tremendous regret of his that those didn't come out positive and that was used as a way of saying x-rays were not beneficial. I firmly believe the chest x-rays are beneficial. They're not as beneficial as CT but I think if you view it in the way that I do that you know CT proved that finding smaller cancers is better than finding bigger cancers and there should be no question is no doubt and nobody should doubt that anymore. And so then the question is how much smaller and chest x-ray finds cancers smaller than it does by waiting for symptom prompted. So to me the only issue is how much better is it than waiting. It's not as good as CT it's not going to find them as small but it finds them and to as sort of further proof that it's beneficial if you find the nodule on chest x-ray nobody's saying well chest x-ray is not any value. We shouldn't pursue this nodule. We shouldn't pursue this nodule. We pursue it because we know if it's a cancer it's better to take it out. And I think the PLCO did show that did have evidence of benefit and I agree there were certain design flaws in it. I think AI will improve the ability of chest x-ray. You know how much it will improve. I don't know but I'd improve it and I think it's very useful and I think in some of these low and middle income countries where they have TV clinics etc. Fantastic. I think this is a great opportunity. To be able to pursue early diagnosis. The next two talks were really fantastic. The technology is moving so quickly and it's it's coming. It's going to change the way we do everything and it's coming fast. I think you know the role of the radiologist is going to change I think in a good way. I think many aspects it can be used in many ways. This technology I think there's gonna be a lot of work on on how to use this information. One one point I want to make is that it's going to be the great equalizer also the especially you know with the interpreting of the chest x-rays you know in these low and middle income countries that don't have that have a shortage of radiologists. This is going to be a quality. This is going to level the field. It's going to alleviate workforce. The scans are going to be read some of them automatically. Some of them are going to say hey this one doesn't even need to be looked at by a radiologist. It's going to put them fill out the data forms automatically by findings. This is going to speed things up. So I think it's going to be the great equalizer. And I think in terms of biomarkers. I think it's going to be a great equalizer in terms of the quality of the data. I think in terms of biomarkers I see I'm out of time so I don't want to spend too much but the biomarkers also moving rapidly. Peter's talk he focused interestingly on its role of interacting with with sort of screening programs. I mean I know Peter would have loved to have talked about all the other roles of the biomarkers and I would have loved to have heard some of his thoughts on this. But I think this is this too is coming. How we're going to sort of be able to potentially triage patients. This is going to be a great use. And this technology is getting better how we evaluate it whether we have to do trials or randomized trials or this and that. I have my own thoughts that would take a lot of time to go through here and what's necessary. But I think the technology is just really pretty spectacular. So I will end my comments there and say that we have I guess one more talk which is going to be delivered by Father John the final benediction. So thank you very much.

medical screenings

quality indicators

chest x-rays

AI technology

healthcare access