How CIMAR’s platform enables a national lung cancer screening program at scale, powered by AWS

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Lung cancer remains the leading cause of cancer-related deaths globally, with the World Cancer Research Fund International reporting 1.8 million deaths worldwide in 2022. While accounting for approximately 12–13 percent of all new cancer diagnoses in the US, EU, and UK, lung cancer is responsible for about 20 –21 percent of all cancer deaths in these regions. The disease is often diagnosed at advanced stages when treatment options are limited.

Personalized screening of high-risk groups using low-dose computed tomography (LDCT) has emerged as an effective method for early detection. LDCT scans create detailed 3D images of the lungs while using 90 percent less radiation than traditional CT scans, which means radiologists can identify potential cancerous areas early. Currently, only the US, China, South Korea, Taiwan, Czechia, and Croatia offer nationwide lung cancer screening programs, with the Netherlands and UK providing coverage in many locations. Some EU countries, such as Poland, successfully conducted multi-year screening trials, which are planned to be converted into nationwide screening programs in the upcoming years.

In this post, we describe how AWS Partner CIMAR’s medical image management platform is enabling the rapid roll-out, scaling, and operation of the National Health Service (NHS) England’s national lung cancer program, connecting 124 acute NHS trusts and multiple mobile scanning units.

NHS England’s lung cancer screening program

In 2019, NHS England launched the Total Lung Health Check (TLHC) program, a lung cancer screening program, to identify people aged 55–74 at increased risk of lung cancer based on their doctors’ records after a study showed that early low-dose CT screening reduced lung cancer mortality by 26 percent in men and 39–61 percent in women. In June 2023, the UK government announced that the TLHC would be the basis for a national targeted lung cancer screening program. The majority of external providers selected AWS Partner CIMAR as the central cloud platform to connect with hospitals to enable the remote acquisition and reporting of scans including the routing to AI and return of results back to hospitals. By using CIMAR’s platform, customers can manage roughly 80 percent of the TLHC diagnostic imaging data. The program’s roll-out began in the second half of 2023 and is expected to detect cancer in as many as 9,000 people and deliver one million scans each year once fully deployed.

Challenges for national lung screening programs

National lung cancer screening programs face several complex challenges in their implementation and operation. The rapid increase in eligible individuals has significantly strained hospital services, particularly imaging departments and skilled radiology professionals. Many hospitals lack sufficient scanning resources or specialist reporting expertise, forcing them to rely on outsourced services to maintain care continuity.

The heterogeneous nature of radiology imaging systems across the NHS, combined with varying operational processes among trusts, creates additional complexity. Service providers must navigate these diverse requirements while providing seamless integration and delivery of care. Additionally, the need to securely store, transmit, and analyze large volumes of imaging data between multiple stakeholders demands robust, cost-effective technological infrastructure.

CIMAR’s solution to these challenges

CIMAR’s platform addresses these complex challenges through a scalable, vendor-neutral, cloud-based architecture that transforms how their customers provide services to the NHS. The platform serves as a unified connection layer that integrates hospital systems, mobile scanning units, AI providers, and remote specialists, enabling seamless data exchange without requiring costly system upgrades.

The cloud-based solution efficiently handles the dynamic nature of lung cancer screening programs, adapting to varying workloads while maintaining performance and reliability. Through a centralized web platform, CIMAR connects trusts with diagnostic screening units and specialist clinicians, helping overcome local resource constraints and geographical limitations

The platform incorporates AI workflows to automate key steps in the imaging and reporting process, reducing the administrative burden so clinicians can focus more on patient care. This integration of technology and clinical expertise has enabled CIMAR’s customers to manage approximately 80 percent of the TLHC diagnostic imaging data, demonstrating the platform’s effectiveness in supporting large-scale screening programs.

CIMAR’s lung cancer screening platform integrates with AWS services

CIMAR’s service gateway seamlessly integrates with Amazon Web Services (AWS), forming the backbone of the cloud infrastructure and the extensive network supporting the lung cancer screening program. This integration enables scalable, secure, and efficient workflows, ultimately improving patient outcomes by streamlining the lung cancer screening process.

One of the critical challenges in lung cancer screening is providing timely and efficient access to imaging for qualified experts to review and provide clinical recommendations. CIMAR addresses this by using AWS storage services and cloud best practices to establish a near-direct link between medical imaging devices and clinical specialists.

Key components of the architecture

As shown in the following diagram, the architecture follows AWS Well-Architected Framework best practices, with gateways communicating with a load balancer that distributes traffic across multiple public-facing servers across different Availability Zones, providing resiliency and scalability. AWS managed services power the platform’s robust backend data storage and processing, allowing CIMAR to effectively organize and scale the service storage logic while responding quickly to trusts and clinicians. The key services include:

Amazon Simple Storage Service (Amazon S3) – Secure and scalable storage of imaging and protected health information (PHI)
Amazon Relational Database Service (Amazon RDS) – Reliable, scalable database layer for managing metadata and workflow-related data
Amazon ElastiCache – Enhanced performance through frequently accessed data caching

Figure 1: High-level architecture of CIMAR’s cloud-native lung cancer screening platform on AWS.

Conclusion

The lung cancer screening program is rapidly expanding across England to reach everyone eligible. As of 2024, over one million invites have been sent out, and over 3,000 lung cancers have been detected, with over 74 percent at an early stage when lung cancer is more treatable. Over 40 NHS trusts are now connected to CIMAR’s platform and are storing and processing lung scans in the cloud.

A secure and cost-effective medical image management solution such as CIMAR, running on the AWS Cloud, represents one core component to successfully roll out, manage, and scale nationwide cancer screening programs for governments today.

To learn more about how other medical imaging HealthTechs are using AWS to better serve patients, check out the following resources:

AWS Public Sector Blog