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Evaluation of the first 18 months of the ‘Abnormal GP Chest X-ray Straight to CT’ Pathway at Princess Alexandra Hospital (Harlow, Essex)
EP30706
Poster Title: Evaluation of the first 18 months of the ‘Abnormal GP Chest X-ray Straight to CT’ Pathway at Princess Alexandra Hospital (Harlow, Essex)
Submitted on 27 Sep 2019
Author(s): James K. Diss, Tamer Adem, Mark Gregory, Elena Stefan, Vijay Jayaram, Sridhar Redla, Sandra Dimmock
Affiliations: Radiology Department, Princess Alexandra Hospital NHS Trust, Harlow, Essex
This poster was presented at BIR Annual Congress 2019
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Poster Information
Abstract: Introduction: Lung cancer is the leading cause of UK cancer deaths, largely due to advanced stage at initial presentation. Approval of National CT screening targeting ‘at-risk’ individuals is expected in the near future. To further enable earlier lung cancer detection, several NHS Trusts have initiated ‘Straight to CT’ pathways in the event of a GP-referred chest radiograph (CXR) suspicious for malignancy. Here we describe the main findings from the first 18 months of this Pathway at our DGH.

Materials & Methods: Imaging and histopathology results from all ‘Abnormal GP CXR Straight to CT’ Pathway cases from November 2017-April 2019 were reviewed.

Results: On average 11 cases were referred to the Pathway each month. Mean Pathway Duration (from CXR to CT Report) was 8.1 +/- 0.3 days, significantly quicker than the pre-Pathway timescale as a result of improved ‘Time to CT report following the initial CXR’: 6.6 + 0.2 versus 11.4 + 1.0 days (p<0.01). The follow-up CT was consistent with malignancy in 43% cases (75% of these were in keeping with a primary lung cancer), while malignancy was excluded in 37%. Indeterminate CT findings requiring further investigation accounted for 20% cases. Findings of additional diagnostic investigations and evaluation of subsequent treatment times are discussed.

Conclusion: This Pathway’s first 18 months demonstrate significantly improved New Lung Cancer Diagnosis Times following an initial abnormal GP CXR. Important considerations in the Pathway’s establishment are discussed, including: (a) addressing IRMER requirements for direct recall of patients for CT, and (b) encouraging patient awareness of this Pathway while minimizing their anxiety.
Summary: We describe the main findings from the first 18 months of the 'Abnormal GP Chest X-ray Straight to CT’ Pathway at our DGH, which has reduced the interval between an abnormal CXR report to CT by an average of 5.5 days, Important considerations in the Pathway’s establishment are also discussed, including: (a) addressing IRMER requirements for direct recall of patients for CT, and (b) encouraging patient awareness of this Pathway while minimizing their anxiety.
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