Background The widespread use of computed tomography (CT), to investigate both lung and non-lung pathology has led to the finding of increasing numbers of incidental pulmonary nodules. The BTS is currently in the process of developing guidelines on the investigation and management of pulmonary nodules, due 2013. We aim to establish current practise with pulmonary nodule follow up, including the use of low dose thin-section techniques and lung nodule volumes, both of which have been recommended to enhance patient safety and diagnostic accuracy respectively.
Methods We developed a structured questionnaire in order to survey 60 hospital trusts in the London and East of England region between May-July 2012. The named lung cancer lead was emailed/faxed with a 40% response rate.
Results All hospitals followed a local trust guideline, based partly on Fleischner Society recommendations. On discovery of an incidental lung nodule 80% of radiology departments alerted a respiratory physician and 20% the referring doctor only. 67% of hospitals reviewed patients in specialist lung cancer clinic initially, the remainder being seen in general respiratory. Follow up methods varied between hospitals, with 29% being followed up in clinic, 29% by telephone and 42% by letter. For follow up scans 52% of departments used conventional “staging” CT chest, 29% used dedicated low dose CT protocols and 19% used unehanced CT scans. The majority of departments scanned the entire lung (62%), 20% used limited slices and 20% used a combination as part of follow up. Only 15% of departments used lung nodule volume measurements routinely, with a further 20% having access on request.
Conclusions There is significant variation both in the way patient’s are followed-up as well as the methods of scanning deployed. Some trusts have developed streamlined pathways to monitor patients, without using valuable clinic slots. The chest physician is very much reliant on the organisation and expertise of their radiology department, with a significant majority not having access to low dose CT or lung nodule volumes. It is a crucially important area that requires continued improvement, both in achieving earlier cancer detection, balanced against the need for limiting the radiation dose.
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