Introduction In Salford, annual 2WW referrals rose from 235 in 2010/11 to 248 (2011/12) and 281 (2012/13) but fell to 249 in 2013/14 as the result of a 5 month pilot1 of our CATCH protocol (Community Access To CT Chest) allowing abnormal “low risk” CXR reports to trigger a GP request for a fast track CT scan. This audit reviews the performance of CATCH for a whole year of activity from 1st May 2014 to 30th April 2015.
Methods The CATCH d-base and electronic patient record were used to identify the patients and dates of CXR and CT examinations in addition to CXR/CT scan reports and final diagnoses. The number of 2WW referrals was determined for the same time period using the cancer waiting times d-base.
Results A total of 117 patients entered the CATCH protocol of which the majority of CXRs demonstrated the presence of a well-defined (47%) or ill-defined opacity (14%) and a further 18% revealed abnormality at the hilum. The remaining CXRs (21%) raised concerns about fat pads, atelectasis or pleural abnormality. For the 115 patients having a CT scan, the findings confirmed cancer in 9%, solitary pulmonary nodule (25%), infection/inflammation (15%), atelectasis (10%), pleural plaque (10%), fat pad (5%) and in 11% the CT scan was normal.
Following CATCH CT scan, 53 (46%) patients required no follow up, 33 (29%) generated urgent referral, 16 (14%) non-urgent referral to the chest clinic, 11 (10%) required follow up surveillance imaging. Timelines for CATCH management are detailed in Table 1. Mean time from CT report to cancer diagnosis was 61.1 days (range 23 to 187) and total number of 2WW referrals for 2014/15 was 234.
Conclusions Following the introduction of CATCH to the Salford Lung Cancer Service, 2WW referrals have fallen further to manageable numbers. The pick-up rate for cancer is only small and reflects the low risk abnormality detected on CXR. The relatively long diagnostic times for cancer reflect the processing of small nodules detected within this select group of patients.
Reference 1 Moorcroft CS, Kamalatharen G, Elliot S, et al. CATCH - community access to CT chest. Thorax 2014;69:A115 doi:10.1136/thoraxjnl-2014-206260.231