Introduction Liverpool has a ‘straight to CT’ service for patients with coded radiology suspicious of lung cancer and for clinicians worried symptoms may indicate malignancy. In our pathway the lung cancer team automatically take patients whose CT suggests lung cancer. For patients whose scan does not suggest cancer the result is forwarded to their GP to act upon as necessary. We have investigated the outcomes for this patient group for the calendar year 2015.
Method 387 CT scans were carried out on the 72 hour ‘straight to CT’ pathway. The cancer services took 179 patients. We have reviewed local radiology, result datasets and hospital records for the remaining 208 patients whose CT results were managed by their GP.
Results Within the group without suggestions of cancer on CT, indications for 72 hour CT were: 90 patients (43%) had coded radiology and 118 ‘worried clinician’ (57%) (23% haemoptysis; 34% other symptoms). The results of the CT scans showed 42 (20%) nodules requiring follow up, 49 (23.5%) inflammatory changes, 49 (23.5%) nil significant, 20 (10%) emphysema, 11 (5%) bronchiectasis and 37 (18%) combinations of other (fibrosis, PE, atelectasis etc). For follow up 17 (8%) were already under the care of a chest physician, 74 (36%) were referred to a chest physician and 117 (56%) were managed in primary care. 73 patients (35.1%) had repeat CT scans. In total 99 scans have been done, 31.3% of these were ordered by primary care 68.7% by secondary care. 4 patients following repeat imaging were diagnosed with cancer. 3 of these had nodules initially, 1 had inflammatory shadowing.
Conclusion The ‘straight to CT’ pathway dictates that all patients with a CT scan not suggestive of lung cancer remain under the care of the referring clinician. Only 35% of patients subsequently needed referral for secondary care advice. The ‘straight to CT’ service not only provides prompt action for patients with cancer but empowers primary care to manage non- malignant diseases. Patients are now managed in the most appropriate setting and inappropriate hospital visits minimised.