Introduction In 2014 we introduced in conjunction with our primary care colleagues a “straight to CT” protocol for patients with suspected lung cancer, to not only to speed up the diagnostic pathway but also to reassure at an early stage patients without the disease. However, some clinicians suggested that this approach may increase the burden of CT scans performed without improving cancer care.
Method “Straight to CT” is available for patients with a CXR coded as concerning for malignancy, or via a general practitioner with concerns based on symptoms and risk factors. Following radiologist review, if appropriate scans are offered within 72 hours: scan positive cases are reviewed by the lung cancer team for onward next investigation, and where the scan is negative the result is faxed by radiology back to the GP. We compared 2015 data with that for 2014, looking for route of referral, investigations performed, and outcome.
Results In 2015  464  were eligible for the “straight to CT” pathway. Of these 258 (56%) [246, 53%] coded chest X-rays and 206 (44%) [222, 47%] ‘worried clinician’ referrals.
Of the coded CXRs, 24  patients (9%)[9%] declined further investigation. Of the 234  who accepted a 72hr hour CT scan, 149 (64%) [119, 53%] had confirmed cancer.
Of the 206  ‘worried clinician’ referrals, 21 (10%) [16, 7%] patients declined further imaging or assessment, and 32 (16%) [29, 13%] were deemed inappropriate. Of the 153  remaining who went on to have 72 hour CT scans only 29 (19%) [42, 24%] had cancer confirmed.
Overall, 387  CT scans were carried out. 178  patients were accepted by the cancer services, and 209  patients remained under primary care.
Cancer conversion rates for accepted patients was 70% [79%]
Conclusions This study has shown that the burden placed on radiological services has remained constant during the two years of our innovative service, and we had previously shown that introducing this protocol did not increase the overall number of scans. We recommend this pathway to other lung cancers units as a way of improving their diagnostic pathway.
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