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  • Impact of radiographer immediate reporting of X-rays of the chest from general practice on the lung cancer pathway (radioX): a randomised controlled trial

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Lung cancer
Original research
Impact of radiographer immediate reporting of X-rays of the chest from general practice on the lung cancer pathway (radioX): a randomised controlled trial
  1. Nick Woznitza1,2,3,
  2. Bhagabati Ghimire4,
  3. Anand Devaraj5,6,
  4. Sam M Janes7,
  5. Keith Piper1,
  6. Susan Rowe2,
  7. Angshu Bhowmik8,
  8. Natasha Hayes2,
  9. Daniel Togher2,9,
  10. Nikita Arumalla8,10,
  11. Erik Skyllberg11,
  12. Iain T H Au-Yong12,
  13. Susan Geary13,
  14. Bindu George12,
  15. Sarah Sheard14,
  16. Stephen Ellis15,
  17. Zoheb Shah16,
  18. Sue Maughn17,
  19. Stephen W Duffy16,
  20. David Baldwin18
  1. 1 School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
  2. 2 Radiology Department, Homerton University Hospital NHS Foundation Trust, London, UK
  3. 3 Radiology, University College London Hospitals NHS Foundation Trust, London, UK
  4. 4 College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
  5. 5 Radiology, Royal Brompton Hospital, London, UK
  6. 6 National Heart and Lung Institute, Imperial College London, London, UK
  7. 7 Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
  8. 8 Respiratory Medicine, Homerton University Hospital NHS Foundation Trust, London, UK
  9. 9 Radiology, Epsom and Saint Helier Hospital NHS Trust, London, UK
  10. 10 Rheumatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
  11. 11 Respiratory Medicine, Barts Health NHS Trust, London, UK
  12. 12 Radiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
  13. 13 Radiology, Sherwood Forest Hospitals NHS Foundation Trust, Sutton-In-Ashfield, UK
  14. 14 Radiology, Imperial College Healthcare NHS Trust, London, UK
  15. 15 Radiology, Barts Health NHS Trust, London, UK
  16. 16 Wolfson Institute of Preventive Medicine, Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
  17. 17 NHS England and NHS Improvement London, London, UK
  18. 18 School of Medicine, University of Nottingham, Nottingham, UK
  1. Correspondence to Dr Nick Woznitza, School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, CT1 1QU, UK; nicholas.woznitza{at}nhs.net

Abstract

The National Optimal Lung Cancer Pathway recommends rapid progression from abnormal chest X-rays (CXRs) to CT. The impact of the more rapid reporting on the whole pathway is unknown. The aim of this study was to determine the impact of immediate reporting of CXRs requested by primary care by radiographers on the time to diagnosis of lung cancer.

Method People referred for CXR from primary care to a single acute district general hospital in London attended sessions that were prerandomised to either immediate radiographer (IR) reporting or standard radiographer (SR) reporting within 24 hours. CXRs were subsequently reported by radiologists blind to the radiographer reports to test the reliability of the radiographer report. Radiographer and local radiologist discordant cases were reviewed by thoracic radiologists, blinded to reporter.

Results 8682 CXRs were performed between 21 June 2017 and 4 August 2018, 4096 (47.2%) for IR and 4586 (52.8%) for SR. Lung cancer was diagnosed in 49, with 27 (55.1%) for IR. The median time from CXR to diagnosis of lung cancer for IR was 32 days (IQR 19, 70) compared with 63 days (IQR 29, 78) for SR (p=0.03).

8258 CXRs (95.1%) were reported by both radiographers and local radiologists. In the 1361 (16.5%) with discordance, the reviewing thoracic radiologists were equally likely to agree with local radiologist and radiographer reports.

Conclusions Immediate reporting of CXRs from primary care reduces time to diagnosis of lung cancer by half, likely due to rapid progress to CT. Radiographer reports are comparable to local radiologist reports for accuracy.

Trial registration International Standard Randomised Controlled Trial Number ISRCTN21818068. Registered on 20 June 2017.

  • Lung Cancer
  • Imaging/CT MRI etc

Data availability statement

Data are available upon reasonable request.

https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

http://dx.doi.org/10.1136/thorax-2022-219210

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Twitter @xray_nick

    • Contributors NW: conceptualisation, data curation, funding acquisition, investigation, methodology, project administration, resources, writing—original draft, writing—review & editing and acts as guarantor for the study. NW as guarantor accepts full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish. BG: data curation, formal analysis, validation, visualisation, writing—original draft, writing—review & editing. AD, SMJ and KP: conceptualisation, funding acquisition, methodology, writing—review & editing. SR: conceptualisation, funding acquisition, investigation, methodology, resources, supervision, writing—review & editing. AB: investigation, methodology, resources, supervision, writing—review & editing. NH and DT: data curation, investigation, project administration, writing—review & editing. NA, ES, ITHA-Y, SG, BG, SS and SE: investigation, writing—review & editing. ZS: data curation, formal analysis, software, validation. SM: conceptualisation, funding acquisition, writing—review & editing SWD: conceptualisation, data curation, formal analysis, funding acquisition, investigation, methodology software, supervision, validation, writing—original draft, writing—review & editing. DB: conceptualisation, funding acquisition, investigation, methodology, supervision, writing—original draft, writing—review & editing.

    • Funding Cancer Research UK Grant Ref: C61561/A24046. The funder did not have any influence

    • Competing interests NW: declares consultancy fees for InHealth, SM Radiology, Collective Minds Radiology. SMJ: declares research grants from GRAIL, Owlstone, Cancer Research UK; personal fees from AstraZeneca, BARD1 Bioscience, Achilles Therapeutics, Jansen; Travel fees Takeda; Advisory board Optellum. This work was partly undertaken at UCLH/UCL who received a proportion of funding from the DoH NIHR Biomedical Research Centre’s funding scheme. BG, AD, KP, SR, AB, NH, DT, NA, ES, SG, BG, SS, SE, ZS, SM and SWD: nothing to declare. ITHA-Y: declares medicolegal work and private radiology practice fees. DB: declares personal fees from MSD, BMS, AstraZeneca and Roche.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.