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

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.

A United Kingdom based survey of clinical practice in the diagnosis of suspected pulmonary embolism.

OBJECTIVE: To identify UK practice in the diagnosis of suspected pulmonary embolism with particular reference to the pregnant population and to determine whether the 2003 British Thoracic Society (BTS) guidelines had influenced practice. METHOD: A postal survey was performed of all 249 nuclear medicine departments in the UK identified from the British Nuclear Medicine Society database. RESULTS: One hundred and one responses were received (41%). Ninety-eight centres (97%) performed scintigraphy with 17 using perfusion only imaging. A median of six (range: 1-27) scintigraphic scans were performed weekly. Ninety-seven centres had computed tomography (CT) capabilities although 11 centres only had single slice CT capability. A median of seven (range: 1-50) CT pulmonary angiographies (CTPAs) were performed weekly. Seventy-two centres used a diagnostic algorithm; 73 centres performed D-dimers routinely and 86 used probability criteria for reporting ventilation/perfusion (V/Q) scans. CTPA was performed in the majority of the cases with an abnormal chest radiograph. In pregnancy, 37 centres routinely performed D-dimers, 80 centres performed a scintigraphic based investigation as a first line test while 12 preferred CTPA. Of the 33 centres (34%) that indicated that the BTS guidelines had changed their practice, 30 (91%) commented that the demand for CTPA had increased and 29 (88%) felt that the service had been improved. CONCLUSION: There continues to be widely varying practice throughout the UK despite the BTS guidelines. There is a shift in practice towards CTPA and variation in the approach to diagnosis in pregnancy. The survey highlights the need to standardize the diagnostic algorithm for suspected pulmonary embolism, especially in pregnancy.