Introduction
Rapid and early diagnosis is are important factors in determining outcomes in lung cancer. The aim of this study was to investigate the impact of immediate reporting of chest X-rays from primary care by reporting radiographers on the time to diagnosis of lung cancer.
Methods
A 12 month, block randomised trial was conducted at a single centre in London, UK. Half of the sessions per week (5) were randomised to an immediate or routine chest X-ray (CXR) report by a reporting radiographer, with an immediate CT where indicated. Time taken to diagnosis of lung cancer or discharge from the lung cancer pathway was determined and Mann-Whitney test used.
Results
During this study 8,732 patients were recruited and a total of 9,137 CXRs were performed with 4,128 (45.1%) CXRs in the immediate radiographer reporting arm. A total of 49 lung cancers were diagnosed, 26 in the immediate arm. Time to diagnosis of lung cancer for patients in the immediate arm was a median of 21.5 days (mean 26.0) compared with 30 days (mean 41.6) in the routine CXR arm (p=0.012). For patients with a suspicious CXR, diagnosis of lung cancer was achieved in a median of 18 days (mean 24.3) compared with 32 days (mean 42.6) in the routine arm (p=0.0375).
Conclusion
At a single centre, immediate reporting of CXRs referred from primary care by radiographers reduced time to diagnosis of lung cancer by a median of 14 days where the CXR was suspicious and by a median of 8.5 days for all patients. This has significant implications for patient outcome and adherence to new cancer targets