An innovative lung cancer screening pilot project in Northern Ireland designed to target selected patients older than 50 began at the end of November. The scheme is based on sensitive, low-cost chest x-ray, the first port of call to exclude lung cancer, according to consultant radiologist Dr. Stephen Hall from the Southern Health and Social Care Trust.
Patients with a history of smoking, breathlessness, weight loss, voice change, or a two-week cough have been singled out by a regional media campaign that encourages self-referral to one of the scheme's six screening centers with a catchment area of 310,000 people.
"In lung cancer awareness month, physicians from the Southern Trust obtained funding from cancer charities, including Macmillan, for a three-month pilot. Most of this money has been put into the media campaign. In total, 70 patients had been screened by the eighth day of the project and three cases needed further investigation; there was one case of probable disease. We believe this drive will impact a significant number of patients," said Hall, who is also associate medical director of the Trust's Cancer & Clinical Care Division.
The aim of this screening pilot is threefold, he explained. First, to pick up and investigate chest symptoms related to early lung cancer; second, to pick up chronic lung disease that may benefit from treatment; and third, to encourage symptomatic patients to go for a direct-access chest x-ray or to contact their primary care provider for a chest x-ray referral.
"At the moment, the pilot is bypassing primary care. Studies have shown that in 25% of [lung] cancer cases, there had already been three attendances by patients to primary care. If patients have a cough and weight loss, why clog up the GP's waiting room?" Hall told AuntMinnieEurope.com.
He pointed to the benefit of x-ray screening -- x-ray being sensitive enough to detect early lung cancer but obviating the extra cost streams associated with detection of subtle abnormalities by CT necessitating follow-up investigation.
"My feeling is that we will be able to confirm 'no harm' at the end of the pilot, and that the scheme will continue beyond February. There are challenges, however," Hall noted. "The catchment area has a high rate of lung cancer incidence as there is a lot of old industry and many smokers. The majority of the target population is male, but men from this rural and working class area are quite slow to attend screening projects."
On the plus side, he points out that so far the pilot patients have been very compliant, filled out the forms and history correctly, and been in and out within 10 minutes. The voluntary nature of the pilot makes it far more appealing for the individual rather than being "summonsed" for a procedure by letter. Furthermore, they don't have to face the large outpatient waiting times, and with six locations to choose from, geographically, patients will not be far from a convenient walk-in center.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
