Can radiographer reporting play a wider role in lung cancer?

2017 12 01 19 18 0879 X Ray Chest Lungs 400

Radiographers can help fill the gaps in cancer care due to growing shortages of senior radiologists by rapidly reporting the chest x-rays of patients with suspected lung cancer, according to a U.K. study.

Researchers led by Nick Woznitza, PhD, a consultant radiographer at University College London Hospitals, assessed whether immediate reporting by radiographers reduced the time to diagnosis of lung cancer. They found that faster is better and that the approach did not compromise the accuracy of reports.

"Immediate reporting of CXRs from primary care reduces time to diagnosis of lung cancer by half, likely due to rapid progress to CT," the group wrote in an article published by Thorax on 8 November.

To speed the path to diagnosis of lung cancer, the National Health Service (NHS) established the National Optimal Lung Cancer Pathway (NOLCP) in 2017. One recommendation is that chest x-rays be reported within 24 hours of acquisition so that, if indicated, a CT can be completed either the same day or within 72 hours.

However, the impact of more rapid reporting on the whole pathway is unknown, according to the researchers.

To explore the issue, Woznitza and colleagues conducted a study at an acute district general hospital in London between 21 June 2017 and 4 August 2018. A total of 8,682 patient x-rays were performed, with 4,096 (47.2%) in the immediate radiographer reporting arm and 4,586 (52.8%) in the standard reporting arm (within 24 hours). A total of 49 lung cancers were diagnosed, including 27 (55.1%) in the immediate arm.

The time to diagnosis of lung cancer for patients in the immediate arm was a median of 32 days compared to 63 days in the routine chest x-ray arm (p = 0.03). The results were strengthened by an external comparison with a nearby hospital using the standard reporting pathway, where immediate reporting had a significantly shorter diagnosis time (p = 0.02), but with a similar median waiting time for lung cancer diagnosis in the control group (63 days), the authors wrote.

In addition, the study found that reporting radiographer and consultant radiologists' chest X-ray reports were comparable. Discordant radiographer and local radiologist cases were reviewed by thoracic radiologists. In 1,361 (16.5%) cases with discordance, the reviewers were equally likely to agree with the local radiologist and radiographer reports, the group added.

Ultimately, the study supports NOLCP's goal of improving logistics by reporting chest x-rays before patients leave the clinic. Given the national shortage of radiologists, radiographer reporting is a way to achieve this, the authors suggest.

"We know that the early, rapid and accurate diagnosis of lung cancer will help improve outcomes for patients. By making use of the expertise of reporting radiographers we found that we could reduce the time to diagnosis by half by giving patients the results of their X-rays at the time they were taken, explaining the findings and arranging a CT chest scan, the next step in the pathway," Woznitza told

The group concluded by recommending the approach for clinical teams as a way to provide patients with a faster diagnosis.

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