Impact of radiographer immediate reporting of chest x-rays from general practice on the lung cancer pathway (radioX)

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.