Experiences of direct access CT scanning for general practitioners and implications for investigation of possible lung cancer

Abstract

In 2008 our trust began to offer local GPs direct access to CT scans of the thorax. We have retrospectively reviewed 111 consecutive cases between April 2008 and July 2009. The mean age of the (Table presented) patients was 67 years (range 23-95); 52% were male. In 104 cases (94%) the GP arranged a chest radiograph (CXR) prior to the CT scan.The clinical details provided in the CT scan requests outlined suspected malignancy on CXR in 42%, non-resolving consolidation in 11%, persistent cough in 9%, chest pain in 7%, suspected fibrosis or bronchiectasis in 5%, nodule follow-up in 5%, pleural effusion in 4%, dyspnoea in 3%, haemoptysis in 2%, other 11%. The CT scan reports indicated probable cancer in 25%, emphysema in 18%, infective changes in 6%, pulmonary fibrosis in 4%, bronchiectasis in 4%. Minor or non-specific incidental findings were seen in 12%, 14% were normal, other in 17%. Following the CT scan, 44% of patients were referred to a chest physician and 11% to another specialty. A total of 23 patients had an abnormal initial CXR and probable cancer on the CT scan. The average time between receipt of the initial abnormal CXR report by the GP and subsequent referral to hospital was 33 days (range 3-103, median 26). We are not necessarily averse to open access CT scanning for GPs. While the results of this study need to be interpreted with caution, these data suggest that the current system may be delaying the opinion of a secondary care physician in patients with suspected lung cancer. Had the above 23 patients been referred to hospital under the Calman cancer 14-day rule at the time of the initial abnormal CXR, they may have received a more rapid diagnosis.