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Radiologist Initiated Referral for Patients Suspected of Having a Thoracic Malignancy FREE TO VIEW

Nadine Strilchuk; Niloofar Taghizadeh; Paul Burrowes; Laura Hampton; Alex Chee; Paul MacEachern; Rommy Koetzler; Sean MacFadden; Alain Tremblay
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Division of Respiratory Medicine, University of Calgary and Alberta Thoracic Oncology Program, Calgary, AB, Canada

Chest. 2015;148(4_MeetingAbstracts):568A. doi:10.1378/chest.2223024
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SESSION TITLE: Lung Cancer Screening & Diagnosis Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: The time interval between detection of a lesion suspicious for thoracic malignancy on imaging and referral to specialty care is too long. Therefore, we aimed to evaluate a potentially faster referral process by having the radiologist trigger a referral to specialty care at the time of CT interpretation.

METHODS: A prospective observational non-randomized study of two groups of patient referred to the Alberta Thoracic Program-South (ATOP-S) was carried out (2012-2014, total n=962): Group 1: Subjects who were referred to the ATOP-S clinic through a pilot program in which radiologist interpreting suspicious CT scans can directly initiate this referral at the time of interpretation. Group 2: Subjects who were referred to the clinic through non-radiologist health care provider. The time interval between dates of 1st suspicious CT scan to receipt of referral (CT-R), 1st specialty appointment date (CT-A), and treatment decision (CT-D) were assessed. The differences in CT-R, CT-A, and CT-D time intervals between two groups were tested with the Mann-Whitney U-Test. P values < 0.05 were considered to be statistically significant.

RESULTS: For 75 subjects in group 1, and for 836 standard referral subjects in group 2 CT-R, CT-A, and CT-D could be calculated. The median (75th-90th percentile) CT-R was 4 (8-13) days in group 1 and 8 (19-37) days in group 2. The median (75th-90th percentile) CT-A was 14 (19-26.4) days in group 1 and 20 (32-52.3) days in group 2. The median (75th-90th percentile) CT-D was 26 (40-63) days in group 1 and 32 (48.8-71) days in group 2. Subjects in group 1 significantly had a shorter CT-R, CT-A, and CT-D intervals compared to subjects in group 2 (P-values <0.01).

CONCLUSIONS: A radiologist initiated referral program significantly reduced the interval between first CT scan suggestive of a lung malignancy to receipt of referral, 1st specialty appointment date, and treatment decision.

CLINICAL IMPLICATIONS: Radiology groups and thoracic oncology programs should consider partnerships to expedite direct referrals in patients with suspected thoracic malignancy.

DISCLOSURE: The following authors have nothing to disclose: Nadine Strilchuk, Niloofar Taghizadeh, Paul Burrowes, Laura Hampton, Alex Chee, Paul MacEachern, Rommy Koetzler, Sean MacFadden, Alain Tremblay

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