Dear Colleagues

Re: Roll Out of Optional GP Direct Access CT Chest for Suspected Lung Cancer Pathway

Following a pilot in North East Glasgow, NHS GG&C are rolling-out an option of GP direct access CT for patients with suspicion of lung cancer pathway for patients who have a normal or equivocal chest x-ray. A copy of the pathway is attached for your information. This is based on the Scottish Referral Guidelines for Suspected Cancer, a copy of which is here, and is an additional option to existing referral pathways.

When ordering chest x-rays please mark the request “Urgent Suspected Cancer” (USoC) in Ordercomms. Please also request FBC and U&Es to aid assessment and expedite further imaging.

HAVE A LOW THRESHOLD FOR CHEST X-RAY PARTICULARLY IF AGED OVER 40, SMOKER/EX-SMOKER OR HISTORY OF EXPOSURE TO ASBESTOS.Chest x-ray reported as equivocal or normal but with persistent concern

If the chest x-ray report is equivocal or shows a minor abnormality, but the report cannot entirely rule out malignancy, or if the chest x-ray report is normal but symptoms persist for longer than six weeks (other than isolated thrombocytosis or cervical and/or persistent supraclavicular lymphadenopathy).

Option 1: GP direct access rapid CT request – refer via Ordercomms for CT chest (mark as USoC)

There are two possible outcomes:-

• CT report is normal / does not show malignancy:-

Please communicate the reassuring report to the patient as per existing practice procedures for communication of results. Any non-malignant conditions will be reported and actions recommended using standardised radiology reporting. Incidental findings are infrequent but may require onward referral.

• CT report shows lung cancer / malignancy:-

Refer using USoC pathways. CT reports suggesting malignancy will be coded / tracked. Respiratory clinics will be informed of the result and request referral if not already processed by practice.

Option 2: Refer as per existing USoC pathways

If chest x-ray report is grossly abnormal / suggests malignancy: no change from current practice

Refer using USoC pathways. This ensures tracking of both patient and the abnormal result.

When referring patients on any USoC pathway please remember to include a performance status using the SCI Gateway template. This is very helpful for planning investigations and treatment options prior to clinic appointments, minimising delays in the patient journey.

Should you have any questions regarding the pathway, please refer to the FAQs document. 

If there is a specific query not covered by either the FAQ document or the information on the website please contact Dr Douglas Rigg on Douglas.Rigg@nhs.scot

Yours sincerely

Dr Joris Van Der Horst, Consultant Respiratory Physician GRI, Clinical Lead WoSCAN Lung Cancer MCN

Dr Douglas Rigg, Lead GP for Cancer,  Greater Glasgow & Clyde

Dr Graeme Marshall, GP, Gorbals Health Centre, Clinical Director, North East
Locality, Glasgow City Health and Social Care, Glasgow