Clinical and Translational Oncology

, Volume 16, Issue 1, pp 64–68 | Cite as

Effectiveness of a protocolized system to alert pulmonologists of lung cancer radiological suspicion

  • V. Leiro-Fernández
  • M. Botana-Rial
  • A. Tilve-Gómez
  • C. Represas-Represas
  • A. Pallarés-Sanmartín
  • A. Fernández-VillarEmail author
Research Article



When lung cancer (LC) is suspected in chest radiography, an adequate interpretation and management by experts would improve the selection, the access to rapid diagnostic units, the diagnostic effectiveness and prevent the loss of patients with suspected LC. To ensure this, we planned a system for alerting pulmonologists by radiologists to radiological suspicion of LC.


This system consists of an alert from radiologists to pulmonologists through a specific email. The pulmonologists alerted has to contact the study doctor petitioner who must refer the patient for study to the Lung Cancer Rapid Diagnostic Unit (LCRDU). We have prospectively analyzed all patients studied in a 2-year period including clinical variables, time invested in the different diagnostic steps and the degree of collaboration and satisfaction among the involved professionals.


Of 118 alerts received, 84 (71 %) were studied in our LCRDU. The median of days until petitioner contact, patient consulted at LCRDU and to obtain a diagnosis was 1 (IQR 0–1.5), 2 (IQR 1–5) and 13 (IQR 7.5–30), respectively. In 45 cases (53 %), the suspicion of malignancy was confirmed (LC 84.4 % and metastasic 10.1 %). After staging was complete, 33 % of non-small cell lung cancer was potentially resectable (clinical TNM stage I–II). The level of satisfaction was high so that only one of the petitioner’s studies chose other diagnostic pathways.


This strategy for radiological suspicion of LC ensures the communication between general practitioners, radiologists and pulmonologist improving the LC diagnostic effectiveness. This system can be easily implemented in health care systems.


Lung cancer diagnosis Lung cancer primary care Lung cancer suspicion Chest radiography Rapid diagnosis Alert system 



We thank Dr. Garcia-Tejedor (in memoriam), whose contribution was crucial to the success of this study.

Conflict of interest

None declared.


  1. 1.
    Olsson JK, Schultz EM, Gould MK. Timeless of care in patients with lung cancer: a systematic review. Thorax. 2009;64:749–56.PubMedCrossRefGoogle Scholar
  2. 2.
    National Collaborating Centre for Acute Care. Diagnosis and treatment of lung cancer. National collaborating Centre for Acute Care, London. 2005. Accessed 17 July 2011.
  3. 3.
    Barret J, Hamilton W. Pathways to the diagnosis of lung cancer in the UK: a cohort study. BMC Fam Pract. 2008;9:31.CrossRefGoogle Scholar
  4. 4.
    Turkington PM, Kennan N, Greenstone MA. Misinterpretation of the chest x ray as a factor in the delayed diagnosis of lung cancer. Postgrad Med J. 2002;78:158–60.PubMedCrossRefGoogle Scholar
  5. 5.
    Rami-Porta R, Crowley JJ, Goldstraw P. The revised TNM staging system for lung cancer. Ann Thoracic Cardiovasc Surg. 2009;15:4–9.Google Scholar
  6. 6.
    British Thoracic Society. BTS recomemendations to respiratory physicians for organising the care of patients with lung cancer. Thorax. 1998;53:S1–8.Google Scholar
  7. 7.
    Reifel J. Lung Cancer. In: Asch S, Kerr E, Hamilton E, editors. Quality of care for oncologic conditions and HIV: a review of the literature and quality indicators. RAND Corporation; 2000. p.113–72.Google Scholar
  8. 8.
    Alberts WM, Bepler G, Hazeton T, Ruckdeschel JC, Williams JH. American collegue of chest physiscians practice organization. Chest. 2003;23:S332–7.CrossRefGoogle Scholar
  9. 9.
    Brocken P, Kiers BA, Looijen-Salomom MG, Dekhuijzen PN, Smits-van der Graaf C, Peters-Bax L, et al. Timeliness of lung cancer diagnosis and treatment in a rapid outpatient diagnostic program with combined (18)FDG-PET and contrast enhanced CT scanning. Lung Cancer. 2012;75:336–41.PubMedCrossRefGoogle Scholar
  10. 10.
    Bjerager M, Palshof T, Dahl R, Vedsted P, Olesen F. Delay in diagnosis of lung cancer in general practice. Br J Gen Pract. 2006;56:863–8.PubMedCentralPubMedGoogle Scholar
  11. 11.
    Salomaa ER, Sällinen S, Hiekkanen H, Lippo K. Delays in the diagnosis and treatment of lung cancer. Chest. 2005;128:2282–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Abal Arca JA, Ramos MA, De la Infanta RG, López CP, Pérez LG, López JL. Lung cancer diagnosis: hospitalization costs. Arch Bronconeumol. 2006;42:569–74.CrossRefGoogle Scholar

Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2013

Authors and Affiliations

  • V. Leiro-Fernández
    • 1
  • M. Botana-Rial
    • 1
  • A. Tilve-Gómez
    • 2
  • C. Represas-Represas
    • 1
  • A. Pallarés-Sanmartín
    • 3
  • A. Fernández-Villar
    • 1
    Email author
  1. 1.Pulmonary ServiceComplexo Hospitalario Universitario de Vigo (CHUVI)VigoSpain
  2. 2.Radiology ServiceComplexo Hospitalario Universitario de Vigo (CHUVI)VigoSpain
  3. 3.Pulmonary ServiceComplexo Hospitalario de Pontevedra (CHOP)VigoSpain

Personalised recommendations