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H. Marshall



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    P1.24 - Poster Session 1 - Clinical Care (ID 146)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Supportive Care
    • Presentations: 1
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      P1.24-003 - A comparison of the Lung Cancer journey - Metropolitan and Non-Metropolitan (ID 674)

      09:30 - 16:30  |  Author(s): H. Marshall

      • Abstract

      Background
      Referrals and diagnostic pathways for people with symptoms of suspected lung cancer vary by where a person lives and ease of accessing services. Lung cancer diagnostic specialist and treatment services are mostly located in major cities, which can make access for people living in regional/rural and remote areas more difficult compared to major cities. Studies have shown that remoteness of residence is associated with an increase of lung cancer incidence and mortality. Hypothesis: The time required for the evaluation of suspected lung cancer is longer for people from regional/rural and remote areas compared to people living in metropolitan Queensland. The aim of the research study is to describe and compare the journey from referral to diagnosis for people with suspected lung cancer from regional/rural and remote areas referred to The Prince Charles Hospital , a tertiary referral center, compared to metropolitan residents.

      Methods
      A retrospective study of consecutive people with suspected lung cancer referred to The Prince Charles Hospital from December 2010 onwards will be reviewed. Data on patient demographics and referral patterns will be collected from medical records and relevant Queensland Health patient information systems. Information systems include Queensland Oncology Online, Queensland Oncology Analysis System (OASys), The Viewer, Hospital Based Corporate Information System (HBCIS), Practix, Outpatient Services Information Management (OSIM), Picture Archive and Communication System (PACS) and Auscare. The following times will be compared between regional/rural/remote (defined as >50km from TPCH) and metropolitan (<50km from TPCH) patients: (A) from receipt of referral to first specialist appointment (FSA), (B) FSA to first pathological (cytology or histology) diagnosis (FPD), (C) FPD to first multidisiciplinary team discussion (MDT) and (D) MDT to first definitive treatment (FDT). .

      Results
      Preliminary results show that there are clear differences in times to first specialist appointments, diagnosis and definitive treatment experienced by patients living in more regional and remote areas compared to patients from the metropolitan area. Patients from more regional and remote areas on average waited longer for their first specialist appointments e.g. Non Metro: N= 103 60% of patients seen within 30 days of a written referral and 28% were seen within 7 days. Metro: N= 60 78% patients seen within 30 days of a written referral and 50% were seen within 7 days There was also a pattern of admitting patients from remote areas to have all diagnostic workup and commence treatment as an inpatient. Admitting patients from remote areas for diagnostic workup appears to have decreased time to treatment for this cohort of patients although the cost effectivenss to the health service is unknown.

      Conclusion
      Lung cancer is a devastating disease and has a poor prognosis. Lung cancer diagnostic and treatment pathways should be developed for patients living in more regional and remote areas of Queensland to ensure times to diagnosis and treatment are optimised. Potentially this will decrease emotional and financial strain suffered by patients and their families as well as being cost effective to health services.

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    P2.19 - Poster Session 2 - Imaging (ID 180)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Imaging, Staging & Screening
    • Presentations: 1
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      P2.19-007 - Pulmonary Nodule Detection by Junior Medical Staff is Improved by Digital Tomosynthesis Compared to Chest X-Ray (ID 1110)

      09:30 - 16:30  |  Author(s): H. Marshall

      • Abstract

      Background
      Junior doctors may fail to detect subtle pulmonary pathology on plain chest X-ray (CXR). Digital tomosynthesis (DT) is an emerging radiographic technique that provides multiple coronal chest images at only 2% of the radiation of a standard chest CT. Previous studies have demonstrated that pulmonary nodule detection sensitivity is three times greater with DT compared to CXR. We investigated whether DT can increase nodule detection rates by junior doctors compared to CXR.

      Methods
      Ten volunteer junior doctors (post-graduate years 1-3) at The Prince Charles Hospital in Brisbane, Australia, a secondary and tertiary referral hospital, were recruited to view CXR and DT images of 11 patients. All patients had CXR, DT and CT images acquired within a 30 day period for the evaluation of lung nodules. CT images (Philips Brilliance, Philips Medical Systems, Best, Netherlands), with collimation 0.625 mm and reconstructed slice width 0.9 mm, reported by experienced radiologists, served as the gold standard. DT images, consisting of 60 exposures through a 30° arc, were acquired using the GE Definium 8000 Xray Unit (GE Healthcare, Little Chalfont, United Kingdom), with simultaneous CXR as a scout image. Nine of these patients had at least one nodule >10 mm on CT, with two control patients without nodules. All participants undertook brief training to familiarise them with DT images one week prior to the study. In the study session, participants were showed anonymised CXR and DT images in random order and asked to mark “definite” or “possible” pulmonary nodules electronically. The markings were compared to CT detected “true” nodules. Markings made where there were no true nodules on CT were recorded as false positives. The time taken to view each image was measured. Participants completed a brief survey after viewing the images.

      Results
      Nodule detection sensitivity, represented by the proportion of true nodules marked “definitely” present, was significantly higher using DT than CXR (28/65 [43%] versus 3/70 [4%], χ[2], p<0.001), as was the proportion of nodules marked either “definitely” or “possibly” present (32/65 [49%] versus 13/70 [19%], χ[2], p<0.001). When considering instances where a nodule was marked either “definitely” or “possibly” present, where there was no true nodule on CT, significantly fewer false positives were made, on average, when viewing DT compared to CXR (0.36 versus 1.18 false positives per image, t-test, p<0.001). Although the time taken to view each DT image was statistically significantly longer than for each CXR image (86.9 seconds versus 67.9 seconds, t-test, p<0.01), the absolute difference was small. Ninety percent of participants agreed that they could identify nodules more confidently with DT than CXR.

      Conclusion
      In this study, junior doctors correctly identified more pulmonary nodules using DT compared to CXR and reported fewer false positive results. The time taken to view DT images was slightly longer than for CXR images, but this difference was small. Despite the small sample size, this pilot experiment has shown that DT may potentially improve identification of pulmonary nodules by junior doctors and a larger study is underway.