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David Gierada

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    WS 01 - IASLC Supporting the Implementation of Quality Assured Global CT Screening Workshop (By Invitation Only) (ID 632)

    • Event: WCLC 2017
    • Type: Workshop
    • Track: Radiology/Staging/Screening
    • Presentations: 1
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      WS 01.22 - Quality Control Throughout Lung Cancer Management (ID 10662)

      08:30 - 21:00  |  Presenting Author(s): David Gierada

      • Abstract
      • Slides

      An effective CT screening program relies on numerous health care professionals from different areas of expertise. Evidence-based guidelines established by professional organizations provide a framework for programs to achieve an optimal balance between the benefits and risks of screening. Interaction and constructive communication among the providers involved is essential for implementation and maintenance of a high quality screening program. This presentation will discuss opportunities for quality control through interdisciplinary collaboration at different phases of the screening process: Program Design Lung cancer screening processes involve numerous components of the health care delivery system. Engaging individuals with relevant expertise and those whose workflow will be affected can help obtain a program structure best adapted to local resources. Patient Eligibility Determination Current guidelines restrict CT screening to persons who meet a specific lung cancer risk profile, understand the benefits and risks, and are able and willing to pursue diagnosis and treatment. Some health care providers may not be familiar with this, and refer patients for CT screening in whom the risks outweighs the benefits. Direct interaction with referring providers may be needed in order to ensure quality in this component of the screening process. A dedicated program nurse navigator or other paraprofessional can be invaluable for this and other components of the screening process. Smoking Cessation Patients pursue CT screening to reduce the risk of lung cancer death. Quitting smoking is an important additional means to this goal, but support for smoking cessation is beyond the expertise of most screening providers. Collaboration with smoking cessation services and professionals is essential for providing encouragement and access in the most effective manner. CT Imaging To ensure adequate image quality at the lowest radiation dose, current guidelines recommend reducing the dose for persons smaller than average, and increasing dose for those larger than average. Quantitative nodule volumetry requires attention to additional technical details. Care should be taken that the CT technology staff efforts are closely aligned with image quality goals. CT Interpretation Screening exam interpretation dictates management and is the central component of lung cancer screening. Use of a standardized reporting and management system based on current evidence is advised, for consistency in the quality of care and assessment of outcomes. Reporting Results Prompt and effective communication of results facilitates timely management of screening abnormalities. This can include written notification of the ordering provider, and ideally the patient, direct telephone contact for findings that need further management, and documentation of communication. A dedicated nurse navigator or other paraprofessional is an ideal reporting liaison for a busy program. Management of Abnormalities Abnormalities may be managed by referring providers or by dedicated clinical collaborators within a comprehensive screening program. Patient tracking using lung cancer screening database software can help monitor compliance with recommendations and can prompt inquiries if diagnostic testing has not been pursued. Collaboration through working clinical conferences may facilitate decision-making regarding diagnosis and treatment. Program Assessment Comparison of program performance metrics with published data and goals may help identify program strengths and deficiencies, and suggest means of quality improvement for individuals or processes.

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