RCR responds to new report on missed lung cancer detection on X-rays

Thursday 14 October 2021

The RCR has responded to a new safety report into the potential for missing lung cancer on the X-rays of patients who initially present to primary care. 

Today’s report from the Healthcare Safety Investigation Branch (HSIB) was sparked by the reference case of 50-year-old non-smoker “Tracey”, whose lung cancer was not picked up for nearly a year, despite multiple visits to her GP, X-rays and radiologist reviews.  

The HSIB investigation and final report considered issues around public and clinical awareness of lung cancer symptoms in non-smokers and the use of X-ray imaging as an initial investigation tool, as well as the potential for artificial intelligence (AI) programmes to improve the detection of lung cancer.

Following its investigation, HSIB has recommended that:

  • NHS England and partners explore whether low-dose CT scanning would be more a cost- and clinically effective way of detecting lung cancer in symptomatic patients presenting via primary care, rather than using X-rays 
  • The National Institute for Health and Care Excellence should review and amend its advice for healthcare professionals on the investigation of possible lung cancer
  • NHSX should work with the RCR and the Society and College of Radiographers to develop benchmarking and validation guidance on AI programmes for lung diseases   

Responding to the report, RCR Vice President for Clinical Radiology Dr William Ramsden, said: 

“Both the national observations and the individual case highlighted in today’s report underline how difficult it can be to diagnose lung cancer on X-rays. The RCR is committed to helping all radiologists minimise errors, and we routinely publish national guidance and clinical learning materials, as well as strongly encouraging radiology teams to audit and learn from discrepancies. 

“We welcome HSIB’s calls for exploration on the feasibility of more widespread use of CT scanning for symptomatic patients. At present it would be difficult to roll out CT scanning and reporting for all of these cases, as the NHS simply does not have the equipment, radiographers and radiologists it would need to meet increased demand.

“There are also lots of promising AI programmes being developed and trialled for the detection of lung cancer nodules on chest X-rays and AI will undoubtedly improve detection and accuracy in future, acting as a second pair of eyes and a safety net. 

“Robust validation and safe system-wide roll out of these programmes is still some time away though, and it will be an extremely complicated and expensive ongoing task for NHS digital leaders. Imaging teams are keen to use fully regulated AI in practice, and we look forward to working further with NHSX and others to advance and embed the clinical use of AI.”