Missed Lung Cancers on Chest Radiographs – A Completed Audit Cycle

Royal College of Radiologists (RCR) Recommended Audit (2023–2025)

Dr Kranthi Sajja

 

Background:
- CXR: first-line tool for chest symptoms.
- Lung cancers often missed due to subtle signs.
- Literature: miss rate 20–60%; up to 90% visible in hindsight.

Standards (RCR 2005):
- Lesion identified in >75% of CXRs (within 1 year).
- If lesion reported → further investigation in >95%.

 

Methods:
- Audit 1 (2023–24): 184 cases, 3 radiologists, 184 analysed.
- Audit 2 (2024–25): 194 cases, 2 radiologists, 194 analysed.

 

 

Data Collected:
  · CXR within 1 year prior to date of lung cancer diagnosis?
  · Original report: Normal / Abnormal.
  · Reviewer agreement?
  · Further Investigation recommended?

 

Results:
- Audit 1: Detection 89.7%, Further Investigation 97.6%
- Audit 2: Detection 92.1%, Further Investigation 97.7%
- Both exceed RCR standards.

Summary & Action Plan:
- Improved performance between cycles.
- Clearer follow-up guidance advised.
- Radiologists to note limitations.
- Ongoing peer review essential.