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Audit of the first 100 PET CT scans performed by the Christie Hospital NHS Trust on patients from North Wales
Audit of the first 100 PET CT scans performed by the Christie Hospital NHS Trust on patients from North
WalesBy Sue ArmstrongAudit Facilitator
Contents:
1) Executive Summary
2) Introduction and Context2.1) PET CT Technology2.2) Commissioning and Planning guidance2.3) Service Provision
3) Aims and Objectives
4) Methodology4.1) Stage 1 – Establishing standard questions4.2) Stage 2 – Collection of data4.3) Stage 3 – Satisfaction levels
5) Results and analysis 5.1) Stage 1 & 25.2) Stage 3 Satisfaction levels
6) Discussion
7) Conclusion and recommendations
8) Appendices
Appendix 1 Cancer Network internal PET CT referral procedureAppendix 2 PET CT request form templateAppendix 3 Patient Register (Log of referrals)Appendix 4 Consultants Questionnaire
1. Executive Summary
PET CT is a new technology that is better able to stage cancer and detect metastasis, and as such may be considered superior to CT imaging alone. No PET-CT service exists in Wales and as such patients from across Wales have travelled to Cheltenham for a service delivered in accordance with Welsh clinical guidelines.
From April 2008 the North Wales Cancer Network, on behalf of its stakeholders commissioned a service from the Christie Hospital in Manchester. This audit proposed to assess the first 100 scans delivered by the Christie analysing,
Access Utilisation and activity Clinical satisfaction Clinical, patient and financial implications
Upon analysis of all the data collated, the Cancer Network findings are as follows;
PET CT scans satisfactorily staged cancer in 88% of all cases. The evidence suggests that PET CT scanning had a positive influence
on the management of patients through staging cancer more accurately.
It is suggested that PET CT informed alternative treatment options in 29% cases with the greatest impact being suggested within Haematological cancers where 75% of PET scans informed potentially alternative treatment options.
Overall, clinicians exhibited high levels of satisfaction with the current referral mechanism.
Overall, clinicians were satisfied with the service provided from Christie NHS Trust.
PET CT scanning prevented potential co-morbidities in patients as a result of confirming disease stage and indicating alternative treatment pathways.
2. Introduction and context
2.1) PET CT technology
PET images demonstrate the chemistry of organs and other tissues such as tumors. A radiopharmaceutical, such as FDG (fluorodeoxyglucose), which includes both sugar (glucose) and a radionuclide (a radioactive element) that gives off signals, is injected into the patient, and its emissions are measured
by a PET scanner. Because cancer cells have a higher metabolic rate than other organs or tumours they can then be highlighted on a PET-CT scan following the injection of the radioactive tracer into the patient. This is beneficial for a variety of reasons;
It can help identify cancer earlier than other techniques. It can differentiate between malignant and benign tumours. It can determine the location and extent of a cancer. It can reveal how a type of cancer is responding to treatment.
These benefits enable a more precise staging of disease to the extent that some treatment can be modified or eliminated, a factor that obviously has benefits to the patient in terms of co-morbidities, but also to the service in terms of reduction of costs.
2.2) Commissioning and Planning guidance
The Welsh Health Circular (63) of 2003 identifies Health Commission Wales (HCW) as the designated commissioners of PET services in Wales. There was to be a phased introduction of PET, with the initial Phase 1 restricted to HCW funding only the strongly evidence-based clinical conditions from July 2005. Phase 1, which incorporates the first 100 scans within this audit includes the following clinical criteria; Lung cancer:
Investigation of the solitary pulmonary nodule in cases where a biopsy is not possible or has failed, depending on nodule size, position and CT characterisation.
Investigation of patients with non-small cell lung cancer who are staged as candidates for surgery on CT, to look for involved intrathoracic lymph nodes and distant metastases.
Investigation of patients with non-small cell lung cancer who are otherwise surgical candidates and have, on CT, limited (1–2 stations) N2/3 disease of uncertain pathological significance.
Investigation of patients with non-small cell lung cancer who are candidates for radical radiotherapy on CT.
Colorectal cancer: Re-staging of colorectal cancer prior to surgery for the removal of
solitary metastasis from the liver or lung or radical extensive pelvic surgery.
Re-staging of known colorectal cancer when conventional imaging has failed to show the cause of rising tumour markers.
Lymphoma:
Re-staging of Hodgkin’s lymphoma after induction therapy. Re-staging of high grade non-Hodgkin’s lymphoma after induction
therapy.
The consultation document ‘A Framework for the Development of Positron Emission Tomography (PET) Services in England’, issued by the Department of Health in July 2004 suggested wider criteria than the Welsh guidance and on this basis recommended approximately 600 scans per annum for the population of North Wales.
In part reflecting the above and the rationalisation of oesophageal surgery to Wrexham the LHBs in North Wales agreed to commission PET-CT for oesophageal cancer. Outside the HCW criteria and this activity is included in the audit sample.
2.3) Service provision
As described the PET CT scanning facility for the population of North Wales is now provided by Christies NHS Trust at a cost of £895 per scan. This service commenced in April 2008 and has a number of distinct features,
Referrals from MDTs are faxed through to the Cancer Network office where they are transcribed and logged.
Referrals are analysed for their compliance with Welsh criteria. Transcribed referrals are e-mailed to the PET-CT department at the
Christie. The Christie attempt to scan within one week and report within two
days. Reporting is in the form of a paper report and two CD ROMs with
images contained.
Previously scanning was provided by the Cheltenham Imaging Centre and The Paul Strickland Scanner Centre at Mount Vernon Hospital in Middlesex, but due to problems with capacity and unreasonable travel distance for patients, the NWCN commissioned Christies NHS Trust based in Withington.
3. Aims and Objectives
The aim of the project is to analyse the details around the first 100 scans referred to the Christie, and if possible, explore the assumption that utilising PET CT will inform the decision making on treatment in a manner that reduces radical treatment associated with significant co-morbidity.
Objectives are:
To measure the usefulness of PET CT scans in staging cancer. To establish whether management of cancer patients is improved/altered
by the use of PET CT scanning. To provide firm evidence of the benefits to the Network and it’s
Stakeholders. To assess the attitude of clinicians toward the logistics of accessing a PET
CT scan. To ascertain any potential cost savings.
Intended Outcome:
The project should help identify any issues with the newly established service, confirm the level of utilisation and identify any benefits and savings.
4. Methodology
As stated previously this project aims to prove the benefits of utilising PET CT scans for cancer patients. In order to test this theory a sample of the first 100 patients referred since the period April 2008 were taken from the Cancer Networks internal log.
Standard questions were then established for each referral criteria to determine the outcome and allow the data to be quantifiable, see below:
4.1) Stage 1 – Establishing standard questions
Criteria 1. Staging of non small cell lung cancer prior to surgery or radical
radiotherapy
Standard Questions:Was satisfactory staging achieved?Did the patient go on to have Radiotherapy?Did the patient go on to have Surgery?Did the patient go on to have treatment other than Surgery or
Radiotherapy?
Criteria 2.Assessment of solitary pulmonary nodule only when biopsy not safe or
practical
Standard Questions:No question just the number of referrals
Criteria 3.Re-staging of colon cancer prior to surgery for removal of metastatic
disease from liver or lungs
Standard Questions:Was satisfactory staging achieved?Did the patient go on to have Surgery on liver or lungs?Did the patient go on to have other treatment?Did the patient go on to have no treatment?
Criteria 4.Re-staging of colon cancer when conventional imaging has failed to
show the cause of rising tumour markers Standard Questions:
Was satisfactory staging achieved?Cause of rising tumour markers shown?Did the patient go on to have no treatment?
Criteria 5.Re-staging of Hodgkin and high grade non Hodgkin lymphoma after
induction Therapy
Standard Questions:Was satisfactory staging achieved?Did the patient go on to have treatment?
Criteria 6.Staging of oesophageal cancer prior to radical surgery
Standard Questions:Was satisfactory staging achieved?Did the patient go on to have Surgery?
4.2) Stage 2 – Collection of data
A spreadsheet was designed to capture all the information and the patient notes on the CANISC system were interrogated to gain answers to the standard questions. The CANISC system was the main source of data for this investigation, but in some instances, where the data could not be found or where patient notes were insufficient, the information was sought from the MDT co-ordinators or the Trust Cancer Managers. Once all the data was obtained the spreadsheet was updated and the results analysed.
4.3) Stage 3 – Satisfaction levels
The next step was to compile a questionnaire to gauge the opinions of the referring clinicians for the method of accessing the service (see appendix 4) and to see whether there were any differences in opinion between sites. The questionnaire was then emailed out to the referring consultants for completion.
5. Results and analysis5.1) Stage 1 & 2
Percentage of scans per hospital
41%
7%27%
25%
Glan ClwydCountess of ChesterBangorWrexham Maelor
The chart above shows what percentage of the 100 scans examined were requested by each hospital, Glan Clwyd requested the most scans at 41%. The chart below shows the percentage of scans conducted for each cancer site clearly showing that lung scans account for just less than half of all scans requested.
Percentage of scans per cancer site
19%
3%
8%
44%
26%
ColorectalHead & NeckHaemLungUGI
The pie chart below illustrates the percentage of scans which were definitely successful in staging cancer; this figure could be higher though, as the 10% that represents the ‘unknown’ category relates to data that is unobtainable rather than truly not known.
Percentage of PET CT scans that helped to stage cancer satisfactorily
87%
3%10%
YesNo Unknown
The table and chart below show within which criteria (or cancer site) the PET CT scan may have been influential in informing a treatment decision choice that altered a clinical pathway that might have otherwise been followed without a PET- scan e.g. oesophagectomy.Most cases of treatment pathways being altered were within criteria 6 which relates to cancers of the oesophagus. Within this cancer site potentially 14 clinical pathways were altered which may not only have resulted in a cost saving to the NHS (see table below) in terms of avoiding significant and traumatic surgery but also caused less co-morbidity for patients found to have extensive disease.
Number of unnecessary invasive treatments prevented per criteria
0
2
4
6
8
10
12
14
16
1 2 3 4 5 6
Criteria
Trea
tmen
ts p
reve
nted
TREATMENT CRITERIA1 Staging of non small cell lung cancer prior to surgery or radical radiotherapy2 Assessment of solitary pulmonary nodule only when biopsy not safe or practical3 Re-staging of colon cancer prior to surgery for removal of metastatic disease from liver or lungs4 Re-staging of colon cancer when conventional imaging has failed to show the cause of rising tumour markers5 Re-staging of hodgkin and high grade non hodgkin lymphoma after induction therapy6 Staging of oesophageal cancer prior to radical surgery
The table below shows 3 of the 6 criteria within which scans are requested, these have been chosen as it is possible to postulate a course of treatment action that might previously have been taken had the scan not taken place. It is possible to conclude that management of patients within the other criteria was also altered as a result of the scan, but this is more difficult to place a cost on. The costings are taken from the 2008-09 Admitted Patient Care Tariff which is used in England; this has been used as there isn’t a national tariff for Wales. The potential cost savings achieved are shown in the table below:
Costings for surgeries prevented by PET CT scanning
CriteriaHRG Code Narrative
*Cost (£)
No. of procedures
preventedPotential
cost
***Cost of PET CT
scansPotential savings
1
Staging of non small cell lung cancer prior to surgery or radical radiotherapy D03 Major Thoracic Procedures £4,090 4 £16,360 £3,580 £12,780
3Re-staging of colon cancer prior to surgery for removal of metastatic disease from liver or lungs
G02 Liver - Complex Procedures £5,956
2**£20,09
2 £1,790 £18,302 D03 Major Thoracic Procedures £4,090
6Staging of oesophageal cancer prior to radical surgery F02
Oesophagus - Very Major Procedures £3,574 14 £50,036 £12,530 £37,506
Totals 20 £86,488 £17,900 £68,588
* costs taken from 2008.09 Admitted Patient Care Tariff used in England** this cost represents the maximum potential cost if both procedures were required i.e. surgery on both liver and lungs*** based on £895 per scan
The potential savings have been calculated by selecting the appropriate procedure from the tariff and multiplying by the number of procedures that were prevented to derive the potential cost, then the cost of the PET CT scans was calculated and deducted from the potential cost to give the potential savings.
5.2) Stage 3 Satisfaction levels
The chart below shows a selection of questions asked of the referring clinicians to assess their perceptions of the new referral mechanism. Overall, it demonstrates quite a high level of satisfaction with the service, with most clinicians rating the pro-forma as clinically appropriate and only highlighting a small number of problems which will be discussed later on. On the whole, the clinicians indicate that they receive reports within a reasonable time period and that the reports are of a satisfactory nature.
Feedback from satisfaction survey on 35 clinicians
0%
20%
40%
60%
80%
100%
120%
Satisfied with pro-forma Problem with referrals Reasonable timescale forreceiving reports
Satisfied with standard ofreports
Overall satisfied with newsystem
Questions asked
Per
cent
age
of c
linic
ians
YesNo
When the referral mechanism changed in April 2008, one of the main concerns was the incorporation of yet another administrative layer into the process; that being the requirement to fax the completed pro-forma request to the Cancer Network with someone there forwarding it on to Christies NHS Trust. The concern being that there was the potential for delay. It is clearly demonstrated over the page though, that this concern has not materialised
as 46% of referring clinicians say the new system is better than the old system and 26% saying it is at least the same and no worse. Fewer than 3% (1 response) say that the new system is not as good as the previous system.
Satisfaction with new referral system compared with previous system
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
45.00%
50.00%
About the same as the previoussystem
Better than the previous system Not as good as the previous system Don't Know
Responses
Per
cent
age
When examining the negative response, it becomes apparent from the comments made that the problems arise once the service has been accessed and the PET CT scan has happened, see extract below;
‘In comparison with Cheltenham the service was almost as good after the initial glitches. Over the past month or 2, since the discussion with Christies about how to send the images, the delivery of the discs has been suboptimal. Reading the report does not indicate the actuality in all cases. There is a tendency to read the images rather than to give an opinion. This became worse after the discussion about how to send the images. The reports arrive, but the discs often are not timely, this has been most noticeable over the past month. Also there is a tendency to report the images rather than to give an opinion on the interpretation of the images (which is the point of having expert opinion).’
These comments indicate that there have been issues with delivery of the discs and reports and also dissatisfaction with the content of the reports. While this is an interesting point though, it is only 1 opinion and was not echoed in any of the other 34 responses.
The pie chart below illustrates the reaction to the question of responsiveness, with 77% of referring clinicians saying that the system is very responsive compared to 23% saying it varies. This further reinforces that the concerns around delays, anticipated as a result of adding another stage in the process, have not had a detrimental effect on accessing the service and overall the referring clinicians are happy with the turnaround of processing the forms.
Responsiveness of new system
77%
23%
Very responsiveVaries
The small number of issues highlighted by clinicians of problems with referrals is shown in the extract below, 3 clinicians out of the 35 surveyed responded that there had been a problem. Upon further analysis of the comments made, it becomes apparent that the problems raised are not around access or responsiveness but rather separate issues. One response refers to a problem with handwriting being difficult to read which can result in delays or errors as the person in the Network office who is transcribing the faxed pro-forma onto an electronic template often will have to contact the person who faxed the form to confirm what is actually written. The second issue highlighted refers to the delivery of the service from the providing trust as opposed to problems with accessing the service which will be discussed in more detail later. Lastly the third response refers to a dispute between the Network and a clinician regarding the need in a certain case for the patient to have a PET CT scan.
Problems with referrals and explanation SiteYes My illegible handwriting Lung
Yes
In comparison with Cheltenham the service was almost as good after the initial glitches. Over the past month or 2, since the discussion with Christies about how to send the images, the delivery of the discs has been suboptimal. Reading the report does not indicate the actuality in all cases. There is a tendency to read the images rather than to give an opinion. This became worse after the discussion about how to send the images. The reports arrive , but the discs often are not timely, this has been most noticeable over the past month. Also there is a tendency to report the images rather than to give an opinion on the interpretation of the images (which is the point of having expert opinion). Upper GI
Yes North Wales Cancer Network vetoed a request that the MDT had agreed. Upper GI
Also analysed was the satisfaction levels between cancer sites with the service, as illustrated in the table below. Interestingly, this clearly shows that problems are within 2 distinct sites; Lung and Upper GI as these are the only sites that have had problems with the service. The issue within the Lung site, as explained in the extract above relates to handwriting and overall does not affect satisfaction levels for the service. However, the issues within the Upper GI site are, as outlined above, more complex and do have a detrimental effect upon the users satisfaction with the service and the referral mechanism.
Cancer site
% of responses for
each site
Problems with
referrals
Reports received
within reasonable timescale
Reports of a
satisfactory standard
Happy with the system overall
Colorectal 8.6% No Yes Yes YesHaematological 17.1% No Yes Yes YesHead & Neck 5.7% No Yes Yes YesLung 37.1% Yes Yes Yes YesUpper GI 28.6% Yes No No NoOther 2.9% No Yes Yes Yes
Total 100.0%
What do you believe would improve the service?
My patients and team seem very happy with the serviceWeb based reporting access
There are occasionally some situations where the scenarios provided in the relevant form do not cover the clinical situation. I think there should be an 'other' column with free text space available. Otherwise the form is well set out.Need to be able to do this electronically
Need to extend the agreed indications for PET scans to include what is currently best practice in other centres and other countries. i.e. upfront PET scans for Hodgkins gives more accurate staging and usually increases the staging and may modify treatment. There are other examples.
See comments made in response to Q6 and timely delivery of the discs to coincide with the reports.
Above is an extract of the comments made by clinicians regarding what they think would improve the service. The need to complete the forms electronically and email them is mentioned, as is Web based reporting access to remove the logistical problems with posting the discs and reports.
6. Discussion
This audit was devised to gain insight into how PET CT scanning assisted in the cancer patients’ pathway; it can be argued from the findings, that the scans impacted on patient care in 2 distinct ways. Firstly, the use of PET CT scanning definitely influenced the management of patients by staging cancer more accurately resulting in a better service for the patient. Secondly, the use of PET CT scans prevented unnecessary, invasive procedures in 29% of cases, this is not to infer that the PET CT had a positive outcome for the patient, merely that the scan showed that the option of invasive treatment might not be beneficial and this finding altered the treatment pathway for that patient. This has wider implications for the NHS as a whole in terms of ensuring resources are better utilised. Although there is evidence to support this finding, it is, however very difficult to attempt to place a cost upon it, with some criteria being more calculable than others. This has been attempted in the ‘Costings for surgeries prevented by PET CT scanning’ table in the results section of this report. This table shows a potential saving to the NHS of just over £68,000. This figure however warrants a note of caution as it is very difficult to predict what ‘might have been’ and it has been calculated using a number of assumptions.
Firstly, it is assumed that each of the procedures ‘prevented’ would have definitely resulted in the significant treatment identified. While this is a logical assumption in each case, especially those within criteria 6 who had suspected oesophageal cancer, it cannot be conclusively stated as fact. Secondly, the costing for criteria 3 ‘Re-staging of colon cancer prior to surgery for removal of metastatic disease from liver or lungs’ assumes that surgery was performed on both liver and lungs in both cases, whereas it might just have been on one or the other.
There is also great difficulty in placing a cost saving on what might have been prevented within criteria 4 – ‘Re-staging of colon cancer when conventional imaging has failed to show the cause of rising tumour markers’ and criteria 5 – ‘Re-staging of hodgkin and high grade non hodgkin lymphoma after induction therapy’. While a cost can be calculated it is difficult to predict with any degree of certainty the alternative treatment that might have been undertaken; however there can be little doubt of the benefit to patients, in terms of earlier intervention and more precise treatment.
The NWCN has benefitted patients by ensuring a more local service is provided by Christies, but this has cost implications, as the cost per scan is more expensive now than when it was provided by the voluntary sector. Does this demonstrate ‘value for money’ when the service could be provided for less or is providing a more local service for vulnerable patients a more fundamental value that cannot be judged on cost alone? However, there is the alternative discussion regarding reduced ambulance costs though again this is difficult to calculate in part because it is not clear how many patients have used the ambulance service and which organisation has a role in monitoring its use.
When attempting to gauge the opinions of the clinicians who regularly use the service, the findings strongly indicate a high level of satisfaction for the current referral mechanism. Lung referrals were the most common with 44% of referrals being in this area. The feedback obtained showed a high level of satisfaction among these clinicians with the only negative comment made referring to the clinicians own illegible handwriting. This comment does raise an interesting point which was echoed in other responses. Specifically, the need for hand writing and faxing the forms which, given the technology available, does seem questionable.
There would seem to be some merit in receiving the form electronically to cut out the need for transcribing the form and this would also reduce the number of queries back to the clinicians and secretaries regarding having to clarify hand writing which can delay things. Some clinicians also commented on the need to evolve the process into a web based reporting tool so that they could access the reports on the web themselves rather than have to wait for a disc to be posted to them. The only negative feedback received related to Upper Gastrointestinal clinicians whose comments reflected dissatisfaction with the service once the PET CT scan had been done rather than problems with the referral mechanism. They complained of the reports not being received within a reasonable timescale and of the reports tending to read the images
rather than give an opinion. Overall though, these feelings were not in the majority with most clinicians reporting they were happy with the system.
7. Conclusion and recommendations
The results achieved support all the initial hypotheses made regarding the benefits of PET CT scanning.
Upon reflection of the findings of this audit and the comments provided, the following recommendations are made;
The continued use of PET CT scanning should be supported and funding should be provided to enable this.
There should be a further audit conducted on the next 100 patients.
The current referral mechanism should be refined to a) require that the faxed referrals not be handwritten but completed electronically to remove problems with legibility of the forms and b) allow these faxed referrals to be scanned (via a networked scanner) and emailed to Christies NHST, this will save time.
A further audit should be conducted concentrating on the provision of the service from Christies NHS Trust and levels of satisfaction with it. The satisfaction survey conducted within this audit concentrated on satisfaction with the referral mechanism rather than service provision, but this highlighted areas where further investigation would be beneficial and recommendations for improvement could be made.
8. Appendix 1.
PET-CT – Christies Referrals Procedures
Receiving a Referral
Receiving a hand written faxed referral:
Transcribe fax to the electronic Christies request form Located on the Network drive – data on ‘nrcldc01’ (F:) > Cancer Network folder, File name – Electronic referral form – Final PET CT Investigation Request.doc Ensure all mandatory items are completed – if not refer back to
the referring Clinician or Secretary When the form has been approved input ‘Verified by D Heron’
within the referrers signature sectionGo to section: Encrypting Word Files
Receiving an electronic typed referral by email:
Note: this will only apply when it has been pre-arranged with a member of the Cancer Network team Ensure all mandatory items are completed – if not refer back to
the referrer When the form has been approved input ‘Verified by D Heron’
within the referrers signature sectionGo to section: Encrypting Word Files
Encrypting Word Files – Password Protection
Open document, and complete necessary fields Click ‘Tools’ located on the main menu bar, then ‘Options’
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An information box will then appear, select the ‘Security’ tab
Enter in password: ****** (one word and all in caps) located under the heading – File encryption for this document indicated by the arrow
Click ‘OK’, another information box will appear requesting you to re-type the password for confirmation then click ‘OK’
Then save the document as usual
Emailing a request
PET CT requests must be encrypted before attaching to a mail message Emails must be sent to: ******* & *******
Registering a request
Each PET CT request needs to be logged on the Network registerLocated on the Network drive – data on ‘nrcldc01’ (F:) > Cancer Network folder, File name – Electronic referral form – PATIENT REGISTER FOR PET CT.doc Complete all columns with the exception of the last, which will be
completed at a later date
.
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8. Appendix 2.
PET CT Investigation Request
Patient Demographics Consultant Referrer
NHS No:Private Pt. Name:
Surname: GMC NoForename: Signature: VERIFIED BY DAMIAN HERONAddress: Address for
Report:Postcode: DoB: E-mail:Home No: Tel. No:Mobile No: Fax No:
Mandatory InformationInpatient? Hosp: Ward: Pregnant? Yes No Contact No: Breast feeding? Yes No
Diabetic? Yes No Communicable infection? Yes No
If Yes, specify? Insulin Tablets Diet If Yes, specify:Pt. weight (kg): Claustrophobic? Yes No
Clinical Indication Staging of non-small cell lung cancer prior to surgery or radical radiotherapy Assessment of solitary pulmonary nodule ONLY when biopsy not safe or practicable Re-staging of colon cancer prior to surgery for removal of metastatic disease from liver or lungs Re-staging of colon cancer when conventional imaging has failed to show the cause of rising tumour markers Re-staging of Hodgkin and high grade non Hodgkin lymphoma after induction therapy Staging of oesophageal cancer prior to radical surgery
Histology and StagingHistologically confirmed cancer?
Yes No Type:
Current clinical stage: T N M
Treatment and InterventionHas this patient had:Surgery? Yes No Type: Date complete:Radiotherapy? Yes No Type: Date complete:Chemotherapy? Yes No Type: Date complete:
Other Clinical Details
For Departmental Use Only DB LT FX Date & Time of Appointment:Christie Hospital No: Authorised:
Please ensure form is fully completed before referring. Thank you. Fax requests to: 01745 589 917
Date Target Patient? (please circle) N / 31 / 62
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8. Appendix 3. North Wales Cancer Network register of referrals.
NORTH WALES PET CT ACTIVITY
TREATMENT OPTIONS
1 STAGING OF NON SMALL CELL LUNG CANCER PRIOR TO SURGERY OR RADICAL RADIOTHERAPY LUNG
2 ASSESSMENT OF SOLITARY PULMONARY NODULE ONLY WHEN BIOPSY NOT SAFE OR PRACTICAL LUNG
3 RE-STAGING OF COLON CANCER PRIOR TO SURGERY FOR REMOVAL OF METASTATIC DISEASE FROM LIVER OR LUNGS COLORECTAL
4 RE-STAGING OF COLON CANCER WHEN CONVENTIONAL IMAGING HAS FAILED TO SHOW THE CAUSE OF RISING TUMOUR MARKERS COLORECTAL
5 RE-STAGING OF HODGKIN AND HIGH GRADE NON HODGKIN LYMPHOMA AFTER INDUCTION THERAPY HAEM
6 STAGING OF OESOPHAGEAL CANCER PRIOR TO RADICAL SURGERY UGI
NO PATIENT
NHS NOPOST CODE/LOCATION
REFERRINGCLINICIAN
SITE TRUST DATE REC'D
DATE SENT TO CHRISTIE
DATE OF PET
CRITERIA PICK LIST REF FORM
OUTCOME EMAILED TO CHRISTIE
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8. Appendix 4.
Consultant Satisfaction Survey – Referrals for PET CT scans
1) What cancer site do you work in? Upper GI Lung ColorectalHaematological Head & Neck Other
2) How often would you say you referred patients for PET CT Scanning?
Frequently Regularly Occasionally
3) When referring patients for PET CT scans, how would you describe the Investigation request form that must be completed?
Insufficient Clinically Excessive Information detail appropriate requirements
4) How responsive do you think this new system of referring is?
Very Not at all Varies
5) Have you had any problems with referrals since the new system was implemented?
Yes No
6) If so, what kinds of problems have you had?
Please comment
7) Do you receive the reports within a reasonable timescale?
Yes No
8) Are the reports of a satisfactory standard?
Yes No
9) Overall, are you happy with the new referral system?
Yes No
10) Would you say the new system is better than the old system?
Yes No About the same
11) If not, what do you believe would improve the service?
Please comment
