A missed opportunity - fibrosis on previous abdominal CTs in patients referred to an ILD clinic

Abstract

Introduction: Early use of anti-fibrotic medication in pulmonary fibrosis protects lung function, prolonging quality of life. Increased use of CT could enable detection of disease before significant symptoms develop. The majority of CT scans are requested by primary care teams, general physicians or surgeons. However these groups are unfamiliar with the significance of classical descriptors for pulmonary fibrosis used by radiologists. A recent case (patient presented with disabling breathlessness requiring oxygen at diagnosis, a year after CT for cholecystitis) led us to audit our ILD clinic with the aim of determining local prevalence. Methods: 116 patient records at a University Clinic were reviewed, to ascertain the prevalence of CT abdomen scans prior to referral. In addition to reports with ’refer to respiratory’ we sought words commonly employed to describe fibrosing interstitial lung diseases (reticulation, honeycombing, ground glass). Findings 11 patients had abdominal CT scans before referral. 5 had fibrosis present. Time from these scans to clinic review ranged from 3 to 36 months. Only 2 reports recommended referral to the respiratory team. A further 2 contained descriptors but no guidance, and one report failed to describe the fibrosis. Reports recommending ’refer to respiratory’ were followed. Of the remaining three patients, all were referred by their GP following presentation with symptoms. Conclusions: Abdominal CTs could enable early referral to ILD clinics, but this opportunity is lost due to reporting habits. Clear guidance to requestors is followed and should be employed as standard. Radiology training and education should target this issue, to improve outcomes for patients.