1. Lung Pathway updated 21/5/10 Dr Woolhouse 1 GP refers patient. CXR suspicious for lung cancer? Report sent to GP. No further action. Report using X15 code to recommend CT scan. Hard copy report sent to GP and Judith Job in CT. Christine Roberts to cover when Judith is away. no yes no yes Judith allocates patient appointment for staging CT scan within one week using dedicated X-ray form (Dr Woolhouse as named referrer). Judith telephones patient to: 1. Offer them a CT appointment. QED and lung CNS to provide written advice on how to deal with patient queries as to the need for CT. Lung CNS can provide a follow up phone call if required. 2. Check and document history of Diabetes, Kidney disease, Myeloma or Organ Transplant. If the patient has any of these conditions then a creatinine measurement from the last 3 months is required. Judy to first check PAS viewer and then phone GP surgery for creatinine result. If no creatinine result available then standard letter to be faxed to GP surgery requesting that creatinine is measured and result faxed back to CT. Note: The usual checklist will still be completed pre-contrast injection to ensure that there are no contraindications. If Judith is unable to contact the patient by telephone then a CT appointment letter will be posted to the patient. To include an additional paragraph requesting the patient to contact the CT department if they have a history of Diabetes, Kidney disease, Myeloma or Organ Transplant so that the above measures can undertaken to ensure that a recent creatinine measurement is available. Judith to keep a list of all patient patients whom have been booked a CT as part of this pathway. list to include name, hospital number, DOB, date of CT appointment. List to be emailed to lung cancer nurse specialists, Dr Woolhouse and the relevant radiologists (Dr Walker, Dr Holloway) each week. Judy to contact patient and offer further appointment Patient attends for staging CT scan? Staging CT scan performed (go to next page) Judy informs Dr Woolhouse who contacts patients GP with offer of a clinic appointment yes no

2. Lung Pathway updated 21/5/10 Dr Woolhouse 2 Staging CT scan performed Patient given information leaflet Suspicious of Lung Cancer? Report to be emailed to QED (Copy to Ruth Parry, Rani Ubhi, Carolyn Russell, Sophie Phillips, Toni Devaney) QED to arrange urgent (within one week) lung clinic appointment (Hard copy report to Dr Woolhouse) Report to Dr Woolhouse via Toni Devaney Toni to keep list and check all patients are subsequently discussed at diagnostic meeting All CTs reviewed at Friday diagnostic meeting using Judiths list. Suspicious CT results - Check patients have been made an urgent lung appt. - Recommend method of diagnostic biopsy (if clinically appropriate) pending clinic appointment Non-suspicious CT results -Template letters sent from Dr Woolhouse secretary to patient and patients GP Clinic appointment Check clotting and spirometry if necessary Lung CNS to give date for biopsy if appropriate Diagnostic biopsy Lung MDT meeting yes no