Can imaging practices provide multidisciplinary lung cancer screening?

One consistent prerequisite to a comprehensive lung cancer screening program is the multidisciplinary team. Is the team a barrier to community imaging practices that want to offer lung cancer screening? No, according to N.J.-based Atlantic Medical Imaging (AMI). Its lung cancer screening program demonstrates how imaging providers can adapt and replicate the essential multidisciplinary team.

Since launching lung cancer screening as a free service in December 2011, AMI has screened approximately 650 patients. The program has been “very successful” with referring physicians, shared David Levi, MD, co-director of the lung cancer screening program. The screening program also has served as a platform for radiologists to extend their patient care chops by providing services such as smoking cessation counseling and results communication to patients.

AMI launched its program shortly after the National Lung Screening Trial (NLST), embracing the challenge of duplicating the trial results in a community setting. The practice has applied a broader interpretation of the multidisciplinary team, said David Kenny, MD, co-director of the lung cancer screening program. “We don’t have all of these disciplines in one setting. What we can do is make sure we are following patients, talking to clinicians and closing the loop with specialists.”

Since launching its screening service, AMI has devised a comprehensive referring physician education program, which started with a series of lectures for primary care physicians and includes pamphlets, marketing meetings and website promotions.

Screening is funded through the AMI Foundation. “We felt lung cancer screening is too important a service not to offer it to patients, but unfortunately, some patients [may not be able to pay out of pocket],” says Levi. With foundation funding, the service is provided at no charge to patients. Patients present with a physician referral, and are first triaged through schedulers, who ensure that patients meet National Comprehensive Cancer Network screening criteria. CT technologists confirm that patients meet criteria prior to scanning.

The NLST took place in a very controlled setting, admitted Kenny. AMI hopes to replicate its results by adhering to strict screening and follow-up protocols.

As a community imaging practice comprised of radiologists, AMI has tweaked processes to recreate the multidisciplinary team model and maintains a close relationship with pulmonologists, thoracic surgeons, and most importantly, primary care physicians.

“We offer to meet with patients to review any significant findings and provide smoking cessation counseling when we give patients their results,” said Levi. Although results delivery can be a tricky situation for radiologists, referring physicians have embraced AMI’s commitment to direct communication. One exception to the process, noted Kenny, is the significant finding, such as a 3 cm lesion. In these cases, the thoracic radiologist will call the referring physician and offer him or her option to discuss the result with the patient.  

Another essential key to replicating NLST results is a dedicated nurse, who collates all of the screening cases and stratifies them according to when follow-ups are due. “We use the Mammography Quality Standards Act as a model to follow and track patients,” explained Kenny. As guidelines are developed, this type of dedicated tracking system will become standard of care, he predicted.

In the interim, lung cancer advocacy groups, including the Lung Cancer Alliance have recognized the value in AMI’s model. The Lung Cancer Alliance has listed AMI as one of 75 medical centers meeting its National Framework for Lung Screening Excellence.