The Care Quality Commission (CQC) has launched a review of NHS radiology services in England in response to findings that the Queen Alexandra Hospital in Portsmouth has been failing to check chest X-rays properly, leading to missed diagnoses of lung cancer. It has also emerged that junior doctors have been asked to carry out specialist radiology work without the appropriate training. Portsmouth Hospitals NHS Trust has made an unreserved apology to the families of three patients, two of whom have died from lung cancer.
During their visit in July, CQC inspectors also found that the hospital had a backlog of 23,000 chest X-rays. None of the 23,000 images from the preceding 12 months had been formally reviewed by a radiologist or appropriately-trained clinician.
A spokesman for CQC said: "When a patient is referred for an X-ray or scan, it is important that the resulting images are examined and reported on by properly trained clinical staff who know what they are looking for - this is a specialist skill."
A chest X-ray is usually the first test used to diagnose lung cancer. Most lung tumours show up as a white-grey mass but X-rays do not provide a definitive diagnosis because they are often unable to distinguish between cancer and other conditions, such as a lung abscess (a collection of pus that forms in the lungs). Therefore if a chest X-ray is suggestive of lung cancer, a patient should be referred to a specialist who will carry out further tests to investigate whether the patient does have lung cancer and, if so, what type it is and whether it remains localised or has spread. An appropriate treatment plan can then be devised and this may include surgery and radiotherapy or chemotherapy.
Alison Johnson, associate director in Penningtons Manches’ clinical negligence team, has experience of representing families who have lost a loved one as a result of a delayed diagnosis of lung cancer. She has recently acted for a widower who lost his wife after she had been referred to a Hampshire hospital for a chest X-ray which was reported as normal. In fact the X-ray showed an area of abnormality and extra density behind the heart, warranting further investigation. The lady was subsequently discharged from hospital care but her health continued to decline and she had a second chest X-ray taken some time later. Following this X-ray, the diagnosis of lung cancer was reached, but sadly not in time to offer her anything other than palliative care as by then her lung cancer had spread.
Investigations established that the standard of reporting of the original X-ray had been poor and it was likely that had it been looked at properly, the correct diagnosis would have been reached quickly, the lady would have undergone surgery to remove the diseased part of her lung (the tumour would at that stage still have remained localised and operable) and she would have had a more optimistic prognosis with a longer life expectancy.
Penningtons Manches was able to secure an admission from the hospital concerned in relation to the poor care provided, an apology to the family, and compensation of £70,000 to reflect the lady’s pain and suffering, the care she was provided with by her family, funeral expenses and her husband’s loss of dependency.
Lung cancer is one of the most common and serious types of cancer. Around 44,500 people are diagnosed with the condition every year in the UK.