Abstract / Clinical Radiology 69 (2014) S11eS22 S13

malignancy. Thy1 samples are considered non- diagnostic for cytologicaldiagnosis and should be no more than 30% of the samples. 70 e 80% ofFNABs of thyroids should be adequate according to Thy staging.Standard, indicator and target: A local standard was used. To meet it,70 e 80% of our FNABs of thyroids should be diagnostic (demonstratingsufficient cellularity) as per local data and consensus [1].Methodology: A retrospective audit to determine the number of FNABsperformed in our Radiology department. Thy staging was recorded andused as the indicator for specimen adequacy.Results of 1st audit round: 13 FNA thyroid from 1/11/05 to 31/10/06. 9/13(69%) were adequate samples i.e. follicular cells seen. 1 of the 9 wasidentified as a follicular lesion therefore surgery was recommended.1st action plan: Introduce coding for FNA thyroid so they can be morereadily identified from PACS and RIS and re-audit with a larger sample size.Results of 2nd round: 131 FNABs of thyroid nodules was performed at ourhospital between 1/1/10 - 31/8/13. 27% of these were Thy1 and insufficientfor cytological analysis. 73% were adequate.2nd action plan: Since the first audit the number of FNA requests has goneup considerably. To increase our diagnostic yield we could agree a protocolfor referral for FNA and patient information leaflet.

Thyroid FNAC inadequacy rates

Authors: Alexander Crowther*, Katie Giles, Lesley Archer

Background: Fine needle aspiration cytology (FNAC) is used in the initialinvestigation of thyroid nodules to indicate the nature of thyroid nodules.The British Thyroid Association cytopathology classification states that’THY 1’ category are non diagnostic and both the British and AmericanThyroid Societies recommend FNAC be repeated under US guidance.Literature suggests that smaller gauge needles reduce the rate of THY1results (25G optimum).Standard, indicator and target: THY1 rate <16.7%. Method of FNAC: 25Gneedle, capillary actionMethodology: CRIS search to identify patients who have had FNAC ofthyroid nodule. Review pathology. Collate radiologist needling techniques.Results of 1st audit round: Total 210 FNA’s performed. FNAC THY1 rates:34%. 7 radiologists performing FNA thyroid, 4 use 25G, 2 use 22G, 1uses variable technique. Lower THY1 rates with 25G needle: 33%THY1 25G needle, 43% THY1 22G spinal needle, 35% THY1 variabletechnique. 28 repeat appointments, 14 hours extra appointment timefor re-FNAC.1st action plan: All FNA use 25G needle, capillary action. One stop clinicwith onsite pathologist if possible. Reduce appointment time from 30 to 15mins.Results of 2nd round: THY1 rate 34.8%. 7 consultants performing FNAthyroid. 100% 25G capillary action compliance of those available forquestioning (1 left region). THY1 rate 28.4% during 1 stop clinic. 40.1%when not 1 stop clinic. THY1 rates vary from 15.4-60%. US FNA slots now15minutes.2nd action plan: Reduce radiologists performing FNA thyroid to 4. Pa-thology input during 1 stop clinic. All FNA thyroid during 1 stop.

Ensuring timely diagnosis of lung cancer: the importance of aradiologist’s recommendation

Authors: Max Ireland*, Sue Kearney, John Howells, Josh Grey

Background: RCR national audit CXR lung cancer diagnosis (2005) set twostandards:In >75% of cases abnormal appearance detected on CXR performed within1 year prior to diagnosis

* Guarantor and correspondent: Alexander Crowther* Guarantor and correspondent: Max Ireland* Guarantor and correspondent: Annette L. Johnstone* Guarantor and correspondent: Waleed Al-Obaydi

Where a lesion is detected, further investigation should be recommendedin >95% of cases. The definition of the abnormal appearances or recom-mended further investigation was not explicit.Standard, indicator and target: To determine whether our practicecomplied with above RCR standards. To determine whether recommendedinvestigation influenced speed of diagnosis.Methodology: From lung cancer MDT database, CXRs were classified as:Normal, Abnormal (recommendation urgent CT), Abnormal (recommen-dation CXR follow-up), Abnormal (no recommendation), Unreported.Films reported tnormal were reviewed to identify missed ‘abnormal’.Average time to diagnosis was: time from CXR and CT confirming cancer.Results of 1st audit round: Over 3 months 86 patients were identified:total CXRs n ¼ 139.Abnormality identified in 87%Further investigation recommended in 75: CT (51%), CXR (33%), none (16%)Time to diagnosisCT 14 days (range 2-25 days)CXX 58 days (range 2 e 365 days) (p < 0.05)None 69 days (range 2-364 days) (p < 0.01)Identification of abnormality exceeded RCR standards, recommendationfor follow-up did not. Speed of diagnosis was dependent on the type offollow up recommended.1st action plan: Recommend CT as primary follow-up where abnormalityis identified on CXR. Re- audit compliance and risk benefit of intervention.

Risks and rewards of CT-guided thoracic biopsy. Complications auditand patient experience survey

Authors: Annette L. Johnstone*, Aung Win, Michael Darby, BobbyBhartia, Shishir Karthik

Background: Between 1st January 2012 and 31st December 2013 weperformed 348 CT guided thoracic biopsies at our large teaching hospital.Standard, indicator and target: BTS guidelines - Guidelines for radio-logically guided lung biopsy. (2003)Methodology: We retrospectively reviewed individual cases looking atboth radiology, histology & microbiology results. Complication rates werecompared against published standards. Over a 12 month period patientsattending our day case unit for biopsy completed an anonymous patientexperience questionnaire.Results of 1st audit round: Of the 348 biopsies, 8 were unsuccessful as thepatients were either unable to tolerate the procedure or developed apneumothorax prior to biopsy (4 patients - 1.1%) 74 % of specimens weremalignant, 21 % were initially reported as being benign. 8 biopsies (4%)were insufficient for analysis. Of the 72 cases initially reported as benign, afinal diagnosis of malignancy was made in 19, thus 15.2% were trulybenign.We present our complication rates along with results from our patientexperience questionnaire.1st action plan: Audit is vital to ensure high standards & comparisonbetween centres. Based on results it enables individuals to provide pa-tients with an accurate local complication rate. Using information gainedfrom the patient experience survey a new consent form was produced.

Pleural phase CT for evaluation of malignant pleural disease

Authors: Waleed Al-Obaydi*, Iain Au-Yong, Mark Roberts, Giles Cox,Nicola Downer

Background: The RCR and BTS guidance is to perform pleural CT toinvestigate for pleural malignancy; however this is not validated by pub-lished data.