Ensuring radiology reporting quality across a national lung cancer screening programme

Low-dose CT (LDCT) lung cancer screening (LCS) in high-risk patients has shown potential in reducing lung cancer mortality. In 2019, the UK National Health Service announced rollout of the Targeted Lung Health Check programme (TLHC) following a successful pilot offering individuals between 55 and 74 years of age who have ever smoked an appointment with a health professional, which may lead to a LDCT referral depending on their risk of developing lung cancer from modelling. In view of expansion of LCS with LDCT, it is paramount that radiologists who participant in screening are adequately qualified and properly trained. To ensure the radiology reporting for an expanding programme remains clinically and cost effective, reporters must engage with nationally-set quality assurance policies. This review article aims to summarise the current individual performance against set thresholds for referral rates for actionable lung nodules and incidental findings, the current process for national external quality assurance and provides suggestions for how these facets can be merged with near-real time double-read quality assurance. We summarise processes to identify reporting outliers and provide targeted feedback to improve reporter-level performance to ensure robustness of a national lung screening programme.