RCR 2019 – CT-based check protocol enables earlier discharge after CT-guided lung biopsy

  • Jo Whelan
  • Oncology Conference Roundups
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  • An early CT scan 60-90 minutes after CT-guided lung biopsy (CTLB) was a safe alternative to an x-ray check after 3 hours, pilot study reports.
  • Patients could be discharged earlier, freeing up recovery beds.

Why this matters

  • The patient pathway for CTLB must be safe and effective but also resource-efficient.

Dr Chitra Ramakumaran (Leeds Teaching Hospitals NHS Trust) presented a pilot study evaluation of an early discharge protocol after CTLB.

In the standard protocol, patients were checked for complications by chest x-ray (CXR) 3 hours after CTLB. In the modified protocol, patients were checked by CT scan after 60-90 minutes. The study included all outpatient CTLBs in patients who received check imaging: 184 received the standard protocol and 61 the modified protocol.

  • The incidence of pneumothorax was higher in the CT protocol (36% vs 25%); CT picked up smaller areas of pneumothorax than would be seen with CXR.
  • A higher proportion of patients were admitted under the CXR protocol (20 [10.8%] vs 4 [6.5%]); in each group, half of the admissions were for pneumothorax and chest drain.
  • The average time to check imaging was reduced by almost half with the CT protocol – from 179 to 86 minutes.
  • Two patients who had a CT check had delayed admissions requiring chest drain.
  • The new pathway was safe in the great majority of patients, and freed up recovery beds by enabling patients to be discharged earlier.
  • At the centre involved, the additional use of the CT scanner did not create disruption to other CT users.

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