Radiology quality assurance in the Yorkshire Lung Screening Trial.

<b>Introduction:</b> Lung Cancer Screening (LCS) using low-dose computed tomography (LDCT) is currently being implemented in many countries. We describe a radiology quality assurance process used in the Yorkshire Lung Screening Trial, adapted from the UK Breast Cancer Screening Programme. <b>Method:</b> A second read process involved three groups: A-5% of negative scans; B-cases where subsequent imaging showed significant incidental findings; C-interval lung cancers. Group A cases were reviewed by one reader and group B/C cases reviewed by three readers, with all readers blinded to the reason for review. For group B and C cases if a majority of the three readers classified as unsatisfactory, an assessment of harm and if appropriate Duty of Candour process is completed. Cases are presented at an Audit meeting for review and learning. <b>Results:</b> 6650 baseline scans were performed and 229 (3.4%) underwent second read (Figure 1). 208 Group A cases were reviewed; 200 (96.1%) were satisfactory, 8 (3.9%) were unsatisfactory with one case requiring a surveillance CT scan after review. All 11 group B cases were satisfactory. There were 10 Group C cases, one of which was unsatisfactory, prompting a missed cancer Duty of Candour process. <b>Conclusion:</b> Missed diagnoses and false negatives are inevitable in screening programmes. This second review process aims to replicate initial reporting conditions, ensure quality and promote learning. <b>Funding:</b> Yorkshire Cancer Research (L403)