Strengths and weaknesses
lung cancer, lung cancers, cancer
LUNG CANCER, LUNG CANCERS, CANCER
The major strength of the study is that it is a randomised controlled trial with block randomisation by session to minimise the chance of a change of practice during the study (in the control arm). The limitations are the relatively small numbers of lung cancers (49) and the fact that the trial took place in a single institution. However, the number was close to that anticipated in the sample size calculations, and both the magnitude of the observed difference and the statistical significance place confidence in the primary outcome. Furthermore, our findings were supported by the external comparison with a neighbouring hospital using the standard reporting pathway, where the median waiting time for lung cancer diagnosis was identical to the median in our control group, giving some support to the potential generalisability of the results.Concern about the accuracy of radiographer reports has been partly addressed in this study, and the only cancer missed was not seen by either radiographer or local radiologist. However, a much larger sample may be required to measure any smaller but still clinically important differences. More important may be the training and continued professional development to monitor and maintain accuracy if radiographers are employed in this way.