LDCT lung cancer screening implementation in a Veterans Affairs hospital: A quality initiative.

e23238 Background: Lung cancer is the number one cause of cancer related deaths worldwide. United States Preventive Services Task Force (USPSTF) recommends annual Lung Cancer Screening (LCS) with Low Dose Computerized Tomography (LDCT) for adults who are current smokers aged 50 to 80 years with at least 20 pack year smoking history or have quit smoking within the past 15 years. Although LCS is a national initiative for Veteran Affairs (VA) Hospitals, there are several barriers in practice. Methods: The LCS program was established with a dedicated coordinator to provide better access to high-quality in-house screening, while reducing the dependance on expensive community care services and referrals. Smoking history in Tobacco Pack Years (TPY) is updated during a Primary Care Physician (PCP) visit, which triggers a clinical reminder in the electronic medical record for LCS. The LCS coordinator would then receive a consult. After shared decision-making with the patient, physician and coordinator, the patients are scheduled for LDCT. If the results are Lung-RADS 1 (negative), 2 or 3 (benign appearing nodules) the patients are notified of the findings and provided with subsequent follow ups. All Lung RADS 4 (suspicious findings) are discussed in the lung tumor board, which includes radiologist, oncologist, pulmonologist, pathologist, cardio-thoracic surgeon, and fellows in training. The committee determines the follow-up scan interval and/or additional investigations. Results: The performance of our LCS Program from June 2022 to January 2024 was reviewed. 5941 patients were assessed for TPY, of those 1127 patients were eligible for LCS scans and 1032 (93.3%) were enrolled into the LCS Program. 951 LDCT scans have been conducted thus far, this includes 598 annual initial screenings, the remaining are follow ups. 57 patients (6.81%) had Lung-RADS 3 findings and are undergoing nodule tracking. 16 patients (1.91%) required diagnostic work-up which includes a PET scan or biopsy. 14 patients (1.67%) have been diagnosed with cancer. Conclusions: Our LDCT Program showed a high acceptance rate of 93.3%, much of which can be attributed to the multiple layers of screening and shared decision-making processes. Patients received three phone calls and a letter as a reminder of their LDCT appointments. Our radiology department has four dedicated slots for LDCT screening each day which allows for further compliance. TPY documentation was identified as a limiting factor in this process. The LCS coordinator verified the TPY history with the patients which helped overcome this shortcoming. Overall a multidisciplinary team approach contributed to the success of our program.