Abstract No. 285 Three-Year Experience with an Interventional Radiology–Centered Multidisciplinary Lung Nodule Clinic

Lung cancer is the number one cause of cancer mortality in the United States. Lung cancer screening with low dose CT has been proven to improve patient outcomes when lung cancer can be identified and treated at early stages. Optimal workup and treatment for thoracic malignancies requires a multidisciplinary approach. Since interventional radiologists are frequently asked to obtain tissue diagnosis for thoracic malignancies, a multidisciplinary clinic for thoracic malignancies centered in an interventional radiology office allows for optimizing efficiency in patient evaluation and management. Development of a multidisciplinary thoracic malignancy program also leads to increased volumes for all specialties involved. Over a 3-year period, patients with either lung cancer screening abnormalities or incidental lung nodules were seen in a monthly multidisciplinary clinic composed of an interventional radiologist, interventional pulmonologist, thoracic surgeon, and supporting staff. Applicable standard societal guidelines were applied to patient management. Clinical outcomes of "time to tissue" were tracked from point of imaging abnormality to clinical evaluation to tissue diagnosis. Programmatic outcomes of interventional radiology (IR) volume and surgical volume and RVUs were tracked relative to historical levels, and generation of ancillary procedures was also tracked. Over 3 years, 201 patient encounters were seen. The median time from imaging abnormality to clinic evaluation, and clinic evaluation to tissue diagnosis were 50 days and 17 days, respectively. Relative to the 2 years prior to starting a multidisciplinary clinic, trans thoracic needle biopsy volume remained relatively flat, but EBUS and navigational bronchoscopy procedures increased. Thoracic surgical resections increased significantly. For every encounter in the multidisciplinary lung nodule clinic, 0.48 IR procedures, 0.37 IP procedures, and 0.16 surgeries were generated. This translates to 10.5 procedural RVUs per encounter, and 2.3 diagnostic radiology RVUs per encounter. A multidisciplinary approach to thoracic malignancy streamlined evaluation and management of patients with lung nodules and helped to grow procedural and diagnostic volume. Interventional radiologists with clinical capacity are positioned as the ideal specialists to coordinate multidisciplinary lung nodule management.