Program Structure

The structure of each LCS program will depend on available resources, the type of institution and practice, and the skills and interests of the individual providers. Often new LCS programs will build upon or arise from pre-existing multidisciplinary lung cancer clinics and/or tumor boards. Most LCS programs fit within one of three general categories.

At one end, a centralized LCS program actively recruits eligible patients, conducts education and shared decision-making visits, assists in smoking cessation, and schedules, orders, performs, and interprets all screening studies. The program also arranges consultations, schedules follow-up studies, and tracks all clinical and outcome data. The centralized LCS program communicates results and plans to the patient and referring provider. This model requires significant resources including a dedicated LCS coordinator, clinical leadership, and an integrated multidisciplinary program team.

At the other end, a decentralized LCS program performs the LCS exam and interpretation and leaves the referring provider responsible for all other functions.

In between the extremes of a completely centralized and a completely decentralized program are many examples of hybrid LCS programs with some centralized processes and other aspects decentralized, i.e., deferred to the primary care provider. Please refer to the panel profiles and organizational structure.

Centralized Programs

Decentralized Programs

Decentralized Access

Forming a Governance Structure and Multidisciplinary Team

Development of a Multidisciplinary Steering Committee can serve as a powerful coalition to guide program development, provide a forum to establish consensus, and promote a team-based approach to overcome obstacles to program implementation. The following descriptions derive from a survey sample of project panelists.

AM: The Rescue Lung, Rescue Life LCS program at Lahey Hospital & Medical Center is a hybrid program with decentralized referral and centralized tracking. It is managed by a multidisciplinary steering committee consisting of representatives from radiology, radiation oncology, pulmonary medicine, thoracic surgery, medical oncology, internal medicine, pathology, marketing, philanthropy, and administration. Co-chairs of the steering committee are from the departments of radiology and oncology. The steering committee responsibilities are to set high-level program structure, define roles and responsibilities of personnel, define high-risk populations, garner administrative and service line support, define quality metrics, oversee outreach initiatives, agree on policies for medically inoperable patients, and work together to remove barriers to increase patient access. Since the program’s inception in 2012, we have performed over 13,000 exams on 5,000 high-risk individuals. We currently perform 60 LCS exams per week, with full capacity estimated to be ~100 scans per week.

AR: The Lung Health Screening program at Christiana Care Health System began enrolling eligible patient in the spring of 2015. This was done in a joint effort with the state of Delaware’s Screening for Life Program that was already performing screening for the uninsured in the areas of colon, breast and prostate. Other healthcare facilities in the state worked in concert as well. The program is centralized and all orders and shared decision making are conducted by the program. The steering committee consists of leaders in radiology, pulmonary, thoracic surgery, IT/statistician, primary care representatives, smoking cessation counselor, along with the nurse navigator. The responsibilities of the steering committee are to set high-level program structure, define roles and responsibilities of personnel, define high-risk populations, garner administrative and service line support, define quality metrics, oversee outreach initiatives, agree on policies for medically inoperable patients, and work together to remove barriers to increase patient access. Currently with about 2,000 enrolled over the past two years and it will grow as needed.

CCT/KK: The Mount Auburn Hospital LCS and Nodule Management program is a hybrid program with decentralized referral and centralized management and tracking of findings. Providers can elect to refer directly to the program for evaluation and entry into the program in a centralized manner. The electronic health record (EHR) triggers a best practice advisory for eligible patients and the order is placed by the provider following SDM and smoking cessation counseling. Eligibility is verified centrally. The program is managed by a multidisciplinary steering committee consisting of key experts in pulmonary, diagnostic and interventional radiology, radiation oncology, thoracic surgery, oncology, pathology, and coordination through a nurse navigator. The program is supported by monthly review of key metrics by an Oncology Steering Committee led by the hospital CEO with members including chairs of medicine, radiology, and chiefs of oncology, radiation oncology, pulmonary, and representation from surgery, development, and fiscal management. Central program staff includes a medical director, radiology director, a nurse navigator, and key support from operations in radiology and IT. A smaller steering committee exists for our LCS program and includes the director and assistant director of the program, the radiology screening program director, the nurse navigator, and the chief of oncology. This group develops major initiatives and opportunities for quality control and growth. Logistic and operational issues and registry reporting requirements are discussed among these individuals with supporting personnel from radiology, quality, and IT where needed. We also identify areas for quality improvement and research. The director of chest imaging manages the radiology requirements and Lung-RADS™ training, reporting process, surveillance letters, and oversees the processes in radiology for verification of screening criteria with each order. We have a direct notification system through our EMR to the ordering provider, primary care physician (PCP), and lung nodule program. If there is a Lung RADS™ 3 or 4 finding, the program navigator speaks directly to the ordering provider’s office to offer an appointment for management. All suspicious findings are discussed at our multidisciplinary clinical team meetings. We currently screen approximately 1,000 patients per year and have shifted the curve to early stage of diagnosis following close to three years of the program.

CF: The PrimaCARE program is a hybrid program with decentralized referral and centralized tracking. Operations are managed by the pulmonary division. We have a steering committee that includes pulmonary (medical director and navigator), thoracic surgery, radiology, primary care, and administration at our practice and oncology and interventional radiology at our local hospital system. The committee meets regularly to review data and discuss strategy going forward. The steering committee reviews data and quality metrics and identifies areas for improvement, assesses PCP participation in LCS and barriers to participation, opportunities for education, and sets goals. We also review finances and discuss opportunities for complying with LCS CMS requirements in a fiscally responsible manner. Staff and physicians in the pulmonary office manage the day-to-day operations of the LCS center. Shared decision-making, and, where applicable, smoking cessation counseling is provided initially by the PCP. Patients also receive educational material at the time of their scan. We currently have approximately 600 patients enrolled. Full capacity is likely over 5,000.

PM: The Cleveland Clinic’s LCS program is a centralized program accessible throughout our health system. Any provider can refer patients to the program. Patients are pre screened for eligibility then scheduled for a counseling and shared decision-making (SDM) visit as well as low-dose CT at one of seven sites blanketing Northeast Ohio. The multi-specialty and inter-disciplinary team has developed a standardized SDM visit, documentation including structured reporting, communication tools, and management algorithms for nodule and common nonnodule findings. Program personnel are trained to provide smoking cessation guidance. Multidisciplinary team led by pulmonary with close partnership with radiology. Data collection and reporting are assisted by internal registries. Approximately 2,500 patients have been screened with further growth anticipated.

RSW/KS: The LCS program at Boston Medical Center has a hybrid structure to its program. There is the option of either decentralized referral (PCP conducts SDM and places LCS order) or centralized referral (PCP refers patient to an LCS/Pulmonary Nodule clinic for SDM visit and decision whether to proceed with screening; if yes, the sub-specialty clinic provider places LCS order). A coordinator notifies the referring provider directly and the referring provider communicates these results to the patient. Screen-detected findings can either be managed in a decentralized fashion by the referring provider (i.e., PCP orders follow up testing and referrals) or through the centralized LCS/pulmonary nodule clinic. The program has centralized tracking of the LCS results and follow up is managed by a multidisciplinary steering committee with co-chairs from pulmonary medicine and radiology. The program is additionally staffed by an LCS program coordinator who is a nurse practitioner and a patient navigator. Since March 2015, over 1,200 individuals have undergone baseline LCS. We currently screen about 90-120 patients per month.

The steering committee meets quarterly to review LCS program metrics such as volume, proportion meeting eligibility criteria, Lung-RADS™ distribution, cancer outcomes, etc. We also discuss challenges that have arisen during implementation and day-to-day operations of the program, e.g., rolling out an EPIC best practice alert, increasing data capture from referrals outside the BMC system, etc.

MKG: The program at Kaiser Permanente Southern California (KPSC) is decentralized. The SDM and LCS orders are placed by the PCP with limited centralized verification, scheduling or tracking. LCS exams at KPSC are ordered by primary care providers and pulmonologists using a standardized order set in the electronic health record. Providers are required to check boxes to confirm that the patient is asymptomatic, meets eligibility criteria, has undergone shared decision making, and has been referred for tobacco cessation treatment (TST), if a current smoker.

The program is run by clinical chiefs of service in the radiology and pulmonary medicine, with input from primary care. We have a robust infrastructure at regional headquarters and individual medical centers to support data analytics and tracking. We perform approximately 4,000 LCS exams per year. The eligible population includes as many as KPSC 30,000 members.

CAP/AW: The Mount Sinai LCS program is a centralized program. It is governed by radiology through the International Early Lung Cancer Action Program (I-ELCAP). This has been an ongoing screening program since 2010. We have used a protocol since starting screening in 1992 at the Weill Cornell Medical Center and have continuously updated it, with references, on our website ( We have a database of 80,000 screening participants worldwide. At the Icahn School of Medicine, we are providing screening at all the clinical sites of the Mount Sinai Health System. The program will continue to expand as CT scanners are added with American College of Radiology (ACR) certification. Scheduling, reading, and tracking are done centrally by the ELCAP staff. Shared decision-making and smoking cessation sessions are provided by the faculty or a nurse practitioner. Smoking cessation has been part of our program since our initial publication on smoking cessation (in the context of CT screening) in 2001. We have a database of 80,000 screening participants worldwide. We are currently screening participants who are covered by Medicare/Medicaid and those who meet the expanded criteria.

EMH: Northwestern Medicine (NM) is the clinical enterprise affiliate of Northwestern University Feinberg School of Medicine. NM consists of three regions (central, north, and west), each of which runs a hybrid clinical LCS program with decentralized referral and centralized tracking. In our central and north regions, the multidisciplinary LCS steering committee is centered in the radiology department, a continuation of our NLST structure. In our west region, the multidisciplinary LCS steering committee is centered in the oncology department. The regions cooperate on overall program strategy and quality initiatives. Since 2013, we have performed initial screens on approximately 2,200 individuals in our three regions. We anticipate our capacity for the three regions to be approximately 6,000 enrollees.

GM: The NYU program is a centralized referral and tracking program. Patients are referred to the program internally via EPIC referral or by calling 1-800-NYULUNG. Once referred, the patient is contacted by the patient coordinator to set up an appointment. The CT scan is ordered and placed on hold until after the initial visit. In the initial visit, the patient is seen by the nurse practitioner and pulmonary attending physician to have a physical exam and further identify if they meet criteria for LCS. During the clinic visit, the patient’s individual lung cancer risk is determined. In addition, smoking cessation counseling is provided. A balanced discussion of individualized risk and benefit of CT screening for lung cancer occurs and documented in the patient’s chart. If the patient meets criteria, they have the CT scan the same day and follow up is scheduled according to the CT reading. The NYU LCS Program provides recommendations and appropriate follow-up for pulmonary nodules as well as close collaboration with referring providers with any abnormal findings that require closer follow up or invasive procedure. Patient demographic, clinical and screening data is captured and logged into our secure, commerciallyAmerican available database. We have a steering committee consisting of thoracic radiologists (3), thoracic surgery (2), medical IT (1), pulmonology (5). We currently have more than 900 patients actively involved in our screening program. We are currently expanding to two additional sites. Our maximum capacity has not yet been established.

EJ: The Ohio State University Early Lung Cancer Detection Clinic (ELCDC) is a combination of a decentralized referral with centralized SDM and orders for LCS and tracking. It is a novel all-inclusive screening lung cancer and smoking cessation program that is managed by pulmonary medicine in conjunction with medical oncology. Following patient referral dedicated nurses call each patient, ensure eligibility and schedule patients in one of two separate screening locations. LCS operations consist of a same-day 90 minute 4 step processes which are outlined here. During the first appointment, each patient will take part in a three-step shared decision-making process with a pulmonologist or pulmonary and critical care fellow. Once the decision to screen is made, the patient will then be immediately screened with a low-dose chest CT.

Low-dose computed tomography will be obtained immediately following the initial screening visit. The CT scanner is conveniently located on site making the transition from ELCDC clinic to radiology seamless.

Positive screens are discussed by our multidisciplinary tumor board consisting of interventional pulmonary, pulmonary medicine, medical oncology, radiation oncology, thoracic surgery, interventional radiology and pathology. Establishment of policies and continuous monitoring of their proper implementation is owned by The Ohio State University James Cancer Center and Division of Pulmonary Medicine. The program is projected to perform 650 LCS scans this academic year (July 2017-2018). We have two locations. Both sites screen 6-8 patients per week.

JM: The LCS program at Rush University Medical Center (RUMC) and Rush Oak Park Hospital (ROPH) is a decentralized referral and centralized tracking program. It is managed by a multidisciplinary team consisting of two thoracic radiologists, thoracic surgeons, a pulmonologist, multiple CT techs, and two program nurse coordinators (LCSC RN). Once the exam is ordered, the LCSC nurse will confirm the patient is eligible for their exam. Once a patient is confirmed eligible, they will complete their screening appointment at either RUMC or ROPH. After a patient has finished their exam, an LCSC RN will meet with them to address any questions regarding the exam, discuss smoking cessation and available smoking cessation resources if applicable, and invite the patient to participate in a research study being conducted by the medical center. After the exam appointment is complete, a thoracic radiologist will read and interpret the screening. Once the screening has been resulted, if the patient’s exam results in a lung RADS 4 exam finding, the thoracic radiologist will notify patient’s ordering provider, who will notify the patient of their results, and choose a treatment plan for the patient. After a patient’s exam has been resulted, if a patient has a negative exam or a Lung-RADS™ 3 reading, an LCSC RN will manually result the screening within the patient’s EMR to send to the ACR for tracking, and a result letter will generate from the EMR to be sent to the patient. The LCSC RN will then remind patient to come back for their exam annually. If a patient has a Lung-RADS™ 4 result, once the patient’s ordering physician has been notified by the thoracic radiologist, an LCSC RN will contact the ordering provider to offer navigation services, to help the patient schedule an appointment with thoracic surgery. The ordering physician may refuse the navigation service if they prefer another form of treatment. Lung-RADS™ 4 exams will be presented at a weekly MDC Chest Conference where a multi-disciplinary team of providers can view the scan and offer opinions for treatment. The LCSC RN oversees registry submission of all screening patients to the ACR, following patients and updating the ACR for one year after screening. The LCSC RN’s are also in charge of generating program metrics and promoting program growth. Since 2015, we have 504 patients enrolled in our screening program and 629 exams have been completed. Of the 629 exams completed, we have found 18 lung cancers and seven other cancers. Our goal is to grow the volume of our program by 5 percent in the next year, accruing at least 25 more screening patients to our program by November 2018.

DTC: The UC Davis Comprehensive LCS Program (CLSP) is a hybrid program with decentralized referral and centralized tracking. It is a multidisciplinary collaborative for comprehensive LCS. To serve our patients in the program, we use a multidisciplinary team of radiologists, thoracic surgeons, pulmonologists, pathologists, medical oncologists, primary care doctors, smoking cessation experts and radiation oncologists to develop a best-practice, patient-centered plan. The program is led by a screening task force through a task force chair. The CLSP offers an LCS Shared Decision-Making Tool Kit to assist the referring provider at the point of care. Smoking cessation assistance is also offered through a myriad of patient centered tools.

DKM: The LCS Program at the Seattle Cancer Care Alliance/University of Washington Medical Center offers the option of either decentralized referral (PCP conducts SDM and places LCS order) or centralized referral (PCP refers patient to the LCS Program) for SDM counseling and LCS order. The program has centralized verification, tracking of results, and smoking cessation counseling. It is managed by a multidisciplinary steering committee with representatives from pulmonary medicine, radiology, primary care medicine, thoracic surgery, marketing and administration. Central program staff in radiology and pulmonary medicine manages day-to-day operations with a dedicated commercially available LCS database. Over 750 individuals have undergone baseline screening with diagnosis of 24 asymptomatic lung cancers. The program estimated full capacity patient population is 2,300.

CGS: The VA Portland Health Care System (VAPORHCS) LCS Program is a centralized program with orders performed by dedicated LCS personnel. It is a multidisciplinary collaboration of primary care, pulmonary, radiology, informatics, and thoracic surgery. Currently, about half of our primary care clinics are equipped to refer patients to our program, about 40,000 patients served by these clinics.

KLS: The Vanderbilt University Medical Center is a centralized program and is governed by a multidisciplinary team. All patients undergo shared decisionmaking visits prior to their CT exam, most often performed by our clinical coordinator, a nurse practitioner with specialized training in LCS and smoking cessation. Since 2013, 1,000 screening CT examinations in more than 800 patients have been completed. We currently have approximately 700 patients enrolled in the program and estimate full capacity to be 3,000 patients enrolled. We have diagnosed more than 25 cancers, the vast majority of which have been early stage disease.

MD: An LCS program should have a “home,” but at the same time it must be multidisciplinary. A home within imaging or pulmonary often makes sense; the core of LCS is based on imaging, and most evaluations that result from screening include small indeterminate nodules that are most often managed by pulmonary. Some institutions establish free-standing programs, while others establish programs within the context of other cancer screening, such as mammography.

CL/AM: While this may be institution specific, the home base for the program seems the best fit in imaging with a multidisciplinary team having specifically defined roles and work flow, and most importantly a reliable navigator to maintain accountability for study results and confirmation of appropriate action and communication of those results. A decentralized system may provide easier access to the program, but will require a centralized system for tracking of mandatory reporting elements.

CCT/KK: This is institution specific, although having a central home with coordination and tracking from that point between all members of the team and for the patient is crucial in running a successful program. Radiology defines the necessary elements of the study itself and assesses eligibility criteria for the study prior to performing it. There needs to be a centralized mechanism to intervene on suspicious findings through a multi-disciplinary team, and to maintain standards for quality as well as to track the many required data elements for registry reporting and program specific quality metrics. The home in our institution is in pulmonary given the need to follow pulmonary nodules over time and decide when intervention is necessary, review imaging with patients, and the management of non-malignant pulmonary conditions that lead to pulmonary nodules. This is also a good opportunity to perform shared decision making and smoking cessation counseling. Follow up frequency also requires more knowledge of the patient than the nodule characteristics seen on imaging. Referrals to diagnostics and treatment come from the pulmonologist who communicates with the navigator for care coordination and discussion with the multi-disciplinary team. Most alternate diagnoses are also managed by pulmonary, which allows the patient to connect with a caregiver for longitudinal care as well. There should also be a robust centralized surveillance system for follow-up of findings on the screening study, as well as criteria for ongoing annual follow-up. This is an area of risk to the patient and to the providers caring for these patients. A centralized process and a navigator are essential to this.

AM: Yes, we could not manage a population health program of this nature at our organization without program navigation.

MD/RSW/KS: Most experienced programs have concluded that it is essential to have a program coordinator. High quality LCS requires attention to details, such as ensuring that only eligible patients are being screened and that patients actually get their screening studies, and any evaluation that comes from an abnormal study. Reimbursement is often dependent on a proper sequence of events—for example, shared decision-making visits must occur before screening studies. All this requires ongoing attention to details, most likely utilizing a data management tool. Without a program coordinator, these details can be overlooked. In addition, abnormal screening studies must be followed up. Nodules detected through screening that are not followed up only to later reappear as a more advanced lung cancer are a serious liability. The coordinator might be shared with other related activities. Some programs have a coordinator support the LCS program as well as an incidental lung nodule program.

CCT: A program navigator is essential to provide care coordination for patients, to ensure education of providers and the community, and to assist with data management. Many navigators also work to ensure appropriate surveillance and reduce loss to follow up. In our program the navigator provides care coordination, outreach, smoking cessation, survivorship visits, and is the “glue” to patient care coordination efforts. She also manages the data collection of clinical care, and maintains educational materials on the program, tracks all diagnostic and treatment strategies, provides resources on nodules and lung cancer, as well as on shared decision making and smoking cessation.

AR: Yes, preferably one who has clinical background (RN, LPN) with appropriate clerical/administrative support.

CF: Yes. Our navigator’s work coordinating the program has been essential to our success. With appropriate coaching and scripting she has been able to do this exceptionally well despite not being an RN or LPN. Our program navigator reviews all referred individuals for appropriateness of screening, schedules exams, collects results and brings to lung cancer program physician for review, contacts patients and PCP’s by phone and mail regarding results, schedules necessary follow-ups, including pulmonary consults for positive scans, and communicates directly with PCP offices regarding patient results and compliance with screening. In addition to the navigator, the program director provides guidance and education to PCP offices.

CCT: Clinical staff who are familiar with the medical terminology and follow appropriate protocols and guidelines manage our databases. In our program, a nurse navigator manages the flow of patients in and out of the database and tracks necessary follow-up. She also tracks all clinical diagnostic and therapeutic care provided and follows process measures related to access and diagnostics. She intersects with other staff members in radiology, oncology, radiation oncology, and thoracic surgery who track oncologic diagnosis, stage, and outcome and transfers necessary information into the LCS program database. A surveillance database also maintained for the purposes of tracking annual follow-up of LCS studies. This database also houses follow-up for incidentally found nodules and nodules found on diagnostic chest imaging.

SR/BM: This will vary from site to site. With the amount of work involved in managing a screening program, this would ideally be done by someone who is dedicated fulltime to the program and not doing it in addition to their other responsibilities. In our program, we have two non-clinical positions dedicated to the program due to our high volume; we did not want to create a bottleneck by having all patients see a clinical navigator prior to screening. However, if the volume allows, having a clinical navigator can be advantageous for shared decision making, smoking cessation, discussion of results, etc. What department the position comes from will also vary, though it should be noted that this is a radiology program above all else, as roughly 90 percent of patients will remain in the annual/interval imaging cycle and never see specialist services.

CF: Our program coordinator, who is not a nurse, manages our database. We have pre-templated letters that we send out to patients, depending on CT result, and we also pre-scripted and coached our program director on phone calls to patients regarding results and follow-up needed based on CT result (after physician review of each case). We do have a goal of getting a nurse navigator so that they could do the shared decision making and smoking cessation counseling.

AM/CL: Communication occurs through different methods. For an individual patient direct communication between providers and program navigators is required. For program management and oversight, every other month steering committee meetings, where radiology working group report outs and research committee report outs, are standing agenda items. Weekly program statistics are reported to the steering committee members through steering committee distribution list e-mail communication. Multidisciplinary weekly conference is an additional forum for communication to discuss Lung-RADS™ 4 findings and to develop consensus recommendations. These are then relayed to the ordering provider either directly (physician-to-physician) or with the nurse navigator in oncology to close the communication loop.

MD/RSW/KS: Communication with the specialists involved in LCS, as well as patients and referring providers, is one of the most important functions of a screening program. Communication with referring providers and patients is often part of the screening coordinators role. Communication among the other components can occur in a variety of settings. Some programs have regular meetings of the screening radiologist, coordinator, and the key providers engaged in nodule management, often pulmonary or thoracic surgery, reviewing studies that might require extra follow-up or evaluation. One large program has found that these meeting are only needed every other week, can take as little as 20 minutes, are very instrumental in keeping the program cohesive and responsive, and can help expedite evaluations. Another forum for communication could be a regularly scheduled lung cancer conference or tumor board, where concerning screening studies are reviewed as a multidisciplinary group.

CCT/KK: Communication occurs daily through specialists and the nurse navigator. The nurse navigator also visits patients receiving treatment and maintains relationships with each of these patients. Our team meetings include review of concerning new nodules and each element of their referrals and work-up to date including imaging, pathology, and therapy. Recommendations are communicated back to the managing provider. Our clinical database is another source of communication and monthly, year to date, and yearly comparisons are reported monthly at our Oncology Steering Committee meeting with key leaders in the organization, in oncology meetings, and in our steering committee multidisciplinary meetings.

AR: Team communicates internally and with referring sources as well as with the state’s program by way of fax and EMR flags.

CF: Personnel communicate primarily through EMR messaging but also through secure texting and email. In addition to our quarterly steering committee meetings, the program director and program navigator meet weekly or biweekly to review any problematic issues. All positive scans are also reviewed monthly at our tumor board.

MD: Very few LCS programs have included rural areas. To be most successful, LCS should be multidisciplinary and many areas may lack some of the key specialists such as pulmonary, thoracic surgery, and radiologists with experience in screening and thoracic imaging. Some programs have approached this by having a local nurse coordinator and imaging, filling the gaps by developing a specialized network of providers with regular teleconferencing with ability to review images together. This network can support the rural program through telemedicine visits with patients traveling to tertiary centers when needed for procedures and other highly specialized care. The principles of LCS remain the same: careful patient selection using accepted criteria, low-dose CT imaging, structured interpretation and reporting, and multidisciplinary management of pulmonary nodules and suspected cancers.

AM/CL/RSW/KS/CCT: Yes, it consists of all colleagues interested in program research initiatives. The research committee meets monthly and works to manage, coordinate, and assist one another with research activities relative to program and program database. The committee also updates stakeholders on research activities and identifies opportunities for future LCS progress. The research group serves to assist with prioritizing research within the institution and partnering with other institutions in collaboration. It also assists with reducing redundancy in project endeavors among a wide group of interests.

CCT/KK: Yes, the program director leads a research and quality improvement team that evaluates priority questions and conducts projects along with residents interested in QI or lung cancer. The project consists of process, access, outcome, and surveillance questions important in LCS and care and meets 2-4 times per month.

AR: Yes. Some of this is done in conjunction with the University of Delaware, especially around smoking cessation. There are also projects from our Value Institute looking into methods and effectiveness of SDM visits among PCPs.

CF: As a program based in a community setting, not affiliated with an academic institution, we do not have a research committee at this time, although we would be open to developing one if the resources become available. In addition, we are collecting data that we would be happy to share.

Example Governance Structure

Rescue Lung, Rescue Life Steering Committee Members

  • Section Head Thoracic Imaging
  • Vice Chair Clinical Services
  • Vice Chair Research
  • Section Head Interventional Radiology
  • Chief Resident
  • VP Hospital-Based Clinical Services
  • VP Cancer Services
  • Associate Chief Nursing Officer
Primary Care
  • Chair & Chief Medical Officer
  • Resident Representative
  • Administrative Director
  • Rescue Lung, Rescue Life Program Coordinator
  • Department Manager, CT
  • Department Manager, Nuclear Medicine
Pulmonary Medicine
  • Chair & Chief Medical Officer
  • Director of Interventional Pulmonology
  • Residency Director
Cancer Services
  • Department Manager, Radiation Oncology
  • Specialty Program Coordinator, Radiation Oncology
  • Rescue Lung, Rescue Life Program Coordinator
  • Chair Radiation Oncology
  • Cancer Center Medical Director
Thoracic Surgery
Business Development
Laboratory Medicine
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Rescue Lung, Rescue Life Steering Committee Members