NHS Grampian paves way for using AI in lung cancer care across Scotland

Following the success of NHS Grampian Innovation Hub’s GRACE project to incorporate AI in the detection of lung cancer, the health board is now trialling a process that could be embedded in lung cancer care across Scotland. 

NHS Grampian is working alongside the Accelerated National Innovation Adoption (ANIA) Pathway team on this potentially transformative work. Diagnostic care for lung cancer has improved across Grampian thanks to the use of innovative Artificial Intelligence (AI) technology that scans x-ray images for more than 120 potential issues and the team is building on these results to inform the roll-out of AI in other areas.  
 
All chest x-ray images continue to be manually assessed by radiologists, but the use of Annalise CXR software highlights images that may show signs of lung cancer, so that they can be reviewed more urgently.  

Consultant radiologist Dr Struan Wilkie explains: “The number of referrals for urgent suspected cancer has increased by about 50% in the last five years across Grampian, across all specialties. While the number of confirmed cases remains relatively stable, this means there’s huge demand for diagnostic radiology services and our teams are using the latest innovations, tools and expertise to ensure patients are treated as quickly as possible. We see about 300 chest x-rays per day in Grampian alone and thousands across the country so using the same tech and lessons learned elsewhere has huge potential benefits for both patients and staff. 

“As healthcare continues to become ever more specialised, as treatments and technologies evolve, so do the demands on staff. Used in the right way, AI can give us a helping hand but it can’t manage risk or take responsibility for patients, so there will always be a need for checks.” 
 

The software was first introduced across 13 sites as part of NHS Grampian Innovation Hub’s GRACE Project in 2022, to evaluate the use of AI in radiology departments. It was the first time the Annalise CXR AI algorithm had been used by a UK health board, and continues to be a huge success.   
 
“Lung cancer remains the most common cancer in Scotland, and the most common cause of death from cancer. But it’s often a hidden killer. Many of our patients have chest x-rays for something else and then it’s picked up, so speeding up that detection process is invaluable,” Struan continues.  

“Through the GRACE Project, we're finding 12% more treatable cancers – which means we're catching them earlier – and getting 95% of people through to treatment is taking us 30 days less. Aberdeen has a rich history of leading the way with imaging in healthcare and we’ve now demonstrated the potential this technology has to improve lung cancer outcomes across the NHS,” he says. 

Health Secretary Neil Gray said: “The Scottish Government is clear that embracing innovation is absolutely vital as we seek to address current pressures and meet the challenges of the future. Artificial Intelligence is a key part of that, so I warmly welcome NHS Grampian’s adoption of this new tool which supports our ambitions for reducing cancer waiting times and improving outcomes. I look forward to seeing how we can learn lessons for the wider health service.”

Outpatient Morag Carmichael was asked for her take on using AI in healthcare when she came along for a chest x-ray at Dr Gray's Hospital this week. She said: "Anything that helps the hospital, the nurses, the doctors the health service improve, become more efficient, has got to be a good thing. As long as a real person looks at the results as well I'm perfectly happy with it."

The team is also exploring the potential of Annalise CXR software to draft reports when it analyses images it does not find any abnormalities in.  

Struan added: “This AI tech is really good at identifying when someone’s x-rays are normal so the auto drafting of some reports has huge potential too. This means we could more quickly review images for examinations with normal findings, giving us more time to spend reviewing the abnormal x-rays, which reduces the time a patient could wait for a report.” 

Lorna Cameron, Programme Manager for Innovation at NHS Grampian commented: “It has been fantastic to see our lung cancer diagnostics pathway improving, and now to be realising the potential this technology has to help us with major challenges like the increasing volume of referrals across Scotland. Here in Grampian, clinical staff review about 70,000 chest x-rays every year and among those there are 300 or so that will show a previously unknown lung cancer. This technology is helping us identify these ‘needles in a haystack’ as quickly as possible and accelerate people to treatment.    

“Innovative technology has the potential to help us improve outcomes, make care more accessible and speed up service delivery. We’re grateful to busy teams across NHS Grampian who are helping us trial new technologies and support the workforce of the future.”  

If you are aware of promising emerging healthcare technology or existing technology with significant evidence gaps that NHS Grampian may be able to evaluate for real world use, please email gram.innovation-hub@nhs.scot