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Information for patients undergoing investigation by the Chest Team

Appointment to see Chest Physician
You may have been referred to see a Chest Physician via your GP or Healthcare Professional due to an abnormality on your scan or X-ray.

New patient appointments usually take about 20 minutes and you will be seen by a Respiratory/ Chest doctor and possibly a Lung Care Clinical Nurse Specialist. Clinics are held in the main outpatients department at Maidstone Hospital and in Outpatients Zone 1 at Tunbridge Wells Hospital.

What happens next?
A doctor or the Lung Care team may request a range of investigations or ongoing monitoring. The tests usually take 2-4 weeks to complete and the results will enable the team to make a diagnosis and to start you on the best treatment or management plan. Further details about the tests can be found below.

Multi-disciplinary meeting and clinic appointment
Following these investigations your case will be discussed at the Lung Multi-disciplinary meeting on a Thursday morning. At this meeting the Lung Clinical Nurse Specialists, the respiratory/chest consultant physicians, thoracic surgeon, radiologists, histopatholgist and oncologists meet to discuss your results and management plan.

You may be called at short notice following this multi-disciplinary meeting to meet the Consultant/Clinical Nurse Specialist to discuss your results and management plan.

Types of Investigations

You may be asked to have the following investigations:

Chest X-ray
A chest X-ray is a one dimensional image that checks your lungs for anything that looks abnormal.

Blood Tests
Whilst attending an outpatient appointment, you may be asked to have a blood test (in particular, full blood count, clotting, liver and renal function). This only takes a few minutes.

A bronchoscopy is a test where a doctor looks at the insides of the airways (bronchus) and lungs. A tube called a bronchoscope is used and is passed into your nose or mouth and down in the lung. The test uses local anaesthetic which is sprayed to the back of the throat. This procedure may require light sedation. During a bronchoscopy samples of cells (biopsy) may be taken from the lung or airway. The procedure takes approximately 15-30 minutes, however, you will be asked not to eat or drink anything for at least 4 hours prior to the procedure.

CT (computerised tomography) Scan
A CT scan takes a series of X-rays, which build up a 3 dimensional picture of the inside of the body. It takes 10-30 minutes and is painless. It uses a small amount of radiation, which is very unlikely to harm you and will not harm anyone you come into contact with. You may be asked not to eat anything for at least 3 hours prior to the scan but you may need to drink 1 litre of water 1 hour before the scan. A blood test is sometimes necessary beforehand.

Lung function tests
Lung function tests (also called pulmonary function tests or PFT’s) check how well your lungs work. The tests determine how much air your lungs can hold, how quickly you can move air in and out of your lungs, and how well your lungs put oxygen into and remove carbon dioxide from your blood. This takes less than an hour.

Lung biopsy – CT guided / Ultrasound guided
This test can be done by CT or ultrasound. You will be given a local anaesthetic first to numb the area. The doctor may ask you to hold your breath for a few seconds while they pass a thin needle through the skin and into the lung. They check the CT/ultrasound to make sure the needle is in the right place. The doctor removes a sample of cells (biopsy) which may be uncomfortable but only takes a few minutes. You may need to stay in hospital for a few hours after the biopsy for monitoring.

PET (positron emission tomography) scan
A PET scan uses low dose radiation to measure the activity of cells in different parts of the body. A mildly radioactive substance is injected into a vein, usually in your arm. The radiation dose used is very small. The scan is performed after at least an hour’s wait and lasts 30-90 minutes. You cannot eat for 6 hours before the scan, although you may be able to drink. PET scans are carried out by an organisation called “Alliance Medical” at Maidstone Hospital who will contact you directly regarding your appointment – please ensure you advise them if you are diabetic or have any other medical conditions.

EBUS (endobronchial ultrasound scan)
Some people may have this test done instead of a bronchoscopy or a CT or Ultrasound biopsy. You will have a mild sedative to help you relax. The doctor passes a bronchoscope (which has a small ultrasound probe on the end) down into your windpipe (trachea), a needle is passed along the bronchoscope to take biopsies from the lung or nearby lymph nodes. This procedure may be uncomfortable but should be painless. The EBUS takes less than an hour but you may need to stay in hospital for a few hours after the biopsy for monitoring.

This test allows the doctor to look at the area in the middle of your chest called the mediastinum and the nearby lymph nodes. You have this test done under general anaesthetic during a short stay in hospital. The surgeon makes a small cut in the skin at the base of your neck and passes a tube like a telescope through the cut into your chest. The tube has a light and camera at the end to allow the doctor to take samples of tissue and lymph nodes (biopsies).

Pleural Aspiration/Biopsy
A pleural aspiration is a simple procedure to remove fluid from the chest and can help relieve breathlessness or assist with diagnostics. This can be performed using an ultrasound scan to identify the best site for aspiration/biopsy. A needle is inserted in the chest using local anaesthetic and fluid or biopsy is taken.

Bone Scan
This test shows abnormal areas of bone. You have a small amount of mildly radioactive substance injected into a vein. The level of radioactivity used is very small and does not cause any harm. Abnormal bone absorbs more radioactivity than normal bone. You will need to wait 2-3 hours after the injection before you have the scan this will take an hour.

Echo-cardiogram (ECG)
An echocardiogram, or “echo”, is a scan used to look at the heart and nearby blood vessels. It is a type of ultrasound scan which sends out high-frequency sound waves that create echoes when they bounce off different parts of the body. This provides information of the function and effectiveness of the heart.

Contact Numbers for Investigations

Details of planned investigations will be provided by the individual departments responsible. However, the following departments can be contacted regarding appointment dates and further information:

CT & CT Guided Biopsy

  • Maidstone: 01622 225688
  • Tun Wells: 01892 634729

PET Scan (Alliance Medical)

  • Patient Contact No: 01622 228235

Bronchoscopy / EBUS

  • Patient Contact No: 01892 638210

Lung Function Tests

  • Maidstone: 01622 224521
  • Tun Wells: 01892 634684

Bone Scan (Nuclear Medicine)

  • Maidstone: 01622 225047
  • Tun Wells: 01892 634733

Ultrasound Scan/Biopsy

  • Maidstone: 01622 224207
  • Tun Wells: 01892 633406