Dr. Arjun Nair serves as the responsible radiologist at University College London Hospitals (UCLH), where he oversees pivotal lung cancer screening programmes. With over a decade of experience in thoracic radiology, Dr. Nair has been deeply involved in screening initiatives such as the SUMMIT study and the Targeted Lung Health Check (TLHC) (now called NHS Lung Cancer Screening) programme, helping to shape innovative approaches to early cancer detection.
In this interview, he shares insights into how Nelson+ supports UCLH’s ground-breaking work, his perspective on the challenges of lung screening, and the tangible impact these efforts have on patient care.
Interviewer: Could you briefly introduce yourself and share your background and experience with lung cancer screening?
Dr Arjun Nair: My name is Dr Arjun Nair, and I’m a thoracic radiologist at UCLH. I have been involved in lung cancer screening for the past 14 years, but more specifically in the Targeted Lung Health Check (TLHC) programme since it began in 2019. Before that, I was working with the SUMMIT lung screening trial (UCL and NCL). In 2022, as SUMMIT transitioned into one of the TLHC programmes, I became responsible for overseeing the screening program at UCLH.
Interviewer: UCLH has achieved impressive results with 115,000 participants invited and 52,000 scans carried out so far. How has Nelson+ supported the programme in improving uptake and optimising workflow?
Dr Arjun Nair: When the SUMMIT trial began, we recognised that no software solution at the time could deliver the end-to-end infrastructure required for lung cancer screening. We had to build everything in-house.
In 2022, as we transitioned to the NHS TLHC programme, we were very pleased that Nelson+ could successfully tender an end-to-end solution. It handled everything – from identifying and targeting participants, risk stratification, and managing workflow, to optimising scanning processes and reporting.
One of the standout features for me as a radiologist is Nelson+’s reporting module, which has been developed collaboratively and continuously improved. The built-in business intelligence tools have also been key in helping us monitor the programme rigorously in real-time.
Without Nelson+, we would have had to integrate various fragmented systems, like electronic patient records, which would have been capable but not optimised for screening. Nelson+ has achieved this for us in a seamless, screening-focused way.
Interviewer: From your perspective, what are the biggest challenges in implementing and running a successful lung screening programme?
Dr Arjun Nair: The biggest challenge has been the correct targeting of participants. Lung cancer screening, unlike unselected population-based screening, is risk-stratification based. This complexity increases with the use of multiple risk scoring tools, which need to be accurately tested and integrated into the software.
Another challenge is communicating effectively with participants. For instance, helping them understand why they might not qualify for screening now but may be re-invited later is key.
Logistics are also a challenge, particularly in balancing workload, managing invites, and ensuring resources like phone screening and nurse-led triage are in place. Having a good overview of ongoing and future workflows is essential for success, and tools like Nelson+ are critical here.
For programmes that involve mobile scanners, additional challenges include managing site-specific logistics, such as moving scanners between locations and handling bespoke follow-up requirements.
Interviewer: Which features of Nelson+ have been the most beneficial to your workflow, and how do they address key challenges?
Dr Arjun Nair: The reporting module has been incredibly beneficial. It integrates seamlessly with our CAD software (Veolity), eliminating the need for manual reporting and reducing reporting time significantly.
The incidental findings module has also been crucial. Initially tailored to our protocols, it has since been aligned with national guidelines. Predefined parameters streamline workflows, ensuring consistency.
Nelson+ also prioritises scans for reporting. If a referrer flags something urgent, we can address it immediately. Features like surface prior reports, which allow us to compare findings across screening rounds, are particularly useful for follow-ups.
The screening review meeting workflow is another highlight. It allows us to create instances for discussion and document comments, providing a richer perspective on participants’ history and care pathway.
Lastly, having a comprehensive overview of each participant’s history, including smoking cessation referrals and previous interventions, gives us valuable insights during reporting.
Interviewer: Could you share specific examples of how Nelson+ has positively supported your daily operations and outcomes?
Dr Arjun Nair: Being able to query scans by time and date helps us manage workflows efficiently, especially during busy periods like the Christmas holidays. Nelson+’s business intelligence tools allow us to monitor programme performance and radiologist reporting metrics in real-time.
On the operational side, Nelson+ enables us to review and streamline participant communications, such as letters and notifications, ensuring clarity and consistency. This significantly improves programme transparency and helps us optimise our outcomes.
Interviewer: How has Nelson+ contributed to improving patient care outcomes in your programme?
Dr Arjun Nair: Nelson+ helps prioritise scans, allowing us to action findings quickly when necessary. It also enables us to reassure patients when scans are negative or incidental findings are benign. This improves patient experience and reduces anxiety.
The system’s call list functionality has also enhanced communication, allowing us to provide more tailored patient care.
While long-term impacts like cancer mortality rates will take time to measure, the qualitative improvements to patient care are already evident.
Interviewer: How has Nelson+ adapted to meet the evolving demands of your programme? Can you share examples?
Dr Arjun Nair: Nelson+ has proven agile in responding to real-world demands. For example, prioritising scans for urgent reporting was a feature rolled out quickly after we highlighted the need.
Another example is the flexibility in configuring thresholds for incidental findings and decision-support tools. Nelson+ has allowed us to adapt to evolving protocols while maintaining accuracy and reliability.
The most recent development, allowing multiple iterations of reports, has also been invaluable. It ensures we understand prior thought processes, particularly during follow-ups.
Interviewer: If you were to recommend Nelson+ to a colleague, which standout strengths or unique features would you highlight?
Dr Arjun Nair: The standout feature is its comprehensive end-to-end solution. Nelson+ tracks participants across the programme, automates communications, and ensures minimal manual intervention. This allows the programme to run efficiently.
From a radiology perspective, features like the reporting module, integrated decision-support tools, prioritisation of scans, and quality assurance metrics make Nelson+ a robust and reliable tool.
Interviewer: How do you see Nelson+ contributing to the future of lung cancer screening in the UK?
Dr Arjun Nair: Nelson+ has the potential to be a foundational tool for lung cancer screening in the UK. Its strength lies in its ability to adapt to local programme needs while maintaining a standardised structure. This flexibility will be critical as screening programmes scale up nationally.
Interviewer: Is there anything else you’d like to add about your experience with Nelson+ or its impact on your programme?
Dr Arjun Nair: Deploying any new software comes with challenges, but with Nelson+, these challenges were manageable. Having a partner willing to engage, adapt, and improve has been invaluable. Nelson+ has demonstrated an eagerness to learn and evolve, which has made our experience positive overall.
Interviewer: Thank you very much for your time, Dr Nair. Your insights have been incredibly valuable.
Dr Arjun Nair: Thank you. I’m happy to help, and please let me know if you need anything else.