Improving the diagnosis of pancreatic cancer through system wide identification and root cause analysis of potentially missed pancreatic cancer diagnoses on abdominal imaging
Around 800 people in the UK each year have a CT or MRI scan that misses their pancreatic cancer, only for the disease to be diagnosed months later. This matters because pancreatic cancer is notoriously deadly—only 6.5% of patients survive five years—and every month of delay shrinks the chance of curative treatment. The scans are meant to catch it, but in roughly 8% of cases they do not. The researchers do not yet know why: whether the cancer was invisible, the radiologist missed it, or the wrong scan was ordered. The team will build a national system to flag these missed cases automatically, notify each NHS trust, and provide a structured tool for local root-cause analysis. If the project succeeds, it will identify correctable factors—such as reporting protocols, scan timing, or training gaps—that can be fixed across the UK’s radiology departments. The goal is not a new scanner or drug, but a systematic reduction in diagnostic failures, which could shift survival rates without a single new piece of technology.
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Research Question Can we improve the diagnosis of pancreatic cancer through investigating when Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) fail to diagnose pancreatic cancer? Background 10,500 people in the UK are diagnosed with pancreatic cancer annually. Their 5-year survival is only 6.5%. Pancreatic cancer is diagnosed on Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) scans. Approximately 8% of people with pancreatic cancer in the UK (around 800 per year) had a CT or MRI scan that did not find their cancer in the 18 months prior to diagnosis - post-imaging pancreatic cancer (PIPC) or potentially missed cancer (Umar 2023). Understanding the reasons for PIPC through detailed review of scans and associated patient and hospital factors will help identify correctable factors to reduce missed cancers. Aims and Objectives 1. Prospectively identify PIPC and tell each NHS trust about PIPC associated with their scans. 2. Enable local review and root cause analysis of each PIPC to understand how many might be preventable. 3. Act on the pooled findings and introduce interventions, in partnership with pancreatic cancer networks and national radiology, surgery and gastroenterological organisations to reduce missed cancers in future. Methods Adults diagnosed with pancreatic cancer (ICD10 code C25.X) in England will be identified from National Cancer Registration and Analysis Service (NCRAS) data. Linked data in the Diagnostic Imaging Dataset (DID) will be used to identify pancreatic cancer patients who underwent an abdominal CT or MRI scan 3-18 months prior to diagnosis. A web-based portal will be developed by Health Data Insight and the project team to provide a structured root cause analysis tool to analyse the most recent 25 PIPC in each trust. Anonymised results will be collated to enable analysis at a national level. Central quality control of local imaging review will be undertaken. Timelines for delivery July 2025 - November 2025: Development of algorithm for detecting PIPC in NCRAS and DID data and development of root cause analysis proforma. December 2025 - June 2026: Development of portal for notifying trusts of PIPC and capturing resulting root cause analysis data with piloting in five trusts. July 2026: Roll out of national PIPC notification and root cause analysis system. July 2026 - February 2027: Capture of data on all PIPC and quality control of local imaging review. March - June 2027: Analysis of PIPC data and begin dissemination of results. Anticipated impact and dissemination We anticipate the project will identify effective interventions to reduce PIPC in future through local and national quality improvement efforts. Organisations responsible for pancreatic cancer care and CT and MRI reporting will encourage participation in the project and share the learning from missed pancreatic cancers with hospitals throughout the UK. A summary of the detailed analysis of missed pancreatic cancers will be presented at conferences and published in medical journals to share learning nationally and internationally. PPI leads will help develop a lay summary of results to aid dissemination to the public through the social media accounts of pancreatic cancer support organisations.
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