Why Choose LungCheck?
The goal of LungCheck is to make people aware of the benefits of lung screening as early detection can save lives. Ireland’s first LungCheck service hopes to detect lung disease at its earliest and most treatable stage before symptoms begin. LungCheck introduces a consultant specialist led premier Lung Cancer CT screening service in Ireland whilst simultaneously screening for COPD/Emphysema, Pulmonary Fibrosis and COVID-19.
4 Lung Checks in 1 Health Screen
The LungCheck service offered by Specialist Screening Healthcare Ireland screens people in the community who are considered at an increased risk of developing the following 4 major life limiting lung diseases:
Service Clinically Led by Consultant Lung Specialist
The LungCheck service is led by Consultant Thoracic and Lung Transplant Surgeon, Clinical Director of Specialist Screening Healthcare Ireland, Professor Karen Redmond, who collaborates with key experts in the field.
Lung Cancer Screening Based on Results of International Clinical Trials
On the back of encouraging results from the UK Lung Cancer Screening Trial (UKLS) and European NELSON Trial, the European Respiratory Society in Europe, and the US Preventative Services Task Force are now recommending annual low dose CT screening for lung cancer.
Serial low-dose computed tomography (LDCT) scans that screen people at higher risk of lung cancer (over 50 years of age with a history of smoking 20 cigarettes a day for 20 years) can save more lives compared to chest X-rays alone. CT scanning also allows detailed analysis that can diagnose Emphysema and Interstitial Lung Disease, all in the one check. Reassuringly no contrast is required during CT scanning for LungCheck services.
Specialist Screening Healthcare Ireland values the lung cancer supports put in place by the Irish Cancer Society. SSHI Directors attended the launch of the Irish Cancer Society’s Lung Cancer Action Plan held in February 2019 at the Sean O’Casey Community Centre in Dublin. The Irish Cancer Society’s plan reinforces the importance of lung cancer screening highlighted in these clinical trials.
What does LungCheck Services Include?
Our LungCheck health assessments includes quality time (either face to face or video conferencing) with a specialist nurse and/or consultant specialist (when clinically indicated), for you to gain a better understanding of your health and health targets going forward.
Health Risk Score & Pre-Screening Consultation
This includes the following:
- Detailed medical history assessment completed at a pre-screening consultation via teleconsultation or at clinic consultation stage with one of our specialist screening healthcare professionals.
- Health Risk Assessment Questionnaire (HRAQ). This will include a Lung Cancer risk assessment prediction score from the following internationally recognised lung cancer risk models:
- Spitz
- Liverpool Lung Project (LLP)
- Hoggart
- Prostate, Lung, Colorectal and Ovarian (PLCO)
There is generally no signs or symptoms in the very beginning and in the earliest and more treatable stages of Lung Cancer. If you are at increased risk of developing Lung Cancer you should be screened. The LungCheck service hopes to detect lung disease in Ireland at its earliest and most treatable stage when Lung Cancer has just started to develop but before symptoms begin.
Physical Examination
Body Mass Index (BMI)
BMI is a measure of whether you’re a healthy weight for your height. A BMI calculation is a screening tool that can indicate whether a person is underweight, a healthy weight, overweight, or considered obese.
If your BMI is outside of the healthy range, your health risks may increase significantly.
Blood Pressure
Blood pressure is a measure of the pressure or force of blood against the walls of your blood vessels (arteries). The top number (systolic) is the measure of the pressure when your heart contracts and pushes blood through the arteries. The bottom number (diastolic) is the measure of the pressure when your heart relaxes between beats.
High blood pressure, or hypertension, rarely has noticeable symptoms. But if untreated, it increases your risk of serious problems such as heart attacks and strokes.
Heart Rate
Having an uncontrolled heart rate for long periods of time (weeks or months) can damage the structure of your heart. The electrical activity of the heart is called the heart rhythm (which is the synchronized or organised pumping action of your four heart chambers).
An irregular rapid heart rhythm caused by Atrial Fibrillation reduces your heart’s ability to pump blood properly and increases the chance of a blood clot forming in your heart, travelling up to your brain, which may cause a stroke.
Respiratory Rate
This is the number of breaths per minute, a clinical sign that represents ventilation (the movement of air in and out of the lungs). A change in respiratory rate is often the first signs of deterioration as the body attempts to maintain oxygen delivery to the body.
Oxygen Saturations
Oxygen saturation refers to the amount of oxygen that’s in your bloodstream. The body requires a specific amount of oxygen in your blood to function properly. The normal range of oxygen saturation for adults is 94 to 99 percent. The blood oxygen level measured with an oximeter is called your oxygen saturation level.
The more the lungs are damaged, the more likely there is to be a problem with oxygen uptake.
Diagnostic Tests
Pulmonary function tests (PFTs) also known as lung function tests are a group of non-invasive tests that measure how well the lungs are working. PFTs gauge how the lungs are expanding and contracting (when a person inhales and exhales) and measure the efficiency of the exchange of oxygen and carbon dioxide between the blood and the air within the lungs. This test is done by having you breathe into a mouthpiece connected to a machine. You will be asked to empty your lungs by gently breathing out as much air as you can. The tests measure lung volume, capacity, rates of flow, and gas exchange.
1. Spirometry Testing
The most effective and common method for diagnosing lung disease including Chronic Obstructive Pulmonary Disease (COPD) is spirometry. This test measures how much air you can breathe in and out of your lungs. Spirometry can help tell if your breathing is affected by a narrow or inflamed airway and help determine which type of lung disease you have and its severity. Spirometry is recommended if you suffer from a persistent cough, shortness of breath, or noisy breathing.
2. Bronchodilator Responsiveness Testing
During the test the technician may give you a medicine to help open your airways and then repeat the test to see if your breathing improves with the medicine. This is called bronchodilator responsiveness testing and is done to see if your lung function gets better with medication, and if so, by how much. This is sometimes called reversibility testing. In bronchodilator responsiveness testing, the spirometry test is done before and after you breathe in some medication. It can be a measure of asthma.
3. DLCO or Gas Exchange
Lung diffusion testing is designed to test how well your lungs allow oxygen and carbon dioxide to pass in and out of your blood. This process is called diffusion. The bronchi deliver oxygen-rich air to the lungs, where gas exchange occurs in tiny air sacs called alveoli. Oxygen diffuses from the alveoli into the capillaries, which carry it out of the lungs and to the rest of the body; carbon dioxide diffuses into the alveoli and is then exhaled out of the body. The respiratory membrane is the barrier through which oxygen and carbon dioxide are exchanged.
Diffusing Capacity (DLCO)
DLCO (Diffusion Capacity of the Lung for Carbon Monoxide) is also known as the transfer factor for carbon monoxide or TLCO (Transfer capacity of the Lung for Carbon Monoxide). It is a measure of the conductance of gas transfer from inspired gas to the red blood cells. DLCO is affected by the lung surface area available for gas diffusion, any condition that reduces the number of functioning alveolar units lowers the DLCO. A high DLCO on a PFT report is most frequently associated with large lung volumes.
Interpreting Pulmonary Function Test Results
Interpreting pulmonary function test results is a multi-step process of assessing the adequacy of the study, comparing the results to an appropriate baseline standard, defining the pattern of abnormality, determining the degree of abnormality, assessing response to bronchodilators and evaluating changes in measurements over time.
PFTs help classify lung disease into the following categories:
- Obstructive
This is when air has trouble flowing out of the lungs due to airway resistance. This causes a decreased flow of air.
- Restrictive
This is when the lung tissue and/or chest muscles cannot expand enough.
- Pulmonary Vascular Diseases
There are two main types of pulmonary vascular diseases: 1) pulmonary embolism and 2) pulmonary hypertension.
For quality assurance, SSHI’s LungCheck CT scans are dual reported by our selected consultant specialist lung radiologists and reviewed by SSHI’s Cinical Director Professor Karen Redmond. If clinically indicated, further discussion will be facilitated at a multidisciplinary team meeting (giving you access to an entire team of specialists who will collaboratively discuss diagnosis and develop and expediate a treatment plan).
What is a CT chest scan?
Lung Cancer research advocates the use of CT scans, a technique that combines special X-ray equipment with sophisticated computers to produce multiple, cross-sectional images or pictures of the inside of the chest that can identify potential cancers. Low Dose Radiation CT (LDCT) used as part of an annual lung cancer screening service produces images of enough quality to detect many abnormalities while using up to 90 percent less ionizing radiation than a conventional chest CT scan. Chest X-rays are not recommended for lung cancer screening. Put simply, a chest X-ray is like a ‘negative’ whilst a low-dose CT scan is like a ‘photograph’. No contrast material is needed when LDCT is used for Lung Cancer screening.
Specialist Screening Healthcare Ireland values the importance of offering a Lung Cancer Screening service utilising validated risk profiles or applying the US Preventative Lung Cancer Taskforce Recommendations offering yearly low-dose computed tomography (LDCT) scan with dual reporting by certified consultant pulmonary radiologists to include a supplementary Specialist Screening LungCheck CT Report.
A once off non-contrast high-resolution CT (HRCT) chest scan is recommended to assess for Emphysema/COPD or Interstitial Lung Disease as this type of CT imaging offers enhanced image resolution providing more precise detail than either a chest X-ray or conventional LDCT.
LungCheck also screens to identify lung disease linked to COVID-19 in individuals who may or may not have experienced symptoms. A CT chest scan helps to identify Covid-19 sequelae affecting the lungs.
What happens after a CT scan report is through?
A suspicious or positive result means that the CT chest scan shows something that is abnormal. This could mean lung cancer. It could also be a false positive, or something that looks like a cancer but is not, such as a scar or infection. If that is the case, you may need additional testing to determine why the CT scan is abnormal.
A negative result means that there were no abnormal findings at the time of the CT scan. It does not mean that you will never develop lung cancer or lung disease.
Additional evaluation of your CT imaging, if clinically indicated
1. StratX Lung Report, if clinically indicated
If clinically indicated from your CT report a StratX lung analysis may be performed on your CT imaging. The StratX Lung Analysis Platform is a secure cloud based quantitative CT analysis service designed to support treatment decision making for bronchoscopic lung volume reduction procedures. The StratX report helps identify and qualify COPD patients most likely to benefit from Zephyr Valve treatment for late-stage emphysema providing fissure completeness, emphysema density and inspiratory volumes to allow identification of target lobes that are good candidates for treatment with Zephyr Valves.
Professor Karen Redmond, Clinical Director of Specialist Screening Healthcare Ireland collaborates with PulmonX (the maker of the Zephyr Endobronchial Valve) in both her public and private surgical practice to routinely carry out this surgery in patients that clinically qualify. Zephyr Valve surgery is a minimally invasive treatment for severe Emphysema and is clinically proven to improve patients’ breathing function, exercise capacity and quality of life.
Hear from Letitia Swardt who underwent Zephyr Valve treatment with Professor Karen Redmond in February 2021 and details her quality of life before and after Zephyr Valves.
2. Imaging Review at Multidisciplinary Meetings (MDM), if clinically indicated
Multidisciplinary meetings (MDMs) are deliberate, regular meetings either face-to-face or via videoconference at which health professionals with expertise in a range of different specialities discuss the options for patients’ treatment and care prospectively. A Multidisciplinary Team (MDT) is a group of expert healthcare professionals from various specialties who meet to develop and review treatment plans.
Types of Lung Cancer Specialists involved in a Lung MDT:
- Respiratory Medicine
- Thoracic Surgery
- Medical Oncology
- Radiation Oncology
- Pathology
- Radiology
- Nurse Specialist
If a clinical concern is raised during your LungCheck assessment and our consultant specialist lung radiologists report an abnormality on your CT Chest scan your case will then be listed at a Lung MDM and presented by our Specialist Screening Healthcare Ireland consultant specialist, Professor Karen Redmond. During the meeting the team will review your medical history, test results and any personal or other health information that you have disclosed to any member of the team. At the MDM a decision is made on your management plan which will then be discussed with you. Everyone at the meeting is bound to keep the information confidential, just as they would in a face-to-face consultation with you.
Treatment plans are collaboratively developed to ensure you will be referred to the right specialist who will be able to provide your treatment. Alternatively, the recommendation may be to continue with a low dose CT (LDCT) chest scan surveillance approach.
Advantages of LungCheck’s Multidisciplinary Team Approach:
- Access to an entire team of specialists collaborating on your care.
- Improves service coordination.
- Shorter timeframes from diagnosis to treatment.
- Patient-centred care with survival advantages.
Personalised Health Targets
Body Mass Index (BMI) / Nutrition Targets
Maintaining a normal BMI is crucial for your future health because a high BMI has been linked to an increased risk for heart disease and type 2 diabetes. People who are overweight or obese often suffer shortness of breath due to excess fat in and around the chest which impedes breathing. Shallow, inadequate breathing is common in people with obesity and this makes exercise more difficult.
S.M.A.R.T Health Goal Strategy
Realistic, well-planned weight-loss goals keep you focused and motivated. They provide a plan for change as you transition to a healthier lifestyle. Our Specialist Screening healthcare professionals work with you to set a smart health goal strategy.
S.M.A.R.T. is an acronym that can be applied to the goals we set for ourselves in order to make them easier to tackle. It specifies that our goals should be.
S
Specific
What am I going to do?
How am I going to do it?
When am I going to do it?
M
Measurable
Making your goal specific means it should be easy to measure whether or not you achieves your goal.
A
Achievable
How realistic is it?
Is this the right time?
R
Relevant
Will this impact on the aspects of my health well-being and lower my health risk in developing lung disease?
T
Time Bound
When to start? What can I do today?
Exercise for Wellness
(+/- onward referral to a pulmonary rehabilitation programme if clinically indicated)
Staying active and undertaking light exercise has been shown to help better tolerate, respond to and recover from lung cancer treatments, such as chemotherapy, radiotherapy and surgery. Pulmonary rehabilitation is a specialised programme of education and exercise designed to help with lung problems such as COPD and Covid-19. A pulmonary rehabilitation program will help you learn how to breathe easier and improve your quality of life.
ExWell Medical is an established nationwide community-based chronic illness rehabilitation programme. Founder and Medical Director, Dr Noel McCaffrey has been providing community based supervised exercise classes, as well as online home programmes. The ExWell skillset and expertise allows for the delivery of programmes aimed at increasing physical activity levels in those with a range chronic illness. If clinically indicated, LungCheck can facilitate referrals to ExWell Medical or a local community services for pulmonary rehabilitation.
Smoking Cessation Targets
(+/- onward referral to a smoking cessation service)
Benefits of Smoking Cessation
When you quit smoking, the health benefits start right away. Smoking is by far the leading risk factor for lung cancer and is also responsible for Emphysema/COPD in around 85 to 95 percent of cases.
If you smoke 20 cigarettes a day, a mugful of tar will build up in your lungs. The toxic chemicals in this tar cause cancer. When you give up smoking, your lungs quickly fight back by coughing up tar.
Quitting while you’re younger can reduce your health risks more (for example, quitting smoking before the age of 40 reduces the risk of dying from smoking-related disease by about 90%), but quitting at any age can give back years of life that would be lost by continuing to smoke.
The effects of quitting smoking are immediate:
- After 12 hours – almost all nicotine will be out of your system. Your blood pressure and heart rate drop.
- After a few days – the level of carbon monoxide in your blood will drop dramatically and return to normal.
- Between 2 to 12 weeks – walking becomes easier and your lung function increases.
- After 1 to 12 months – coughing and shortness of breath decrease.
The HSE provides and promotes a wide range of smoking cessation services, ranging from online and social media supports through a National Smokers’ QUITline 1800 201 203 and HSE quit clinics. Our Specialist Screening Healthcare professionals can go through these free supports with you. Alternatively, we can provide onward referral to a Tobacco Cessation Specialist who is trained to deliver intensive support directly to smokers to help them quit. A Tobacco Cessation Specialists’ role incorporates dedicated time to deliver behavioural support which consists of advice, discussion and exercises to support smokers to quit.
Sign up to a Quit Plan for free to get a personalised plan and double your chances of success with quitting.
Comprehensive Consultant Specialist LungCheck Screening Analysis with Recommendations
Specialist Screening Healthcare Ireland provides a comprehensive LungCheck Screening Analysis including a detailed review of all test results from our consultant specialists directly to you and your General Practitioner with a copy of all test reports completed. CT images will be provided on disc to each patient.
Your LungCheck Screening Analysis will include both diagnostic and consultant specialist findings and recommendations:
Findings:
- Health Risk Assessment Questionnaire (HRAQ) findings to include your individual Lung Cancer risk assessment prediction score.
- Physical examination findings.
- CT chest report to include SSHI’s LungCheck supplementary CT report offering dual reporting by consultant specialist lung radiologists.
- Pulmonary Function Tests (PFTs) Report
- StratX Lung Report, if clinically indicated from CT report will be included.
Recommendations:
- Personalised health targets incorporating a S.M.A.R.T Health Goal Strategy to include BMI, healthy eating, smoking cessation, and exercise for wellness targets.
- If clinically indicated from CT chest report, your CT imaging will be discussed at a Lung MDM (Multidisciplinary Meeting) offering specialist opinion with MDT (Multidiscipliniary Team Meeting) consensus opinion. The outcome of the MDM will be included in your LungCheck Screening Report.
- Consultant specialist summary opinion from LungCheck’s Clinical Director, Professor Karen Redmond.
- Specialist Screening Healthcare Ireland’s LungCheck screening service supports individual referral (when clinically indicated) to Lung Cancer, Emphysema and Lung Fibrosis specialists. Other health targets are also prioritised, with a referral to a tobacco cessation specialist, culinary expert, clinical phycologist and/or pulmonary rehabilitation expert if required.
Consultation with LungCheck's Consultant Thoracic Lung Specialist (if clinically indicated)
A consultation with Professor Karen Redmond is included, if clinically indicated and recommended in your LungCheck Screening Report.
Follow-up Courtesy Call Post Screening
At 3 months a member of our Specialist Screening Healthcare team will follow up with you directly to ensure health targets and recommendations are being implemented.
LungCheck Fees
LungCheck, Ireland’s newest premier lung screening service offered by Specialist Screening Healthcare Ireland charges a self-pay fee totaling €1,495.00, qualifying for tax relief on payments made. Tax relief is available at the standard rate of tax at 20% via the Department of Revenue. You will be issued a receipt which you can submit to revenue as they may require a copy of proof of payment.
If you have private health insurance, some insurance providers reimburse their members for health screening. Please check with your insurance provider if your membership plan will reimburse any, all or part of the cost. You may receive a percentage reimbursement on the fee paid but this is dependent on your specific insurer and insurance policy.
If you have any queries regarding reimbursement please contact your health insurer to discuss the outpatient portion of your specific policy plan. You can claim tax relief on the portion not covered by your health insurer.
Blood Tests
Full range of preventative screening blood tests available upon request.
Counselling Supports
There is a lot of evidence that counselling can help you to cope better with the many difficulties you face, during and after your diagnosis and treatment. It can help reduce the stress you face, provide support and therapy as well as help overcome the depression and anxiety that illness, especially cancer can cause.
Improving Nutrition and Healthy Eating
Specialist Screening Healthcare Ireland’s Lifestyle Culinary Experts will share their extensive knowledge of nutrition and meal-based plans.
Six Minute Walk Test (6MWT)
You may require a 6MWT that measures the distance an individual is able to walk over a total of six minutes on a hard, flat surface. The goal is for the individual to walk as far as possible in six minutes. In healthy subjects, this ranges from 400 to 700 m, the main predictor variables being gender, age and height. This test checks your oxygen need while you walk. The 6MWT provides an assessment of overall functional ability and captures the impact of multiple factors on exercise capacity. These include cardiovascular disease, arthritis, and diabetes, as well as cognitive dysfunction and depression.
Sputum Analysis
Sputum is the mucus you cough up and an examination of this may be required if you have a productive cough. Analysing your sputum may help detect some lung cancers or identify a bacterial infection.