Sarah Maund, Radiology Cancer Navigator, Stuart Baines, Lead for Radiographer Advanced Practice, Jamie White, Reporting Radiographer, Cwm Taf Morgannwg University Health Board
Radiology Pathway Navigation – A New Direction
Strategic Case for Adoption:
Innovations in cancer pathways are imperative to address the significant demand (CT and MRI scan demand is growing by 11% annually), the urgent turnaround of referrals and to reduce inequalities in access. Additionally, Wales has just 6.1 radiologists per 100,000 population—the lowest among UK nations—with a 30% staffing shortfall (RCR, 2023).
Since its implementation in 2022, the Radiology Pathway Navigation model at Princess of Wales Hospital (POWH) has demonstrated significant improvements in both the lung and colorectal National Optimal Pathways (NOPs) for cancer by addressing key bottlenecks in radiology processes.
Currently, radiology services across modalities collaborate well, but there is no continuous pathway linking each stage of the patient’s diagnostic journey. The lack of a cohesive, streamlined process results in delays, repeated hospital visits for investigations, and duplication of efforts in vetting referrals. The Navigator role addresses these inefficiencies by creating a more integrated pathway, thus reducing wait times for investigations, optimising clinician time, and enhancing staff productivity. The model aligns with national priorities for planned care and cancer services by improving diagnostic efficiency and patient outcomes.
New Service Approach:
The Radiology Pathway Navigation initiative introduces a Specialist Band 7 Radiology Cancer Navigator to streamline the radiology referral process, a role previously handled by radiologists, service managers, radiographers, and support staff. This redesign of the Single Cancer Pathway (SCP) for radiology aims to improve patient experiences and service efficiencies by expediting referral vetting, optimising imaging capacity, and providing a dedicated point of contact.
Methodology:
The innovative work focuses on patients referred for chest X-ray, MRI, and CT imaging for colorectal cancer. The role of the Navigator is to ensure coordinated care across these modalities, reducing delays and enhancing the overall patient journey.
Clinic & Systems Impact:
In 2024 alone, the Radiology Navigator facilitated 710 additional staging CT appointments in POWH — an average of 60 per month.
- Colorectal Cancer: Staging CT waiting times have decreased by 69% since 2022. Currently, 69% of patients diagnosed with a colorectal malignancy at colonoscopy receive their CT scan on the same day.
- Lung Cancer: Since 2022, there has been an 84% reduction in Chest X-ray (CXR) reporting times, a 29% decrease in the interval between CXR and staging CT, and a 67% reduction in time from initial GP suspicion to first multidisciplinary team (MDT) discussion.
- Shortening waiting times: Lowering the average wait from colonoscopy referral to CT staging from thirteen days to four days.
- Streamlining radiology pathways: Reducing the vetting process from five days to two and decreasing staff touch points from seven to four.
- Increasing radiology capacity: CT scanning capacity increased to 118%, with 530 extra patients scanned during the project period.
- Providing coordinated care: Facilitating seamless transitions for patients needing multiple examinations and procedures.
- Enhancing patient experience: Offering a dedicated point of contact and improved access to pre- and post-procedure information, including online resources
Economic Impact:
The project demonstrated significant resource optimisation and potential for cost savings:
- Resource impact: During the nine-month implementation period, the navigator role freed up 996 hours of radiology and management time.
- The navigator role has since been embedded into Cwm Taf due to its evidence of impact in releasing staff capacity, improving service efficiency, patient flow and outcomes.
Key Requirements:
The initial investment required includes funding for a Band 7 Radiology Cancer Navigator (1 FTE) and a Band 3 administrator to increase capacity, although it is anticipated that there may be opportunities to draw upon and train existing workforce capacity.
Benefits:
- Reduced delays: Streamlined processes significantly shorten the time from referral to appointment, improving patient flow.
- Optimised staffing: The reduction in staff touchpoints and vetting time allows for more efficient use of clinical resources.
- Improved patient coordination: The Navigator ensures a continuous pathway for patients undergoing multiple investigations, reducing the need for repeated visits.
- Patient-centred care: Enhanced communication and access to information improve the patient experience and support shared decision-making.
- Positive staff feedback: 100% of surveyed staff reported that the Navigator role benefits the service.
The Radiology Navigator role has proven to be a cost-effective, scalable model that accelerates access to diagnostic imaging, enhances patient outcomes, and alleviates workforce pressures. The model not only improves the quality and timeliness of cancer care, but also contributes to prudent resource use, generates significant time savings for consultant radiologists and modality leads, which enhances job satisfaction within the radiology workforce. Clinical teams also have considerable time savings by having a single point of contact within radiology. This concept is well-positioned for national adoption.
Resources for Health Boards
Relevant Policy
Our Programme for transforming and modernising planned care and reducing waiting lists in Wales (2022).
Goals:
- Effective referral
Priorities:
- Transformation of outpatients
- Prioritisation of diagnostic services
- A focus on early diagnosis and treatment of suspected cancer
- Implementation of a fair and equitable approach to patient prioritisation
- Eliminating long waiters at all stages of the pathway
- Building planned care capacity
- Appropriate information and support
Welsh Innovation Strategy (2023)
Priorities:
- Diagnostics
- Reducing waiting lists
- Supporting a talented workforce
Promote, prevent and prepare for planned care (2023):
Supports:
- Advice and guidance to patients and individualised care along the pathway
- Efficiency of care
- Increased service capacity
NHS Wales Technical Planning Guidance 2025 – 2028
Supports the ministerial priority of timely Access to Care
Service Presentation Material:
Radiology Pathway Navigator Presentation
Radiology Pathway Navigator Poster
Service Implementation Material:
Available upon request:
- Adoption Case for Change
- SOP
- Job description
Testimonials:
“Having a Radiology Cancer Navigator assists us with reducing patient pathway delays and also having a point of contact so that we can high light patients who may have additional needs. We care for many patients on their cancer journey with learning disabilities and dementia, patients with these additional needs have in the past been significantly delayed to miscommunication. Having a point of contact is so beneficial, reducing unnecessary anxiety to our patients at this stressful time, and ensuring their investigations are done and discussed in time in the MDT. Any concerns we have had are escalated either by email or in person to Sarah (Radiology Navigator) and are always acted on immediately, always approachable and ensures appointments are speeded up preventing any unnecessary delays. In my opinion the role of the Radiology Cancer Navigator is invaluable, and improves the patient’s cancer journey.”
(CTMUHB – Macmillan Gynaecological Nurse Specialist)
”I just want to thank you again for all your effots in getting this service up and running. We find it very beneficial to our patients and cancer service pathway!”
(Upper GI Clinical Nurse Specialist, POW)
