National root cause analysis of post-imaging pancreatic cancer

  • Research type

    Research Study

  • Full title

    Improving the diagnosis of pancreatic cancer through system wide identification and root cause analysis of missed pancreatic cancer diagnoses on imaging

  • IRAS ID

    359385

  • Contact name

    Nigel Trudgill

  • Contact email

    nigel.trudgill@nhs.net

  • Sponsor organisation

    Sandwell West Birmingham NHS Trust

  • Duration of Study in the UK

    1 years, 9 months, 1 days

  • Research summary

    Aims of the research

    1. To find the number of pancreatic cancers that were missed on specialist scans (Computed Tomography /Magnetic Resonance Imaging and endoscopic ultrasound) in each hospital in England.

    2. To investigate why the diagnosis was missed.

    3. To introduce recommendations to improve pancreatic cancer diagnosis.

    Background

    Each year in the UK, around 10,500 people are told they have pancreatic cancer. For about 800 of them, a scan was done up to 18 months before their diagnosis—but the cancer wasn’t spotted. We call this post-imaging pancreatic cancer or ‘potentially missed’ cancer. If pancreatic cancer is found early, it is possible to cure it by surgery. This project will help us understand why some cancers were missed. The learning will help find pancreatic cancer earlier and improve survival.

    How we will do it

    We will investigate the reasons behind potentially missed pancreatic cancers by using the same successful methods that helped us find out why some gullet, stomach and bowel cancers were missed.

    We will look at national pancreatic cancer data and the scans that were done. We will find patients who had a scan that diagnosed pancreatic cancer. We will then check if they had earlier scans up to 18 months before, that did not diagnose the cancer. This will be done for each hospital in England.

    We will ask radiologists from each hospital to carefully compare old and recent scans. They will try to figure out why the cancer might have been missed, if it was.

    We will also collect scan images for future research. We plan to use Artificial Intelligence to help find pancreatic cancer earlier in future research.

    Patient and public involvement - Pancreatic Cancer UK supported an event to help with the project design.

  • REC name

    East of England - Cambridge South Research Ethics Committee

  • REC reference

    25/EE/0203

  • Date of REC Opinion

    2 Oct 2025

  • REC opinion

    Favourable Opinion