← For Referring Clinicians

For Imaging Clinics, Screening Doctors & Radiologists · Referral Route

Your Patient’s Scan Has Found Something in the Chest
A Named Route, and a Letter Back

A whole-body MRI, a chest CT, a coronary calcium score or a lung health check has reported a finding in the chest. Mr Lawrence Okiror, Consultant Thoracic and Robotic Surgeon at Guy’s and St Thomas’ and London Bridge Hospital, reviews the images personally, sees the patient within 2–3 working days, and writes to you and to the patient’s GP within 2 working days of the consultation. Most patients referred with a chest finding do not have an operation.

Last reviewed: October 2026 · Mr Lawrence Okiror FRCS(CTh) FRCSEd(CTh) · GMC 6150382 · ORCID 0000-0003-2446-9164

Refer a Patient → What Comes Back

10-second summary

Send the report, the images and one line of history to Jo Mitchelson, PA: 020 7952 2882 · pa@lungsurgeon.co.uk. Acknowledged within 24 working hours. Seen within 2–3 working days at London Bridge Hospital, The Lister Hospital Chelsea, Canary Wharf, the City of London, or by video. Clinic letter to you and to the GP within 2 working days. Outcome note when the question is closed. No financial arrangement of any kind attaches to referrals.

When to Refer

Which chest findings on screening imaging
warrant a thoracic opinion?

Refer when the report describes any of the following. The list is drawn from British Thoracic Society nodule thresholds and from the findings that whole-body and cardiac imaging produce most often. Where a report is equivocal and none of these applies, a telephone conversation with Mr Okiror is available before any referral is made.

The lungs

  • Solid or part-solid nodule of 6 mm or more
  • Any nodule that has grown between two scans, whatever its size
  • Persistent ground-glass nodule on a repeat scan
  • Lung mass or suspicious opacity
  • Emphysema or bullous disease in a patient who is breathless
  • Any nodule in a patient with a current or previous cancer

Patient page: a shadow on a lung scan → · ground-glass nodule → · lung cancer in never-smokers →

The mediastinum

  • Anterior mediastinal mass or “possible thymoma”
  • Middle or posterior mediastinal mass or cyst
  • Enlarged mediastinal or hilar lymph nodes without an obvious cause
  • Any mediastinal finding in a patient with muscle weakness, drooping eyelid or double vision

The pleura, chest wall and diaphragm

  • Pleural thickening, plaques or effusion
  • Rib, sternal or chest-wall lesion, or a lump the patient can feel
  • Recurrent or unexplained pneumothorax
  • Raised hemidiaphragm with breathlessness

And one situation that is not on any guideline. A patient who has been given a surveillance recommendation and cannot tolerate the uncertainty. A single consultation with the images on screen, an explanation of what the finding is and is not, and a stated interval with a stated end point settles this more reliably than a further scan. It is a legitimate reason to refer.

Three Things the Scan Did Not Settle

Why the scan that found it
is often the wrong scan to characterise it

Survey imaging is set up to cover the whole body or the heart, and the chest comes into view around that purpose. Three consequences follow, each with a published figure behind it and a patient-facing page that explains it in plain words for the person you are referring.

Whole-body MRI

Small nodules are missed

Pooled per-lesion sensitivity of MRI for nodules of 4 mm and above is 87.7%, falling to 80.5% below 8 mm and 57.1% at 4 mm and under, and those figures come from dedicated lung sequences that a whole-body screening protocol does not include. A chest reported clear on whole-body MRI has not had its lungs examined to CT standard. A finding on MRI that needs characterising needs a CT.

Patient page: a scan has flagged something in your chest →

Calcium score and CT coronary angiogram

The field of view stops at the heart

Nodules were reported in 13.9% of 2,479 CT coronary angiograms, 73% of them under 6 mm and 60% in never-smokers. When a full-chest ultra-low-dose CT was added to calcium scoring in 2,750 participants, nodules appeared in 38%, lung cancer in 1.16%, and 12 of the 32 cancers lay outside the cardiac field of view. 87% of nodules over 6 mm were benign.

Patient page: a nodule found on a heart scan →

CT in the anterior mediastinum

A fluid-filled cyst can read as a solid mass

A thymic cyst containing protein carries much the same density as a solid tumour on CT, and a normal or rebound thymus is common in adults. One quaternary centre reported that around 44% of thymectomies had been performed for benign lesions. Chemical-shift MRI separates hyperplastic thymus from tumour with reported sensitivity and specificity of 100% at the recommended threshold. It takes a few minutes and is not part of a screening protocol.

Patient page: a finding in the front of the chest →

What Happens Next

The five outcomes,
in order of frequency

The consultation is a review of the images, with the patient, against the history and any earlier imaging. It ends in one of five decisions. The first two account for most referrals.

1
Reassurance and discharge
A calcified granuloma, a hamartoma with fat on the images, a nodule below the guideline threshold, a nodule unchanged against a scan from years ago, a normal thymus. The letter says so, with the reasoning, so that it holds when the patient reads it again.
2
Surveillance at a stated interval, with a stated end point
Intervals follow the British Thoracic Society 2015 guideline and the Fleischner Society 2017 recommendations, with volumetry where the scanner allows it. The letter names the interval, the scan, and the point at which surveillance ends. An open-ended arrangement to keep scanning is not offered.
3
One targeted scan
A dedicated CT of the chest where the finding came from MRI or a cardiac field of view; chemical-shift MRI for an anterior mediastinal finding; PET-CT where a solid nodule is 8 mm or more and the risk score justifies it. One study aimed at the specific question, arranged locally where the patient lives at a distance.
4
Tissue diagnosis
Robotic navigational (ION) bronchoscopy at London Bridge Hospital for peripheral nodules, with cone-beam CT confirmation and same-day cytology; EBUS for central nodes; cervical mediastinoscopy as a day case where whole nodes are needed. In the Guy’s and St Thomas’ programme the pneumothorax rate after navigational bronchoscopy is around 2%. Ion bronchoscopy →
5
Surgical assessment
Robotic lung-sparing resection for confirmed or highly probable early lung cancer, with segmentectomy wherever the oncology allows; mediastinal, pleural and chest-wall surgery where indicated. For selected fit patients with a small peripheral lesion, biopsy and resection can be completed under one anaesthetic. Every surgical decision is preceded by discussion at the chest multidisciplinary team meeting. Combined biopsy and robotic surgery →
What Comes Back to You

The referring clinic hears the outcome,
on every patient

A clinic that reports an abnormality carries the responsibility for it until someone else has taken it on. Correspondence on this pathway is written so that the referrer can see that handover, and what came of it.

Step 1
Acknowledgement within 24 hours
Jo Mitchelson confirms receipt by email within 24 working hours, with the proposed appointment slot. Where the report raises a suspicious lesion the appointment is prioritised the same day.
Step 2
Consultation within 2–3 working days
London Bridge Hospital, The Lister Hospital Chelsea, Canary Wharf, the City of London, or video. The images are opened on screen with the patient. Earlier imaging is compared where it exists.
Step 3
Letter within 2 working days, outcome note at closure
A typed clinic letter to you and to the GP: the finding on review, the working diagnosis, the plan, the interval and end point. When the question closes, a short outcome note follows, including histology where there is any.

For reporting radiologists. The outcome note is written for the person who described the nodule: the finding as reported, the finding on review, the plan, and the histology or the operation where there was one. Where the plan is discharge, the note says so. A reporting radiologist who sends a patient on this route sees what the nodule was.

153
Personal anatomic resections
2024–25
80%+
Robotic or VATS
minimally invasive
635
Ion procedures GSTT
2024–25
99.59%
Operative survival rate
GSTT 2024–25

SCTS National Thoracic Surgery Audit 2024–25 and GSTT Thoracic Surgery Monthly Audit. Operative survival rate refers to survival of the operation, not long-term cancer survival. St Thomas’ Hospital #1 UK · Guy’s Hospital #2 UK · London Bridge Hospital #10 UK · Newsweek World’s Best Hospitals 2026.

Frequently Asked Questions

Questions From
Referring Clinics

Questions asked by imaging centres, screening and executive-health clinics, reporting radiologists and private GPs before sending a first patient.

Refer a Patient →

Or call Jo Mitchelson:
020 7952 2882

What should an imaging clinic send when referring a chest finding?
Three things: the radiology report, the images (a disc, a download link or PACS access details), and one line of history — age, smoking history, and whether any earlier chest imaging exists. Earlier imaging matters more than anything else that can be sent, because a nodule that was present and unchanged years ago answers most of the question on its own. Send to Jo Mitchelson, PA, at pa@lungsurgeon.co.uk or on 020 7952 2882. Receipt is acknowledged within 24 working hours with the proposed appointment slot. A formal referral letter is welcome but is not required to book the appointment; the report and images are what the consultation needs.
Does the patient need a GP referral before being seen?
No. Self-referrals welcome, and a referral from an imaging clinic, a screening doctor, a reporting radiologist or a private GP is accepted directly. Appointments are available within 2–3 working days at London Bridge Hospital, The Lister Hospital Chelsea, Canary Wharf and the City of London, and by video consultation for patients at a distance. The patient’s own GP is copied into the clinic letter unless the patient asks otherwise, so the NHS record stays complete whichever route the patient arrived by.
What does the referring clinic receive back?
A typed clinic letter within 2 working days of the consultation, sent electronically to the referrer and to the patient’s GP. It states what was found on personal review of the images, the working diagnosis, the plan, and the surveillance interval and end point where surveillance is the plan. When the question closes — discharge, a completed surveillance period, a biopsy result, or an operation — a short outcome note follows, so the clinic that found the abnormality knows what it was. Reporting radiologists rarely see what happened to the nodule they described; on this pathway they do.
Will private medical insurance cover a consultation for a finding on a self-pay screening scan?
Usually, yes. UK insurers generally exclude the screening scan itself when it was self-referred and the person had no symptoms. The position changes once the scan has reported an abnormality: from that point the consultation, and any imaging or biopsy arranged to characterise the finding, is the investigation of a clinical problem, and most policies cover it as such. Mr Okiror is recognised by AXA Health, Bupa, WPA, Vitality, Cigna, Aviva, Allianz, Saga, The Exeter and most other UK insurers. Jo Mitchelson confirms cover before the appointment and provides a written self-pay estimate where the patient prefers not to involve an insurer. Consultations from £250.
Will Mr Okiror comment on findings outside the chest?
No, and the boundary is stated to the patient plainly. Whole-body scans routinely report findings in the liver, kidneys, adrenal glands, prostate, spine and brain, and an opinion on those from a thoracic surgeon would not serve the patient. What the clinic letter does say is which of the extrathoracic findings look as though they warrant a specialist opinion and which are the common harmless ones, so that the referring clinician and the patient are not left to work that out from a report. The chest — lungs, mediastinum, pleura, chest wall and diaphragm — is dealt with in full.
Is there any financial arrangement between the referring clinic and the practice?
None. No referral fee, commission, discount, reciprocal arrangement or introduction payment attaches to any referral in either direction, and none will be offered or accepted. General Medical Council guidance is explicit that referral decisions must not be influenced by financial incentives, and the pathway is built on clinical access, speed, personal image review and a closed loop of correspondence rather than on any commercial tie. Declaration: speaker fees from Pulmonx relating to endobronchial valve use in air leak, most recently December 2023; no current relationship.
Is there a lung nodule clinic in London that accepts referrals from imaging and screening clinics?
Yes. Mr Okiror runs a lung nodule and abnormal chest imaging service across London Bridge Hospital, The Lister Hospital Chelsea and outpatient clinics at Canary Wharf and the City of London, and accepts referrals directly from private imaging centres, health-screening and executive-health clinics, reporting radiologists and private GPs. Where tissue is needed, robotic navigational (ION) bronchoscopy is performed at London Bridge Hospital; where surgery is needed, robotic lung-sparing resection follows under the same consultant. Uncertain cases are discussed at the chest multidisciplinary team meeting before any surgical decision. Most nodules referred do not need either.

Related pages

Your Patient Has a Lung Nodule

BTS thresholds, Brock limitations and the referral triggers for GPs and physicians

 For GPs

Every condition accepted, insurers recognised, and the referral letter assistant

 GP Briefing: Lung Nodule

The clinical briefing and downloadable PDF for referring practices

 A Scan Has Flagged Something in Your Chest

The patient page: what each scan sees well, what it misses, and which second test settles it

 A Nodule Found on a Heart Scan

Calcium score and CT coronary angiogram: how common, how often benign, and what the field of view leaves out

 A Finding in the Front of the Chest

Possible thymoma on a screening scan, and the MRI sequence that settles it

 Positive Cancer Blood Test, Normal Scan

What the chest half of that question can and cannot settle

 Chest Imaging Explained

What CT, MRI, PET-CT and VQ SPECT-CT each contribute at each stage

 Ion Robotic Bronchoscopy

Tissue from peripheral nodules without an incision, as a day case

 Combined Biopsy and Robotic Surgery

Diagnosis and resection under one anaesthetic for selected patients

 Lung Nodule Precision Pathway

From scan result to definitive answer in days: the integrated private pathway for a referred nodule

 Shadow on a Lung Scan

Patient page for the person you are referring — what a shadow can be and how risk is scored

 Ground-Glass Nodule

Surveillance intervals, the solid-component trigger and when segmentectomy is the answer

 Lung Cancer in Never-Smokers

Why an incidental nodule in a never-smoker is not dismissed, and the pathway that follows

 A Nodule After a Previous Cancer

Why the standard size intervals do not apply once there is a cancer history, and what is done instead

 Second Opinion

Independent review of imaging and diagnosis, within 2–3 days

Send the report and the images.
Mr Okiror reviews them personally.

Acknowledged within 24 working hours. Seen within 2–3 working days. Clinic letter to you and to the GP within 2 working days. Outcome note when the question is closed.

Refer a Patient → For GPs

Jo Mitchelson, PA  · 020 7952 2882 · pa@lungsurgeon.co.uk

St Thomas’ Hospital #1 UK · Guy’s Hospital #2 UK · London Bridge Hospital #10 UK · Newsweek World’s Best Hospitals 2026

✉Refer 📞020 7952 2882