RSNA: Oncologists require more teamwork with rads (Part 2 of 4)

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CHICAGO—Radiologists need to approach referring physicians with diverse communication and collaboration strategies. RSNA outlined specific details of four specialists’ needs during the What the Referring Physician Needs to Know session presented Nov. 28 at the 96th annual scientific meeting of the Radiological Society of North America (RSNA).

Health Imaging News will share referring physicians’ wish lists in a four-part series during RSNA week. Part 2 details the oncologists’ needs.

Moderated by Mary C. Mahoney, MD, director of breast imaging at University of Cincinnati in Ohio, the four-part session queried a variety of physicians to help radiologists better understand how to meet their needs. Mahoney asked the four physicians to respond to five questions:

  • What information do you like to see in radiology reports?
  • How do you want important results communicated to you?
  • Would you like radiologists to speak to patients about clinical findings (or lack thereof) on an imaging exam?
  • How do you figure out the correct imaging exam?
  • Do you know about American College of Radiology (ACR) Appropriateness Criteria?

The medical oncologist’s perspective

Unlike family practice providers profiled in part 1, medical oncologists provide very subspecialized care and have very specific needs from radiologists, shared Mary F. Mulcahy, MD, an assistant professor of hematology and oncology at Northwestern University Feinberg School of Medicine in Chicago.

Mulcahy divided her needs according to a clinical timeline. During the initial evaluation and staging process, oncologists need to know if there are metastases, whether the primary tumor is resectable and if there might be an impending catastrophe such as an occult pulmonary embolism. Later in the clinical process when the oncologist is evaluating the patient’s response to therapy, she needs information about new lesions, changes in target lesion size, changes in density perfusion and necrosis and an evaluation of signs or symptoms.

Mulcahy suggested that radiologists speak to patients if they are acquainted with the clinical plan. Otherwise, a conversation between a radiologist and patient might confuse or stress the patient.

The oncologist shared two cases to illustrate how radiologist might create useful reports for her colleagues. In the first case, a patient with a pancreatic mass, the oncologist needed to determine if the mass was resectable according to National Comprehensive Cancer Network (NCCN) guidelines, which lean heavily on imaging data.

The model report, indicated Mulcahy, contains all of the salient features needed to discuss treatment options with the patient. Specifically, it covers the pancreas with an assessment of adjacent vasculature and lymph nodes to determine respectability. A detailed radiology report with images is the basis for an intelligent conversation with patient and surgeon, offered Mulcahy.

The second example, a patient with metastatic colon cancer on clinical trial, required that the oncologist adhere to clinical trial guidelines. Specifically, she needed to identify target lesions to assess response to therapy according to a predefined rule set that hinges on measurements of target lesions on serial images.

“Clinical trial patients require objective data,” she stated. Specifically, the protocol requires oncologists to sum the longest diameters of the target lesions to indicate response with progressive disease defined as a 20 percent increase from the smallest sum of the longest diameter, partial response defined as a 30 decrease from baseline measurements and stable disease as the area in the middle.

Mulcahy pointed out the bi-directional nature of collaboration, acknowledging that radiologists need clinical information from oncologists in new diagnoses, staging, resectability determination and response to therapy assessment. She suggested that oncologists provide patient and disease data to radiologists via the EMR, collaborative imaging review—either face-to-face or via a web-based PACS and through participation in tumor boards.

These strategies set the stage for collaborative ordering, where radiologists could offer oncologists advice about what tests to order. Ultimately, comprehensive specialist-specific collaboration could help oncologists provide better patient care.