european society of radiology

8/13/2019 European Society of Radiology

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E u r o p e a n S o c i e t y o f R a d i o l o g y

MIKING

CNCERVISIBLE

e

ro eom n n


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INTERNATIONALDAYOF

u!li"hed !y the

ESR # European Society of Radiology In

cooperation with

ES$I # European Society of $ncologic Imaging

$cto!er %&'%

Coordination(

ESR $ffice) Neutorga""e *)'&'& Vienna) +u"tria

hone( ,- ./'0 1// .& 2.#& 3a4( ,-./'0 1//.&2.#

..' E#Mail( communication"5myESR6org7776 myE

SR6org

Managing Editor: 8ulia atu99i Editors: Sim:n

Lee) Michael Crean

Contributing Writers: Michael Crean ,Chapter 10) Sim:n Lee ,Chapter /0) M;li"ande Rouger ,Chapter '-.0) i9?a ,Chapter %0Art

Direction & Layout: Ro!ert un9 Photo Credits: "ee page *.

@he logo for the Inter natio nal


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An Introduction Page 4Prevention creening

'6@he =alu; of "creening in cncer care

%6National "creening programme"( o!Decti=e" and reality

/6atient information

.6 @hing" to ?eep in mind !efore an e4amination i" carried out

163uture de=elopment"

Page !age age '' age'% age'.

age'F

Detection'6 Medical imaging in the detection of cncer

%6@he role and "?ill" of the radiologi"t

/6@he communication flo7

.6 Informing the pu!lic

163uture de=elopment"

Page"#age %' age %. age %F age %

age /&

taging'6@he importance of "taging

%6@he radiologi"t ta?e" centre "tage

/6@he communication chain

.6Loo?ing for7ard

Page $$age /. age /2 age / age .&

%reatent & %herapy'6@reatment monitoring 7ith imaging( "a=ing time

%6@he gro7ing u"e of image#guided therapie"

/6Inter=entional radiology and minimally in=a"i=e treatment"

.6 3uture de=elopment"

Page 4$age .. age .2 age . age 1&

'o((ow)up Care'6@he importance of follo7#up care

%6@ool" of the trade

/6@he radiologi"t" role

.6 Ahat the pu!lic "hould ?no7 a!out imaging in follo7#up care

Page *$age 1. age 12 age 1* age 2&

About the Interviewees Page +$

,(ossary Page +#


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Ma?ing Cncer Vi"i!le(he Role of Imaging in

$ncology Cncer) in all of it" more#than#%&& form") i" one of theleading cau"e" of death 7orld7ide6 +ccord# ing to theAorld Health $rgani"ation) the di"ea"e accounted for

around '/ of all death" in %&&6


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are=end:n

1. THE VALUE OF SCREENING IN CANCER CARE2. NATIONAL SCREENING PROGRAMMES:OBJECTIVES AND REALITY3. PATIENT INFORMATION4. THINGS TO KEEP IN MIND BEFORE AN


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Radiology" role i" central to cncer man#

agement) 7ith a 7ide choice of tool" and

techniJue" a=aila!le for the detection) "taging

and treatment of the di"ea"e6 But 7hat i" le""

7ell ?no7n i" the =alu; of medical imaging in

recogni"ing early man# ife"tation" of cncer

and "mall clinically undetecta!le tumour"

!efore they !ecome clinically apparent a

capacity that pu"he" radiology to the fore of

oncologic care6

Medical e4pert" agree that mo"t cancer" can

!e dealt 7ith effecti=ely if detected early In

thi" re"pect) imaging i") "econd only to la!

te"t") 7hen it come" to the mo"t =alua!le tool"

cncer care team" ha=e at their di"po"al6 Inparticular) different radio# logical te"t" ha=e

!ecome =ery helpful in "creening a" they can

"ho7 precancerou" le"ion" !efore they !ecome

malignant and cau"e "ymptom"6

Early detection and pre=ention of di"ea"e ha"

!ecome crucial in the fight again"t cncer)

e"pecially in people at higher r i"? of

de=eloping malignancy) a part of the general

population that 7ill continu; to gro7 7orld7ide

in the decade" to come6

$f cour"e) there i" noguarantee that radiology

can pre=ent cncer !eforeit i" there) !ut it i" oftremendou" help in

detecting precancerou""ituation" li?e colonic

polyp" and li=er cirrhoticnodule"6 If 7e detect atumour early) it may ma?etreatment much "impler

and cheaper and may e=en"a=e li=e"

rof6 =e" MenO 3rance

@here are many 7ay" for radiologi"t" to

identify the early "ign" of an indi=idual

de=eloping cncer6 $f the =ariou" tool"

a=aila!le) tho"e that u"e 4#ray technology)

"uch a" mammography for !rea"t cncer

"creening) are "tandard e4amination"6

Recently) multidetector computed tomo#

graphy ,C@0) a computeri"ed imaging tool

7hich i" u"ed to create /< image" !a"ed on 4#

ray") ha" "ho7n it" "trength in applica# tion"

"uch a" colorectal cncer "creening6

Multidetector C@ i" no7 !eing u"ed much more

freJuently in the detection of pre# malignant

le"ion") "o#called polyp") in the large !o7el)

the di"co=ery # follo7ed !y endo"copic

re"ection # of 7hich may "ig# nificantly impro=e

patient progno"i" !y prompting appropriate

management6

@he !enefit" of "creening ha=e !een pro=en

repeatedly "ince it" introduction6 Mam

mography "creening ha" helped reduce !rea"t

cncer mortality !y /&) according to a recent

"tudy) 7hich 7a" conducted o=er almo"t three

decade"'6

+ recent National Lung Screening @rial ,NLS@0

in the Pnited State" "ho7ed a reduc# tion of

%& in lung cncer mortality among hea=y

"mo?er" 7ho 7ere "creened 7ith lo7#do"e

"piral C@ =er"u" tho"e "creened 7ith traditional

che"t 4#ray6

@hi" add" to e4i"ting"ucce""ful imaging"creening "tudie" "ucha" !rea"t and colon6

Aithout Jue"tion) earlydetection of di"ea"e i"greatly impro=ed 7ithimaging6


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MAKING CANCER VISIBLE PREVENTIONTHE ROLE OF IMAGING IN ONCOLOGY AND


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Mo"t countrie" ac?no7ledge the importance of

running national "creening pro# gramme" for

certain group" of patient"6 Ho7e=er) today) the

only 7ide"pread "creening programme" are for

!rea"t cncer in 7omen u"ually aged roughly

!et7een .& and F.) 7ho repre"ent the group

7ith the highe"t ri"? of de=eloping cncer6

Large "erie" "eem topro=e the !enefit of "uch a

"creening) at lea"t in acarefully "elected

population6rof6 =e" MenO) 3rance

Screening practice" =ary con"idera!ly from

one country to another6 Ahile Korea offer"

"creening on a national le=el for "tom# ach)

li=er) colorectal) !rea"t and uterine cer=i4

cncer) the mo"t common type" in that

country) China and South +frica) for e4ample)

do not yet ha=e any e"ta!li"hed national

"creening programme"6 Mo"t countrie" in

+merica and Europe operate

"creening programme" for !rea"t and cer=ical

cncer) and many of tho"e 7ho ha=e not

already launched nation7ide programme" for

colorectal cncer are plan# ning to introduce

them "oon6 Lung cncer i" al"o under

e=aluation a" a po""i!le "u!# Dect of "creening

in many countrie"6

Setting up a national "creening pro# gramme i"

a comple4 ta"?) partly !ecau"e it i" difficult to

define preci"e target group" 7ith age limit")

"imilar clinical hi"torie") and =ariou" other

characteri"tic"6 Guide# line" for "creening are

determined locally and !a"ed on the re"ource"

of healthcare "y"tem") the health concern" of

the population) and cultural attitude" and

prioritie"6

High rate" of under#reported di"ea"e pre"# ent

another challenge in collecting clear and

relia!le figure") 7hile re"tricted acce"" to the

late"t technology remain" a pro!lem in many

part" of the 7orld6 @he a!"ence of adeJuate

tool" for detecting early or pre# cancerou"

condition" i" all the more alarm# ing in poorer

countrie") 7here cncer inci#

dence i" e4pected to increa"e !y a" much a"

*& !y %&/&) according to a recent "tudy %6

In mo"t de=elopingcountrie") acce"" to

"creening i" e4tremelylimited or e=en non#

e4i"tent6 Gi=en that cncerincidence i" e4pected to

ri"e dramatically in "ome ofthe"e countrie" in the

coming decade") the glo!almedical community "hould

7or? together to defineminimum "creening

recommendation" for allcountrie" and to pro=ide

the nece""ary re"ource" #including eJuipment andtraining # for e""ential

"creening programme"6rof6 Hed=ig Hrica?) PS+

%@he "tudy QGlo!al cncer tran"ition" according to the

Human


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PATIENTAithout "uch glo!al guideline" or nation# 7ide

"creening programme") it i" all the more

important to pro=ide clear recom# mendation"

to patient"6 Some people are more at ri"? than

other" due to their clini# cal hi"tory or family

!ac?ground) and doc# tor" can ad=i"e them on

ho7 to proceed to a=oid any future

complication"6

eople 7ho ha=e high ri"?factor") "uch a" a family

hi"tory of particularcancer" and "ome relatedgene carrier") "hould !e

"creened

It i" generally accepted that people aged o=er

11) 7ith a "mo?ing hi"tory of one pac? per day

o=er /& year") and former "mo?# er") 7ho ha=e

Juit 7ithin the la"t '1 year")

"hould !e "creened for lung cancer6 3or 7omen

7ith a lifetime cancer ri"? of %& or greater)

for in"tance 7omen 7ith a genetic ri"?) a

!rea"t e4amination 7ith magnetic re"onance

imaging ,MRI0 i" recommended6 eople 7ith

li=er cirrho"i" andor hepatiti" B or C =iru"

"hould !e "creened to detect any "ign" of li=er

cancer6

eople can o!tain information a!out "creening

from their general practitioner")

gynaecologi"t") urologi"t") and any other

"peciali"t) 7ho "hould !e a!le to ad=i"e 7hen

to "creen and for 7hat6 Some patient" may

al"o !enefit from their companie" medical

in"urance) 7hich in "ome coun# trie" may

co=er the annual health#chec? for their

employee" o=er a certain age6 @he "ucce"" of

"creening depend" entirely on ho7 7ell#informed the pu!lic i" and on the health

policie" of each country6

ro=iding the pu!lic 7ithcomplete information i"really a ?ey i""ue for the"ucce"" of a "creeningcampaign6 Ha=ing the

patient a" a partner ma?e"e=erything ea"ier rof6 =e" MenO) 3rance

u!lic a7arene"" campaign" play a maDor role

in thi" dialogue) and the participation of

in"titutional partner" i" highly de"ir# a!le6

Healthcare "ta?eholder" and cancer patient

"ocietie" "hould !e incorporated into the"e

campaign"6

Information i" al"o ?ey to impro=ing pu!lic

healthcare6 @he more informed the pu!lic i")

the li?elier they are to pu"h their go=#

ernment" to ta?e action6


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3al"e po"iti=e diagno"i"may re"ult in o=er#

in=e"tigation of 7hatultimately turn" out to !e a!enign condition6 @hi" can

in turn re"ult inunnece""ary an4iety in thepatient and unnece""ary

@he !e"t option for patient" i" to di"cu"" all

the"e i""ue" directly 7ith their doctor") 7ho

"hould inform them of all the po""i!le ri"?") a"

7ell a" the !enefit") !efore deciding to

undergo "creening te"t"6 atient" "hould ?no7

that "creening i" not perfect it may not detect

e=ery cncer) !ut it can detect cncer early

enough to achie=e remi""ion6

l3#fluorodeo4ygluco"e ,3


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;

+ /#dimen"ional image from a neuro"urgical na=igational"y"tem) 7hich allo7" the neuro"urgeon to "ee functional

information during the operation6 @he tumour i" in yello76 @hemotor corte4 ,the part of the !rain that Control" motorfunction0 i" in red6 urple indicate" the large =ein" o=erlying the

FUTUREImaging techniJue" ha=e "ignificantly

impro=ed in recent decade"6 +" technolo# gie"

are con"tantly !eing refined) imaging

modalitie" 7ill !ecome e=en more accurate

and relia!le in the future6 Lo7# do"e che"t

"piral C@ in lung cncer "creening i" =ery

promi"ing6 But there are "till enormou"

challenge" and Jue"tion" to !e an"7ered

!efore thi" techniJue can !e appro=ed for u"e

around the 7orld6 $ne of the main pro!lem"

remain" the "ig# nificant di"parity in acce"" to

and u"e of tool" for pre=ention and early

detection of cncer6

It i" de"ira!le to de=elop"trategie" to ena!le ne7

technologie" to !eimplemented uni=er"ally inorder to reduce mortality6


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etection

1. MEDICAL IMAGING IN THEDETECTION OF CANCER2. THE ROLE AND SKILLS OF THERADIOLOGIST3. THE COMMUNICATION FLO!


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Imaging play" a maDor role in the detection of

cancer a" it pro=ide" a detailed in"ight into the

e4act location and e4tent of the di"ea"e6 It can

al"o pro=ide detailed information a!out

"tructural or cancer#related change"6 Emerging

method" of molecular imaging) 7hich com!ine

traditional imaging technology and nuclear

medicine tech# niJue") can al"o !e u"ed to

o!tain more detailed information a!out

a!normalitie") including their di"tinct

meta!oli"m6

@here are =ariou" 7ay" to detect cancer u"ing

imaging method"6 Cancer may !e detected

incidentally) 7hen an e4amina# tion i" carried

out for other rea"on") or there may !e clear

"ymptom" and the patient may undergo

imaging to confirm) l:cate) and determine the

e4tent of the di"ea"e6 +nother po""i!ility i" of

cour"e the detec

tion of a malignancy 7hile participating in a

"creening programme6

Certainly radiology i" !yfar the !e"t method forcancer detection in themaDority of cancer"6Ho7e=er) the =a"tmaDority of tumour" areonly apparent 7ith anad=anced te"t) e"peciallyat the initial "tage) andradiology i" certainly the

Modern medical technology offer" a 7ide

range of imaging method" to imaging "pe#

ciali"t"6 Aell ?no7n method" u"ed for the

detection of cancer are ultra"ound ,PS0)

computed tomography ,C@0) magnetic re"#

onance imaging ,MRI0 and mammography) the

latter !eing u"ed "pecifically to detect !rea"t

cancer6

@he techniJue of choicedepend" on the type and"ite of the cancer6 +ll ofthe"e modalitie" pro=ide

cro""# "ectional anatomicalimage"6 PS and C@ are

generally le"" e4pen"i=eand more 7idely a=aila!lethan MRI and are therefore

u"ed more freJuentlyaround the 7orld6

rof6 Hed=ig Hrica?) PS+

In many ca"e" cancer i" identified !a"ed on

the di"co=ery of a!normalitie" in the


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appearance of "oft ti""ue and !one6 But there

are al"o functional imaging tech# niJue") 7hich

detect phy"iological or functional change")

"uch a" "pecific change" in !lood flo7 that can

al"o "ignify the pre"# ence of cncer6

+ =ery promi"ing "et of imaging techniJue" are

a=aila!le to radiologi"t" through the method"

of molecular imaging) 7hich dif# fer" from

traditional imaging in that !io# mar?er pro!e"

are u"ed to target "pecific area" or "u"piciou"

finding"6 In general) a !iomar?er i" anything

that can !e u"ed a" an indicator of di"ea"e or

change" in the human !ody) 7hich interact"

chemi# cally 7ith it" "urrounding" to produce

an effect that can then !e "een on the "creen6

In compari"on to other method" 7hich "ho7

change" in "i9e) den"ity or 7ater conten) theradiologi"t can o!"er=e molecular

change") 7hich open" up a completely ne7

field of po""i!ilitie" "uch a" earlier detec# tion

and !etter under"tanding of tumour

de=elopment6 $ne of the mo"t promi"ing

molecular imaging techniJue" i" po"itron

emi""ion tomography ,E@0) 7hich i" mo"t

often com!ined 7ith C@ ,E@#C@0 and u"ed to

trac? pro!e" in order to detect meta# "tatic

di"ea"e6

Ahen it come" to the characteri"ation of a

finding) or the differentiation !et7een a

malignant or !enign a!normality) it i"

"ometime" difficult to reach a final diagno"i"6

@o a=oid unnece""ary in=a"i=e pro# cedure"

and "a=e the patient further di"comfort) a

compari"on of =ariou" image") often o!tained

through different method") i" the fir"t "tepto7ard" a final diagno"i"6 If a definite diagno"i"

"till cannot !e made) a !iop"y) 7here "mall

part" of the a!normal#


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ity are collected for further e4amination) i"

nece""ary6

Side#effect" may occur and =ary depend# ing

on the method u"ed and the area of the !ody

to !e e4amined6 @he u"e of con# tra"t agent"

may cau"e allergie" and may po"e ri"?" to

patient" 7ith renal in"uf# ficiency6 @echniJue"

"uch a" PS and MRI do not entail any radiation

e4po"ure and are generally con"idered to !e

=ery "afe6 In "ome "ituation" ho7e=er) MRI i"

not recommended) for in"tance in patient" 7ith

a pacema?er or other metallic implant)

!ecau"e of the magnetic field u"ed during the

e4amination6 Method" li?e 4#ray and C@) on the

other hand) e4po"e the patient to ioni"ing

radiation6 Radiologi"t" al7ay" u"e the lo7e"t

radiation do"e po"# "i!le to get the de"ired

re"ult" and mod# ern imaging de=ice" are

con"tantly !eing

impro=ed to generate higher re"olution image"

7hile "ignificantly decrea"ing the amount of

radiation and e4po"ure time6

Effect" on the patient can!e con"idered a" related todi"comfort during the te"t)

u"e of contra"t agent")irradiation and directlyin=a"i=e te"t" "uch a"

!iop"ie"6 Radiation effect"are from ioni"ing radiation

from 4#ray and C@6 Effect"are proportional to thedo"e of radiation andcumulati=e effect" ofmOltiple e4amination"

although the"e are "eldomrele=ant in daily practice6


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THE ROLE AND THE SKILLS

@he radiologi"t i" li ?ely to !e the fir"t per# "on

to detect a tumour !a"ed on either clear

"ymptom" or pre=iou" "u"picion"6 Imaging

"peciali"t" al"o detect cncer during routine

"creening and are the mo"t e4perienced

phy"ician" in choo"# ing from a 7ide range of

a=aila!le imaging techniJue" in order to get

the !e"t re"ult"6 Ahen a tumour or an

a!normal# ity i" detected) the fir"t ta"? of the

radiologi"t i" to identify the e4act location of

the tumour and the e4tent of the di"ea"e6 +fter

the detection of cncer) the radiologi"t

interpret" the cro""#"ectional image" of the

patient) ma?e" the diagno"i" and determine"

the "tage and e4tent of the di"ea"e !a"ed ontheir finding"6

Image interpretation i" the

mo"t =i"i!le contri!ution ofradiologi"t"6


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+ lot of communicationta?e" place 7ith the clinicaloncologi"t" and "urgeon")u"ually in the conte4t ofregular multidi"ciplinary

committee meeting"6Ho7e=er) it i" good practice

to communicate 7ithcolleague" 7ho ha=e

referred patient" fore4amination" and)o!=iou"ly) are in charge of

the patient6 @hi"communication can !e !y

telephone) e#mail or


25/74

Characteri"ation ofeJui=ocal ultra"oundfinding" ,not "ho7n0

7ith C@6 C@ of the?idney "ho7" a cy"tic"tructure in the left?idney ,7hite arro706Ho7e=er)thi" i" not a"imple cy"t6 C@demon"trate" a "olidnodule ,green arro70)7hich i" "u"piciou" for


26/74

Ahen the final diagno"i" i" reached and

clarified) the ne4t "tep i" to inform the patient

of their condition and the further "tep" and

treatment option" a=aila!le6 +t thi" "tage) the

role and the in=ol=ement of the radiologi"t =ary

and are "trongly depen# dent upon the local

"ituation6 In mo"t ca"e" it i" referring

phy"ician" 7ho 7ill inform the patient a!out

the re"ult") a" they are generally the people

7ho ha=e the mo"t detailed ?no7ledge of the

patient" medical hi"tory6 @here are al"o ca"e")

7here the final diagno"i" can only !e reached

!y performing a pathological te"t) 7hich

e4elude" the participation of a radiologi"t6 But

the con=entional !ac?ground role of the

radiologi"t i" changing "lightly a" the

multidi"ciplinary approach and patient"

demand" ma?e the radiologi"t more and

more in=ol=ed6 Ahen 7or?ing in multidi"#

ciplinary team") the attending phy"ician often

reJue"t" that the radiologi"t !e pre"# ent 7hen

the patient i" informed of a find# ing) "o that

"pecific Jue"tion" regarding imaging can !e

an"7ered !y a "peciali"t6

@he radiologi"t i" in many ca"e" the fir"t

per"on to detect a tumour) !ut rarely the one

7ho inform" the patient6 But the radiologi"t i"

"ti ll left 7 ith a degree of per"onal

re"pon"i!ility a" the patient ha" to !e ad=i"ed

to "ee their attending phy"ician Juic?ly to

di"cu"" their diagno"i" and further option"6 He

"hould ma?e it clear to the patient that they

"hould "ee? further treatment and "ee their

doctor6 In the"e "itua# tion") patient" might

al"o a"? the radiologi"t directly for clear

information6

3or in"tance) if a cnceri" detected) the patient"hould !e =ery clearly

encouraged to con"ult hi"referring clinician =ery

"oon in order to organi"ethe medical "trategy6More and more the

patient" a"? for clearly"hared comprehen"i=einformation6 Ho7e=er)

thi" i" not a "imple"ituation) !ecau"e it maychange the patient" life)

"o the 7ay theinformation i"

communicated "hould !e


27/74

Computedtomography image ofthe che"t u"ing lo7

Aith imaging !eing one of the maDor play# er"

in the fight again"t cancer) it i" impera# ti=e

that the pu!lic !e 7ell informed a!out it"

!enefit" and po""i!ilitie"6 @he early detection

of cancer) i t" progno"i" and detai led

information a!out the e4tent of the di"ea"e

7ouldnt !e a=aila!le to patient" 7ithout

medical imaging6 +ll further treatment

deci"ion" are !a"ed on the"e finding"6

@here i " al"o a need to inform the pu!lic a!out

the 7ide range of imaging tech# niJue"

a=aila!le and 7hich are the !e"t diagno"tic

te"t" for a "pecific cancer or condition6 More

recently de=eloped method" "uch a" E@#C@

are not 7ell ?no7n to patient") !ut !ring

crucial !enefit" to the field of oncologic

imaging6

Information on the a=aila!ility of the dif# ferent

method") 7hether they are a=aila!le at all or

only in "peciali"ed ho"pital depart# ment")

7ould ma?e it ea"ier for patient" to con"ider

their option" 7hen they ha=e to

undergo a "pecific procedure6 It i" al"o in the

pu!lic" !e"t intere"t" to !e a7are of the "pe#

cific co"t" of imaging and 7hether a referral i"

needed if they 7ant to "ee a "peciali"t or

undergo a "pecific imaging e4amination6

Be"ide" all the information on the !enefit" of

modern imaging) the pu!lic "hould al"o !e

made a7are of the po""i!le di"ad=an# tage"and "ide effect" 7hich go hand in hand 7ith

"ome techniJue"6 Some method" e4po"e the

human !ody to larger amount" of radiation

than other" and "ome "uch a" ultra"ound and

MRI u"e no radiation at all6 It i" important for

patient" to !e a7are of tho"e fact" in order to

under"tand 7hy the radiologi"t ha" to decide in

each indi=idual ca"e 7hich method i" the mo"t

appro# priate6 @hi" i" particularly important for

patient" 7ith "pecial condition") 7ho may for

in"tance !e allergic to contra"t agent" or ha=e

meta l implant" ) in the ca"e of MRI

e4amination6 regnancy al"o limit" the u"e of

"ome method"6


28/74


29/74

@he population"hould !e informed

a!out the importanceof imaging in cncer

detection6 @hu" thepopulation 7ill !e a!eto reJuire that healthauthoritie" ta?e action

aimed at

implementing cncer

FUTURE

Medical imaging "trongly depend" on tech#

nology) "o progre"" and further de=elop# ment"

in the field of imaging technology are =ital to

the progre"" of the di"cipline it"elf6 $=er the

la"t .& year") there ha=e !een maDor

inno=ation" in the field of medical imaging)

"uch a" C@ and MRI) 7hich currently achie=e a

high le=el of diagno"# tic accuracy and "patial

re"olution 7hen com!ined 7ith the method" of

molecular imaging) 7hich i" for many

radiologi"t" the mo"t promi"ing tool for the

future6

@he =ery early "tage" of cncer and other ill#

ne""e" "hould then !ecome detecta!le u"ing

cu"tomi"ed !iomar?er" 7hich can detect the"malle"t trace" of the di"ea"e6 @he u"e of

radiola!elled gluco"e in com!ination 7ith

E@) 7hich i" a!le to produce a /< image of a

functional proce"" in the !ody) ha" !ecome an

integral part of cncer diagno"i"6 +" tumour" or

inflammation u"e up high le=el" of gluco"e) the

radiologi"t can ea"ily trac? the location and

"pread of the di"ea"e6

But it i" not only ne7ly de=eloped method"

that !ring a!out impro=ement" in cncer

detection e"ta!li"hed method" "uch a" MRI

al"o ha=e a lot to offer6 +t the moment mo"t

MR de=ice" operate at a magnetic field#

"trength of '61 and / @e"la) !ut in e4periment"

"trength" of up to '' @e"la ha=e !een achie=ed

and pro=ide e4tremely high Juality image"6


30/74

Brea"t MR imageof In=a"i=eLo!ular

E@#MR i" a cutting#edge imaging modality and ha"!een relea"ed !y "ome =endor" =ery recently6 Comparedto E@#C@) E@#MR pro=ide" a !etter !ac?ground image

7ith impro=ed "oft ti""ue contra"t 7ithout radiatione4po"ure6 Moreo=er) integration of molecular and

functional information generated from E@ and MR couldpro=ide u"eful information in characteri"ing the cncer6

rof6 Hiro"hi Honda) 8apan

re"ult") and 7ill certainly "ee further de=el#

opment" that 7ill aid under"tanding of the

function) "tructure and e=olution of ti""ue" li?e

cncer 7hen treatment i" admini"tered6

It i" of cour"e hard to predict ho7 ne7 method"

or de=ice" 7ill influence onco#

logic imaging and 7hen patient" 7ill !en# efit

from it6 Ahat can !e "aid for "ure i" that

imaging 7ill !ecome an e=en more po7er# ful

cncer detection tool in the future e"pe# cially

7hen !iomar?er" and molecular method" ha=e

!een de=eloped to their full potential6


31/74

C@ for tumour "taging C@ ina patient 7ith long#"tandingupper a!dominal pain "ho7"a large) ad=ancedpancreatic cancer ,arro7"0)7hich infiltrate" the

"urrounding =e""el"6 @hecancer 7a" found to !eunre"ecta!le !ecau"e of the


32/74

taging

1. THE IMPORTANCE OFSTAGING2. THE RADIOLOGIST TAKESCENTRE STAGE


33/74

@here are many clinical factor" that might rai"e

the initial "u"picion of cncer) and there are

=ariou" method" u"ed to con# firm it" pre"ence

in one form or another6 @he actual diagno"i" of

cncer i" generally made through la!oratory

te"t" of a ti""ue "ample collected through

!iop"y or "ur# gery) the need for 7hich i"

u"ually deter# mined !y !lood te"t") imaging)

or !oth6 So) imaging alone cannot pro=ide

definite diagno"i") !ut it =ery often help"

doctor" to reach their conclu"i:n6

+" the pre=iou" chapter e4plained) radiol# ogy

pro=ide" =ital tool" for detecting and

characteri"ing tumour" that ha=e !een

e=idenced =ia other method") !ut it i" al"o

e4tremely u"eful in ta?ing the ne4t "tep6 Being

a!le to =i"uali"e the e4act location of a

"u"pected tumour allo7" doctor" to clo"ely

e4amine the "urrounding area) pro=iding a fir"t

impre""ion of 7hether or not any potential

cncer may ha=e "pread) and if "o) ho7 far6

Not only doe" thi" mean doctor" can =i"ually

pic? the !e"t point in that area for the !iop"y

"ample to !e ta?en from) !ut it al"o pro=ide"

the fir"t hint" a" to the Q"tage of 7hat may

later !e con# firmed a" cncer6

$nce a hi"tologicdiagno"i" i" made)imaging i" the ?ey

diagno"tic tool u"ed to"tage the cncer # that i")

to determine e4actly7here the primary tumouri" located and ho7 far the

cncer ha" "pread6 3or"ome tumour") imaging

finding" are "till"upplemented !y finding"from "urgery # !ut 7ith thecontinuou" ad=ancementof cro""#"ectional imagingand the de=elopment of

molecular imaging)"taging laparotomy i"!ecoming o!"olete6+ccurate "taging i"

e""ential in order to "electthe appropriate treatment6

@hu") !y "taging cncer)radiologi"t" and other

imaging "peciali"t"


34/74

+" rof6 Hrica? "ay") a" "oon a" cncer i" diag#

no"ed) the mo"t important thing to e"ta!li"h)

7hich 7ill determine the fir"t "tep" of treat#

ment # if not the entire treatment plan # i" the

preci"e e4tent of the cncer6


35/74


36/74

Chemicale4change"aturation

tran"fer ,CES@0ima in of a

@he !road range of radiological tool" and

techniJue" a=aila!le mean" radiologi"t" can

choo"e ho7 to e4amine the !ody 7hen "tag ing

cancer6 @he deci"i:n of 7hich method to u"e

can !e influenced !y =ariou" factor") "uch a"

the area of the !ody 7here the pri# mary

tumour i" located) the area" to 7hich cancer i"

mo"t li?ely to "pread) the "en"iti=# ity of the

patient to radiation ,influenced !y age)

phy"ical condition) pregnancy) etc60 and) in

"ome ca"e") the co"t of the e4amination6

C@) E@#C@ and) increa"ingly) MRI are perhap"

the mo"t commonly u"ed method" employed in

"taging) particularly 7here a 7hole#!ody e4am

i" reJuired) !ut other techniJue" "uch a"

ultra"ound) 4#ray) and mammography are al"o

commonly u"ed6 +"ide from the"e method") all

of 7hich are u"ed to loo? in"ide the !ody from

out"ide) doctor" may al"o occa# "ionally u"e

endo"copy in the cour"e of "taging) 7hich

in=ol=e" the in"ertion of an endo#

"cope ,a =ery "mall tu!e containing a light and

camera0 into the !ody6

No "ingle method i" guaranteed to "pot

e=erything) !ut the !ig ad=antage of ha=# ing

"o many option" to choo"e from i" that they

can often !e u"ed in com!ination to pro=ide a

more comprehen"i=e picture6

In order to an"7erdifferent Jue"tion") theradiologi"t can u"e allimaging techniJue"6

But it i" important tounder"tand that there i"no "ingle perfecte4amination6 In mo"tca"e") a com!ination ofe4amination" i" the

appropriate "trategy) e=enif computed tomography i"

Ahile complete "taging relie" on a com#

!ination of clinical finding") including !lood

te"t") radiology pro=ide" the central and pi=otal

"taging proce"") "o the radiologi"t" role at thi"

point in the cncer care continuum i"

a!"olutely e""en# tial6 +" 7ell a" managing and

operating the eJuipment u"ed for "taging and

diagno"i") and "electing the method" u"ed to

carry out the e4amination") the radiologi"t i"

al"o the per"on 7ho 7ill analy"e and interpret

the re"ulting image") 7ith reference to

important clinical ?no7l# edge a!out the

patient" current condi# tion and medical

hi"tory6 @he radiologi"t i" therefore relied upon

not only to detect already e=ident finding") !ut

to ?no7 to 7here a gi=en tumour may "pread

and to confirm or e4elude the pre"ence of local

and di"tant meta"ta"e" ,the ne7 "ite" of

"pread0 through detailed analy"i" of the"e

location"6

@he radiologi"t ha" afundamental

under"tanding of the"trength" and 7ea?ne""e"

of the imaging tool"a=aila!le and 7hich

imaging modalitie" are!e"t "uited for thein=e"tigation of particulartumour type"6 articular

cancer" are !e"tappreciated 7ith certain

type" of in=e"tigation" anda radiologi"t i" !e"t

"ituated to ?no7 7hich i"the mo"t appropriate

@he radiologi"t " e4pert analy"i" 7ill !e an

integral factor in the deci"i:n a!out the cour"e

of action to !e ta?en) !ut the deci"ion" are

u"ually made !y a multidi"

ciplinary team of doctor") re"pon"i!le for the

management of each cncer patient6 Image"

o!tained in the e4amination" 7ill !e pre"ented

and commented on !y the radiologi"t) !efore

!eing di"cu""ed !y the team) u"ually including

oncologi"t" and pathologi"t"6 3reJuently) ne7

Jue"tion" may !e rai"ed) due to ne7 e=ent" or

!io# logical finding") and =ery commonly) the

radiologi"t 7ill return to pre=iou" e4amination"

7ith the "ame or another imaging tool) in order

to characteri"e image" or to en"ure that

nothing 7a" mi""ed6


37/74

THECOMMUNICATION

@here are u"ually many people in=ol=ed in the

management of an indi=idual ca"e of cncer)

"ome of 7hom the patient 7ill ha=e ci:"e

contact 7ith and "ome of 7hom remain =ery

much Q!ehind the "cene"6 Mo"t healthcare

in"titution" ta?e a mul# tidi"ciplinary approach

to cncer care) meaning that the management

of each patient i" the re"pon"i!ility of a team

of

doctor" from =ariou" !ranche" of medicine) all

of 7hom 7or? together clo"ely to achie=e the

!e"t po""i!le re"ult"6 +t e=ery "tage of a

patient" progre"") meeting" u"ually ta?e place

that dra7 on the e4perti"e of oncologi"t"

,cncer "peciali"t"0) patholo# gi"t" ,"peciali"t"

in di"ea"e proce""e"0) radiation oncologi"t"

,"peciali"t" in treating cncer 7ith radiation0)

and radiologi"t") a"

+t a local le=el good communication 7ith all mem!er" ofthe multidi"ciplinary team managing a patient i" ?ey toJuality care6 It i" no7 routine in many countrie" for the

initial diagno"i") imaging "taging and potentialmanagement "trategie" for cncer patient" to !e

di"cu""ed in a multidi"ciplinary team meeting6 @hi"en"ure" that there i" good communication !et7een all

partie"6rof6 Vic? Goh Pnited Kin dom


38/74

STAGING

7ell a" numerou" other phy"ician")

includ# ing tho"e 7ho "peciali"e in the

particular !ody region" affected6

Indi=idual team mem!er" are in=ol=ed to

=arying degree" in the different "tep" of

cancer care) !ut communication i" "till

=ital6 3or the radiologi"t) thi" mean"

compiling clear) detailed and accurate

tion finding" for the team) a" 7ell a" pro#

=iding recommendation" and

coordination of follo7#up ,co=ered in

chapter fi=e of thi" !oo?let06 +lthough

patient" may not nece"# "arily hear

directly from radiologi"t") their

in=ol=ement in meeting") and

particularly through freJuent contad 7ith

the referring clinician) i" an important

Ahen it come" to informing the patient

of the actual diagno"i") thi" i" done !y

the oncologi"t or referring phy"ician in

the maDority of ca"e") although

occa"ionally the radiologi"t 7ill !e

in=ol=ed6 @hi" =are" from country to

country) !ut in general the radiologi"t

7ill only !e con"ulted 7hen the patient

-In China. patients receivetheir edica( iaging reports/ro the departent o/radio(ogy. and they wi(( seetheir physicians0surgeons withthe reports1 2ccasiona((y. thepatient wi(( consu(t the

radio(ogist direct(y and theradio(ogist wi(( provide the

-Depending on (oca( c(inica( practice. theradio(ogist either ta(5s to the patient direct(y.or to the re/erring physician1 In ,erany. /ore3ap(e. ost private radio(ogy centres o//er

direct patient interviews and discussion o//indings a/ter the iaging1 In ost hospita(s.

however. that is ipossib(e to provide and/indings wi(( be counicated to the patient

during c(inica( rounds on the ward1rof6 +nno Gra"er) Germany


39/74

STAGING

LOOKIN


40/74


41/74

Not only can the "ame type of cncer!eha=e differently in different patient")

!ut e=en 7ithin a "ingle patient)meta"tatic tumour" ari"ing from the

"ame cncer may !eha=e differently6 Infact) e=en different region" 7ithin a"ingle tumour may ha=e their o7n

di"tinct molecular characteri"tic"6Becau"e molecular imaging candi"tingui"h difference" in the"e

characteri"tic" 7ithin and !et7eentumour") the role of imaging "peciali"t"

in diagno"ing) characteri"ing) and"taging cncer) a" 7ell a" determiningthe appropriate treatment) i" li?ely to!ecome e=en more pronounced 7ith

ro re"" in molecular ima in and


42/74

reatment erapy

1. TREATMENT MONITORING !ITH IMAGING:

SAVING TIME2. THE GRO!ING USE OF IMAGE"GUIDEDTHERAPIES


43/74

$nce cncer ha" !een locali"ed and

"taged) doctor" can proceed 7ith

treatment6 Here) a" in e=ery "tage of

oncologic care) imaging i" of

fundamental importance6 Imaging

techniJue" can !e u"ed to monitor

therapy) 7hich allo7" doctor" to gauge

the "ucce"" of the therapeutic plan from

the !egin# ning6

Being a!le to chec? the effecti=ene"" of

a treatment early on mean" a change in

cour"e can !e made a" "oon a" it

!ecome" nece""ary) 7hich i" a crucial

time"a=er in the !attle again"t cncer

and a factor in impro=ing Juality of lifeduring and after treatment6 Imaging

in a patient and) if not) can help doctor"

to choo"e a more "uita!le "trategy6

Ahether radiation therapy)

chemotherapy) or !oth) are carried out)

imaging can mea"ure their effecti=ene""

!y "ho7ing ho7 the tumour re"pond" to

them6

Variou" re"pon"e criteria model" ha=e

!een de=eloped for thi" purpo"e) of

7hich the mo"t commonly u"ed i" the

RECIS@ ,Re"pon"e E=aluation Criteria In

Solid @umour"0 model a "et of pu!li"hed

rule" that define 7hen cncer patient"

impro=e ,re"pon"e0) "tay the "ame

,"ta!ili"ation0 or 7or"en ,progre""ion06+n initial "ean i" ta?en !efore the

ou" imaging techniJue" are then u"ed

once therapy commence") to determine

it" effect6 Ahen the cour"e of treatment

end") a final e4amination i" performed to

a""e"" 7hether the re"pon"e of the

cncer to treatment ha" !een complete)

partial or "ta!le6 Information a!out

treatment re"pon"e i" crucial for

doctor") a" they can u"e it to plan the

ne4t "tep") i6e6 7hether the patient

need" further treatment or) in the !e"t

ca"e") follo7#up care) if tumour" ha=e

!een de"troyed6

@reatment re"pon"e i" traditionally

moni# tored !y mea"uring thedimen"ion" of the primary tumour and


44/74

-Iaging is used to assess response to treatent (arge(y using tuour si6e and0orrecurrence1 It is a(so used to onitor possib(e side e//ects o/ therapy and

therapeutic interventions1 Conventiona( iaging. such as 3)ray. u(trasound 789.coputed toography 7C%9 and agnetic resonance iaging 7MI9 uti(ise

easureents to assess response or progression1 esponse is typica((y c(assi/iedas being ;progressive disease


45/74

-

+nother role of imaging in cncer treat#

ment i" to facilitate the deli=ery of

therapy6 Radiation ,radiotherapy0 or

chemical agent" ,chemotherapy0 are

=ery freJuently u"ed in treatment) and

the medical team 7ant" to !e a" "ure a"

po""i!le that they hit their target"

7ithout harming the "urrounding organ"

or ti""ue"6 @he"e treatment" u"ed to !e

applied to the 7hole !ody) !ut many are

no7 performed locally) to de"troy Du"t

the tumour and minimi"e any complica#

tion"6 @he"e therapie" reJuire a =ery

-Iaging is used to guide the treatent o/ c=ncer in avariety o/ ways1 adiation onco(ogists use iaging to

deterine the (ocation o/ the c=ncer and proper(yposition the radiation bea1 >uc(ear edicinephysicians use iaging to trac5 the activity o/

radiopharaceutica(s in the body and deterinewhether they are reaching their target accurate(y and in

su//icient ?uantity1 A(so. iaging e?uipent is nowinsta((ed in any surgica( operating roos1

rof6 Hed=ig Hrica?) PS+

7hether they are radiotherapi"t") "urgeon" ing "?ill" to guide them during their inter#

or nuclear medicine phy"ician") increa"# =ention"6 ingly rely on per"onnel 7ith

"pecific imag#


46/74

-Iage)guided surgery based on preoperative C% andMI has becoe popu(ar especia((y in brain surgery.

and is wide(y used /or the resection o/ brain tuours1P(anning o/ radiation therapy is a(so based on C%

iages. so that the tuour receives su//icient doseso/ radiation whi(e contro((ing the dosage to preserve

critica( organs1 Iage)guided therapy can iprovetreatent outcoe and reduce the ris5 o/

cop(icationsro 6 Hiro" i Hon a a an

@here are many e4ample" of ho7 C@ or

MRI can !e u"ed to guide treatment6

Neu# ro"urgeon" commonly u"e 7hole#

image" to plan "urgery in detail) and "ur#

geon" increa"ingly u"e /< image" during

their inter=ention" in li=er "urgery6 +fter

"urgery C@ image" ena!le phy"ician" to

ma?e "ure that the tumour i" gone6 In

radiation therapy image guidance i" al"o

more and more commonly u"ed to

impro=e "afety6

So radiologi"t" are re"pon"i!le for treat#

ment monitoring and they help deli=er

therapy a" accurately and "afely a"

po""i!le6 In addition) they "ometime"

perform the treatment them"el=e"6

@he"e acti=itie" ha=e actually gi=en ri"e


47/74


48/74

+ %#dimen"ional imageofa !rain tumour ,circled0and the part" of the!rainthat control motion ofthehand ,"een in yello7andorange06 @hi"information

In recent year") a gro7ing num!er of

image#guided therapie" ha=e 7idened

the range of cancer treatment option"6

Inter=entional radiology) a "u!"pecialty

of radiology) ha" !een de=eloping "ince

the early '*F&S and many inno=ati=e

image# guided techniJue" ha=e !een

e"ta!li"hed) e"pecially 7ith regard tocancer treatment6 @he"e techniJue" are

minimally in=a"i=e) meaning that they

can !e per# formed through a tiny

inci"i:n and there# fore in=ol=e minimal

phy"ical "tre""6 @he ad=antage of the"e

techniJue" i" that they po"e little ri"? to

the patient much le"" than con=entional

"urgery) 7hich u"ually reJuire" larger

inci"ion"6 @he"e techniJue" typically u"e

ultra"ound) 4#ray) C@ or MRI to guide the

application of radiofreJuencie" ,R30 or

e4treme temperature") 7hich cau"e the

tumour to "hrin?6 @he treatment i"

deli=ered through a "mall tu!e or

time image") to de"troy the tumour

7ith# out damaging the "urrounding

ti""ue"6

Image#guided therapeutic procedure"

may !e u"ed in many ca"e"( !rain) li=er)

lung or renal cancer patient" are

increa"# ingly treated thi" 7ay6 +"rofe""or Hri# ca? point" out) there are

many different po""i!le option") all of

7hich may !e u"ed to treat different

cancer"6 Em!oli"a# tion con"i"t" of

o!"tructing !lood =e""el" that feed a

tumour until it "hrin?" and die"6

Em!oli"ation i" u"ed to treat not only

li=er) !ut al"o !one and lung cancer6

Catheter" can al"o tran"port chemi# cal

agent" to the "ite of the tumour) and

relea"e agent" 7hich 7ill eat up the

tumour6 Radiologi"t" may al"o admin#

i"ter radiation them"el=e") for in"tance

in a treatment called "electi=e infernal

rial directly into the arterie" that "upply

the tumour6 Radiologi"t" al"o commonly

perform radiofreJuency a!lation) 7hich

u"e" electromagnetic ,radio0 7a=e" com#

!ined 7ith PS or 4#ray) to a!late lung

and li=er meta"ta"e" a" 7ell a" primary

renal cancer"6

@he ad=antage of minimally in=a"i=e

image#guided therapie" i" that they can

reduce the ri"? of complication" and

"horten in#patient "tay"6 @hey are al"o

an e4cellent alternati=e to "urgery for

patient" 7ho are "e=erely ill) refu"e to

ha=e "urgery) or 7ho"e cancer cannot

!e "urgically remo=ed6 hy# "ician" can

recommend to patient" 7hich treatment

they "hould undergo after con# "idering

all the information and gathering all the

e4perti"e on a ca"e#!y#ca"e !a"i"6 @he

type of cancer) clinical hi"tory of the

patient) and a=aila!ility of re"ource" 7ill

-Instead o/ a5ing a (arge incisi@n. an interventiona( radio(ogist wi(( typica((y useiaging to guide a catheter or need(e to the treatent site to de(iver a therapeuticagent1 'or e3ap(e. in an approach ca((ed thera( ab(ation. iaging is used to guide a

need(e to a tuour and then e3tree teperatures are app(ied via the need(e todestroy the tuour1 %hera( ab(ation ay be used to treat cancers in the 5idney. (iver

or (ung. aong other sites1 In hepatic artery ebo(isation. a treatent /or (ivertuours. iaging is used to guide a catheter to the hepatic artery. and partic(es are

then inected to b(oc5 the /(ow o/ b(ood /ro the artery into the tuourB soe doctorsay a(so choose to inect a cheotherapeutic agent or partic(es that eit radiation1

ro 6 He =ig Hrica ) PS+


49/74

FUTURE

Re"earch i" !ooming in many area" of cncer imaging)

includ#

ing treatment imaging) and thi" "hould re"ult in !etter

monitor#

ing option" and more refined image#guided therapie" 7ithin

the

ne4t ten year") according to e4pert"6 Radiotherapy and

"urgicaltechniJue" are currently under the "cope of re"earcher") a"

7ell a"

ne7 chemotherapeutic agent" and Qintelligent drug"

-%he proising deve(opents in c=ncertreatent that invo(ve radio(ogists inc(udethe abi(ity to se(ective(y de(iver therapeutic

agents to target tissues and therebyreduce systeic to3icity1 Patients withc=ncer wi(( bene/it /ro the new PE%

etabo(ites that target speci/ic tissue andwi(( iprove the sensitivity and speci/icityo/ c=ncer detection and treatent

response1rof6 +ndre7 Little) +u"tralia


50/74

3urther ad=ance" "hould al"o !e e4pected in phy"ical

a!lation and electroporation) a treatment that facilitate" the

introduction of a drug or a piece of coded#


51/74


52/74

I yI '

1

MT

i

>

rn

PfD

# i

ollo7#upare

1.THE IMPORTANCE OF FOLLO!"UP CARE

2.TOOLS OF THE TRADE3.THE RADIOLOGISTS ROLE4.!HAT THE PUBLIC SHOULD KNO!ABOUT IMAGING IN FOLLO!"UP CARE. "


53/74


54/74

Cancer can !e a particularly re"ilient di"ea"e6 In fact) mo"t

medical profe""ional" a=oid u"ing the term Qcure) due to the

fact that many cancer" are capa!le of recurring later on in life6

In"tead) phy"ician" in=ol=ed in cancer care prefer to tal? of

Qremi""ion) ha=ing halted or reduced the "pread of the

di"ea"e6 Some patient" may e4peri# ence partial remi""ion)7here there i" a 1& reduction in tumour gro7th) or e=en

complete remi""ion) 7here the tumour and all manife"tation"

of the cancer ha=e di"appeared6 @hough there i" no definite

cure) patient" can) and often do) "ur=i=e cancer and it i" not

al7ay" the ca"e that the cancer remerge"6

Becau"e of the re"ilient and per=a"i=e nature of cancer cell" it

i" important that patient" undergo regular chec?up" after they

ha=e !een declared to !e in remi""ion6 3ollo7#up care in=ol=e"

a "erie" of regular e4amination" in order to monitor cancer

remi""ion and pinpoint any po""i!le recurrence6 atient" "hould

undergo follo7# up chec?" to en"ure their cancer remain" in

remi""ion !ecau"e the earlier recurrence i" "potted) the !etter

the progno"i"6 @hi" i" 7here imaging play" one of it" mo"t

recurrence !efore "ymptom" appear6 It i" a corner"tone of

follo7# up cancer care6

-Medica( iaging is vita((y iportantto onitoring therapy response and/o((ow)up care o/ cancer patients1Iaging provides a non)invasiveoutpatient assessent /or patients.which is accessib(e to the genera(counity not on(y in aor urbancentres. but a(so in re@te and rura(counities1

%he digitisation o/ edica( iaginge3ainations perits re@te diagnosis

and e3pert second opinions0rof6 +ndre7 Little) +u"tralia

Medical imaging allo7" oncologi"t" to ma?e follo7#up chec?"

le"" uncomforta!le or intru"i=e to patient" and it" efficiency

en"ure" that patient" can !e monitored and informed of any


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58/74

THERADIOLOGISTS@he radiologi"t i" re"pon"i!le for

interpret# ing the image" acJuired

through a range of techniJue" and then

communicating their analy"i" to the

patient" phy"ician6 @hi" mean" the

radiologi"t need" to under"tand more

than Du"t image" they mu"t !e familiar

7ith oncologic medicine in order to di"#

tingui"h the appearance of cncer from

other di"ea"e" or anomalie"6 Gi=en the

radiologi"t" ?no7ledge and e4perience

of the imaging feature" of cncer and it"

the early "ign" of cncer recurrence)

ma?# ing their role pi=otal to the

effecti=ene"" of follo7#up care6

+gain) a" i" the ca"e at earlier "tage" of

cncer care) the radiologi"t operate" a"

part of a medical team to gi=e patient"

the !e"t follo7#up care and to en"ure

prompt detection of any po""i!le

complication"6 Imaging i" not the only

mean" u"ed to detect po""i!le

complication"6 atient" are li?ely to

had during the "taging of their di"ea"e)

"uch a" !iop"ie" or !lood te"t"6

Ho7e=er) radiologi"t" pro=ide a non#

in=a"i=e mean") 7ith minimum

di"comfort to the patient) of a""e""ing

the need to carry out more in=a"i=e or

uncomforta!le procedure" and can thu"

"a=e patient" a great deal of "tre""6

@he radiologi"t 7or?" !ehind the "cene"

to pro=ide treating phy"ician" 7ith

indi"pen"a!le information) helping them

to ma?e crucial deci"ion" on further

treatment or te"t"6

-A u(tidiscip(inaryapproach and the ointparticipation o/ other

e3perts with theradio(ogist are essentia(1

rof6 Marco"


59/74

WHAT THE PUBLIC

SHOULD KNOW "-%hey shou(d 5now that iaging is the ost

iportant re/erence /or the /o((ow)up o/treatent1 At the sae tie. c(inica(

in/oration and. in soe cases. bio(ogica( dataare iportant1 %he edica( decisi@n a(ways

re(ies on a u(tidiscip(inary approach1rof6 =e" MenO) 3rance

@he general pu!lic are often made

a7are) through campaign" of =ariou"

?ind") of "creening programme" for

certain can# cer"6 Ahile many people

may ha=e "ome idea of 7hat an actual

cncer diagno"i" entail" in term" of

change") other" may not !e fully a7are

of 7hat come" after the initial

treatment6


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-During reission. patients are e3ained oreregu(ar(y in the ear(y period a/ter cop(etion o/therapy and then uch (ess /re?uent(y when

disease reission has been con/ired1'or e3ap(e. patients in estab(ished reission

a/ter breast cancer or soe testicu(ar cancers areusua((y on(y iaged on an annua( basis

rof6 +ndre7 Little) +u"tralia

atient" "hould al7ay" report any pain

or "ymptom" to their phy"ician 7hile in

many ca"e" thi" i" due to normal factor"

it can prompt the oncologi"t to in=e"t#

gate further6 Medical imaging on the

hand) can help detect recurrence or

complication" !efore they !ecome

"ymptomatic6 Mo"t techniJue" are Juic?

and can detect complication") allo7ing

phy"ician" to 7or? 7ith the radiologi"t to

ermea!ility mapof malignant li=ertumour" relate" to

potential complication" a" early a" po"#

"i!le) helping to en"ure the =ery !e"t

po"# "i!le progno"i"6

FUTUREDEVELOPMENTS

"Cncer i" the "u!Dect of a great deal of

re"earch) much of 7hich goe" into

de=eloping method" of detection and

treatment6 Ho7e=er) many

de=elopment" can al"o !en# efit patient"

already !attling the di"ea"e6

Impro=ement" 7ithin the field of medical

=alua!le time for patient" !y pinpointing

a po""i!le recurrence earlier than i" cur#

rently po""i!le6

Ahere cncer i" concerned) "ooner i"

al7ay" !etter and thi" i" particularly true

in term" of the initial detection of

tumour" and recurrence follo7ing

Some imaging tool") di"cu""ed in other

chap# ter" of thi" !oo?let) ha=e "ome ofthi" potential6 Molecular imaging and

technology li?e po"itron emi""ion

tomography ,E@0 could !e u"ed more

7idely to di"cern the preci"e meta!oli"m

of cncer tumour") gi=ing oncologi"t"

more detailed information regarding the

nature of the cncer6 @reating phy"ician"

7ill !e a!le to monitor indi=idual

-In the /uture.o(ecu(ar iaging

wi(( (i5e(y be usedto assessdi//erences intreatent responsewithin and betweendi//erent tuour

@he !enefit" imaging !ring" to cncer

care at pre"ent are clear6 It allo7" the

phy"ician) in cooperation 7ith the

radiologi"t) to di"cern "ign" of cncer)

non#in=a"i=ely and efficiently6 Ahile thi"

a!ility !y it"elf ma?e" a huge impact oncncer care) it i" con"tantly de=eloping

and ne7 techniJue" to impro=e patient

care "hould emerge in the year" ahead6

-%his is an iportant issue1 Even i/ iaging providesuse/u( in/oration as it is. we wou(d (i5e it to be better1We are (oo5ing /or ethods that wou(d not on(y te(( usthat the treatent is e//ective or not. but a(so te(( usore ?uic5(y. and. i/ possib(e. even to predict it /ro

the beginning1 Iaging and other sciences are wor5inghard on this issue. because it wou(d save tie and

iprove treatent e//ectiveness1 A(though not possib(etoday. we 5now that soe iaging ethods have the

potentia( to provide this in/oration1%E>A%I2>ALDAF2'ADI2L2,F1C2M

M$RE R+%I>'21MFE12,

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