Post on 04-Jun-2018
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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
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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
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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
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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
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@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
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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
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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
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taging
1. THE IMPORTANCE OFSTAGING2. THE RADIOLOGIST TAKESCENTRE STAGE
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@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"
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+" 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
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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
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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
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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
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STAGING
LOOKIN
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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
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reatment erapy
1. TREATMENT MONITORING !ITH IMAGING:
SAVING TIME2. THE GRO!ING USE OF IMAGE"GUIDEDTHERAPIES
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$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
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-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
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-
+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#
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-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
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+ %#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+
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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
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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#
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I yI '
1
MT
i
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PfD
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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. "
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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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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"
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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
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