Types of Procedures Performed by Diagnostic Radiology Practices:Past Patterns and Future Directions

Radiology reporting in oncology-oncologists' perspective

BACKGROUND

Structured reporting and standardized criteria are increasingly recognized as means of improving both radiological and clinical practice by allowing for better content and clarity. Our aim was to examine oncologists' opinions and expectations concerning the radiologist's report to identify general needs in daily practice and ways to improve interdisciplinary communication.

METHODS

A 19-question survey was sent to 230 oncologists from three different countries (France, Romania, Switzerland) identified on the online web pages of different hospitals and private clinics. The survey was sent by electronic mail with an online survey program (Google Forms®). All recipients were informed of the purpose of the study. The data were collected by the online survey program and analysed through filtering the results and cross-tabulation.

RESULTS

A total of 52 responses were received (response rate of 22.6%). The majority of the respondents (46/52, 88%) preferred the structured report, which follows a predefined template. Most of the respondents (40/52, 77%) used RECIST 1.1 or iRECIST in tumour assessment. Nearly half of the oncologists (21/52, 40%) measured 1-3 cases per week. On a 10-point Likert scale, 34/52 (65%) oncologists rated their overall level of satisfaction with radiologists' service between 7 and 10. In contrast, 12/52 (19%) oncologists rated the radiologists' service between 1 and 4. Moreover, 42/52 (80%) oncologists acknowledged that reports created by a radiologist with a subspecialty in oncologic imaging were superior to those created by a general radiologist.

CONCLUSION

Structured reports in oncologic patients and the use of RECIST criteria are preferred by oncologists in their daily clinical practice, which signals the need for radiologists also to implement such reports to facilitate communication. Furthermore, most of the oncologists we interviewed recognized the added value provided by radiologists specializing in oncologic imaging. Because this subspecialty is present in only a few countries, generally in large clinics, further training might become a challenge; nevertheless, intensive efforts should be made to enhance expertise in cancer imaging.

Current opinions on medical radiation: a survey of oncologists regarding radiation exposure and dose reduction in oncology patients

PURPOSE

The aim of this study was to evaluate oncologists' opinions about the use of ionizing radiation in medical imaging of oncology patients.

METHODS

An electronic survey was e-mailed to 2,725 oncologists at the top 50 National Cancer Institute-funded cancer centers. The survey focused on opinions on CT dose reduction in oncology patients and current philosophies behind long-term imaging in these patients.

RESULTS

The response rate was 15% (415 of 2,725). Eighty-two percent of respondents stated that their patients or families have expressed anxiety regarding radiation dose from medical imaging. Although fewer than half of oncologists (48%) did not know whether CT dose reduction techniques were used at their institutions, only 25% were concerned that small lesions may be missed with low-dose CT techniques. The majority of oncologists (63%) follow National Comprehensive Cancer Network guidelines for imaging follow-up, while the remainder follow other national guidelines such as those of the Children's Oncology Group, the American Society of Clinical Oncology, or clinical trials. Ninety percent of respondents believe that long-term surveillance in oncology patients is warranted, particularly in patients with breast cancer, melanoma, sarcoma, and pediatric malignancies. The majority of oncologists would consider the use of low-dose CT imaging in specific patient populations: (1) children and young women, (2) those with malignancies that do not routinely metastasize to the liver, and (3) patients undergoing surveillance imaging.

CONCLUSIONS

Cumulative radiation exposure is a concern for patients and oncologists. Among oncologists, there is support for long-term imaging surveillance despite lack of national guidelines.

Quantitative imaging in oncology patients: Part 1, radiology practice patterns at major U.S. cancer centers

OBJECTIVE

The objective of our study was to examine radiologists' opinions and practice patterns concerning tumor measurements in cancer patients.

MATERIALS AND METHODS

An electronic mail survey was sent to 565 abdominal imaging radiologists at 55 U.S. National Cancer Institute (NCI)-funded cancer centers. The survey contained questions about departmental demographics, procedures for interpretation of imaging in oncologic patients, and opinions concerning the role of radiologists in using the Response Evaluation Criteria in Solid Tumors (RECIST) system for tumor measurements.

RESULTS

Two hundred ninety-six responses (52%) were received. The distribution of the size of the respondents' abdominal imaging groups was as follows: 1-5 (16/295, 5%), 6-10 (112/295, 38%), 11-15 (77/295, 26%), and > 20 (73/295, 25%). Most respondents dictate some but not all tumor measurements in the first clinical scan (236/270, 87%). For follow-up imaging, 95% (255/268) of respondents dictate tumor measurements for selected index lesions. Most respondents believe inclusion of tumor measurements in the first scan is the responsibility of the radiologist (248/262, 95%). Ninety percent of respondents (235/261) believe inclusion of several index lesion measurements is satisfactory to document disease activity. Eighty-two percent (214/260) of respondents were familiar with RECIST. Forty-two percent (110/262) of respondents' departments have a centralized process for approval of industry-sponsored oncologic trials in which imaging is an important component of the protocol end point.

CONCLUSION

Most oncologic imaging at NCI-sponsored cancer centers includes tumor measurements on initial and follow-up imaging. Very few radiology departments have a centralized process for approval of clinical trial protocols that require imaging.

Quantitative imaging in oncology patients: Part 2, oncologists' opinions and expectations at major U.S. cancer centers

OBJECTIVE

The purpose of this article is to examine oncologists' opinions and expectations concerning imaging and tumor measurements in patients with cancer.

MATERIALS AND METHODS

An electronic mail survey was sent to 2,400 medical, gynecologic, and radiation oncologists at 55 U.S. National Cancer Institute-funded cancer centers. The survey contained questions about departmental demographics, opinions regarding imaging for patients with cancer, PET/CT utilization, and utilization of the Response Evaluation Criteria in Solid Tumors (RECIST) system in therapy protocols that use imaging as a therapeutic end point.

RESULTS

A total of 492 responses (21%) were received. Sixty percent (294) of respondents were medical oncologists, 9% (45) were gynecologic oncologists, 26% (127) were radiation oncologists, and 5% (25) answered "Other." Ninety-eight percent (431/438) of respondents provide clinical care, and 99% (420/425) have participated in clinical trials. Most respondents (94% [410/438]) expect some or all tumors to be measured at the time of standard initial clinical imaging. Over half (65% [275/426]) think that tumor measurements should be bidimensional. Only 25% (101/400) of respondents' institutions have department rules on the implementation of RECIST measurements. Sixty-eight percent of participants (269/397) think that RECIST is flawed but serviceable. Over half of respondents (56% [221/398]) were not familiar with RECIST 1.1 modifications.

CONCLUSION

Most oncologists at National Cancer Institute-sponsored cancer centers expect tumor measurements to be made in the routine imaging of patients with cancer. Almost two thirds of respondents think that bidimensional measurements of index lesions are satisfactory in routine oncologic imaging. Little consensus exists in the implementation of RECIST measurements for clinical trials at these centers.

An interventional radiology clinical rotation to enhance student learning

To achieve the goal of adequately preparing graduating nurses for entry into practice, an undergraduate clinical nursing curriculum was enhanced by including an interventional radiology clinical rotation. The author describes the basics of this experience and the planning steps prior to implementation, including hospital approval, preceptor selection, and evaluation of the overall clinical experience.

Trends and future needs in clinical radiology: insights from an academic medical center

OBJECTIVE

Advances in technology, expanding indications and defensive medical practice, in combination with population aging, have all contributed to a substantial increase in utilization of imaging and therapeutic radiology procedures in recent years. Moreover, the integration of education, innovation and research into high-volume workflow, although challenging, is a key requirement in teaching hospitals. Therefore, identifying forthcoming demand in the use of radiology services at a referral center might be of special interest and facilitate health policy planning in this context.

METHODS

Data regarding conventional radiographic, ultrasonographic and computed tomography (CT) investigations, radiotherapy sessions, and interventional procedures were collected for a 5-year period (2000-2004). Based on these observations, we deployed appropriate models to forecast utilization rates in 2005-2009.

RESULTS

Between 2000 and 2004, ultrasound examinations increased by 31.8%, mammography by 31.6%, CT scans by 17.4%, interventions by 14.5% and radiotherapy sessions by 13.9%, while conventional investigations decreased by 42.5%. We identified significant increasing trends for ultrasound, mammography, CT and interventions (all p<0.001 for linear component). Compared to current levels, the workload for these modalities is expected to rise in the next 5 years by 43%, 31%, 20% and 14%, respectively. Radiotherapy sessions demonstrate an unstable, non-significant increasing trend (p=0.189), while utilization of conventional radiography declines rapidly (p<0.001 for linear trend, 5-year prediction -51%).

CONCLUSIONS

In forthcoming years, the demand for radiology services at referral centers will increase substantially. Advances in digital technology alone will not suffice to completely alleviate the need for additional resources and well-trained personnel.

A portrait of interventional radiologists in the United States

OBJECTIVE

In recognition of the emergence of interventional radiology as an important "new component of...radiology," the objective of our study was to provide an extensive and detailed portrait of interventional radiologists, their professional activities, and the practices in which they work.

MATERIALS AND METHODS

We tabulated data from the American College of Radiology's 2003 Survey of Radiologists, a stratified random-sample survey that oversampled interventionalists and achieved a 63% response rate with a total of 1,924 responses. Responses were weighted to make them representative of all radiologists in the United States. We compared information about interventionalists with that for other radiologists.

RESULTS

Depending on the definition of who is an interventionalist, 8.5-11.5% of radiologists are interventionalists. By most definitions, only slightly under half of interventionalists spend 70% or more of their clinical work time performing interventional procedures. Interventionalists work, on average, 56-58 hr weekly, a few hours longer than other radiologists. The average interventionalist performs procedures in five of the seven categories of procedures into which we divided interventional radiology, compared with one or two categories for other radiologists. The average interventionalist performs procedures in five of the seven broad categories (such as MRI, CT, and nuclear medicine) into which we divided all of radiology, much the same breadth of practice as other subspecialists and also as nonsubspecialists.

CONCLUSION

Interventionalists have become a sizable group within radiology. They are in some ways like other radiologists and in other ways different, but they do not spend as much of their time in their subspecialty as some assume and, overall, are not as different.