Cancer Imaging: An Essential and Evolving Specialty

Radiologists who read scans performed on cancer patients should become familiar with imaging assessment criteria.

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The current era of precision oncology has led to major paradigm shifts in the treatment of cancer. These shifts have a direct impact on our imaging studies and our assessment of therapeutic response. Radiologists reading scans of patients with cancer should be familiar with imaging assessment criteria because they are used by our referring clinicians to make treatment and management decisions for the patients we share.

Ideally, we should do this by putting imaging to the test as a primary objective in well-designed prospective randomized trials and by collaborating with national and
international clinical practice guideline organizations such as the National Comprehensive Cancer Network® Clinical Practice Guidelines in Oncology and Clinical Pathways — using evidence-based management to ensure that all patients receive preventive screening, diagnostic, treatment, and supportive services that are most likely to lead to optimal outcomes.1 Implementation of these guidelines at the point of care through decision support reduces the variability in clinical practice and improves outcomes.2 The ACR Appropriateness Criteria® — evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition — is also one of the main ways that we put imaging to the test.

By combining our knowledge of anatomy, biology, computer science, tumor metrics, and multiparametric, multimodality, and hybrid imaging, we can gather clinical
imaging evidence and develop guidelines that will provide appropriateness criteria and decision support tools to augment clinical decision-making — helping our referring clinicians order the proper test for the proper patient at the right time. This also gives us an opportunity to continuously align our practice with the rapidly evolving standards of care throughout the disease continuum.

Establishing and maintaining cancer imaging expertise within your department or clinical setting may require changes in the traditional models of imaging workflow
and reporting.3 Radiologists may need to learn a new language; expand their expertise beyond the infrastructure traditionally based on organ, modality, or body part;
understand cancer and molecular biology; become familiar with various cancer therapies, their mechanisms of action, and specific toxicities; embrace other imaging modalities such as functional and molecular imaging; and take their place as imaging clinicians who are integral members of a multidisciplinary team. I would encourage all radiologists who read imaging exams performed on cancer patients to become familiar with the language of modern oncology and to recognize this as a learning opportunity that will not only greatly facilitate their understanding of tumor biology and the mechanism of action of cancer drugs, but will also have a direct impact on their radiologic interpretation and the effective communication of their readings to the rest of the oncology team.

Radiology education is also evolving. Successful implementation of cancer imaging expertise will indeed be facilitated by updating the training of current and future
generations of cancer imaging clinicians — with focused training in cancer imaging supported by a proper curriculum relevant to current and future oncologic practices. It will help ensure a level of competency that will keep radiologists relevant and integral members of the multidisciplinary team taking care of cancer patients. This training will also provide cancer imaging clinicians with the flexibility and ability to adapt to the continuously evolving field of cancer treatment.4 Given that cancer itself and the care of this multifaceted disease are in constant evolution, we must be flexible, vigilant, and willing to continuously educate ourselves and change our practice if necessary to provide optimal care to our patients.

Dr. McGinty would like to acknowledge the role of Annick D. Van den Abbeele, MD, FACR, associate professor of radiology at Harvard Medical School, in the development of this column.

1. Kinsman L, Rotter T, James E, Snow P, Willis J. What is a clinical
pathway? Development of a definition to inform the debate. BMC Med.
2. Panella M, Marchisio S, Di Stanislao F. Reducing clinical variations
with clinical pathways: do pathways work? Int J Qual Health Care.
3. Van den Abbeele AD, Krajewski KM, Tirumani SH, et al. Cancer imaging
at the crossroads of precision medicine: perspective from an academic
imaging department in a comprehensive cancer center. J Am Coll Radiol.
4. Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell.

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