Page 142 - Registrar Orientation Manual 2016

Reference:
1257
Effective date:
7 July 2015
Expiry date:
6 July 2018
Page:
25 of 35
Title:
Imaging Guidelines
Type:
Clinical Guideline
Version:
02
Authorising initials:
Malignancy (Suspected)
CT will be prioritised as urgent if the clinical information indicates a high probability of cancer. Abdominal and Chest CT should be requested at the same time to avoid repeating CT scans.
Note that patients with weight loss rarely have malignancy unless there are other findings, so if weight loss is the only problem look for another cause and consider referral to a dietician.
It is always important to consider whether further imaging is appropriate, especially if a patient is frail or has multiple co-morbidities and may not be a candidate for any therapy.
Clinical urgency: Very dependent on acuity. Imaging will not usually be performed out of hours. Less urgent scans can be done as an outpatient. Radiology will give a day and time for non-urgent scans to allow a patient to be discharged if they are only awaiting a scan.
The ‘Choosing Wisely’ recommendations include:
Don’t use whole-body scans for early tumour detection in asymptomatic patients. Don’t perform CT screening for lung cancer among patients at low risk for lung cancer.
Malignancy (Confirmed)
While in the diagnostic work-up of patients with suspected malignancy CT Abdomen and Chest is usually used, once a diagnosis has been confirmed PET-CT scanning is often a better test, especially if treatment decisions hinge on excluding metastases not apparent on CT.
As with suspected malignancy, it is important to consider whether further imaging is appropriate, especially if a patient has multiple co-morbidities and may not be a candidate for any therapy.
The Australian Imaging guidelines also have pathways for Cancer Staging.
The Midland Cancer Network have also developed specific guidelines for the work-up of a number of
cancers including: Non-Small Cell Lung Cancer and melanoma
PET scanning has been of limited availability, but now that its role is better established, it is funded for a number of indications. National guidelines for PET scanning have been developed and these are shown below. PET scanning for other indications needs to be negotiated.
The ‘Choosing Wisely’ recommendations include:
Don’t perform CT surveillance for evaluation of indeterminate pulmonary nodules at more frequent intervals or for a longer period of time than recommended by established guidelines.
Don’t perform PET, CT, and radionuclide bone scans in the staging of early prostate or breast cancer at low risk for metastasis.
Don’t perform surveillance imaging (PET, CT, and radionuclide bone scans) for asymptomatic individuals who have been treated for breast cancer with curative intent.
Limit surveillance CT scans in asymptomatic patients following curative-intent treatment for aggressive lymphoma.
Don’t perform baseline or routine surveillance CT scans in patients with asymptomatic, early-stage chronic lymphocytic leukemia (CLL).
Avoid routine imaging for cancer surveillance in women with gynaecologic cancer, specifically ovarian, endometrial, cervical, vulvar and vaginal cancer.
Avoid using PET or PET-CT scanning as part of routine follow-up care to monitor for a cancer recurrence in asymptomatic patients who have finished initial treatment to eliminate the cancer unless there is high-level evidence that such imaging will change the outcome.