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Towards a comprehensive head‑and‑neck oncological radiology (HNOR) consortium: Are we there yet?
We are grateful to Mondal et al.[1] and Basu et al.[2] for their critical review of our study titled, “Second opinion interpretations by specialty radiologists in head-and-neck oncology and their impact on clinical management: A retrospective observational study,” and we thank them for the valuable comments.[3] We would like to acknowledge their comments and address each of their concerns and queries.
Our work was the first of its kind in the Indian population; our study included 492 patients. Many patients get their initial investigations conducted at radiological centers near their residences, as per the advice of their local practitioners, and they then visit tertiary care hospitals upon referral. Many such tertiary care institutions ask for repeat imaging, which places a burden on the healthcare system. Repeat imaging can be effectively avoided by simply reviewing the images of the locally performed scans by an expert in-house radiologist. With the increasing number of such patients visiting tertiary cancer care centers, performing such a study, as rightly mentioned by Mondal et al.,[1] was the need of the hour.
Background
The main objective was to assess whether CT reports of radiologists subspecialized in oncologic imaging respond better to oncological referrals than reports from general radiologists. The secondary objective was to assess differences in ratings between a senior and junior oncologist. Two hundred radiological reports pertaining to oncological patients were retrospectively selected of which 100 each were written by subspecialized radiologists and general radiologists, respectively. The senior and junior oncologists each rated all CT reports using a Likert scale from 1 to 5 (1 = very poor, 5 = excellent) for the following information: anatomical details; interpretation of findings; need for further explanations; appropriateness of conclusions; overall satisfaction. Comparisons between ratings assigned to reports from generalist radiologists and subspecialty radiologists were performed using the Mann–Whitney U test. Agreement between both oncologists was assessed through Gwet's coefficient.
Results
For all but two of the five items obtained from the senior oncologist, oncologists' ratings were significantly higher for subspecialty radiologists' reports ( p < 0.01); mean values from both oncologists were generally higher for subspecialty reports ( p < 0.001). Agreement between the senior and junior oncologist in the rating of reports from general and subspecialty radiologists was either moderate to substantial (0.5986–0.6788) or substantial to almost perfect (0.6958–0.8358).
Conclusions
According to a senior and junior oncologist, CT reports performed by subspecialized radiologists in oncologic imaging are clearer, more accurate, and more appropriate in the interpretation and conclusions compared to reports written by general radiologists. Likewise, the overall satisfaction of the oncologist from a subspecialized radiologist report is higher.
Background: The incidence of cancer is on the rise in India as well as around the globe. Earlier oral, breast, and cervical cancers constituted a major burden of cancer in India. However, the recent world statistics suggest that the proportion of lung, colorectal, breast, and prostate cancers is increasing. The Indian National Cancer Registry reports provide robust data regarding the cancer incidence in India.
Objectives: We aimed to analyze the Indian National Cancer Registry report of 2020 to determine whether there has been a change in the trend of cancer incidence.
Materials and Methods: Six population-based cancer registries (PBCR) with the highest number of patients were selected from each zone of the country. From these, a total of 1,87,891 patients were included in the study to ensure a pan-India representation. The relative proportion of oral, breast, cervical, lung, ovarian, endometrial, and prostate cancers was determined from these PBCRs. The mean of these values for each of these cancer types from the six PBCRs was considered the mean proportion of these cancer types across the country.
Results: According to data from the PBCRs, lung and oral cancers were found to be the leading cancer types among men, and breast and cervix uteri cancers among women. The mean relative proportions showed that oral, breast, and cervical cancers still constitute the major bulk of this disease in India. Moreover, it was observed that the incidence of lung cancer has significantly increased. Likewise, the incidence of the cancers of the prostate, ovary and endometrium is also on the rise. The highest age-adjusted incidence rates (AAR) for men were noted in the Aizawl district of Mizoram and the highest AAR for women was in Papumpare district of Arunachal Pradesh.
Conclusion: There continues to be a disproportionately high incidence of cancers in northeast India. Policymakers and healthcare professionals should focus on the emerging cancers along with oral, breast, and cervical cancers, which still constitute the major cancer burden in our country.
Background: In India, head and neck cancer (HNC) has always been a challenge to treatment due to its various disease., treatment., and patient.related factors. Recent developments in the field of both radiology and radiation oncology brings us to a stage where combined collaborative efforts are required for proper management of HNC. The article identifies the potential areas of such need through online survey.
Materials and Methods: This anonymous online survey with specific questions and their responses from radiation oncology community identifies potential areas of radiology expertise as perceived by a radiation oncologist. The questions were simple Likert-type and the best possible response was sought for.
Results: There were 57 email responses and majority (37) agreed upon the extreme importance of such collaborative efforts. The major areas where a radiation oncologist would seek help are target volume delineation and response evaluation posttreatment in HNC, though other areas are also important albeit to a lesser degree.
Conclusion: There is urgent need of radiology.radiation oncology workshops in managing HNC in the modern era of image.based and image-guided treatment. Future larger hospital.based survey would determine need on a large scale basis at resolving these issues.
Background: Patients with medical imaging performed and interpreted elsewhere often come to tertiary referral centers for further management. At our tertiary cancer hospital, external imaging studies of patients with head-and-neck cancer undergo formal second opinion reporting by subspecialty oncoradiologists.
Objectives: We aimed to audit the second in-house review of outside scans by specialized head-and-neck radiologists to estimate the potential impact on patient management. Our secondary objective was to determine the direct impact of the second opinion by head-and-neck specialist radiologists on the change in diagnosis, stage, and management of patients. We also aimed to determine the indirect impact on the cost–benefit ratio and the time taken for decision making.
Materials and Methods: This was a retrospective review of original and second opinion reports for consecutive patients that came with films/compact discs (CDs) and reports of computed tomography (CT), magnetic resonance imaging (MRI), or positron resonance imaging - computed tomography (PET-CT), initially performed and interpreted at another institution, and later, a second opinion review of imaging was done by the in-house subspecialty radiologists in head-and-neck onco-imaging between May 2016 and December 2017. The rates of discrepancy for staging and recommended management and the report accuracy were determined and compared to the gold standard: pathological staging.
Results: Following the specialist in-house radiologist's second opinion review, the cancer stage changed in 28% (139/492) cases, and the management recommendation changed in 6.7% (67/492) of the patients with head-and-neck cancer. Compared to the histopathology results that were available for 93/492 (19%) cases, the second opinion interpretation was correct 87% of the time (81/93). The average time saved by the second radiology opinion was 8.6 days. Significant monetary savings amounting to ₹11,35,590 ($13,788.3) were achieved.
Conclusion: A second opinion review of outside imaging in patients with head-and-neck cancer by expert in-house onco-radiologists results in a change in the stage of cancer and the management plan in a significant number of cases, saves time by expediting the work-up, and helps to avoid expenditure on repeat imaging.
Although CT and MRI are crucial imaging modalities for the preoperative staging and surgical planning of head and neck tumors, the quality of reports, as
well as adequate imaging methodology, are equally critical. The content and quality of the report, and the proper communication of these findings to the
treating physicians are the sole determinants of optimal patient care. Synoptic reporting is a method of presenting specified data pieces in a predetermined
format. When compared to random reporting, synoptic reporting gives standardized information in less time. It enables more comprehensive reports and
ensures that no details are overlooked. By highlighting the crucial imaging results and altering overall management, it ensures improved surgical planning.
Aims:
Increasingly complex imaging techniques, such as computed tomography, magnetic resonance imaging and positron emission tomography/computed tomography scans are being used by radiation oncologists to improve the accuracy of their radiotherapy planning contours, despite limited formal training in diagnostic imaging. This study aimed to assess whether the availability of an 'in-house' radiologist would be beneficial in enhancing the interpretation of oncological imaging and accuracy of contouring.
Materials and methods:
A radiology/oncology fellow was based in the oncology department, providing radiological advice on diagnostic and planning images, for two sessions per week over a 9 month period. Oncology staff were able to book a time slot with the radiologist on a MOSAIQ cancer database and record the reason for the consultation and its outcome. The radiologist also reviewed the accuracy of the patient's contours for the weekly quality assurance audit meetings.
Results:
The radiologist reviewed 56 scans during the 49 consultation sessions. Advice over diagnostic images and target volume delineation were the main reasons for the consultations, which resulted in a change of practice in 45% of cases, ranging from changing target volumes (25%) to carrying out further imaging (20%). For the quality assurance audit meetings, the radiologist's review of 99 patients' planning contours resulted in a significant change in management in 6% of cases.
Conclusions:
This is the first study to attempt to formally quantify the clinical benefit of having a dedicated 'in-house' radiologist within a radiation oncology department, clearly showing the valuable impact of such a role.
Impact of a dedicated radiologist as a member of the head and neck tumour board: A single-institution experience
- Alterio