Imaging Guidelines - New Jersey, Maryland, And Washington, D.C. - Regional Cancer Care Associates

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Imaging Guidelines for RCCA in New Jersey, Maryland, and Washington, D.C.

Regional Cancer Care Associates (RCCA) has developed imaging guidelines to decrease cumulative radiation exposure and improve cost efficiencies during cancer treatments. A consensus opinion has emerged that substantive reduction in subsequent follow-up imaging sessions. By implementing guidelines for routine follow-ups that feature a more comprehensive imaging at the initial stage, we are able to decrease the necessity and extent of routine follow-up imaging sessions in the future.

Guidelines for Common Types of Cancer Treatment

The guidelines include mid-cycle re-imaging and more frequent follow-up imaging when it is associated with a potential survival benefit. Separate protocols are available for different forms of various types of cancer, including:

Exceptions to Imaging Guidelines

The guidelines do not apply when a patient is being evaluated for a new or existing symptom. They also do not apply for patients with abnormal physical findings or an abnormality in a laboratory test. A final exception is when unrelated radiographs are also being performed. Regional Cancer Care Associates is dedicated to providing innovative care for more effective cancer treatment and assessment. Contact our team at RCCA to learn more about our range of services related to imaging and medical hematology/oncology.

 

Disease

TNM Stage

Initial

Follow-up

CPT Codes

Breast

DIS

None

None

 

T1a through T3, N0
T1a through T2, N1

None unless an abnormality

None unless an abnormality

 

T4
T3,N1
N2
N3

1.PET
2.Contrast CT (chest/abd/pelvis)
3.Bone Scan

None unless an abnormality

 

Breast

M-1

1.PET
2.Contrast CT (chest/abd/pelvis)
3.Bone Scan

Disease site (only) Contrast CT
or bone scan every 4-6 months during therapy.
None when off therapy unless an abnormality

 

GI
Esophagus
and Stomach, Small Bowel

Tis

None

None

 

GI

Esophagus

and Stomach, Small Bowel

 

T1a

1.Contrast CT (chest/abd/pelvis)

2.Endoscopic Ultrasound (when able)

 

None unless an abnormality

 

T1b-T4b

Or any N

1.PET

2.Contrast CT (chest/abd/pelvis)

3. Endoscopic

Ultrasound (when able)

Completely Resection-None unless an abnormality.

Partial Resection- Disease site (only) Contrast CT scan every 3-6 months during therapy.

None when off therapy unless an abnormality.

 

 

GI

Esophagus and Stomach, Small Bowel

M1

1.PET

2.Contrast CT (chest/abd/pelvis)

Disease site (only) Contrast CT scan every 3-6 months during therapy.

None when off therapy unless an abnormality.

 

 

GI (colon and rectum)

Tis

None

None

 

T1-T4b

Or any N

1.Contrast CT (chest/abd/pelvis)

2.Rectal Only-Trans rectal Ultrasound or MRI

1.Contrast CT (chest/abd/pelvis)

2.Rectal Only-Trans rectal Ultrasound or MRI

 

M1

1.Contrast CT (chest/abd/pelvis)

2.PET If Liver or Lung only disease on CT

3.MRI Liver pre surgery

Completely Resection- Contrast CT scan (Chest and abdomen) at 6 months, 1, 2 and 3 years then None unless an abnormality.

Partial Resection- Disease site (only) Contrast CT scan every 3-6 months during therapy.

None when off therapy unless an abnormality.

 

Hepatocellular

Liver only T1-4

1.Contrast CT (chest/abd/pelvis)

2. MRI Liver

Completely Resection- Contrast CT scan or MRI (abdomen) at 4 months, 1, 2, 3, 4 and 5 years then None unless an abnormality.

Partial Resection- Disease site (only) Contrast CT scan every 3-6 months during therapy.

None when off therapy unless an abnormality

 

 

M1

1.Contrast CT (chest/abd/pelvis)

Disease site (only) Contrast CT scan every 3-6 months during therapy.

None when off therapy unless an abnormality

 

Lung NSCLC

Tis

None

None

 

Lung NSCLC

T1a-T4

Any N

1.Contrast CT (chest/abd/pelvis)
2.PET

3.MRI Brain

Contrast CT chest only 6 months, 1 year, 2 year, 3 year

then CXR annually x2 years

then none unless an abnormality

 

M1

1.Contrast CT (chest/abd/pelvis)
2.PET

3.MRI Brain

CT disease site (only) every 3-6 months during therapy

None when off therapy unless an abnormality

 

Lung SCLC

T1a-T4

Any N

1.Contrast CT (chest/abd/pelvis)
2.PET

3.MRI Brain

Contrast CT Chest only 6 months, 1 year, 2 years, 3 years

then CRX annually x2 years

Then none unless an abnormality

 

M1

1.Contrast CT (chest/abd/pelvis)
2.PET

3.MRI Brain

CT disease site (only) every 3-6 months during therapy

None when off therapy unless an abnormality

 

NHL (B cell Large Cell)

Any T or N

1.Contrast CT (chest/abd/pelvis)
2.PET

After 2-3 cycles Contrast CT disease site (only)

Then after completion of therapy PET

Then contrast CT (chest/abd/pelvis) at 6 months, 12 months

Then annually x 2 more years

Then none unless an abnormality

 

NHL (B cell Follicular)

Any T or N

1.Contrast CT (chest/abd/pelvis)
2.PET

After 2-3 cycles Contrast CT (disease site only)

Then after completion of therapy PET

Then contrast CT (chest abd pelvis) at 6 months, 12 months

Then annually for 2 more years

Then none unless an abnormality

If maintenance rituximab CT (no PET) every 6ms MAX (prior to next maintenance).

For watch and wait pts post diagnosis CT q6 ms x 2y max then yearly.

PET only if suspicion of transformation

 

Hodgkins

I/II/III/IV

1.Contrast CT (chest/abd/pelvis)
2.PET

After 2-3 cycles PET-CT,

after completion of therapy Contrast CT and PET

Then contrast CT (chest/abd/pelvis) at 6 months,

Then annually x 3 years

Then None unless an abnormality

 

Melanoma

Tis, T1a

None

None

 

 

T1b through T4b, N0

1.CXR

None

 

 

Any N

1.Contrast CT (chest/abd/[pelvis-only for inguinal and pelvic disease])
2.PET

3. MRI Brain

Contrast CT (Chest Abd [Pelvis-only for inguinal and pelvic disease]) 6 months, 18 months and two years. Repeat PET one year

Then none unless an abnormality

 

 

M1

1.Contrast CT (chest/abd/pelvis)
2.PET

3. MRI Brain

Disease site (only) Contrast CT scan every 3-6 months during therapy.

None when off therapy unless an abnormality

 

 

[1] Smith-Bindman R, Miglioretti DL, Johnson E, et al. Use of Diagnostic Imaging Studies and Associated Radiation Exposure for Patients Enrolled in Large Integrated Health Care Systems, 1996-2010. JAMA. 2012;307(22):2400-2409. doi:10.1001/jama.2012.5960.

[2] Dr Amy Berrington de Gonzalez DPhil,Rochelle E Curtis MA, et al. Proportion of second cancers attributable to radiotherapy treatment in adults: a cohort study in the US SEER cancer registries, The Lancet Oncology – 1 April 2011 ( Vol. 12, Issue 4, Pages 353-360 )