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 advises a substantive reduction in subsequent follow-up imaging sessions. By implementing guidelines for routine follow-ups that feature 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

Hodgkin

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 )

 

Oncology Medical Home (Doctors)

Working with you to beat your patient’s cancer

Oncology Medical Home (OMH) is a patient-centered model of care that prioritizes your patient’s needs through enhanced care coordination, compliance with rigorous performance standards and a unified focus on beating cancer. At RCCA, we’ve adopted the OMH model to improve every aspect of your patient’s experience, including a patient-centric focus and evidence-based treatment. And to everybody’s benefit, we consider care coordination between primary care physicians, specialists and oncologists an integral part of our approach.

Patients’ wishes are the priority, and OMH brings everyone together – doctors, patients and payers – to ensure they are met

Generally, people orient their medical treatment around a primary care physician who refers to specialists. However, when treating cancer, patients and doctors need to consider all medical concerns in the context of that cancer. In this sense, RCCA will serve as another “medical home” for your patient. To meet this standard, we provide both a compassionate, primary care environment and a rigorous system of self-improvement across all of our clinics, with your patient as our priority. Also, by only providing care that’s backed by solid evidence, we give patients the best treatments available while saving them money on medications and procedures that haven’t held up against (or been subjected to) scientific rigor.

By following the tenets of OMH, we provide evidence-based cancer care in a compassionate environment

The core values of OMH seek to optimize each aspect of your patient’s cancer care experience. Here are the key tenets of OMH:

  • Patient-centric – Every decision we (you, your patient and his/her oncologist, together) make will revolve around your patient’s needs.
  • Care coordination – Rapid communication and problem-solving between everybody involved in your patient’s care.
  • Accessible and efficient – Care needs to be affordable, of the highest quality and available to your patient.
  • Evidence-based – We only provide treatments with proven effectiveness.
  • Regular assessment and continuous improvement – By evaluating our performance in each category and comparing our results to those of other OMH cancer care centers, we’re continuously innovating our methods and elevating the level of care we’re able to provide.

We seek input to further improve our care

Consistent with our never-ending process of evaluation and optimization, hearing from you and your patient is critical to providing the best possible cancer care — and it’s an indispensable part of the OMH model. We invite you to notify us if you have any comments, questions or concerns.

For more information, or to schedule an appointment, call (844) 346-7222. You can also schedule an appointment by calling the RCCA location nearest you.

Coordinated care is important for cancer patients

Caring for cancer patients can be a difficult challenge. Various types of doctors and other healthcare professionals can be involved in providing cancer care. Patients can interact with physician assistants, cancer nurses, social workers, pharmacists, nutritionists and counselors, among others. Patients may need several different kinds of treatments. These can range from surgery and chemotherapy to radiation therapy, as well as new and advanced treatments of many kinds.

These many factors can make for a complicated situation, with patients and their loved ones in the middle. It’s a lot to understand and keep track of. When that happens, it’s important to keep all of the people and information organized and clear at all times. If things get disorganized, mistakes can occur. Even if no mistakes are made, care can become more costly. For example, with several doctors involved, tests may be done unnecessarily.

Better organizing patient care

Many medical practices and hospitals have decided to make sure their cancer care is organized, coordinated and systematic. To make this happen, these providers usually do the following:

  • Tell every doctor and medical team member about all of a patient’s appointments. This helps doctors deliver diagnostic and treatment services in the most efficient way.
  • Coordinate each patient’s tests across the medical team. This helps make sure that the doctors have the test results they need before each patient appointment. It also helps avoid unnecessary tests.
  • Help patients arrange for other types of patient services, such as emotional support groups and pain management services.
  • Use electronic medical records and other computerized technology to keep each patient’s care as organized as possible.

Nurses can help coordinate care

In recent years, some medical practices and hospitals have asked their nursing staffs to help coordinate patient care. These nurses help patients in many ways, including:

  • Talking with newly-diagnosed cancer patients, families and caregivers
  • Offering emotional support to patients, families and caregivers
  • Helping patients understand the care they’re getting
  • Coordinating care and services among all of the medical team members
  • Helping patients deal with health insurance and other confusing aspects of the healthcare system
  • Teaching patients to help themselves in many ways
  • Teaching patients to call our office when they are not feeling well

Regional Cancer Care Associates — Coordinated cancer care close to home

Regional Cancer Care Associates (RCCA) delivers highly organized, coordinated cancer care. That means your patients get the support, education and individualized attention they need. Our oncologists work closely with our physician assistants, nurse practitioners, nurses, pharmacists and you and your staff to ensure your patients are getting the finest care available.

For more information, or to schedule an appointment for one of your patients, call (844) 346-7222. Patients can also schedule an appointment by calling the RCCA location nearest to them.