In the era of personalized cancer care, accurate staging and imaging are the foundation for optimal treatment recommendations. Increasingly, radiation oncologists are dependent upon diagnostic rads for the precise identification and enumeration of metastatic disease to guide therapy.
The Magic Word: As Christopher Straka, MD, noted in the ARRS Online Course Radiation Oncology for the Diagnostic Radiologist, many patients are managed primarily by medical oncologists—who may only trigger a referral to a rad onc if they see the specific term: oligometastatic.
Leveling Up: To pull back the black box of rad onc and improve outcomes, Dr. Straka shared some suggested standards:
- Enumerate: Provide a clear count of metastatic sites in your impression.
- Prostate-Specific: For PSMA PET scans, specifically enumerate the number of extra-axial metastases.
- Resolve Equivocals: If a lesion is uncertain, don’t just call it equivocal; please suggest the next modality that would provide certainty.
- Breadcrumbs: Use arrows, imaging annotations, and specific slice numbers to help rad oncs quickly locate targets.
RadFYI: Effective communication between rads and treating oncs has never been more important for metastasis-directed therapy. Direct consultation remains the gold standard for complex cases.
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