Alexander Rand, MD, University of Vermont, and Michael Chorney, MD, Penn Medicine, University of Pennsylvania Health System, contributed to this post.
Opinions are the authors’ own and do not reflect their institutions’ opinions.
Imaging is critical for the detection and evaluation of cancer. Cancers manifest on dedicated screening and diagnostic studies as well as incidentally on other studies. Tumors may change in size, distribution and enhancement pattern during treatment, which directly impacts treatment decisions. Radiologists must be able to assess cancer’s complex evolution over time on imaging to provide the best patient care. Unfortunately, health care’s current reliance on compact discs (CDs) for image transfer often leaves radiologists without prior examinations for comparison.
Cancer screening imaging enables early detection and prompt treatment to reduce patient mortality. Radiologists strive both to detect cancers and discriminate between benign and malignant masses or nodules. Some cancers, particularly breast cancers, may only become apparent with subtle changes in size and morphology over time. Long-term stability of a mass makes cancer less likely. If suspicion for cancer remains very low, or biopsy carries high risk for morbidity, follow-up imaging can help determine if intervention is warranted. However, patients often forget to bring their CDs or discover that the images are missing or corrupted. When prior images are unavailable, the radiologist may be compelled to recommend another imaging study or biopsy. Unnecessary follow-up studies and biopsies may cause patients anxiety, stress or complications, as well as burden the already strained health care system.
Cancer patients may receive follow-up imaging at multiple institutions, especially for emergent complications. Radiologists’ frequent lack of comparison examinations from other institutions hinders the interpretation of these studies. Direct comparison to historical images ought to be readily available to better assess tumors, therapeutic response and emergent oncologic complications.
We encourage practices to transition from CDs to cloud-based file-sharing to have patients’ prior examinations readily available to interpreting providers at all institutions at which a patient may seek care. The comparison image availability would enable faster, better cancer screening interpretation, diagnosis, assessment of disease progression and detection of complications. Costly and sometimes unnecessary biopsies and additional rounds of follow-up examinations would be reduced.
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