Korean J Radiol.  2017 Feb;18(1):18-27. 10.3348/kjr.2017.18.1.18.

Radiology Consultation in the Era of Precision Oncology: A Review of Consultation Models and Services in the Tertiary Setting

• DiPiro PJ
• Krajewski
• Giardino A
• Braschi-Amirfarzan M
• Ramaiya NH

• KMID: 2468119
• DOI: http://doi.org/10.3348/kjr.2017.18.1.18

Abstract

The purpose of the article is to describe the various radiology consultation models in the Era of Precision Medicine. Since the inception of our specialty, radiologists have served as consultants to physicians of various disciplines. A variety of radiology consultation services have been described in the literature, including clinical decision support, patient-centric, subspecialty interpretation, and/or some combination of these. In oncology care in particular, case complexity often merits open dialogue with clinical providers. To explore the utility and impact of radiology consultation services in the academic setting, this article will further describe existing consultation models and the circumstances that precipitated their development. The hybrid model successful at our tertiary cancer center is discussed. In addition, the contributions of a consultant radiologist in breast cancer care are reviewed as the archetype of radiology consultation services provided to oncology practitioners.

Keyword

Radiology consultation; Radiology services; Precision medicine; Tertiary cancer center

MeSH Terms

Breast Neoplasms/diagnostic imaging
Decision Support Techniques
Female
Humans
Interprofessional Relations
Oncology Service, Hospital/*organization & administration
Patient-Centered Care/organization & administration
Precision Medicine/*methods
Radiology/*organization & administration
Referral and Consultation/*organization & administration
Tertiary Healthcare/organization & administration
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 43-year-old woman with newly diagnosed inflammatory breast cancer. A-C. Axial fused PET-CT images of supraclavicular region, upper and mid chest demonstrate focal tracer uptake at right supraclavicular region (white arrow, A), right subpectoral region, right axillary region (white arrows, B), within right anterior chest wall (white arrow, C) and right internal mammary node (white arrowhead, C). D-F. In contrast-enhanced axial CT images at same level, which was performed at outside institution 1 week earlier, lesions are not easily identified. PET-CT = positron emission tomography-computed tomography

• 

  Fig. 2 51-year-old woman with invasive lobular breast cancer. A. Contrast-enhanced coronal CT image of abdomen reveal mild gastric wall thickening (white arrow, A) with minimal perigastric stranding (white arrowhead, A). B. Follow-up contrast-enhanced coronal CT image after 3 months demonstrates marked increase of gastric thickening (white arrow, B) and new peritoneal carcinomatosis (white arrowheads, B). C. Follow-up contrast-enhanced coronal CT image after 3 months demonstrates further interval increase of gastric thickening (white arrow, C) and worsening of measurable and non-measurable peritoneal disease (white arrowheads, C).

• 

  Fig. 3 48-year-old woman with advanced breast cancer metastatic to bones. A. Coronal CT image of the abdomen (bone window) reveal extensive lytic lesion involving left iliac bone (white arrow, A) and small lytic lesion within L5 vertebral body (white arrowhead, A). B. Follow-up coronal CT image of abdomen (bone window) shows marked increased sclerosis of left iliac lesion (white arrow, B), L5 vertebral body lesion (white arrowhead) and apparent new well-defined sclerotic lesion within L2 vertebral body (black arrow, B), which is consistent with treatment response.

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