Quantitative Radiology Reporting in Oncology: Survey of Oncologists and Radiologists.

OBJECTIVE: Tumor quantification is essential for determining the clinical efficacy and response to established and evolving therapeutic agents in cancer trials. The purpose of this study was to seek the opinions of oncologists and radiologists about quantitative interactive and multimedia reporting. SUBJECTS AND METHODS: Questionnaires were distributed to 253 oncologists and registrars and to 35 radiologists at our institution through an online survey application. Questions were asked about current reporting methods, methods for Response Evaluation Criteria in Solid Tumors (RECIST) tumor measurement, and preferred reporting format. RESULTS: The overall response rates were 43.1% (109/253) for oncologists and 80.0% (28/35) for radiologists. The oncologists treated more than 40 tumor types. Most of the oncologists (65.7% [67/102]) and many radiologists (44.4% [12/27]) (p = 0.020) deemed the current traditional qualitative radiology reports insufficient for reporting tumor burden and communicating measurements. Most of the radiologists (77.8% [21/27]) and oncologists (85.5% [71/83]) (p = 0.95) agreed that key images with measurement annotations helped in finding previously measured tumors; however, only 43% of radiologists regularly saved key images. Both oncologists (64.2% [70/109]) and radiologists (67.9% [19/28]) (p = 0.83) preferred the ability to hyperlink measurements from reports to images of lesions as opposed to text-only reports. Approximately 60% of oncologists indicated that they handwrote tumor measurements on RECIST forms, and 40% used various digital formats. Most of the oncologists (93%) indicated that managing tumor measurements within a PACS would be superior to handwritten data entry and retyping of data into a cancer database. CONCLUSION: Oncologists and radiologists agree that quantitative interactive reporting would be superior to traditional text-only qualitative reporting for assessing tumor burden in cancer trials. A PACS reporting system that enhances and promotes collaboration between radiologists and oncologists improves quantitative reporting of tumors.

From shared data to sharing workflow: merging PACS and teleradiology.

Due to a host of technological, interface, operational and workflow limitations, teleradiology and PACS/RIS were historically developed as separate systems serving different purposes. PACS/RIS handled local radiology storage and workflow management while teleradiology addressed remote access to images. Today advanced PACS/RIS support complete site radiology workflow for attending physicians, whether on-site or remote. In parallel, teleradiology has emerged into a service of providing remote, off-hours, coverage for emergency radiology and to a lesser extent subspecialty reading to subscribing sites and radiology groups. When attending radiologists use teleradiology for remote access to a site, they may share all relevant patient data and participate in the site's workflow like their on-site peers. The operation gets cumbersome and time consuming when these radiologists serve multi-sites, each requiring a different remote access, or when the sites do not employ the same PACS/RIS/Reporting Systems and do not share the same ownership. The least efficient operation is of teleradiology companies engaged in reading for multiple facilities. As these services typically employ non-local radiologists, they are allowed to share some of the available patient data necessary to provide an emergency report but, by enlarge, they do not share the workflow of the sites they serve. Radiology stakeholders usually prefer to have their own radiologists perform all radiology tasks including interpretation of off-hour examinations. It is possible with current technology to create a system that combines the benefits of local radiology services to multiple sites with the advantages offered by adding subspecialty and off-hours emergency services through teleradiology. Such a system increases efficiency for the radiology groups by enabling all users, regardless of location, to work "local" and fully participate in the workflow of every site. We refer to such a system as SuperPACS.