template for pancreatic carcinoma reporting · template for pancreatic carcinoma reporting...

19
Radiology Structured Reporting for Pancreatic Carcinoma Isaac R. Francis, M.B; B.S University of Michigan Hospitals Ann Arbor, Michigan

Upload: others

Post on 20-May-2020

20 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: Template for Pancreatic Carcinoma Reporting · Template for Pancreatic Carcinoma Reporting Pancreatic Cancer Template Work Group M Al-Hawary, S Chari, EK Fishman, D Hough, ... •

Radiology Structured Reporting for Pancreatic

Carcinoma

Isaac R. Francis, M.B; B.S University of Michigan Hospitals Ann Arbor, Michigan

Page 2: Template for Pancreatic Carcinoma Reporting · Template for Pancreatic Carcinoma Reporting Pancreatic Cancer Template Work Group M Al-Hawary, S Chari, EK Fishman, D Hough, ... •

SAMPLE UNSTRUCTURED REPORTS

Page 3: Template for Pancreatic Carcinoma Reporting · Template for Pancreatic Carcinoma Reporting Pancreatic Cancer Template Work Group M Al-Hawary, S Chari, EK Fishman, D Hough, ... •

M

M M

M

M

M

M

Page 4: Template for Pancreatic Carcinoma Reporting · Template for Pancreatic Carcinoma Reporting Pancreatic Cancer Template Work Group M Al-Hawary, S Chari, EK Fishman, D Hough, ... •

Structured Reports Attributes of a “Good” Radiology Report

• Clarity • Correctness • Confidence • Concision • Completeness • Consistency • Communication • Consultation • Timeliness • Standardization

* Reiner BI J Digit Imaging 2009

Page 5: Template for Pancreatic Carcinoma Reporting · Template for Pancreatic Carcinoma Reporting Pancreatic Cancer Template Work Group M Al-Hawary, S Chari, EK Fishman, D Hough, ... •

RSNA Radiology Reporting Templates Structured Reporting

RSNA Structured Report Initiative (M Heilburn, Univ. of Utah, Salt Lake City, UT)

• PRIMARY TUMOR: • - Size, location, attenuation, size of pancreatic duct • MESENTERIC ARTERIES - Arterial anatomy: Arterial tumor abutment or encasement:

Proximal celiac artery, SMA, and hepatic artery • MESENTERIC VEINS • - Venous tumor abutment or encasement: less than or equal

to 180 degrees or greater than 180 degrees - SMV, SV and Portal venous system • LOCOREGIONAL SPREAD - Lymph nodes, peritoneum, omentum, ascites • DISTANT SPREAD: - Focal liver lesion, lung, etc. * Tolat P et al. Medical College of Wisconsin

Page 6: Template for Pancreatic Carcinoma Reporting · Template for Pancreatic Carcinoma Reporting Pancreatic Cancer Template Work Group M Al-Hawary, S Chari, EK Fishman, D Hough, ... •

Template for Pancreatic Carcinoma Reporting

Pancreatic Cancer Template Work Group

M Al-Hawary, S Chari, EK Fishman, D Hough, DS Lu, M Macari, AJ Megibow, N Merchant, F Miller, R Minter, K Mortele, D Simeone, D Sahani, EA Tamm Beth Israel Deaconess, Johns Hopkins,

Massachusetts General Hospital, Northwestern University, New York University, MD Anderson, Mayo Clinic, University of Southern California, University of Michigan, Vanderbilt University

Page 7: Template for Pancreatic Carcinoma Reporting · Template for Pancreatic Carcinoma Reporting Pancreatic Cancer Template Work Group M Al-Hawary, S Chari, EK Fishman, D Hough, ... •

Radiology Reporting Templates

Structured Reporting American Pancreatic Association

• PRIMARY TUMOR: • - Size, location, attenuation, presence of atrophy, MPD, and CBD

diln. • MESENTERIC ARTERIES - Arterial anatomy: Proximal celiac artery, SMA, and hepatic artery - Tumor abutment (less than or equal to 180 degrees or

encasement (greater than 180 degrees) -Distance of tumor involvement of hep. artery from celiac axis • MESENTERIC VEINS • - Venous anatomy: • - SMV, SV and Portal venous system • - Tumor abutment (less than or equal to 180 degrees or

encasement (greater than 180 degrees) • - Distance from tumor to first jejunal vein branch • LOCOREGIONAL SPREAD - Lymph nodes, peritoneum, omentum, ascites • DISTANT SPREAD: - Focal liver lesion, lung, etc. *M Al-Hawary et al ( Work in Progress)

Page 8: Template for Pancreatic Carcinoma Reporting · Template for Pancreatic Carcinoma Reporting Pancreatic Cancer Template Work Group M Al-Hawary, S Chari, EK Fishman, D Hough, ... •

PANCREATIC CARCINOMA Resectability Criteria

� No distant metastases � No SMV or PV abutment,

distortion, encasement or occlusion/thrombus

� Clear fat planes around the celiac axis, hepatic artery and SMA

* NCCN Guidelines version 2.2012

Page 9: Template for Pancreatic Carcinoma Reporting · Template for Pancreatic Carcinoma Reporting Pancreatic Cancer Template Work Group M Al-Hawary, S Chari, EK Fishman, D Hough, ... •
Page 10: Template for Pancreatic Carcinoma Reporting · Template for Pancreatic Carcinoma Reporting Pancreatic Cancer Template Work Group M Al-Hawary, S Chari, EK Fishman, D Hough, ... •

Small resectable tumor No abutment/encasement of CA,HA, SMA or SMV and PV

Page 11: Template for Pancreatic Carcinoma Reporting · Template for Pancreatic Carcinoma Reporting Pancreatic Cancer Template Work Group M Al-Hawary, S Chari, EK Fishman, D Hough, ... •

Radiology Reporting Templates Structured Reporting

American Pancreatic Association • PRIMARY TUMOR

- 2 cm , low density in head with no PD or CBD diln. or upstream atrophy • MESENTERIC ARTERIES - No abutment or encasement of celiac artery, SMA, and

hepatic artery - Standard hepatic arterial anatomy - MESENTERIC VEINS • - No venous tumor abutment or encasement of SMV or PV • LOCOREGIONAL SPREAD - no enlarged lymph nodes. No local tumor extension into

adjacent organs DISTANT SPREAD: - No focal hepatic lesions, omental/peritoneal nodules or

ascites *M Al-Hawary et al ( Work in Progress)

Page 12: Template for Pancreatic Carcinoma Reporting · Template for Pancreatic Carcinoma Reporting Pancreatic Cancer Template Work Group M Al-Hawary, S Chari, EK Fishman, D Hough, ... •

PANCREATIC CARCINOMA Unesectability Criteria

• HEAD: • Distant metastases, >1800 encasement of

SMA, CA abutment, occluded PV/SMV, aortic invasion

• BODY: • Distant metastases, >1800 encasement of

CA, SMA, occluded SMV/PV, aortic invasion

• TAIL: • Distant metastases, >1800 encasement

of CA, SMA

* NCCN Guidelines version 2.2012

Page 13: Template for Pancreatic Carcinoma Reporting · Template for Pancreatic Carcinoma Reporting Pancreatic Cancer Template Work Group M Al-Hawary, S Chari, EK Fishman, D Hough, ... •

M M

M M

M

UNRESECTABLE PANCREATIC CARCINOMA- BODY >180 encasement of CA, HA, SMA and retroperitoneal ext.

Page 14: Template for Pancreatic Carcinoma Reporting · Template for Pancreatic Carcinoma Reporting Pancreatic Cancer Template Work Group M Al-Hawary, S Chari, EK Fishman, D Hough, ... •

> 180 degrees encasement of SMA

Page 15: Template for Pancreatic Carcinoma Reporting · Template for Pancreatic Carcinoma Reporting Pancreatic Cancer Template Work Group M Al-Hawary, S Chari, EK Fishman, D Hough, ... •

UNRESECTABLE PANCREATIC CARCINOMA- UNCINATE >180 degrees encasement of SMA-Tethered/occluded SMV

Page 16: Template for Pancreatic Carcinoma Reporting · Template for Pancreatic Carcinoma Reporting Pancreatic Cancer Template Work Group M Al-Hawary, S Chari, EK Fishman, D Hough, ... •

PANCREATIC CARCINOMA Borderline Resectability Criteria

� No distant metastases � SMV or PV abutment, distortion,

encasement or short segment occlusion/thrombus of SMV or PV but with suitable proximal and distal landing sites for venous reconstruction

� GDA encasement up to origin from HA, and short segment encasement or abutment of HA without CA involvement

� SMA abutment not to exceed 180 degrees

* NCCN Guidelines version 2.2012

Page 17: Template for Pancreatic Carcinoma Reporting · Template for Pancreatic Carcinoma Reporting Pancreatic Cancer Template Work Group M Al-Hawary, S Chari, EK Fishman, D Hough, ... •

BORDERLINE RESECTABLE PANCREATIC CARCINOMA SHORT SEGMENT CONTACT WITH HA

T T

T T

Page 18: Template for Pancreatic Carcinoma Reporting · Template for Pancreatic Carcinoma Reporting Pancreatic Cancer Template Work Group M Al-Hawary, S Chari, EK Fishman, D Hough, ... •

Obstacles to use of Structured Reporting

• Time consuming- decreased efficiency and productivity

• Structured reports are difficult to standardize across centers as consensus difficult to achieve

• Even with complex exams as in cardiac imaging (CCTA), SR’s are adapted to suit individual centers • For ex. cardiologists main interest is in the

coronary arteries in a coronary CTA, but radiologists have to interpret the whole exam- so a template suited to the cardiologists may not be ideal for the radiologist

• Benefits mainly are to referring clinicians, and possibly hospital administrator and insurance company

* Bosman JML at al Insights Imaging 2012

Page 19: Template for Pancreatic Carcinoma Reporting · Template for Pancreatic Carcinoma Reporting Pancreatic Cancer Template Work Group M Al-Hawary, S Chari, EK Fishman, D Hough, ... •

Radiology Reporting Templates Structured Reporting

• PRIMARY TUMOR

• MESENTERIC ARTERIES - CA, HA, SA, SMA - Arterial variants

• MESENTERIC VEINS - SV, SMV, PV • LOCOREGIONAL SPREAD • DISTANT SPREAD