Imaging Guidelines for RCCA in New Jersey, Connecticut, Maryland, and the Washington, DC area

Regional Cancer Care Associates (RCCA) has developed imaging guidelines to decrease cumulative radiation exposure and improve cost efficiencies during cancer treatment. A consensus opinion has emerged that advises a substantive reduction in subsequent follow-up imaging sessions. By implementing guidelines for routine follow-ups that feature more comprehensive imaging at the initial stage, we are able to decrease the necessity and extent of routine follow-up imaging sessions in the future.

Imaging Guidelines for RCCA in New Jersey, Maryland, and Washington, D.C.

Regional Cancer Care Associates (RCCA) has developed imaging guidelines to decrease cumulative radiation exposure and improve cost efficiencies during cancer treatments. A consensus opinion has emerged that advises a substantive reduction in subsequent follow-up imaging sessions. By implementing guidelines for routine follow-ups that feature more comprehensive imaging at the initial stage, we are able to decrease the necessity and extent of routine follow-up imaging sessions in the future.

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Guidelines for Common Types of Cancer Treatment

The guidelines include mid-cycle re-imaging and more frequent follow-up imaging when it is associated with a potential survival benefit. Separate protocols are available for different forms of various types of cancer, including:

Exceptions to Imaging Guidelines

The guidelines do not apply when a patient is being evaluated for a new or existing symptom. They also do not apply for patients with abnormal physical findings or an abnormality in a laboratory test. A final exception is when unrelated radiographs are also being performed. Regional Cancer Care Associates is dedicated to providing innovative care for more effective cancer treatment and assessment. Contact our team at RCCA to learn more about our range of services related to imaging and medical hematology/oncology.

Disease	TNM Stage	Initial	Follow-up
Breast	DISC	None	None
	T1a through T3, N0 T1a through T2, N1	None unless an abnormality	None unless an abnormality
	T4 T3,N1 N2 N3	1.PET 2.Contrast CT (Chest/ABD/Pelvis) 3.Bone Scan	None unless an abnormality
Breast	M-1	1.PET 2.Contrast CT (chest/abd/pelvis) 3.Bone Scan	Disease site (only) Contrast CT or bone scan every 4-6 months during therapy. None when off therapy unless an abnormality
GI Esophagus and Stomach, Small Bowel	Tis	None	None
GI Esophagus and Stomach, Small Bowel	T1a	1.Contrast CT (chest/abd/pelvis) 2.Endoscopic Ultrasound (when able)	None unless an abnormality
GI Esophagus and Stomach, Small Bowel	T1b-T4b Or any N	1.PET 2.Contrast CT (chest/abd/pelvis) 3. Endoscopic Ultrasound (when able)	Completely Resection-None unless an abnormality. Partial Resection- Disease site (only) Contrast CT scan every 3-6 months during therapy. None when off therapy unless an abnormality.
GI Esophagus and Stomach, Small Bowel	M1	1.PET 2.Contrast CT (chest/abd/pelvis)	Disease site (only) Contrast CT scan every 3-6 months during therapy. None when off therapy unless an abnormality.
GI (colon and rectum)	Tis	None	None
	T1-T4b Or any N	1.Contrast CT (chest/abd/pelvis) 2.Rectal Only-Trans rectal Ultrasound or MRI	1.Contrast CT (chest/abd/pelvis) 2.Rectal Only-Trans rectal Ultrasound or MRI
	M1	1.Contrast CT (chest/abd/pelvis) 2.PET If Liver or Lung only disease on CT 3.MRI Liver pre surgery	Completely Resection- Contrast CT scan (Chest and abdomen) at 6 months, 1, 2 and 3 years then None unless an abnormality. Partial Resection- Disease site (only) Contrast CT scan every 3-6 months during therapy. None when off therapy unless an abnormality.
Hepatocellular	Liver only T1-4	1.Contrast CT (chest/abd/pelvis) 2. MRI Liver	Completely Resection- Contrast CT scan or MRI (abdomen) at 4 months, 1, 2, 3, 4 and 5 years then None unless an abnormality. Partial Resection- Disease site (only) Contrast CT scan every 3-6 months during therapy. None when off therapy unless an abnormality
	M1	1.Contrast CT (chest/abd/pelvis)	Disease site (only) Contrast CT scan every 3-6 months during therapy. None when off therapy unless an abnormality
Lung NSCLC	Tis	None	None
Lung NSCLC	T1a-T4 Any N	1.Contrast CT (chest/abd/pelvis) 2.PET 3.MRI Brain	Contrast CT chest only 6 months, 1 year, 2 year, 3 year then CXR annually x2 years then none unless an abnormality
Lung NSCLC	M1	1.Contrast CT (chest/abd/pelvis) 2.PET 3.MRI Brain	CT disease site (only) every 3-6 months during therapy None when off therapy unless an abnormality
Lung SCLC	T1a-T4 Any N	1.Contrast CT (chest/abd/pelvis) 2.PET 3.MRI Brain	Contrast CT Chest only 6 months, 1 year, 2 years, 3 years then CRX annually x2 years Then none unless an abnormality
Lung SCLC	M1	1.Contrast CT (chest/abd/pelvis) 2.PET 3.MRI Brain	CT disease site (only) every 3-6 months during therapy None when off therapy unless an abnormality
NHL (B cell Large Cell)	Any T or N	1.Contrast CT (chest/abd/pelvis) 2.PET	After 2-3 cycles Contrast CT disease site (only) Then after completion of therapy PET Then contrast CT (chest/abd/pelvis) at 6 months, 12 months Then annually x 2 more years Then none unless an abnormality
NHL (B cell Follicular)	Any T or N	1.Contrast CT (chest/abd/pelvis) 2.PET	After 2-3 cycles Contrast CT (disease site only) Then after completion of therapy PET Then contrast CT (chest abd pelvis) at 6 months, 12 months Then annually for 2 more years Then none unless an abnormality If maintenance rituximab CT (no PET) every 6ms MAX (prior to next maintenance). For watch and wait pts post diagnosis CT q6 ms x 2y max then yearly. PET only if suspicion of transformation
Hodgkin	I/II/III/IV	1.Contrast CT (chest/abd/pelvis) 2.PET	After 2-3 cycles PET-CT, after completion of therapy Contrast CT and PET Then contrast CT (chest/abd/pelvis) at 6 months, Then annually x 3 years Then None unless an abnormality
Melanoma	Tis, T1a	None	None
	T1b through T4b, N0	1.CXR	None
	Any N	1.Contrast CT (chest/abd/[pelvis-only for inguinal and pelvic disease]) 2.PET 3. MRI Brain	Contrast CT (Chest Abd [Pelvis-only for inguinal and pelvic disease]) 6 months, 18 months and two years. Repeat PET one year Then none unless an abnormality
	M1	1.Contrast CT (chest/abd/pelvis) 2.PET 3. MRI Brain	Disease site (only) Contrast CT scan every 3-6 months during therapy. None when off therapy unless an abnormality

[1] Smith-Bindman R, Miglioretti DL, Johnson E, et al. Use of Diagnostic Imaging Studies and Associated Radiation Exposure for Patients Enrolled in Large Integrated Health Care Systems, 1996-2010. JAMA. 2012;307(22):2400-2409. doi:10.1001/jama.2012.5960.

[2] Dr Amy Berrington de Gonzalez DPhil,Rochelle E Curtis MA, et al. Proportion of second cancers attributable to radiotherapy treatment in adults: a cohort study in the US SEER cancer registries, The Lancet Oncology – 1 April 2011 ( Vol. 12, Issue 4, Pages 353-360 )

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Regional Cancer Care Associates is one of fewer than 200 medical practices in the country selected to participate in the Oncology Care Model (OCM); a recent Medicare initiative aimed at improving care coordination and access to and quality of care for Medicare beneficiaries undergoing chemotherapy treatment.