• News App
  • To:
  • On-site Radiologist Could Be New Model of Care in Radiation Oncology

    February 01, 2013

    The presence of a dedicated in-house radiologist improves patient care in the radiation oncology department and is on track to become the way of the future.

    The presence of a dedicated in-house radiologist improves patient care in the radiation oncology department and is on track to become the way of the future, according to research presented at RSNA 2012.

    Daily Bulletin coverage of RSNA 2012 is available at RSNA.org/bulletin.

    Radiation oncologists are using increasingly complex cross-sectional imaging techniques to improve the accuracy of their radiation therapy planning contours, despite little formal training in diagnostic imaging, said Noel Young, M.D., a radiologist at the University of Western Sydney in Sydney and co-author of the paper, “Incorporating a Radiologist in a Radiation Oncology Department: A New Model of Care?”

    “Contour accuracy is essential in conformal techniques like intensity-modulated radiation therapy,” Dr. Young said. “There is need for a more reliable imaging review.”

    Dr. Young and colleagues studied the impact of having a radiology fellow in the radiation oncology department over a nine-month period. The fellow provided radiological advice on diagnostic and treatment planning images for two sessions per week and reviewed the accuracy of the patient’s tumor contours for the weekly quality assurance audit meetings.

    “The oncology staff was able to book time slots with the radiologist and complete a feedback questionnaire afterward,” Dr. Young said.

    There were 49 consultation sessions during the study period, including a review of 56 diagnostic imaging or treatment planning scans. The radiologist’s advice resulted in a change of patient management in 25 percent of cases and recommendations for further evaluation in another 20 percent. Changes to target volume and normal tissue volume were among the radiologist’s recommendations.

    “A good percentage of patients benefitted from this interaction and the oncologists were open-minded about having changes made to their target planning,” Dr. Young said.

    In one case, the planning CT revealed a vertebral lesion in a patient with potentially metastatic prostate cancer. The radiologist confirmed the finding as a benign tumor on an earlier diagnostic CT, avoiding unnecessary further imaging or biopsy.

    “A radiologist who is located within the department has access to the patient’s clinical notes and other multimodality diagnostic imaging and time to review the planning scans in detail prior to the meeting,” said study co-author Marion Dimigen, M.D., from Liverpool Hospital in Sydney. “This results in a qualified interpretation of imaging leading to better radiation oncology care.”

    The radiologist also reviewed 94 CT scans for the quality assurance audit meetings. Queries over the accuracy of the contours resulted in a significant change of management in six patients. Dr. Young displayed images from one case where the radiologist had added a nearby lymph node group to the target area in a patient with Merkel cell carcinoma, a rare form of skin cancer.

    Drs. Young and Dimigen suggested that access to an on-site radiologist may become the new model of care as radiation therapy planning imaging becomes more complex.

    “The rationale behind this being a fellowship position is to conduct collaborative research between the two specialties,” Dr. Dimigen said. “However an alternative model of care may be funding a radiologist for sessions within the radiation oncology department to review diagnostic and radiotherapy planning images for direct clinical care.”

    “Having more clinical interaction between radiology and clinical medicine—in this case, cancer care—is the way of the future,” Dr. Young added.

    Radiology and Radiation Oncology Need Closer Alliance

    Anthony L. Zietman, M.D., M.B.B.S.

    After a long separation, it may be time for radiation oncology and radiology to get back together, according to a leading expert.

    Anthony L. Zietman, M.D., M.B.B.S., a professor of radiation oncology at Harvard Medical School and director of the radiation oncology program at Massachusetts General Hospital—both in Boston—traced the long separation to the early days of radiology, when the therapeutic side of the practice existed in the shadows of the diagnostic side.

    “Radiologists spent nine months training in therapy,” said Dr. Zietman, delivering the Annual Oration in Radiation Oncology at RSNA 2012. “During the 40s and 50s, small groups of radiologists began concentrating more on therapy and less on diagnosis. These physicians argued that therapy was a separate area, and that nine months of training was woefully inadequate.”

    RSNA annual meetings in the 1950s became occasions for unofficial gatherings of fledgling radiation oncologists at Chicago restaurants—Dr. Zietman showed an invitation to one such meeting at Barney’s Steakhouse—and in 1958, the radiation oncologists ended up forming the American Club of Radiation Oncologists, precursor to the American Society for Radiation Oncology (ASTRO). The development of specialized radiation oncology residency training programs followed and, by the late 1960s, two completely separate specialties had been established.

    “The amicable divorce between therapy and diagnosis was complete,” Dr. Zietman said.

    The ensuing decades saw both specialties prosper. Diagnostic radiology spun off its own therapeutic branch—interventional radiology—with many subspecializing in cancer therapy using ablative techniques, while radiation oncology became the most sought after residency in the U.S., according to Dr. Zietman. But trouble looms on the horizon for both specialties, he warned, due to an increasing reliance on technology.

    “The problem is that as you become more and more technological, you make yourself less and less necessary,” he said. “The art of radiotherapy has progressively been lost as we’ve taken a technological focus.”

    Dr. Zietman believes it is time to consider rebuilding the union between the professions. He pointed out that radiation oncologists and interventional radiologists have complementary strengths that would serve cancer patients well.

    “Radiation oncologists are good at treating small lesions, and less good at treating bulk tumor, while interventional radiologists handle bulk tumor much better with their ablative techniques,” Dr. Zietman said. “Think how powerful it would be if we could put them together.”

    Pilot programs that offer a hybrid specialty to interested medical residents would be a good way to bring the erstwhile partners back together, Dr. Zietman suggested.

    Obstacles to a union remain, including tradition, self-interest and training concerns, but Dr. Zietman said that strengthening the bond between radiology and radiation oncology is essential to protect each specialty from becoming irrelevant.

    Noel Young, M.D.
    Patients stand to benefit from having an on-site radiologist
    Patients stand to benefit from having an on-site radiologist in the radiation oncology department, according to research presented at RSNA 2012.
  • comments powered by Disqus

We appreciate your comments and suggestions in our effort to improve your RSNA web experience.

Name (required)


Email Address (required)


Comments (required)





Discounted Dues: Eligible North American Countries 
Costa Rica
Dominican Republic
El Salvador
Netherlands Antilles
St. Vincent & Grenadines
Country    Country    Country 
Afghanistan   Grenada   Pakistan
Albania   Guatemala   Papua New Guinea
Algeria   Guinea   Paraguay
Angola   Guinea-Bissau   Peru
Armenia   Guyana   Phillippines
Azerbaijan   Haiti   Rwanda
Bangladesh   Honduras   Samoa
Belarus   India   Sao Tome & Principe
Belize   Indonesia   Senegal
Benin   Iran   Serbia
Bhutan   Iraq   Sierra Leone
Bolivia   Jordan   Solomon Islands
Bosnia & Herzegovina   Jamaica   Somalia
Botswana   Kenya   South Africa
Bulgaria   Kiribati   South Sudan
Burkina Faso   Korea, Dem Rep (North)   Sri Lanka
Burundi   Kosovo   St Lucia
Cambodia   Kyrgyzstan   St Vincent & Grenadines
Cameroon   Laos\Lao PDR   Sudan
Cape Verde   Lesotho   Swaziland
Central African Republic   Liberia   Syria
Chad   Macedonia   Tajikistan
China   Madagascar   Tanzania
Colombia   Malawi   Thailand
Comoros   Maldives   Timor-Leste
Congo, Dem. Rep.   Mali   Togo
Congo, Republic of   Marshall Islands   Tonga
Cote d'Ivoire   Mauritania   Tunisia
Djibouti   Micronesia, Fed. Sts.   Turkmenistan
Dominica   Moldova   Tuvalu
Domicican Republic   Mongolia   Uganda
Ecuador   Montenegro   Ukraine
Egypt   Morocco   Uzbekistan
El Salvador   Mozambique   Vanuatu
Eritrea   Myanmar   Vietnam
Ethiopia   Namibia   West Bank & Gaza
Fiji   Nepal   Yemen
Gambia, The   Nicaragua   Zambia
Georgia   Niger   Zimbabwe
Ghana   Nigeria    

Legacy Collection 2
Radiology Logo
RadioGraphics Logo 
Tier 1

  • Bed count: 1-400
  • Associate College: Community, Technical, Further Education (UK), Tribal College
  • Community Public Library (small scale): general reference public library, museum, non-profit administration office

Tier 2

  • Bed count: 401-750
  • Baccalaureate College or University: Bachelor's is the highest degree offered
  • Master's College or University: Master's is the highest degree offered
  • Special Focus Institution: theological seminaries, Bible colleges, engineering, technological, business, management, art, music, design, law

Tier 3

  • Bedcount: 751-1,000
  • Research University: high or very high research activity without affiliated medical school
  • Health Profession School: non-medical, but health focused

Tier 4

  • Bed count: 1,001 +
  • Medical School: research universities with medical school, including medical centers

Tier 5

  • Consortia: academic, medical libraries, affiliated hospitals, regional libraries and other networks
  • Corporate
  • Government Agency and Ministry
  • Hospital System
  • Private Practice
  • Research Institute: government and non-government health research
  • State or National Public Library
  • Professional Society: trade unions, industry trade association, lobbying organization