A multidisciplinary approach to cancer diagnosis and treatment can
optimize patient care and change outcomes. Studies show that the
multidisciplinary setting can be an independent predictor for improved
5-year survival compared to treatment outside of such a setting.
oncology, there are many stakeholders throughout the process of image
interpretation, measurement, monitoring, and reporting of cancerous
lesions. This requires substantial data sharing and coordination.
Franciscan Saint Francis Health, Indianapolis, IN, (Saint Francis) the
radiology and oncology departments initiate the process, working closely
to review and analyze multi-modality oncology datasets for tumor
detection and monitoring. Since they adopted the IntelliSpace Portal, a
multidisciplinary data collaboration platform by Philips Healthcare, the
doctors and staff at Saint Francis have found the resulting increase in
consistency and accuracy key to their success in lesion surveillance
and in transforming patient care.
Streamlining lesion surveillance
Several time-consuming steps are involved in lesion surveillance. In
many radiology departments, post-processing involves tracking down and
loading multiple patient examinations to compare baseline to nadir
scans, scrolling through a series of datasets to find the lesions and
lymph nodes, measuring quantitative parameters, and calculating tumor
burden based on Response Evaluation Criteria in Solid Tumors (RECIST)
and World Health Organization (WHO) criteria.
At Saint Francis,
radiologists were previously tasked with identifying lesions on a data
sheet on the PACS and matching those with prior and current stacks of
images before dictating the lesion measurements, explained J. Louis
Rankin, RT (R)(MR) (PET), 3D Technical Coordinator, Imaging Services, at
A complete transformation in workflow was ushered
in with the introduction of IntelliSpace Portal, featuring the
Multi-Modality Tumor Tracking application (MMTT). The IntelliSpace
Portal is a thin-client solution for advanced image review and analysis,
designed to share data across multispecialty, multimodality, and
multivendor platforms. The MMTT application provides tools to decrease
the time required to implement RECIST and supports datasets from CT, MR,
PET/CT, and other modalities.
“The IntelliSpace Portal has
automated many of these steps,” said Rankin. With the “Smart ROI,” the
lesion volume as well as the maximum and minimum diameters can be
measured semi-automatically. At the same time, the baseline and
follow-up image series with the saved quantitative results are loaded
into the MMTT application (Figure 1).
The system calculates the
quantitative RECIST criteria based on percentage change in lesion
diameter (Figure 2) and posts the results on the screen, plotted on a
graph over time (Figure 3). All of the quantitative results are stored
with the image series, which includes a summary of the results and
screen shots of the lesions with treatment response categories for the
oncology team to reference.
“Instead of scrolling through the
data, finding the lesion, and wondering if it’s the correct target
lesion, now the application does that for you,” said Rankin.
The follow-up series is automatically sent to the IntelliSpace Portal Server, also reducing substantial amounts of time.
“Once a study is in tumor tracking, it can save 20 to 30 minutes of prep time for the physician to read,” said Rankin.
new process also cuts reading time by 5 to 10 minutes for a 5-lesion
study, indicated Andrew J. Mullinix, MD, Diagnostic Radiologist at Saint
Francis. “The hassle factor that it takes away is huge because you’re
no longer spending a lot of time searching for the lesions when you
could be adding diagnostic information,” Dr. Mullinix said.
Enhanced quality in patient care
Consumers are becoming more actively involved in healthcare decisions, thanks largely to demand for more efficiency.2
MMTT tumor tracking application increases efficiency by enabling
consistency and accuracy in lesion tracking. Dr. Mullinix said one of
the most useful features of MMTT is its ability to plot a graph of the
lesions over time. “Because you’re comparing the lesion to 3 or 4 or 5
prior studies, you get a nice longitudinal feel for what the tumor is
doing, not just a staccato sense,” he said.
can enhance quality of care. A recent patient of Dr. Mullinix presented
with 2 mediastinum lymph nodes and 2 lung nodules. Dr. Mullinix was able
to see, on a single graph, progressive disease in the mediastinum, but
not in the lung nodules—circumstances that changed the course of
Once a radiologists completes a report, the oncology
group can move forward with lesion response. The graph is especially
helpful with monitoring progressive disease. “If a patient has reached
20%, he has progressive disease and must come off study,” explained
Cindy Stoner, CCCP (Certified Clinical Research Professional). “With the
real-time data on tumor percentage changes in tumor sizes plotted on
the graph, the oncology team can better prepare patients for changes in
treatments,” Stoner said
“Today, our patients are so informed
about the drugs and treatment, they call for the results right after
each scan. Tumor tracking has allowed us to give them more information,
and prepare patients if we have to take them off study and suggest
alternatives,” she added.
Consistency across disciplines
Portal and the tumor tracking application have helped optimize
oncological lesion surveillance by automating steps, saving time, and
improving the presentation of the data.
“The workflow takes a
team approach, and the IntelliSpace Portal has impacted my workflow,”
said Dr. Mullinix. “It has made our workflow smoother, the lesions are
easier to find, it’s easier to report, and it makes the referring
physicians happy because it’s a more complete report.”
Ultimately, it is transforming the way doctors at Saint Francis deliver care.
best part about IntelliSpace,” said Rankin, “is the accuracy and
consistency. The more accurate and consistent we are, the more volumes
of data we can build up, which will help us be more accurate and concise
with cases in the future.”