The second part of my interview with Dr. Kristin Manning (part 1 here), expert radiologist at Seattle Radiologists, follows up on the basic principles of the cancer workup and turns to the limitations of our ability to clarify tough lesions.  Understandably, many patients and caregivers are frustrated to learn that after multiple imaging studies, from a CT to a PET scan to an MRI and sometimes more, we still sometimes can’t say with certainty whether a questionable lesion represents cancer or something else.  How could that be?  Dr. Manning discusses how a tough lesion appears questionable despite plenty of good scans and smart radiologists trying to interpret them.   Along with discussing the frequent benign lesions that cause anxiety for patients and their doctors as we try to sort them from cancer, she also discusses the still open question about risk from radiation involved in imaging for cancer.

As always, you’ll find below the audio and video versions of the podcast, along with the transcript and figures.

dr-manning-pitfalls-in-cancer-imaging-audio-podcast

dr-manning-pitfalls-in-cancer-imaging-transcript

dr-manning-pitfalls-in-cancer-imaging-figures

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One common thread in the management of most solid tumors (the cancers of organs like lung, breast, colon, kidney, and others, as opposed to cancers of the blood (leukemias) or lymphatic system (lymphomas) is the use of scans to assess whether the cancer is responding, progressing, or remaining stable.  Because these imaging studies provide a scorecard and a good indicator of future prognosis, they are often a source of anxiety for patients (“scanxiety”, a topic that has been discussed in another post), though oncologists also become invested in the outcomes of their patients.  I still struggle with the optimal timing for a discussion of a patient’s most recent scans, and I’m interested in hearing about the experience from the other side, as well as my oncology colleagues, about what works best for them.

From my participation online, this is clearly an important issue, since we regularly receive questions from our audience about the significance of results described in a scan report.   We try to provide some general guidance but can’t really provide a detailed interpretation of the specific language of everyone’s scans.   This isn’t because we want to be difficult, but rather because they only provide part of the story.   Radiologists have a remarkably frequent comment featured in their report: “clinical correlation is recommended”, which means that someone reviewing pictures in a vacuum can’t adequately assess what the images represent without real clinical context that includes details of a patient’s medical problem, treatment, and current symptoms. So a medical specialist who is trained specifically to interpret radiology studies often can’t say anything definitive about what the pictures represent – they need the assistance of someone who knows the clinical details. And because a report provides only a brief summary of the images, it’s nothing like seeing the pictures.  By the same principle, I’m going to predict that the “text only” and audiobook versions of Playboy will probably never take off.

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   PET scans have become a central component of oncology over the last decade, yet how best to use them remains controversial.  The current podcast, with Dr. David Djang, the Director of Nuclear Medicine at Swedish Medical Center in Seattle, covers what a PET scan does, along with the strengths and limitations of this form of imaging.

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