A Multidisciplinary Approach to Cancer: A Radiologist’s View

Introduction

Multidisciplinary care teams are those that are composed of members from multiple different medical specialties working together to achieve the highest quality of care for the patient. Such teams are particularly needed in complex environments such as cancer hospitals. Frequently patients and their physicians are faced with different options for workup and therapy that cross the boundaries of specialties. These multidisciplinary teams may be comprised of medical oncologists, radiation oncologists, surgeons, radiologists, pathologists, and representatives from a variety of supportive services including nutrition, rehabilitation, and chaplaincy. In order for such a diverse group to work effectively together, communication and mutual understanding are critical.

Imaging plays a central role in the care of patients with cancer. Subsequent chapters deal with some of the specifics regarding the use of imaging in the multidisciplinary environment, such as tumor staging, lesion respectability, and treatment-related complications. Many clinical decisions are influenced by the results of imaging studies, and the radiologist must, therefore, be a central member of the multidisciplinary care team. The significant role of imaging can be seen in the continued growth in the numbers of scans performed each year, particularly in the advanced imaging studies such as x-ray computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography with x-ray CT (PET/CT).

One of the major challenges for radiologists in the multidisciplinary environment is that imaging intersects with nearly all aspects of patient care. Scans ordered by a radiation oncologist for the purpose of treatment planning may be interpreted with a different emphasis and perspective than scans ordered by a surgeon before planned curative resection or by a medical oncologist in anticipation of systemic chemotherapy. The radiologist needs to be aware of the clinical scenario in which the scan is being ordered and should have an understanding of the implications of the scan results for the patient. To provide the most relevant information, the radiologist must have direct and frequent interaction with the other members of the care team through participation in tumor boards or other multidisciplinary activities.

Central to the role radiologists play in the management of patients with cancer is communication. Results need to be conveyed in an understandable and clinically relevant fashion, and preferably in a timely manner. The following sections describe the radiologist’s perspective on multidisciplinary cancer care and discuss ways to effectively ­communicate in such an environment.