In 2003, Cancer Care Ontario (CCO) established a small working panel, the Diagnostic Imaging Panel, consisting of medical, radiation and surgical oncologists, diagnostic radiologists, and methodologists, to review guidelines published during the last five years on the use of cross-sectional imaging in oncology. After examining documents from nineteen guideline developers, the Panel concluded that the available guidelines did not meet the inclusion criteria or did not focus on the particular issues of interest to be endorsed. Therefore, the Panel decided to review the primary research and develop recommendations for Ontario on the use of computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US) for the initial staging, assessment of tumour response during active treatment, and follow-up for patients with six types of cancer: lymphoma, breast cancer, colorectal cancer, prostate cancer, lung cancer, and ovarian cancer. Although regularly used in patients with lymphoma, gallium-67-citrate (Ga-67) scans and positron emission tomography (PET) scans are not reported on here because they were not a part of the original project scope. These modalities will be addressed in a separate document.
Because a systematic review of the literature identified few randomized studies to provide guidance on the use of cross-sectional imaging in the management of patients with cancer, cohort studies and case series reports were also included in the evidence review, and expert opinion was incorporated in the development of the recommendations. The initial selection and summary of relevant evidence was completed by methodologists at the Program in Evidence-Based Care (PEBC) in consultation with the clinical experts from the Diagnostic Imaging Panel.
The reviews served as the evidentiary foundation to inform the deliberation of clinical experts. Formal and informal consultations with radiologists was facilitated by Dr. Anne Keller, diagnostic imaging representative of the CCO Clinical Council, and undertaken with members who participated in the provincial MRI and CT Wait Times Strategy Expert Panel and the CCO Diagnostic Imaging Panel. In addition, consultations with oncologists were undertaken, mainly through the relevant disease site groups (DSGs) of CCO's Program in Evidence-Based Care. The recommendations that emerged through these consultations are presented in the format developed by the Canadian Association of Radiologists.
Input was sought from the CCO Hematology Disease Site Group (DSG) as well as clinical radiologists involved in the investigation of patients with lymphoma. The Panel reviewed the available evidence and determined that there was insufficient evidence to allow for definitive recommendations. Where data was not available, the Expert Panel considered published consensus guidelines and statements.