From molecular imaging biopsy guidance to intra-arterial therapy for hepatocellular carcinoma, the “France Presents” session delivered a full spectrum of cutting-edge research in oncologic imaging at RSNA 2013.
The Société Française de Radiologie chose to focus the “Presents” session on diagnostic and interventional oncologic imaging and the role of radiologists in managing cancer patients, said presenter Valerie Vilgrain, M.D., chair of the Department of Radiology at the University Beaujon Hospital in Clichy, France.
Both anatomic evaluation and routine functional tumor imaging are increasingly combined to provide optimal tumor staging and response, said Alain Luciani, M.D., Ph.D., a professor of radiology at the University Paris Est Creteil and a radiologist at the University Hospital CHU Henri Mondor, who presented “Whole-body Diffusion in Hematology Malignancies.”
“Current MR developments, including respiratory triggering, phased array coils and parallel imaging, bring whole-body MR imaging to clinical practice, especially in oncology patients,” Dr. Luciani said.
Ongoing national and international protocols led by French academic imaging teams are currently underway for the assessment of multiple myeloma and lymphoma, Dr. Luciani said. In a France/Taiwan research program supported by French public funding, investigators are exploring whole-body diffusion-weighted imaging as a standalone method compared to PET-CT for lymphoma staging with novel instrumental developments dealing with diffusion in hematologic malignancies.
Dr. Vilgrain’s presentation focused on the role of the radiologist on a multidisciplinary team in the treatment of colorectal liver metastases. “In recent years there has been significant growth in multidisciplinary teams, working as a result of increasing specialization, advances in medical technologies and recommendations by national agencies, especially in oncology,” she said.
The radiologist’s role on these teams is key, Dr. Vilgrain said. “In colorectal liver metastases, based on an extensive imaging workup and patient clinical status, radiologists and hepatobiliary surgeons discuss whether the patient is resectable, unresectable or borderline. In unresectable or borderline patients, radiologists evaluate tumor response to choose optimal treatment.”
Radiologists also have a critical role in addressing chemotherapy-induced liver toxicity and in potentially avoiding radical hepatectomy by isolating lesions with advanced imaging, she said.
These teams are vital for optimal patient care, Dr. Vilgrain said, citing a 2012 study in the British Journal of Radiology demonstrating that patients who did not benefit from a multidisciplinary team were denied potentially curative treatments.
Established in 2003, the French National Cancer Plan was developed to reduce the number of cancer cases and deaths and improve quality of life. The plan also aimed to establish multidisciplinary team meetings for every patient. “Radiologists have become important contributors to these teams and their presence is mandatory when discussing oncologic cases,” Dr. Vilgrain said.
The story of cancer begins with biopsy, said Eric De Kerviler, M.D., a professor of radiology at Hôpital Saint-Louis in Paris, whose presentation focused on molecular imaging techniques for biopsy guidance. “The standard imaging modalities used for needle guidance are often adequate to identify the lesion or determine the needle trajectory, but cannot overcome the variable expression of molecular targets within tumors,” Dr. De Kerviler said.
Molecular imaging enables the visualization of cellular function, and therefore offers better insight into a tumor’s biology, demonstrating areas of increased metabolism or cellularity, abnormal perfusion or tissue stiffness, Dr. De Kerviler explained.
Molecular imaging can create a clearer map of the optimal biopsy route, Dr. De Kerviler said. “What if we could dispose from a molecular GPS?” he asked.
Techniques for intra-arterial therapy of liver malignancies were presented by Thierry J. De Baere, M.D., director of the Department of Interventional Radiology at the Institut Gustave Roussy in Villejuif, France.
“For hepatocellular carcinoma (HCC), 3D angiography image guidance with computer image analysis improves outcomes of chemoembolization because 3D imaging allows us to better depict tumors in the liver,” Dr. De Baere said. “Tumor feeding vessels can be depicted with a sensitivity of 99 percent, with limitations in vessels below one millimeter when patients have been already treated.”
“We need research in drug and delivery platforms dedicated to intra-arterial therapy,” Dr. De Baere said. “In the future, we could have one syringe for HCC, one for liver metastases, and so on.”
Radiologists, technologists and other stakeholders are working together to successfully implement dose reduction strategies worldwide, according to presenters of anRSNA 2013 session.
In the European Union (EU), projects such as Clinical Audit Guidelines, a tool developed to facilitate the implementation of clinical audit programs in medical imaging and radiation therapy departments, and other programs that collect dose distributions and provide education and training are key to promoting a radiation safety culture, said Graciano N. Paulo, M.Sc., R.T., vice-president of the European Federation of Radiographer Societies.
“All these EU projects were made on a multi-stakeholders model, based on the contribution of organizations representing EU regulators, radiologists, radiographers, medical physicists and research centers, among others,” Paulo said.
Paulo emphasized the need for more guidelines covering the entire EU, including radiation dose information and speciﬁc advice for imaging children and pregnant women. Also needed are clearer and stronger measures to encourage the availability and the use of referral guidelines, he said.
“Radiographers, being the final point of contact for the patient, have the responsibility to guarantee the correct procedure to the right patient, while ensuring maximum optimization and effective use of equipment,” Paulo said.
Partnerships have also helped another major organization, the International Society of Radiographers and Radiologic Technologists (ISRRT), make great strides in bringing radiation safety to developing countries, according to Donna E. Newman, B.A., R.T., director of professional practice at the ISRRT.
The ISRRT works with the World Health Organization (WHO) and others to promote best radiography practices, education and standards throughout the world. Society programs like the donor-enabled Travel Support Fund help bring technologists from developing countries to the organization’s World Congress.
As an example, Newman cited Boniface Yao, a technologist from Ivory Coast in Africa whose trip to the ISRRT World Congress in Toronto was made possible through the fund. Yao returned home after the congress and presented several workshops in his native country and at a national conference in Cameroon.
“He said that this opportunity allowed him to put himself in a bigger world,” Newman recalled.
The ISRRT also offers the Dosewise Competition, a contest in which radiographers across the world send in examples of their best practices to protect patients from excess radiation. The winner gets a trip to the ISRRT international conference or the RSNA annual meeting.
Other ISRRT workshops send instructors to developing countries to provide education and training to colleagues who can’t go to the conferences.
Session moderator Michael D. Ward, Ph.D., vice-dean of the Goldfarb School of Nursing at Barnes-Jewish College in St. Louis, echoed the RSNA 2013 theme—the Power of Partnership—when he discussed the importance of disseminating the latest information on dose optimization.
“These events bring together physicians, radiographers, physicists and other staff members and regulators to share best practices,” he said. “Then we go back and spread the word through our organizations.”
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