Proposed reporting of Index Lesions:
The goal is to create a system of reporting oncology studies that can be adopted by all radiology sections while easily read by referring physicians. The below system adopts facets of RECIST 1.1 without significantly impacting workflow as RECIST 1.1 would.
LESION SELECTION:
3 Index lesions per AI report will be created on the first study. There will be a maximum of 2 lesions chosen per organ (similar to RECIST 1.1). If there are only 2 lesions, then only 2 will be selected. If there are 4 or more, then choose the 3 best lesions and describe the others in the body of the report. Key images with the measurements should be made on PACS for the subsequent follow-ups.
Here is how it will look:
INDEX LESIONS:
[AI1]: [Location] : [Long Dimension x Short Dimension] cm (Se/Im [Series/Image])
[AI2]: [Location] : [Long Dimension x Short Dimension] cm (Se/Im [Series/Image])
[AI3]: [Location] : [Long Dimension x Short Dimension] cm (Se/Im [Series/Image])
The index lesions will be at the top of the findings section.
For series numbers, please use the series number listed on the images. Do not use the series numbers from the PACS thumbnails. This way the series numbers are consistent between PACS and eUnity.
STAGING STUDIES
If there are no prior studies to compare it to, please select “AI Index lesions no priors”
EXAMPLE:
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FINDINGS:
POWERSCRIBE FIELD: “AI Index lesions no priors”
Index lesions (Staging study):
AI 1: Hepatic segment 4: 3 x 2.5 cm (Se/Im2/142)
AI 2: Hepatic segment 6: 2 x 2 cm(Se/Im2/160)
AI 3: Paracaval Lymph Node:1.6 cm short axis (Se/Im2/165)
Liver: Multiple other liver lesions through out the liver. Index lesions referenced above.
…
Impression:
- Metastatic disease involving the liver and lymph nodes.
Again, please Key Images any index lesions for reference on the follow up studies.
RESTAGING STUDIES
For the follow up reports, use “AI Index lesions with priors”. Please use the same index lesions should be used for all follow up reports. If a patient does not have “index lesions” on their prior report, please still use “AI Index lesions with priors.”
For this section, “New Lesions” field has been added. For this, either put “none” if there are no new lesions. If there are new lesions, please only report 1 new lesion in the NEW LESIONS section. Additional lesions can be described in the FINDINGS.
EXAMPLE WITH TREATMENT RESPONSE
POWERSCRIBE FIELD: “AI Index lesion with priors”
FINDINGS:
INDEX LESIONS (Restaging):
AI 1: Hepatic segment 4 – 2 x 2 cm (Se/Im2/145)(previously 3 x 2.5 cm)
AI 2: Hepatic segment 6 -1.5 x 1 cm (Se/Im2/155)(previously 2 x 2 cm)
AI 3: Paracaval Lymph Node – Resolved (previously 2 cm)
New Lesions: None
Impression:
- Decreased size of hepatic metastases with resolution of retroperitoneal lymphadenopathy.
EXAMPLE WITH WORSENING DISEASE AND NEW LESIONS
POWERSCRIBE FIELD: “AI Index lesions with priors”
FINDINGS:
Index lesions (Restaging):
AI 1: Hepatic segment: 4.5 x 5 cm (Se/Im2/145)(previously 3 x 2.5 cm)
AI 2: Hepatic segment: 6.3 x 3 cm (Se/Im2/155)(previously 2 x 2 cm)
AI 3: Paracaval Lymph Node: 2.5 cm short axis(Se/Im2/170) (previously 2 cm short axis)
New Lesions:
Osseous metastases, right sacrum: (Se/Im 2/240)
Impression:
- Worsening metastatic disease …
CHANGING INDEX LESIONS
The index lesions may be changed at the discretion of the reporting radiologist if previously reported index lesion does not accurately reflect the disease or is felt to be invalid on follow up studies. Please only do this when necessary.
EXAMPLE:
Index lesions (Restaging):
AI 1: Hepatic segment 4: 5 x 5 cm (Se/Im2/145 (previously 3 x 2.5 cm)
AI 2: Hepatic segment 5: 4 x 4 cm (Se/Im 2/152 (previously 3 x 2 cm )
AI 3: Paracaval Lymph Node :2.5 cm short axis (Se/Im 2/170) (previously 2 cm short axis)
New Lesions: None
Please note, the Index lesion 2 has been changed as the new AI2 is felt to better reflect disease changes. Please reference this lesion for future studies.