Request and reporting models for computed tomography in the multidisciplinary management of cancer patients: consensus between the Italian Society of Medical and Interventional Radiology (SIRM) and the Italian Society of Medical Oncology (AIOM).

BACKGROUND: Multidisciplinary management of oncological patients has improved patient outcomes, responding effectively and efficiently to the patient's health needs. A critical element remains adequate communication, also between radiologist and oncologist, which promotes correct patient management. The Italian Society of Medical Oncology (AIOM) and the Italian Society of Medical and Interventional Radiology (SIRM) have created a working group of representative members to improve not only communication between the two categories but, above all, to allow each member of the different categories to benefit from guidelines of good clinical practice both for filling out the examination request form than the radiological report, and therefore, also allowing clinicians and radiologists who do not work in reference centers, to correctly manage patients in the various phases of their oncological path.

MATERIALS AND METHODS: A panel of expert oncologists (AIOM members) and radiologists (SIRM members) was established. Multi-round consensus-building Delphi exercise was performed to create a comprehensive structured report (SR) template and a comprehensive requesting model for computed tomography (CT). The requesting model was divided into six sections: (a) oncological family history; (b) relevant clinical data; (c) staging; (d) re-staging; (e) other reason; and (f) follow-up. Regarding CT SR, 3 models were proposed: (1) for staging; (2) for treatment evaluation, and (3) for follow-up. CT SR in staging phase was divided into nine sections: (a) primary tumor; (b) lymph node metastases; (c) liver metastases; (d) lung metastases; (e) brain metastases; (f) other organs (incl. skeleton) metastases; (g) peritoneum; (h) incidental findings and complications; and (i) conclusion. CT SR in treatment evaluation phase was divided into ten sections: (a) primary tumor; (b) lymph node metastases; (c) liver metastases; (d) lung metastases; (e) brain metastases; (f) other organs (incl. skeleton) metastases; (g) peritoneum; (h) treatment-related complication; (i) incidental findings; and (l) conclusion. CT SR in follow-up phase was divided into six sections: (a) appearance of lesions; (b) node metastases; (c) liver lesions; (d) peritoneum; (e) incidental findings and complications; and (f) conclusion. Cronbach's alpha (Cα) correlation coefficient was used to evaluate internal consistency for each item and the quality analysis according to the average inter-item correlation. Each expert expressed individual comments for each specific template section by using a four-point scale (0 = strongly disagree, 1 = slightly disagree, 2 = modestly agree, 3 = strongly agree).

RESULTS: With regard to the 3 CT SR reports, at the first round, all sections achieved ratings above the "good" level. The staging items showing the highest level of agreement among experts in the first round were lung metastases and incidental findings and complications. For treatment evaluation, the items with the highest agreement were treatment-related complication and incidental findings. For follow-up, the items with the highest agreement were appearance of lesions and incidental findings and complications. At the first round, Cronbach's alpha (Cα) correlation coefficients were 0.92, 0.95, and 0.90 for staging, re-staging, and follow-up, respectively. At the second round, all sections achieved ratings at the "excellent" level. Regarding requesting model, at first round, all sections received an overall score equal to or greater than the level defined as "good" (score = 2). The item that showed the highest level of agreement in the first round was the follow-up section, with a mean value of 2.75 ± 0.62. The correlation coefficient, Cronbach's alpha (Cα), was 0.75. In the second round, for both the CT SR report and the oncologist request template, all elements received "excellent" ratings. During the inter-society agreement, six AIOM members assessed the CT SR model developed by SIRM, while six SIRM members evaluated the CT requesting model proposed by AIOM. In this single Delphi round, all participants assigned the maximum score (3) to every item across all sections.

CONCLUSIONS: The inter-society collaboration between AIOM and SIRM is a milestone in improving communication between radiologists and oncologists. The CT request and reporting documents meet the needs of quality care even outside of referral centers, and although do not represent an obligation, they can facilitate understanding between the different categories of professionals involved in patient management.