Because the mechanisms of action of most targeted treatments differ from those of traditional cytotoxic chemotherapies, a variety of new imaging-based response assessment criteria have been developed, and more are needed. Radiologists who have completed fellowships in body imaging, chest imaging, or other areas can acquire subspecialized expertise in imaging certain kinds of cancer by working in centers that provide team-based, multidisciplinary cancer care. In addition, some dedicated tertiary care cancer centers offer fellowships specifically in oncologic imaging subjects; these fellowships allow radiologists to develop subspecialty expertise more rapidly and may also give them valuable experience in cutting-edge research.

Subspecialization itself should furthermore ensure that cutting-edge knowledge in oncologic imaging is maintained and advanced through ongoing training and close and sustainable collaboration with a multidisciplinary clinical oncology team. Unfortunately, even in high-income countries such as Japan, Korea, Hong Kong, and the United States, oncologic imaging is still not a formally recognized subspecialty for which certification is available. In the United States, out of more than imaging fellowships offered, only a handful are formal oncologic imaging fellowships; furthermore, the supply of radiologists with any kind of fellowship training is limited, and many imaging facilities do not require it.


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In the future, advanced computer tools for analyzing images discussed more extensively in the next section of this article may help raise the quality of oncologic imaging among general radiologists as well as subspecialists. However, in the nearer term, one way to help optimize cancer imaging in higher-income countries may be through the development of second-opinion image reporting services staffed and overseen by radiologists with subspecialty expertise in oncologic imaging. Some specialty cancer centers in the United States are already successfully offering such second-opinion services to patients being cared for at other institutions.

However, to help reach all the patients who could potentially benefit from second-opinion reporting, many more such services would need to be established, and the supply of oncologic imaging subspecialists qualified to staff them would need to be expanded. Professional societies must work together with government policymakers to disseminate awareness of the importance of specialized cancer imaging expertise.

In addition, professional societies should formally recognize oncologic imaging as a subspecialty or better yet, a set of subspecialties , develop and promote practice standards in oncologic imaging, develop training curricula and fund fellowships and other training opportunities in oncologic imaging, and encourage the development of second-opinion reporting services in oncologic imaging along with standards for their accreditation. International efforts to advance some of these goals have already begun. For example, to promote quality standards and the recognition of oncologic imaging as a radiologic subspecialty, the European Society of Radiology ESR has included a chapter on oncologic imaging in both the European Training Curriculum for Radiology and the European Training Curriculum for Subspecialization in Radiology 37 , 38 ; it is hoped that this will encourage national societies to also integrate oncologic imaging in their radiology training curricula.

In , the International Cancer Imaging Society was formed specifically to foster education in oncologic imaging, stimulate research, and bring together radiologists and clinicians involved in cancer care.

Grainger & Allison's Diagnostic Radiology: Expert Consult: Online and Print by Andreas Adam

Opportunities for education in oncologic imaging—such as courses, workshops, and online webinars—are offered by societies such as the European Society of Oncologic Imaging, the International Cancer Imaging Society, and the Radiological Society of North America, to name just a few. Opportunities for more intensive, subspecialized training can also be accessed through international societies. For example, the European School of Radiology supplies applications to a number of short- and long-term visiting scholarships and fellowships at centers of excellence in Europe and the United States, which are funded by the ESR, national societies, the pharmaceutical industry, academic institutions, and other sources.

Within the last 6 years, European initiatives have also been launched to help standardize training and practice in hybrid imaging eg, positron emission tomography—CT and interventional radiology—two areas of imaging that are becoming increasingly important in cancer care. Just as oncologic radiologists are key members of disease management teams, they need to be integrated into the leadership bodies that design broad, cancer-related policies and initiatives around the world.

In low-resource regions, a lack of imaging equipment typically goes hand in hand with a paucity of radiologists, and those radiologists who are present are likely to face intense clinical workloads. Although in the developed world, the existing medical infrastructure enables medical subspecialization and networking between different medical facilities, the situation in the developing world demands that radiologists, especially those working in smaller and geographically isolated community hospitals, have a great breadth of expertise.

Not only do they need to be able to exploit all the imaging methods available on site, they must also be able to examine all body parts and meet the requirements of the multidisciplinary therapy approaches available. Meeting these demands is, of course, challenging, and a variety of obstacles may complicate efforts to help.


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    • The growth of the Internet has already made teleradiology part of the daily experience of many radiologists. Oncologic radiologists are particularly familiar with teleradiology, because imaging studies acquired at other institutions are transmitted to their centers for second-opinion reporting and follow-up assessment. Cross-border telemedicine has huge potential to improve patient care in rural areas and developing countries by providing access to specialist services.

    By , cross-border telemedicine programs had been attempted or were underway in at least 76 countries, according to a systematic review of the literature. The programs encountered a variety of obstacles, particularly with regard to funding, legal issues eg, data security, liability , cultural factors eg, language, lack of mutual trust , and contextual factors eg, lack of reliable infrastructure for information exchange, lack of resources to implement recommendations made by remote physicians.

    Although many of the programs were found to be ineffective or unsustainable, those that fared best tended to rely on low-cost technologies and involve close twinning relationships with remote academic centers that provided training and mentorship of local personnel. Rapid developments in computerized clinical decision support and artificial intelligence AI could also be of particular value for advancing cancer care in low-resource regions. Decision support systems for selecting appropriate imaging methods and imaging protocols according to established guidelines are increasingly being used in the developed world and could potentially be adapted for many different settings.

    Clinical decision support for radiologists has also been developed to promote standardization of interpretation, terminology, and follow-up recommendations during the generation of imaging reports.

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    Computer-aided detection and diagnosis CAD systems have evolved to semiautomatically or even automatically detect pulmonary nodules or breast lesions, among other pathologies. As suggested by Saurabh Jha and Eric Topol, 50 the use of computers to detect and characterize abnormalities could free up radiologists to act as information specialists, who would interpret the data provided in its larger context, advise on the need for any further diagnostic testing, and integrate findings to guide treating physicians. An emphasis on understanding local conditions lies at the heart of the work of RAD-AID, an international, nonprofit organization founded in that aims to expand the availability of medical imaging services in developing countries.

    It addresses the fact that the value of imaging depends entirely on the context in which it is used. For instance, a mammography program will obviously be of little benefit if there are no surgeons, radiation oncologists, or oncologists available to treat breast cancers, and a donation of equipment will be of no help in a place without electricity or personnel able to use and maintain it properly. The tool highlights the importance of interdisciplinary collaboration in advancing imaging services.

    RAD-AID, which is affiliated with the United Nations and the WHO, aims to foster partnerships between nonprofit organizations, the private sector, government agencies, technology companies, and health care institutions. As highlighted in a white paper from the conference, keys to the long-term success of such efforts include business financing and training for imaging entrepreneurs, the development of information technologies for knowledge transfer, and the development of effective models for providing clinical training and low-cost imaging.

    The organization Imaging the World ITW has developed one promising model that combines teleradiology with imaging technology that requires limited user training. Specifically, ITW trains local health-care staff to perform so-called volume scanning ultrasound protocols, which require only the use of external landmarks and no knowledge of internal structures; the images can then be sent via cell phone to radiologists with the expertise to interpret them. Their model has been piloted in Uganda as a means of monitoring maternal and fetal health and has obvious potential applications for cancer care.

    Clinical training of staff in low-resource regions can be bolstered by online courses or learning modules, some of which are available on the websites of RAD-AID and other organizations. However, to foster long-term, systemic improvements and the development of local expertise, face-to-face intensive training programs are particularly valuable. Not only do they allow the acquisition of practical, hands-on experience under direct supervision but also they can foster the development of long-term mentoring and strong cross-cultural collaborative relationships.

    In turn, such relationships can help trainees develop the leadership skills and connections to effect change in their countries of origin, such as the initiation of teaching, research, or cancer screening programs. To date, local training programs in ultrasound have been established at more than 70 JUREI-affiliated centers in 55 countries.

    Health care institutions across the United States and Europe are involved in international outreach programs that aim to produce a similar long-term effect. The large international imaging societies, through their existing programs and activities, are uniquely placed to promote scientific exchange and offer education to radiologists from low-resource regions. The European School of Radiology, for example, works with imaging leaders in such countries to identify outstanding candidates for oncologic imaging fellowships in the United States.

    In addition, the ESR recently took several measures to strengthen its efforts in Latin America, including the provision of subsidized places at the European Congress of Radiology exclusively for Latin American applicants, as well as the opening of an office in Bogota with a full-time staff member to represent the society on site at Latin American radiology congresses.

    Governments of developing nations may also reach out directly to foreign centers of excellence or nonprofit organizations to develop training programs, or they may work with industry to design customized imaging facilities that meet their individual needs. Although there is no one-size-fits-all solution to fulfilling the cancer imaging needs of developing countries, the greater the number of people and disciplines involved in the effort, the faster solutions can be found and implemented.

    Grainger & Allison's Diagnostic Radiology: Expert Consult: Online and Print

    Potential volunteers include not only experienced, fully employed physicians and staff but also trainees and recent retirees, who may have more flexibility. For example, the recently formed International Cancer Experts Corp, a member of the Union for International Cancer Control, seeks to include trainees, early career leaders, senior health care workers, and retirees in multidisciplinary panels of experts assigned to provide training and mentoring in protocol-based cancer care. Working through a designated hub which may be an academic center, private practice, or professional organization in the developed world , the volunteer experts may be asked to both conduct short initial training visits to health care centers in low-income regions and provide ongoing support through teleconferencing and telecommunications.

    International efforts to provide oncologic imaging training and expertise in underserved regions must be accompanied by the political will from the governments of these regions to develop long-term strategies to improve diagnostic facilities and expand the availability of imaging equipment and treatment.


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    Furthermore, to ensure the sustainability of any improvements, measures must be taken to retain trained and specialized oncologic radiologists and oncologists in the public service and give them appropriate resources and structures to train others. In conclusion, cancer as a major global health care problem is expected to worsen because of a growing and aging population as well as harmful environmental conditions in expanding urban areas, especially in developing countries. The quality of patient care everywhere is affected by the quality of cancer imaging. Dramatic regional disparities in the availability of imaging equipment need to be addressed.

    Furthermore, there is a shortage of appropriately trained oncologic imagers worldwide. To advance oncologic imaging, training opportunities in both developed and developing countries must be expanded and tailored to regional needs. Large professional societies have increasingly been providing leadership in the creation of clinical practice guidelines and curriculum development as well as offering online and in-person learning opportunities. More such efforts are needed, along with increased advocacy to raise awareness of the importance and complexity of oncologic imaging among the medical community and government policymakers.

    With respect to improving oncologic imaging in low-resource countries in particular, businesses, nonprofit organizations, and health care institutions have demonstrated that it is possible to establish successful collaborations with local governments and health care organizations either directly or by working through member organizations such as RAD-AID. Tools for telemedicine can be of great help to these efforts, as will developments in artificial intelligence.

    Nevertheless, the unmet needs for oncologic imaging around the world remain vast. Radiologists at all levels—those in training, midcareer, or even retired—are greatly needed to contribute clinical expertise, teaching skills and mentorship in multidisciplinary efforts to improve cancer care. Heinz-Peter Schlemmer, Leonardo K. Collection and assembly of data: Data analysis and interpretation: Final approval of manuscript: Accountable for all aspects of the work: The following represents disclosure information provided by authors of this manuscript.

    All relationships are considered compensated. Relationships are self-held unless noted. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www. Consulting or Advisory Role: Siemens Healthineers, Bracco Diagnostics. Siemens Healthineers Inst , profound Inst. Stock and Other Ownership Interests: Bayer SA do Brasil.

    No relationship to disclose. Global Challenges for Cancer Imaging. Search for articles by this author. Licensed under the Creative Commons Attribution 4. Efforts and Strategies to Implement Change. Palliative Care in the Global Setting: Primary Prevention of Cervical Cancer: Cancer Trends in Mexico: Treating Nephroblastoma in Rwanda: Novel Humanitarian Aid Program: A Perspective From Malawi. World Cancer Report Estimates of worldwide burden of cancer in Int J Cancer Variations in cancer survival and patterns of care across Europe: Roles of wealth and health-care organization.

    Return to Book Page. Online and Print by Andreas Adam Editor. Now published in 2 volumes, the new edition of this landmark text gives you a succinct but comprehensive account of all currently available imaging modalities and their clinical applications. Extensively revised and restructured, it is an excellent review text for resident radiologists, offering detailed information on all the imaging modalities and interventional procedur Now published in 2 volumes, the new edition of this landmark text gives you a succinct but comprehensive account of all currently available imaging modalities and their clinical applications.

    Extensively revised and restructured, it is an excellent review text for resident radiologists, offering detailed information on all the imaging modalities and interventional procedures needed for exam preparation. Additionally, it helps the practicing radiologists with a concentrated overview of the latest imaging techniques covering all parts of the body. Hardcover , pages. Published September 1st by Churchill Livingstone. To see what your friends thought of this book, please sign up.

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    Lists with This Book. This book is not yet featured on Listopia. Lucid yet upto date Very nice book helps to solve day to day problems in practice. Keep updating and every edition almost completely changes,showing how fast radiology is evolving. Priya Darshini marked it as to-read Aug 09,