Malignant disease is one of the leading causes of death in the United States with over 11 million people with a cancer diagnosis. 1,4 Pathologists and radiologists are the physicians most often responsible for the initial diagnosis of cancer. While neither pathologists nor radiologists are generally considered providers of direct patient care, the information generated by these specialists is vital to patient diagnosis and subsequent selection of therapeutic options. Patients, surgeons and oncologists are the primary recipients of these reports, but there are other healthcare actors, such as clinical trial nurses, bio-repositories, insurance companies and local and national public health reporting agencies, which also use this information.
Despite being separate specialties, pathologists and radiologists are increasingly required to collaborate to diagnose and stage cancer cases. This relationship has grown in part due to modern imaging technology’s ability to detect and biopsy earlier, and therefore smaller, lesions as well as the need for both specialists to correlate their patient-specific findings. To increase and substantiate correlations, radiologists and pathologists require more open lines of communication including the creation of standardized, structured electronic reports that can be easily exchanged between the two specialties and with other physicians.
Because the patients’ health depends on these critical diagnoses, the Office of the Assistant Secretary of Planning and Evaluation (ASPE) sponsored a study to determine if the processes and workflows of radiologists and pathologists could be improved. To implement this study, SciMetrika, the contractor, convened a work group that included members with domain expertise in the fields of pathology, radiology and medical informatics. These individuals, including representatives from the Kansas University Medical Center (KUMC) and University of California Los Angeles (UCLA) contributed to the development of this report. The representatives from KUMC and UCLA were chosen as members of this group based on their active collaborative programs between the pathology and radiology departments at their respective institutions.
The work group was initially tasked with developing a consensus about the scope of collaborative efforts between these two specialties. In numerous meetings, the limitations of the current radiology-pathology workflow process and possible ways to improve it were discussed. The group also considered two alternative collaboration models adopted by KUMC and UCLA to integrate the work of radiologists and pathologists to improve communications. Both efforts stress the correlation of radiology and pathology results to improve the overall outcomes of the cancer diagnosis and treatment process. In the KUMC model, a multidisciplinary conference approach is used to resolve issues of radiologic-pathologic discordance, specifically in the diagnosis and treatment of breast cancer cases. At UCLA, a new project has been developed to establish integrated radiology-pathology workflows and reports for a number of malignant diseases. Both models will be discussed in later sections of this report.