The Importance of Radiology and Pathology Communication in the Diagnosis and Staging of Cancer: Mammography as a Case Study. 5.2 Critical components of radiology-pathology workflows in diagnosis of cancer


Initially, a workflow must ensure the proper communication of pertinent clinical history including history of prior diseases. This patient information is usually sent from the referring clinician to the radiologist and/or pathologist. It is imperative that this clinical information be shared between radiologists and pathologists as both may not have received the information from the ordering clinician. It is also necessary that patient history be captured in the medical record as it might be the only source of patient information for either the radiologist or pathologist. In addition, a workflow must support the communication of the findings of any prior diagnostic imaging studies, including the degree of suspicion related to malignant disease and other relevant findings.

In order to ensure optimal patient care, information and specimen submission workflows should enable radiologists and pathologists to unambiguously link a pathology specimen to the following information:

  1. The demographic and clinical history of the patient;
  2. Contact information to facilitate communication between the radiologist and pathologist;
  3. Information related to the appropriate recipient of the final report;
  4. Pertinent data on the specimen itself, including
    a.        The anatomical origin of the specimen;
    b.      The methods used in the collection and pre-analytical processing prior to arrival at the pathology laboratory;
    c.       Unique specimen identifiers (e.g., bar codes) that can be used to securely label the samples at the time and site of collection.

Workflows must ensure the flow of communication of results (both positive and negative) between pathologists and radiologists to support the formal correlation process of radiology and pathology results and resolve any discordance in a timely manner. The proposed workflow in Figure 2 illustrates a high level summary of an idealized workflow model that maximizes the information transfer between the primary disciplines under consideration and identifies key roles including the referring clinician, radiologist, and pathologist in addition to other users of radiology-pathology information like cancer registries. Appendix A presents more detailed illustrations of each phase of the workflow process – screening, biopsy, and diagnosis.

Figure 2 : Proposed Workflow

Graphic. Proposed Workflow

This diagram represents a high-level summary of an idealized workflow process that maximizes the flow of information between the referring clinician, radiologist, and pathologist involved in the cancer diagnosis process as well as additional users of radiology-pathology information such as cancer registries.

Ultimately, the patient’s medical records must include not only clinical history but also a complete account of all the relevant radiology and pathology information, preferably in an electronic format.

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