Radiology Structured

Reporting for Pancreatic

Carcinoma

Isaac R. Francis, M.B; B.S

University of Michigan Hospitals
Ann Arbor, Michigan
SAMPLE UNSTRUCTURED REPORTS
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 Structured Reports
Attributes of a “Good” Radiology Report
• Clarity
• Correctness
• Confidence
• Concision
• Completeness
• Consistency
• Communication
• Consultation
• Timeliness
• Standardization

* Reiner BI J Digit Imaging 2009

RSNA Radiology Reporting Templates
Structured Reporting
RSNA Structured Report Initiative
(M Heilburn, Univ. of Utah, Salt Lake City, UT)

• PRIMARY TUMOR:
• - Size, location, attenuation, size of pancreatic duct
• MESENTERIC ARTERIES
- Arterial anatomy: Arterial tumor abutment or encasement:
Proximal celiac artery, SMA, and hepatic artery
• MESENTERIC VEINS
• - Venous tumor abutment or encasement: less than or equal
to 180 degrees or greater than 180 degrees
- SMV, SV and Portal venous system
• LOCOREGIONAL SPREAD
- Lymph nodes, peritoneum, omentum, ascites
• DISTANT SPREAD:
- Focal liver lesion, lung, etc.

* Tolat P et al. Medical College of Wisconsin

 Template for Pancreatic
Carcinoma Reporting
Pancreatic Cancer Template Work Group

M Al-Hawary, S Chari, EK Fishman, D Hough,

DS Lu, M Macari, AJ Megibow, N Merchant,
F Miller, R Minter, K Mortele, D Simeone,
D Sahani, EA Tamm

Beth Israel Deaconess, Johns Hopkins,

Massachusetts General Hospital, Northwestern
University, New York University, MD Anderson,
Mayo Clinic, University of Southern California,
University of Michigan, Vanderbilt University
 Radiology Reporting Templates
Structured Reporting
American Pancreatic Association
• PRIMARY TUMOR:
• - Size, location, attenuation, presence of atrophy, MPD, and CBD
diln.
• MESENTERIC ARTERIES
- Arterial anatomy:
Proximal celiac artery, SMA, and hepatic artery
- Tumor abutment (less than or equal to 180 degrees or
encasement (greater than 180 degrees)
-Distance of tumor involvement of hep. artery from celiac axis
• MESENTERIC VEINS
• - Venous anatomy:
• - SMV, SV and Portal venous system
• - Tumor abutment (less than or equal to 180 degrees or
encasement (greater than 180 degrees)
• - Distance from tumor to first jejunal vein branch
• LOCOREGIONAL SPREAD
- Lymph nodes, peritoneum, omentum, ascites
• DISTANT SPREAD:
- Focal liver lesion, lung, etc.
*M Al-Hawary et al ( Work in Progress)
 PANCREATIC CARCINOMA
Resectability Criteria

ƒ No distant metastases
ƒ No SMV or PV abutment,
distortion, encasement or
occlusion/thrombus
ƒ Clear fat planes around the celiac
axis, hepatic artery and SMA
* NCCN Guidelines version 2.2012
 Small resectable tumor
No abutment/encasement of CA,HA, SMA or SMV and PV
 Radiology Reporting Templates
Structured Reporting
American Pancreatic Association
• PRIMARY TUMOR
- 2 cm , low density in head with no PD or CBD diln. or
upstream atrophy
• MESENTERIC ARTERIES
- No abutment or encasement of celiac artery, SMA, and
hepatic artery
- Standard hepatic arterial anatomy
- MESENTERIC VEINS
• - No venous tumor abutment or encasement of SMV or PV
• LOCOREGIONAL SPREAD
- no enlarged lymph nodes. No local tumor extension into
adjacent organs
DISTANT SPREAD:
- No focal hepatic lesions, omental/peritoneal nodules or
ascites

*M Al-Hawary et al ( Work in Progress)

 PANCREATIC CARCINOMA
Unesectability Criteria
• HEAD:
• Distant metastases, >1800 encasement of
SMA, CA abutment, occluded PV/SMV,
aortic invasion
• BODY:
• Distant metastases, >1800 encasement of
CA, SMA, occluded SMV/PV, aortic
invasion
• TAIL:
• Distant metastases, >1800 encasement
of CA, SMA
* NCCN Guidelines version 2.2012
 UNRESECTABLE PANCREATIC CARCINOMA- BODY
>180 encasement of CA, HA, SMA and retroperitoneal ext.

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> 180 degrees encasement of SMA
UNRESECTABLE PANCREATIC CARCINOMA- UNCINATE
>180 degrees encasement of SMA-Tethered/occluded SMV
 PANCREATIC CARCINOMA
Borderline Resectability Criteria
ƒ No distant metastases
ƒ SMV or PV abutment, distortion,
encasement or short segment
occlusion/thrombus of SMV or PV but
with suitable proximal and distal landing
sites for venous reconstruction
ƒ GDA encasement up to origin from HA,
and short segment encasement or
abutment of HA without CA involvement
ƒ SMA abutment not to exceed 180 degrees
* NCCN Guidelines version 2.2012
BORDERLINE RESECTABLE PANCREATIC CARCINOMA
SHORT SEGMENT CONTACT WITH HA

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 Obstacles to use of Structured
Reporting
• Time consuming- decreased efficiency and
productivity
• Structured reports are difficult to standardize
across centers as consensus difficult to achieve
• Even with complex exams as in cardiac imaging
(CCTA), SR’s are adapted to suit individual centers
• For ex. cardiologists main interest is in the
coronary arteries in a coronary CTA, but
radiologists have to interpret the whole exam- so a
template suited to the cardiologists may not be
ideal for the radiologist
• Benefits mainly are to referring clinicians, and
possibly hospital administrator and insurance
company
* Bosman JML at al Insights Imaging 2012
Radiology Reporting Templates
Structured Reporting

• PRIMARY TUMOR
• MESENTERIC ARTERIES
- CA, HA, SA, SMA
- Arterial variants
• MESENTERIC VEINS
- SV, SMV, PV
• LOCOREGIONAL SPREAD
• DISTANT SPREAD