Goals and Objectives of the Oncologic Imaging Service 

• Provide harmonization in oncologic imaging reporting practices to reduce clinically significant variability. 
• Optimize efficiency of the outpatient CT imaging reporting workflow with improved performance in report turnaround time for imaging with same-day outpatient visits. 
• Harmonization of reporting practices for routine clinical CT and clinical research workflows to reduce discrepancies between routine clinical reports and research trial tumor response criteria assessments. 
• Promote quality of off hours emergent and inpatient care of oncology patients through UPHS ED coverage by oncologic imaging focused faculty.
• Promotion of research and education in advanced oncologic imaging at Penn.

The oncologic imaging service provides rotating fellows, residents and medical students the latest advances to the field of oncologic imaging. This is accomplished through a combination of:

• on-service teaching
• lectures
• multidisciplinary tumor boards
• weekly imaging case conferences
• focused research projects

In addition to dedicated time on the CT-based oncologic imaging service, this fellowship offers elective time to develop skills in oncologic imaging on other subspecialty services for a fellowship year that is tailored to your interests. 

Goals

• Complete the following clinical requirements:
  • Oncologic imaging service (4 months).
  • Thoracic oncology (2 months)
  • Abdominal imaging (MRI; 2 month)
  • Nuclear medicine (2 months)
  • Elective time (2 months; options include nuclear medicine, pediatric radiology, neuroradiology, head/neck oncologic imaging, oncologic imaging research, clinical oncology service)

• Identify tumors of interest to pursue for a more advanced understanding of oncologic management- each month on the oncologic imaging service will focus on one of these tumors.
• Achieve knowledge-based objectives.
• Attend one tumor board per week of service (in areas of interest declared prior to beginning of the rotation)
• Attend a total of 5 days of clinical oncology service (oncologic outpatient service, oncologic inpatient service, biopsy, radiation-oncology, surgery) in declared area(s) of interest. 
• Provide TRAC MINTLesion reporting of clinical trial patients.
• Attend TRAC weekly baseline tumor case review conference.
• Attend and present cases at the bi-weekly oncologic imaging service case conference.
• Function as part of a clinical team composed of the attending faculty and 3D core lab technologists.

Objectives

Knowledge-based Objectives

• Understanding of common pitfalls in CT interpretation during staging and therapy response follow-up of cancer.
• Refine understanding of the function of the radiologist as part of the oncologic management team.
• Mastery of the measurement rules of the commonly used tumor response criteria including RECIST1.1, Cheson, Lugano, iRECIST and Lyric and the application of these rules to every day real world oncology.
• Advanced understanding of oncologic management of declared tumors of interest (in area of interest declared prior to beginning of the rotation).
• Greater than 90% accuracy in interpretation of oncologic CT imaging.

Technical, Communication, and Decision-making Skills

• Facility with the lesion tracking function on Sectra
• Complete approximately 20 CT accession numbers daily (approximately 10-12 patients)
• Participate in communication with clinicians regarding patient findings and clinical questions.
• Facility with the MintLesion software
• Understanding of how CT imaging protocol parameters (ie. image slice thickness, use of intravenous and oral contrast) impact oncologic assessments.

Clinical Requirements

• Oncologic imaging service (4 months).
• Thoracic oncology (2 months)
• Abdominal imaging (MRI; 2 month)
• Nuclear medicine (2 months)
• Elective time (2 months; options include nuclear medicine, pediatric radiology, neuroradiology, head/neck oncologic imaging, oncologic imaging research, clinical oncology service). 

Additional Clinical Imaging Requirements

• Attend and present cases to one multidisciplinary tumor board per week of service. (ie. lung cancer, pleural malignancy, gastrointestinal oncology, lymphoma, melanoma, neuroendocrine oncology)
• Attend a total of 5 days of clinical oncology service to gain first-hand experience on how imaging data is used in the clinic (oncologic outpatient service, oncologic inpatient service, biopsy, radiation-oncology, surgery) in area of interest.
• Participate in providing tumor response assessments for innovative clinical trials at Penn
• 1 week of overnight 10PM-8AM coverage of the HUP/PPMC emergency department.

Oncological Imaging Conferences

• Weekly multidisciplinary tumor board conferences (fellows cover one weekly conference). These conferences are focused on patient management and attended by a disease focused oncologic team including oncologists, radiation oncologists, primary care subspecialists, surgeons, pathologists and radiologists.
  • lung cancer
  • pleural malignancy
  • melanoma
  • gastrointestinal oncology
  • genitourinary oncology
  • §neuroendocrine malignancy
  • lymphoma

• Bi-weekly Oncologic Imaging Service case conference-these biweekly case conferences are dedicated to teaching principles of oncologic imaging
• Weekly tumor response assessment core (TRAC) baseline imaging review conference- this weekly meeting reviews imaging exams for clinical trial patients being assessed by TRAC

Clinical Imaging Equipment

Fellows on service for the Oncologic Imaging service have access to imaging produced on state-of-the-art imaging equipment and imaging software post processing techniques. For example, our institution is one only a small number of institutions in the world with the novel photon-counting CT scanner which produces imaging with exceptionally high resolution and low background noise allowing for detection and characterization of disease with precision. UPHS Imaging equipment includes the following:

Computed tomography (CT)

• Siemens Somatom Force
• Siemens Definition AS40
• Siemens Definition AS+ 128
• Siemens Definition Flash
• Siemens Naeoton Alpha
• Siemens Definition Edge

Workstations and postprocessing software

• Four monitor and dual monitor PACS workstations
• TeraRecon Thin Client access at each reading station
• GE Advantage Windows workstation with advanced vessel analysis and volume rendering software
• Siemens SyngoVia thin client
• Dedicated 3D Imaging Laboratory
• MintLesion Oncologic assessment software

Oncologic Imaging Research

Taking a deep dive into a subject through biomedical research is a phenomenal way to advanced imaging knowledge and become an expert in the field. The University of Pennsylvania routinely ranks Top 10 in NIH-sponsored funding by U.S. News and World Report. This year Penn ranked #2 in American Association of American Universities in R&D Spending. The Department of Radiology is a leader in research within Penn with opportunities for imaging research ranging from the bench to the bedside. Oncologic Imaging service fellows have elective time during which can be dedicated to research, with a goal of carrying a project to completion with presentation at a national or international meeting. 

Penn Radiology Research Resources