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Cancer Imaging Program

Cancer Imaging Program. GRH, SMGH, GGH, CMH. Cancer Imaging Program LHIN 3. Updates Jan 2012. ORGANIZATIONAL STRUCTURE. History of Cancer Imaging Program. 2004 CCO becomes advisor to provincial government CCO mandate to enhance the quality of cancer services

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Cancer Imaging Program

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  1. Cancer Imaging Program

  2. GRH, SMGH, GGH, CMH Cancer Imaging ProgramLHIN 3 Updates Jan 2012

  3. ORGANIZATIONAL STRUCTURE

  4. History of Cancer Imaging Program • 2004 CCO becomes advisor to provincial government • CCO mandate to enhance the quality of cancer services • Governmental concerns over wait times for cancer imaging • Lack of mechanism for dialogue and collaboration within cancer imaging services in province • 2009 Cancer Imaging program becomes 10th program created by CCO • CCO (Jan 2012) Strategic Directions

  5. QUALITY FRAMEWORK • Quality and Performance Improvement Cycle • Information collection • Knowledge synthesis by experts • Transfer ---------Clinician Engagement • Performance-------agreements, incentives, public reporting

  6. Dimensions of Quality Framework • Safe • Effective • Accessible • Timely • Responsive • Patient Centered • Efficient • Equitable

  7. VISION OF CANCER CARE ONTARIO • Working together to create the best cancer system in the World

  8. MISSION OF CANCER CARE ONTARIO • We will improve the performance of the cancer system by driving quality, accountability and innovation in all cancer related services

  9. Goals of the Cancer Plan 3 • 1. Help Ontarians lessen the risk of developing cancer • 2. Reduce the impact of cancer through effective screening and early detection • 3. Ensure timely access to accurate diagnosis and safe high quality care

  10. Ontario Cancer Plan 3 • 4. Improve the patient experience along every step of the cancer journey • 5. Improve the performance of the Ontario cancer system • 6. Strengthen Ontario’s ability to improve cancer control through research

  11. Cancer Journey

  12. Walton D. (2011, Dec 30). Botched medical tests spur probe; Alberta is latest province to order review of procedures after mistakes of ‘considerable concern’ discovered. Globe and Mail, p. A1. • Taylor P. (2011, Dec 30). The great debate: cancer screening; Changes to guidelines for mammograms and PSA tests grabbed headlines-and the public is still wondering what to do, p. L6

  13. 7 Strategic Goals of CIP • Improve the quality of cancer imaging • Improve Patient Access • Improve Early Detection and Diagnosis • Facilitate and accelerate evidence based change

  14. Strategies of CIP • Integrate Cancer Imaging in the patient journey • Improve communication • Optimize Safe utilization of cancer imaging

  15. Diagnostic Assessment Program • Lung Cancer: ref from family doc, nurse practitioner based on abn CXR or CT • Colorectal Cancer: regional colonoscopy network, GI nurse navigator. Referral with +FOBT • Breast Cancer: Waterloo Wellington Breast Centre • Prostate Cancer • DAP-EPS : electronic pathway solution for physicians/ patients

  16. Accomplishments of Cancer Imaging Program • Guidelines :Program in Evidence based Care- Breast • Best Practice Standards: lung, CRC pathway maps • IR study: lung biopsy, PICCs and PACs study • IR Checklist • Rectal Cancer MRI

  17. Rectal Anatomycourtesy of Radiology Assistant

  18. Mri rectum courtesy of radiology assistant

  19. MRI Rectum synoptic reporting • Macros • Protocol: T2WI, no fat sat with 4 planes including oblique through short axis of tumor 4mm slices • Official document • Video of webinar • Manual • Rad Assist

  20. PET IMAGING • www.petscansontario.ca • 9 hospital based scanners, 3 IHF scanners • Esophageal cancer to be insured • Insured: thyroid, solitary pulm nodule, germ cell, CRC, NSCLC, Myocardial viability • Median approval to performance is 5 business days • Online requests made

  21. Sarcomacourtesy of orthopaedia.com

  22. SARCOMA SERVICE • Formalization of a Multidisciplinary Sarcoma Team • Mt Sinai, Ottawa and Hamilton • Recommendations from expert panel • Imaging evaluation to be reviewed at specialized centres • MCCs for sarcoma • Follow up of cases based on expert opinions • MRI and PET , tumor perfusion and diffusion evaluation to be available • Quality assurance measures

  23. Breast Imaging: High Risk-BRCA • First Degree relative of a mutation carrier • Family History-multiple cases of breast, ovarian cancer • Primary breast cancer in both breasts • Both breast and ovarian cancer in same woman • Breast cancer </= 35 years old • Invasive serous ovarian cancer • Breast and/or ovarian cancer in Ashkenazi Jewish family • BRCA 1 or 2 in any blood relative • Male breast cancer

  24. Breast Nurse Navigator • Receives requisition • Arranges genetics clinic appt • Provides psychosocial support and education • Coordinates follow-up • OBSP communicates results to woman and physician

  25. INTERVENTIONAL RADIOLOGY SURVEY • Overall PICC not a problem • Port-A- Caths insertion varied across province • Interventional procedure check list

  26. Wait Times • MRI Blitz used to reduce wait times • Back log management being considered by ministry- 70% hours to be funded • Cancer Identifier: new coding CAS, CAD, HRBC • CAR & access to care. Expert panel to be created, environmental scan

  27. New Cancer Code • CAD, CAS, HRBC • 10 days

  28. Conclusion • CIP: Innovative way to improve cancer imaging across province. • Knowledge Silos to under one umbrella • Data Collection drives planning

  29. Conclusion • Interventional Radiology : PICC good, PAC bad, check sheet • MCCs and DAPs, New Cancer coding, • BRCA + 34,000 • Pet Imaging • Synoptic Reporting: rectal now, lung future • Individuals needed by CCO for interview regularly • Multidisciplinary Sarcoma Team

  30. Have we changed?????

  31. QUESTIONS: Projects 2012 • Cancer Centre at Grand River to be hosting a conference on Colorectal Cancer in Spring 2012. • Funding for Radiology of $4000: Breast Conf. OAR Mar31.

  32. Dead Sea, sea salt, baking soda and medical tourism claim…….?

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