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

12. Cancer Journey

13. 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

14. 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

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

17. 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

18. 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

19. Rectal Anatomycourtesy of Radiology Assistant

20. Mri rectum courtesy of radiology assistant

21. 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

22. 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

23. Sarcomacourtesy of orthopaedia.com

24. 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

25. 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

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

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

28. 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

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

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

31. 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

32. Have we changed?????

33. 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.

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