Medical imaging is essential for both patients with gynaecological cancer and for patients with benign gynaecological conditions to determine the characteristics of pelvic organs and assess the extent of spread. More than one medical imaging technique may be recommended for one patient. The reason for this is that different techniques give complementary information, that (put together) provide comprehensive information that influences a patient’s management.
A gynaecologist is able to interpret standard imaging films. Gynaecological oncologists are also able to interpret CT scans and MRI scans. In complex cases a gynaecologist or a group of gynaecologists will confer with their preferred radiologist or a group of radiologists about the meaning of imaging results and their clinical impact.
Ultrasound is widely used for the scanning of ovarian and pelvic masses to triage patients who require surgery or not. The quality of the ultrasound largely depends on the experience of the sonographer and determines its usefulness. Ultrasound is the first examination of choice for pelvic pain and abnormal uterine bleeding. It may detect fibroids, adenomyosis or tumours.
CT scans use X-ray technique and is used for almost all patients who require surgery for gynaecological cancer preoperatively. It provides necessary information about the possible extent of tumours. This information will then guide the patient’s surgical management. CT scanning is also valuable in the follow-up of patients who previously had treatment for gynaecological cancer. One CT scan uses the radiation dose of 7 Chest X-Rays and therefore those scans need to be requested mindfully.
PET/CT has become immensely valuable for the management of cervical and ovarian cancer. It is extremely useful for the treatment planning of cervical cancer and for the follow-up of ovarian cancer. Unfortunately, Medicare reimburses PET/CT only in certain circumstances for those two tumours but PET/CTs for other indications can be requested at the patient’s own cost.
MRI scans have been proven magnificent in the management of pregnant patients with cancer, in the management of patients with all types of gynaecological cancer and in patients with large uterine fibroids and bleeding disorders (adenomyosis, endometriosis).