derriford:vetting [RadRegWiki]

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====== Vetting Guidance ======

All guidance contained within represents suggested local practice from Derriford consultants, but is only general guidance - do not apply blindly and where uncertainty persists ask someone.

By pathology (malignancies):


==== GI Cancer ====

=== New Suspected Cancer ===

New presentations with suspected GI cancers can end up in the general vetting silo when requested as CT AP - CT colons go straight to GI.
These CT AP requests should be vetted as appropriate, but cannot be converted to CT colons - discuss with GI if you feel this is warranted. There is no minimal prep CT protocol in Derriford.

=== Staging and Follow Up ===

For staging and follow up CT TAP with arterial chest and PV abdomen and pelvis is recommended - the dual phase of the liver is felt helpful in assessing incidental haemangioma.

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==== Suspected ENT Cancer ====

This covers suspected upper aerodigestive tract, major salivary gland tumours, and neck lymphadenopathy with unknown primary.
MRI neck requests should be sent to the head and neck vetting silo "HNREP".

If low risk:
  * Non-contrast MRI neck

If high risk:
  * MRI neck with contrast
  * CT thorax with contrast for staging

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=== Risk Stratification: ===

LOW RISK Patients:
  *  Have 2WW symptoms - e.g. referred otalgia, chronic lateralising throat pain, FOSIT
  *  Have NORMAL examination including fibre-optic nasendoscopy.
  *  No palpable suspicious neck lumps (by ENT/MaxFacs) or normal neck US.
  *  No previous H&N malignancy/treatment.
  *  Following multiple normal surveillance studies, can change to non-contrast surveillance.

HIGH RISK Patients:
  *  Have abnormal examination on FNE - suspicious nasal, pharyngeal or laryngeal mass.
  *  Oral cavity lesion on MaxFacs examination.
  *  Abnormal neck lump (ideally confirmed as pathological on US).
  *  Post-treatment patients / suspected recurrence.


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=== MRI Head/Orbits ===

While these are often requested, MRI head is rarely indicated in suspected ENT cancers - MRI neck sequences are sufficient to assess skull base invasion and perineural spread. MRI head is only required where there is a scalp lesion with suspected skull invasion, or where there is the suspicion of intracranial metastasis indicated by suspicious neurological symptoms. Feel free to send these study to the HNREP vetting silo for H&N to assess.