An Incipient Lancet Oncology Commission, Toward Bridging the Global Shortfall in Medical Imaging Critical to Cancer Management

Background and context: Medical imaging is an evidence-based, vital puzzle piece in cancer management, without which public health targets for NCDs and more specifically for cancer cannot be achieved. Yet global access to radiology and nuclear medicine remains untenably low, and absent from major metrics for progress monitoring. Aim: This commission is forming to define a few most impactful, achievable priorities toward global provision of essential imaging services for the continuum of cancer management for every patient in need. The highest attainable standard of health is indeed a human right, and essential cancer management services include medical imaging, for example, for follow-up to assess response to therapy; image-guided interventions, such as biopsies, placement of catheters for chemotherapy, and more; screening in certain contexts; imaging for planning of treatment, such as before surgery or radiotherapy; and image-guided treatment, both curative and palliative, such as for radiofrequency ablation of tumors. Strategy/Tactics: Preliminarily brainstormed, possible commission topics to address in a task force divided per section include: 1) how to incorporate medical imaging and nuclear medicine as a priority in universal healthcare ´essential´ packages; 2) the role for innovation, artificial intelligence, use of big data, links to the cloud, electronic medical records, machine learning, teleradiology, and better interpretation of complex images (e.g., computer-assisted detection for pulmonary nodules, mammography); 3) easier systems for interpretation and reporting/dictation templates; 4) technologies to decrease radiation exposure; 5) imaging for therapy planning and patient follow-up; 6) precision medicine - targeted, personalized, and patient-centered; 7) nuclear medicine theragnostic potential; 8) implementation of quality management systems; clinical imaging referral guidelines; strengthening country disease registries most relevant to tailoring cancer imaging needs; 9) structured needs assessments and readiness evaluation for stepwise improvement of radiology. Program/Policy process: This commission is convening relevant international stakeholders to foster collaboration and select a few high-impact global cancer imaging targets to address over the coming several years, with long-term sustainable spinoff initiatives anticipated. Outcomes: Ongoing. A commission roadmap of next steps is being generated, to coincide and synergize with NCDs targets. What was learned: The evidence base for incorporating medical imaging in addressing NCDs in the post-2015 development agenda is strong, but a roadmap has yet to be defined. Medical imaging for all remains elusive and relevant technologies are evolving rapidly, including artificial intelligence, which stand to greatly serve population-based global cancer management needs.