title: RECIST measurements in cancer treatment: is there a role for physician assistants? - A pilot study.
abstract: BACKGROUND
  Decision making in cancer treatment is influenced by standardized RECIST measurements which are subjective to interobserver variability. Aim of this pilot study was to evaluate whether it is feasible to transfer the radiologist's task of RECIST measurements to a trained radiology physician assistant and whether this influences diagnostic performance.
  
  
  METHODS
  177 lesions in twenty patients were measured on baseline and two follow-up CTs using RECIST 1.1: Arm A according to routine clinical practice where various radiologists read scans of the referred patients. Arm B according to the experimental setting where a radiology physician assistant performed RECIST measurements of target lesions defined by the radiologists on baseline scans. Performance and agreement were compared between groups.
  
  
  RESULTS
  Standard deviation between lesion measurements of arm A and B was four millimeters. Interobserver agreement comparing response category classification was substantial, ĸ = 0.77 (95% CI: 0.66 - 0.87). Sensitivity and specificity for the radiology physician assistant for assessing progressive disease were 100% (95% CI: 61% - 100%) and 94% (95% CI: 81% - 98%) respectively.
  
  
  CONCLUSIONS
  RECIST measurements performed by a paramedic are a feasible alternative to standard practice. This could impact the workflow of radiological units, opening ways to re-assigning radiologists' important, standardized but time consuming tasks to paramedics.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Sailer
authors.forename: Dave C E
authors.initials: DC
authors.lastname: Douwes
authors.forename: Vincent C
authors.initials: VC
authors.lastname: Cappendijk
authors.forename: Frans C
authors.initials: FC
authors.lastname: Bakers
authors.forename: Bart A J M
authors.initials: BA
authors.lastname: Wagemans
authors.forename: Joachim E
authors.initials: JE
authors.lastname: Wildberger
authors.forename: Alfons G
authors.initials: AG
authors.lastname: Kessels
authors.forename: Regina G H
authors.initials: RG
authors.lastname: Beets-Tan
mesh_terms: D006801:Humans; D016014:Linear Models; D009369:Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy; D010823:Physician Assistants; D010865:Pilot Projects; D024382:Professional Role; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed