Pediatric Oncology Imaging Guidelines

This policy covers pediatric oncology imaging — diagnostic, staging and surveillance advanced imaging (CT, MRI, PET/nuclear where applicable) across numerous childhood cancers and predisposition syndromes per the eviCore PEDONC guideline sections (e.g., leukemias, CNS tumors, lymphomas, neuroblastoma, renal/liver tumors, retinoblastoma, long‑term survivors). Major limitations/requirements: applies primarily to patients <18 with AYA (15–39) considerations and age‑based exceptions, requires a recent (≤60 day) history/physical and appropriate labs before advanced imaging (unless guideline‑supported off‑therapy surveillance), routine non‑localized imaging is not supported, many PET and contrast‑enhanced MRI uses are limited/rare, and atypical presentations require physician review.

"Echocardiography is preferred over MUGA for evaluation of cardiac function prior to cardiotoxic chemotherapy."