Oncology Imaging Guidelines

This policy governs the use of advanced oncology imaging modalities (CT, MRI, PET, bone scan and related studies) for staging, surveillance, and management across a broad array of cancers — e.g., primary CNS, head and neck, lung (SCLC/NSCLC), breast, colorectal, renal, sarcomas, thyroid, pancreatic, neuroendocrine and other malignancies in adult, pediatric and AYA populations. Major limitations/requirements include age‑specific oncology vs pediatric guidelines, physician review for atypical presentations, a recent clinical evaluation (within 60 days) prior to advanced imaging (except guideline‑scheduled off‑therapy surveillance), one‑time approval of initial staging when initiating standard therapy, modality preferences favoring CT, and contrast/renal precautions (iodinated contrast allergy management, GBCA contraindicated if eGFR <30, etc.), with advanced imaging generally not indicated for patients declining standard oncologic therapy.

"Bone scan supplemented by plain x-rays are the initial imaging modalities for suspected malignant bone pain."