Best Practices for Post-Treatment Surveillance Imaging in Head and Neck Cancer: Application of the Neck Imaging Reporting and Data System (NI-RADS)

Head and Neck Cancer

AJR Am J Roentgenol. 2020 Sep 2. doi: 10.2214/AJR.20.23841. Online ahead of print.


Imaging surveillance is an important component of the post-treatment management of head and neck cancers. There is variability in the surveillance regimen utilized by various practitioners and institutions, with no official National Comprehensive Cancer Network guidelines for asymptomatic patients beyond 6 months post-treatment. Moreover, the post-treatment neck is a complex imaging exam with significant inter-reader heterogeneity, particularly in terms of the manner in which degree of suspicion

for disease recurrence is expressed. The Neck Imaging Reporting and Data System (NI-RADS) was introduced by the ACR in 2018 as a practical guide to the interpreting radiologist. NI-RADS is a proposed interpretive framework that can be applied to any standardized or institutional surveillance imaging protocol. NI-RADS simplifies communication between radiologists and referring clinicians and provides management guidance linked to specific levels of suspicion. The ACR NI-RADS committee also provided general best practice recommendations for imaging surveillance modality and timing in the 2018 white paper. The manuscript will begin with a review of existing literature regarding choice of modality and timeline for surveillance in treated cancer of the head and neck. NI-RADS will then be presented as an approach to imaging reporting, interpretation and design of next steps in management.