Cancer imaging at Siteman Cancer Center is more than diagnosis. It is one of the most important tools for understanding the complexity of cancer in the body and determining the best path forward.
At Siteman Cancer Center, WashU Medicine radiologists use advanced imaging technologies to identify cancer, define its extent and evaluate how it responds to treatment. The information gained from each scan helps guide critical decisions across the continuum of care—from diagnosis and treatment planning to monitoring response and recovery.
This expertise is grounded in a long history of scientific leadership. WashU Medicine researchers have helped shape the field of medical imaging through discoveries and innovations that continue to influence cancer care around the world. Today, that same commitment to advancing imaging science helps patients at Siteman benefit from highly precise, personalized approaches to cancer diagnosis and treatment.
Because Siteman Cancer Center provides access to WashU Medicine radiologists with renowned expertise in the interpretation of complex cancers, patients often come to Siteman for a second opinion – when a cancer diagnosis is uncertain, treatment decisions carry significant consequences, or you want scans evaluated by WashU Medicine specialists who focus exclusively on cancer. Our specialists routinely review imaging studies performed at other institutions to confirm findings, better define the extent of disease and identify details that may influence diagnosis, staging or treatment planning.
For patients facing a complex, rare or advanced cancer, this additional level of expert review can provide greater clarity and help ensure critical decisions are informed by the most precise understanding of the disease possible. And our radiologists work closely with specialists across every cancer discipline, bringing the collective expertise of a leading academic cancer center to every image and every case.
Our Siteman care coordinators – oncology-trained nurses who help with scheduling, finding the right specialist, and guidance – can help you through the process.
Call us directly or submit a form, and we will call you back.
Second Opinion Imaging at Siteman
With cancer, treatment decisions depend on accurately defining the extent of disease, making precise imaging the foundation of your care. No matter where you are in your cancer journey, a second opinion at Siteman Cancer Center can best inform your next steps.
Contact our care coordinators to learn more about second opinion imaging if you are navigating:
- A new cancer diagnosis and want confirmation or more precise staging
- Different or conflicting recommendations from physicians
- A rare, advanced, or particularly complex cancer diagnosis
- Unclear, difficult to interpret, or inconsistent imaging findings and pathology results
- Additional areas of concern that appear in scans and need to be explored
- An unexpected response to treatment, your cancer has returned, or you need further evaluation
Our care coordinators – oncology nurses who help with scheduling and navigation – will guide you from your first call. Ask about a second opinion.
Why Choose Siteman
The efforts of WashU Medicine specialists at Siteman were recently recognized by the National Cancer Institute (NCI), which awarded radiation oncologists a five-year, $7.8 million federal grant to support our radiation oncology center. Called the MicroEnvironment and Tumor Effects of Radiotherapy Center (METEOR), the grant is used to research how radiation affects the immune system and to propose new radiation treatment combinations to improve the outcomes of patients with advanced cancer.
WashU Medicine radiation oncologists at Siteman compose one of only five centers in the Radiation Oncology-Biology Integration Network (ROBIN), signaling an exclusive group of experts and next-generation researchers dedicated to improving the lives of people with cancer.
In a typical year, radiologists from WashU Medicine will perform:
- Around 800,000 diagnostic exams
- 14,000+ nuclear medicine exams
- 50,000+ interventional radiology procedures – reducing the need for traditional open surgery
Radiologists offer the most specialized exams and procedures for breast cancer at the Joanne Knight Breast Health Center at the Center for Advanced Medicine (CAM) and the Gary C. Werths Building at Siteman Cancer Center. They also provide 3D mammography at all of Siteman’s satellite locations and with our mobile mammography van to reach even more people in the region.
Your care team will only order an imaging test if the benefit outweighs the risks of radiation exposure. We are here to answer any questions or concerns during the process so that you can make informed decisions about your treatment.
Nurses at Siteman answer every call and every form. Speak with them directly 8:00 am to 4:30 pm CT Monday- Friday for guidance on appointments, second opinions, and referrals.
Types of Cancer Imaging We Use
More than half of the clinical imaging tools and technologies at Siteman Cancer Center didn’t exist or were not fully developed 35 years ago – but radiologists and radiation oncologists at WashU Medicine were at the forefront of developing many of them. Below are some of the various methods of imaging we may use during the process of your treatment.
X-rays are the oldest type of medical imaging and used more than any other method. This imaging uses electromagnetic radiation to see inside the body with a focus on the bones, organs, and tumors.
Tomosynthesis uses a low dose of X-rays to form a 3D picture that creates an image of the breast from different angles. Doctors will position the breast similar to a traditional mammogram. A little pressure from the imaging machine keeps the breast tissue stable during the procedure.
WashU Medicine radiologists who specialize in breast imaging also lead contrast-enhanced mammographies (CEM). A CEM mammogram uses contrast dye to make it easier to spot cancer growth in certain circumstances like with women who have dense breast tissue.
Learn more about breast cancer imaging and diagnosis at Siteman.
A CT scan, also known as a CAT scan or Spiral CT, uses X-ray technology to form a medical image. A tube revolves around your body to create a 3D image by gathering cross-sectional slices. This type of imaging gives your doctor a clearer picture from various angles compared to a standard X-ray scan.
Sometimes, we might use a contrast dye during your CT scan. This makes it easier to see abnormal activity in the body in the produced images.
WashU Medicine radiation oncologists were instrumental in developing the world’s first big-bore CT Scanner in 1999, featuring an 85-centimeter bore that can position patients with immobilization devices. Today, it’s the standard machine radiologists use for real-time simulating and CT imaging.
A SPECT scan is a type of nuclear imaging test that combines two technologies to show radiologists how your blood flows. It involves a CT scan and a tracer that reveals how the body reacts to the substance for interpretation. Nuclear medicine radiologists interpret these images to pinpoint abnormalities in the body.
A PET scan uses a small amount of radioactive compound that shows metabolic activity of tissues in your body. It helps clinicians find cancer cells by highlighting areas displaying abnormal glucose levels.
PETs help WashU Medicine radiologists detect cancer earlier or track tumor responses to treatment.
Sometimes, your doctor may order a PET in conjunction with a CT or MRI. These scans are done at the same time using the same machine.
Combining these imaging techniques offers high-quality images that show body structures and cancer activity in cells. This helps doctors target cancer cells with more accuracy, causing less damage to the rest of the body.
WashU Medicine radiologists at Siteman have offered PET-MRI scanning since 2014, which deliver key insights about cancer cell spread that MRI alone cannot provide.
MRIs are medical imaging tests that do not use any radiation — instead, the machine makes an image using a magnetic field, radio frequency pulses, and computers. This creates detailed images of organs, soft tissues, bones, and other internal structures of the body.
During your scan, you will lie on a table that slides into the scanner, which then takes a series of photos in cross-sections of your body to produce a 3D image.
These detailed images are great for spotting tumors and details in the brain, spinal cord, and joints. MRI may not be an option for some patients with metal implants like pacemakers, rods, or joint replacements.
Other types of MRIs Siteman uses for cancer imaging:
- Functional MRI (fMRI): This scan helps doctors map the brain. They ask the patient to do simple tasks like moving an arm or saying their name. Then, radiologists and neurosurgeons can map the patient’s brain networks such as speech and motor control.
- Intraoperative MRI (iMRI): After removing a tumor and draining cerebrospinal fluid during brain surgery, the fMRI map becomes inaccurate, so surgeons use iMRIs to give them updated information to complete the surgery with greater accuracy. Surgeons use a mobile MRI machine to remap the remaining tumors.
- MRI-guided laser interstitial therapy: This advanced technique, also known as Laser Interstitial Thermal Therapy (LITT), was developed by WashU Medicine neurosurgeons. This technique uses a powerful laser probe during MRI scans to target cancer cells deep in the brain while sparing nearby tissue. cancer cells deep in the brain while sparing nearby tissue.
Ultrasounds are one of the safest and most painless methods of imaging since they do not use any radiation. Also called sonography, they produce pictures of the inside of the body using sound waves.
Physicians perform ultrasounds by using a transducer (wand) with a gel placed directly on the skin or in the body. The probe collects sounds that bounce back to generate a live video and produce images.
Physicians might use these types of ultrasounds during your treatment.
- Endoscopic ultrasound: This method uses a probe on a fiber-optic endoscope. It lets doctors see the inside of the intestines so they can tell apart tumors, cysts, and stones in the bile duct, pancreas, and other abdominal organs.
- Doppler ultrasound: This ultrasound checks how fast blood flows in the veins and arteries of the organs and other parts of the body.
Theranostics uses specially engineered radioactive tracers, called radiopharmaceuticals, in combination with advanced imaging techniques, such as PET/CT, SPECT/CT, and PET/MRI. Working together, the two elements not only find and map cancer cells throughout the body, but they create a path that cancer-destroying drugs can follow with precision.
See our theranostics page for more information about this specialty we offer.
Siteman Kids patients at St. Louis Children’s Hospital receive care from WashU Medicine physicians who specialize in pediatric oncology. They use the same advanced imaging technology as our adult program, with an approach carefully adapted to children’s developing bodies and unique emotional needs.
Our expert team focuses on your child’s comfort during the imaging procedure and will work with you and your child to ensure the process is as safe and gentle as possible.
Experts in Cancer Imaging at Siteman
Cancer imaging is most powerful when it is connected to the expertise needed to act on what it reveals. At Siteman Cancer Center, imaging specialists are part of a multidisciplinary team that includes surgeons, medical oncologists, radiation oncologists, pathologists, and researchers who focus exclusively on cancer.
This close collaboration allows imaging results to be reviewed in the full context of your diagnosis, helping ensure that every recommendation is informed by the collective expertise of a leading academic cancer center.
For patients, this means seamless access to the specialists, technologies, clinical trials and support services needed throughout the cancer journey—all within one integrated cancer program and with the highest expertise.
WashU Medicine radiologists, radiation oncologists and nuclear medicine scientists at Siteman Cancer Center are internationally recognized as leaders in advanced medical imaging. They bring an exceptional level of expertise directly to your care by developing key advancements that reduce side effects and provide more insights into your cancer.
Part of this recognition Siteman earned by meeting the standards set by the American Society for Radiation Oncology (ASTRO) Accreditation Program for Excellence (APEx). APEx accreditations are awarded if a center meets 16 evidence-based standards of radiation oncology practice, including the process of care, the radiation oncology team, safety, quality management, and patient-centered care.
Among the legacy of innovations pioneered at Siteman Cancer Center, radiation experts at WashU Medicine invented a wearable technology called “cancer goggles” that helps surgeons see cancer cells in more detail. While wearing these high-tech glasses, cancer cells glow blue, so surgeons can tell cancer cells apart from healthy ones. While not available as a standard of care, they are being tested in the treatment of breast cancer, pancreatic cancer, and melanoma.
By embracing new advances in medical imaging, your care team can pinpoint the root of cancer with greater accuracy. This gives our patients better care with less invasive medical intervention.
Your Second Opinion at Siteman
Siteman wants to be your first choice for cancer care, but that might not always be possible. If you have received a cancer diagnosis, started care somewhere else, or are a physician seeking specialized care for your patient, ask us about a second opinion. You can start the process. To make it easy, our care coordinators guide scheduling for yourself or your patient.
What to Expect
Each type of scan requires different steps. Your care team will provide you with specific care instructions before you undergo a medical scan.
Before your scan, you should let your doctor know about any prescriptions you are taking. You can continue to take your regular prescriptions unless otherwise told. You should also inform your doctor if you are pregnant or have any allergies.
To prepare for your scan on the day of, doctors may ask you to fast before your appointment, take contrast medicine, or wear certain clothing. Wear comfortable clothing to your appointment and remove any jewelry or accessories.
Some scans, such as a CT or PET, require fasting beforehand. Your care team will let you know of any other specific instructions to follow on the day of your appointment.
To produce the best images, you’ll be asked to stay as still as possible during the scan. A radiology technician will be able to see and hear you during the scan, and you will have access to a call button.
Some machines are very loud. Technicians will provide you with earplugs or headphones to make you more comfortable during the process.
Most of the time, you can resume normal activity after the scan is over. If you used a contrast medicine for your scan, be sure to drink plenty of fluids afterward to flush it out of your system.
Depending on the type of scan, some images are available immediately, such as in an ultrasound, CT scan, or X-ray. But all images need to be read and interpreted before results are shared. It is not unusual for MRI results to take two weeks.
Your doctor will discuss the results with you during a follow-up appointment.
X-rays, mammograms, CT, PET, and nuclear medicine use radiation to produce images. The amount of radiation with some of these tests, like x-rays and mammograms, is minimal. Other tests may require more radiation. Any exposure to radiation can increase cancer risk, so your doctor will only order a scan if the benefits for treatment outweigh the risks.
Some contrast medicine might cause allergic reactions. Be sure to talk to your doctor before your appointment to understand the potential side effects.
