Screening Pathways

These resources outline medical imaging pathways available, based on gender, age and risk profiles. They are intended to support Referrers when considering appropriate imaging in asymptomatic populations.

Imaging can be a valuable tool for screening and early detection, however it does not replace clinical assessment. Screening is most effective when early detection is shown to improve outcomes and the benefits outweigh the risks. The stratification below is designed to help identify which patients are most likely to benefit from our screening pathways, and where their use is most appropriate.

Average risk

• No significant family history
• No known genetic mutations
• No major smoking history (for lung)

Moderate risk

• One first-degree relative with cancer (breast, prostate, colorectal)
• Dense breasts (women)
• Former moderate smoker

High risk

• BRCA1/2 or other gene carriers (women)
• Lynch syndrome (colon)
• Heavy smokers (lung)
• Strong family history (>2 first-degree relatives)

What about whole-body MRI (WB-MRI)?

Some patients may ask about whole‑body MRI because it sounds like a comprehensive way to “check everything” and find disease early.

While whole‑body MRI can be useful in certain medical situations, it is important to understand both its benefits and its limitations.  At present, there is no evidence that whole-body MRI screening in average risk individuals reduces the chance of dying from cancer or improves overall life expectancy. It can also lead to incidental or low‑risk findings that cause unnecessary worry and lead to further tests or procedures that are not needed. 

Whole-body MRI is not currently recommended by professional bodies, and the Australian/New Zealand College of Radiologists (RANZCR) does not support WB-MRI as a screening tool in people without symptoms or without known cancer or cancer-predisposition syndromes. 

Whole-body MRI may be appropriate:

• as part of specialist-led care or surveillance.
• in high-risk genetic conditions such as Li-Fraumeni Syndrome (inherited TP53 loss).
• for specific medical reasons, such as inflammatory or systemic disease.

As evidence and protocols continue to evolve, the clinical indications for WB-MRI may increase, and we will adopt these where appropriate, however, at this time screening is most effective when it is targeted, evidence based, and matched to a person’s actual risk, using tests proven to improve outcomes (such as bowel, breast, or lung screening in defined risk groups). 

Targeted abdominal MRI should be aligned to oncology/genetic guidelines, and is indicated in patients with the following syndromes:

• BRACA 1/2
• Lynch syndrome
• FAP
• MEN1 / MEN2
• VHL
• Other hereditary cancer syndromes.

Abdominal MRI targets include:

• Pancreas (pancreatic cancer surveillance)
• Liver (hepatobiliary tumours)
• Kidneys (renal tumours, VHL)
• Adrenals (MEN, hereditary pheochromocytoma)