Do you recommend carotid ultrasound screening at some point post definitive H&N XRT?

That is a great question and something that has frequently crossed my mind. However, this is not something I have routinely ordered for my patients. One of the reasons is the lack of adequate long term follow-up. This is usually seen a few years post-RT and many patients are lost to follow-up 4-5 ye...

Yes.

I start 4 years out from treatment.

You don’t have to wait for a trial to prove it is effective and cost effective.

You don’t want to wait until you’ve seen your first cured patient die or be seriously incapacitated by a CVA.

If there are no other risk factors and/or no significant stenosis I ...

I'm in Dr. Wollman's camp on this one, and as the data demonstrating increased stroke rates in long-term head/neck survivors (more common in the p16+/HPV-associated era), and have begun incorporating into surveillance alongside other survivorship care (e.g., thyroid function). Dr. Pino-Torres's poin...

A patient with carotid artery calcification on CT (diagnostic or at simulation) should be referred for carotid ultrasound. You may find significant or critical carotid artery stenosis that warrants repair before the start of radiation.