December 2023

Guidelines for using noninvasive imaging techniques to monitor cardiac function in adults undergoing cancer treatment are available. Children with cancer, however, require a different imaging approach. Screening and detection strategies in younger children have largely relied on longitudinal monitoring of echocardiographic measures of left ventricle (LV) systolic function, mainly fractional shortening (FS) and ejection fraction (EF). Despite the important role of echocardiography in the follow-up of this patient group, a recent multicenter study indicated that the overall quality of routine pediatric echocardiograms for childhood cancer survivors was not sufficient to reliably assess LV function. This finding highlights the need to develop recommendations for the standardization of echocardiographic functional assessment as applied to pediatric oncology patients. Additionally, the role of newer echocardiographic techniques such as myocardial deformation imaging and other noninvasive imaging modalities, including cardiac magnetic resonance imaging (CMR) and computed tomography (CT), has not been well defined for this indication. The aim of this document is to provide guidance on the application of multimodality imaging in children undergoing cancer treatment. The Writing Committee focused on indications for and performance and interpretation of current clinically used imaging techniques. This document is not intended to make recommendations regarding the impact of cardiac imaging results on cancer treatment, as this is highly controversial and should be the topic of separate practice guidelines.