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Background Treatment of brain metastases can be tailored to individual lesions with treatments such as stereotactic radiosurgery (SRS). Accurate surveillance of lesions is a prerequisite but challenging in patients with multiple lesions and prior imaging studies, in a process that is laborious and time consuming. We aimed to longitudinally track several lesions using a PACS-integrated lesion tracking tool (LTT) to evaluate the efficiency of a PACS-integrated lesion tracking workflow, and characterize the prevalence of heterogenous response to treatment after GK. Methods We selected a group of brain metastases patients treated with GK at our institution. We used a PACS-Integrated LTT to track the treatment response of each lesion after first GK intervention to maximally seven diagnostic follow-up scans. We evaluated the efficiency of this tool by comparing the number of clicks necessary to complete this task with and without the tool, and examined the prevalence of heterogenous response to treatment. Results A cohort of eighty patients was selected and 494 lesions measured and tracked longitudinally for a mean follow-up time of 374 days after first GK. Use of LTT significantly decreased number of necessary clicks. 81.7% of patients had heterogenous response to treatment at the end of follow-up. The prevalence increased with increasing number of lesions. Conclusions Lesions in a single patient often differ in their response to treatment, highlighting the importance of individual lesion size assessments for further treatment planning. PACS-integrated lesion tracking enables efficient lesion surveillance workflow and specific and objective result reports to treating clinicians.

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