Minnie is absolutely correct. The physical exam is definitely the gold standard. That's why the NCCN guidelines have timetables for their frequency vs. time from end of Tx. Annual chest x-rays are part of that protocol also. My RO, by the way, has serious doubts as to the usefullness of an annual chest x-ray - in her words, especially if "you were not a smoker". If you're really serious about a chest x-ray then the spiral CT is the best way to go ("exquisite images" to quote her).

Gail's point should thoroughly understood as well. Reading IS an art and the head and neck a highly specialized, complex part of the body. That is why we BEG people to go to a CCC or CC or a very least, get a second opinion from one. It's comparable to bringing your BMW to a Hyundai dealer for repair.

Jim,
My head & neck surgeon went to medical school at UCSFCCC so I have confidence in his abilities. As it was explained to me, scans are only a small component of the total diagnostic procedure. All of my scans get read twice, both at Kaiser, where they are typically done, and also at UCSF. It's my RO who wants the annual MRI and it's part of UCSF standard follow-up protocol for H&N patients. She has residents and students double checking me as well - many times I have to encourage them to really put the gloved hand down there so they can feel what it's supposed to be like. They tend to be shy at times.

Remember also that even the BEST scanning equipment cannot "see" or detect a tumor smaller then 2mm ~ 1/8". How small a tumor or node can they palpate? Brian probaby knows that answer to that (I would hazard a guess of a cm or a little less).

My personal feeling, which I have stated many times before, is that my own risk is no longer from local recurrence (statistically 5% or so at 3 years post Tx) but distant metastesis and that is why I am pushing for an annual PET/CT. I want to know what's happening in my liver, kidneys, lungs and brain.