From dark art to a pregnant goat in the machine, Dr Richard Keal reflects on his NHS career in radiology.
When I started training in medicine in 1971, radiology was literally a dark art. The Middlesex Hospital X-ray department was in the basement of the hospital, a gloomy place populated by pale individuals, some wearing red goggles, who were rarely seen outside and certainly never communicated with medical students. We heard rumours of strange investigations performed there, such as air-encephalograms, which sounded more like medieval torture than anything diagnostic. Radiology had very little impact on my life as a medical student apart from my elective in Hamilton, Ontario in 1975. Here I heard a lecture by an eminent neuro-radiologist from England lamenting that he had had to come to Canada to see images from the new “EMI Scanner” – the start of the revolution in imaging.
After qualifying, I tried several specialities before ending up as a cardiology registrar. Here I was responsible for all the emergency pacing and assisting at cardiac catheterisations. I had no radiation protection training other than being told that we had to wear lead coats and radiation monitoring badges. The portable image intensifier kept cutting out and it was only when I was training in radiology that I learnt that this was due to the permitted time limit being exceeded. I often wonder whether this was the reason I developed cataracts later on.
A further career change found me training in radiology in Aberdeen. This was an exciting time: Aberdeen had two CT scanners, new real time ultrasound machines and a completely new department no longer hidden in the basement. However the real star was the NMR (as it was called then) scanner. When I arrived to train in 1983, The Mark 1 (the world’s first whole-body MRI scanner) had been relegated to research use and was available for the radiology trainees to use. I had my head scanned on it. The 64 x 64 pixel image at least proved I had a brain! I was unfortunate to have been scanned just after a pregnant goat had been in it and the smell was indescribable. We were the first trainees in the world to be taught and examined on MRI imaging for our part 1 exam. Looking at the scanner, now in the museum in Aberdeen, it is impossible to believe that a machine built of copper plumbing components with a chicken wire and aluminium foil Faraday cage and a ZX81 processor could have ever produced images.
Coming to Leicester in 1986 was like a step back in time! No MRI, a B-mode ultrasound system and a CT scanner that no registrars were allowed access to. It was here that I did my first (and last) trans-lumber aortagram and saw other investigations such as cervical myleograms. I had learnt to do lymphangiograms in Aberdeen and I used to spend many a quiet morning performing them.
With my interest in cardiac imaging, I was appointed as a consultant cardiac radiologist at the cardio-thoracic centre. I was one of the few radiologists in the country with an interest in echocardiography and in close cooperation with the cardiac surgeons, introduced intra-operative trans-oesophageal echocardiography into the operating theatres, a technique now commonplace and performed usually by anaesthetists today. As a radiologist, the hospital management were used to me asking for expensive pieces of equipment and when it came to replacing our echocardiography systems, they didn’t ask any questions when I told them that digital imaging was now standard, replacing VHS tapes, and that we required a digital archive. The result was the largest digital echocardiography department in Europe complete with a 400 GB optical jukebox the size of a small room. I followed this up by persuading them to install the first dedicated cardiac MRI scanner in the country.
I started my career by learning invasive cardiac catheterisation and ended it by performing CT coronary angiograms, such has been the pace of change in the last 40 years. Unfortunately, imaging appears to have superseded history and the workload is now excessive. The hospital I worked in now has three MRI scanners (two cardiac), two CT scanners, numerous echocardiography systems, two SPECT systems and a PET scanner; all imaging techniques that didn’t exist or were in their infancy when I started in medicine. What does the future hold?
About Dr Richard Keal
I was born in 1953 and educated at Alleyn’s School in Dulwich. I scraped into the Middlesex Hospital Medical School in 1971 with three Cs at A-level having never studied any biology. After an uneventful medical school career, apart from failing pharmacology twice, I qualified in 1976. I immediately married the lovely nurse I had met over the tea urn on the first ward I was on as a medical student. Uncertain as to what area to specialise in, I tried several specialities as a junior doctor including A & E, cardio-thoracic surgery, thoracic medicine and cardiology. I finally settled on radiology and was offered a registrar post in Aberdeen in 1983 after being sent to see a psychiatrist to ensure I was sane. I moved to Leicester in 1986 as a senior registrar and was appointed as a Consultant Cardiac Radiologist at Groby Road Hospital on 1April 1990. In 1995, I became Head of Department at Glenfield Hospital and continued in post until deposed by the merger of the three Leicester Hospitals in 2002. I spent the next years as the grumpy old man of the department gradually withdrawing from various modalities as new consultants were appointed. I retired in 2013, but continued part-time as clinical head of cardiac nuclear medicine and ARSAC license holder. I finally retired in 2017 when the MDU fees became greater than my private practice earnings. Our three sons are pursuing highly successful careers outside medicine.