Hats off to Sir Peter Mansfield (1933-2017)

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Sir Peter Mansfield left school with no qualifications to become one of the most eminent scientists in the world of physics. Here, Dr Adrian Thomas pays tribute to the man who lived through World War Two and with dogged determination forged his way in science to become a distinguished and recognised physicist who played a major part in the story of MRI.

 

Sir Peter Mansfield was born on 9 October 1933 in Lambeth in London, and grew up in Camberwell. His mother had worked as a waitress in a Lyons Corner House in the West End of London, and his father first worked as a labourer in the South Metropolitan Gas Company, and then as a gas fitter. Mansfield recounted being sent with other children on a holiday to Kent for disadvantaged London children by the Children’s Country Holiday Fund.

Peter Mansfield was 5 years old when the war broke out in 1939. He remembers standing with his father at the entrance of an air raid shelter watching anti-aircraft shells exploding around German bombers caught in the searchlights. As the Blitz intensified he was evacuated from the dangers of the capital, as were so many other London children. With his brother he was sent to Devon, where he was assigned to Florence and Cecil Rowland who lived in Babbacombe, Torquay. The Rowlands were called Auntie and Uncle, and Mansfield  attended the nearby junior school. Cecil Rowland was a carpenter and joiner by trade, and encouraged Peter to develop his practical skills by giving him a toolbox, and tools were slowly acquired. He obviously obtained some proficiency since with some guidance he made several wooden toys which he was able to sell at an undercover market and a toyshop in Torquay. His life was not without danger even outside London, and in early 1944,whilst out playing, he saw a German twin-engined Fokke-Wulf plane flying at rooftop level. The tail gunner was spraying bullets everywhere, and he rapidly took shelter behind a dry-stone wall.

On his return to London his secondary schooling was at Peckham Central, moving  to the William Penn School in Peckham. Shortly before he left school at 15 he had an interview with a careers adviser. Peter said that he was interested in science, and the adviser responded that since he was unqualified that he should try something less ambitious. He was interested in printing and so took up an apprentice in the Bookbinding Department of Ede and Fisher in Fenchurch Street in the City of London, and whilst there he took evening classes.   Developing an interest in rockets he was offered a position at the Rocket Propulsion Department (RPD) at Westcott, near Aylesbury.

In 1952 he was called up into the Army for his National Service, where he joined the Engineers. The Army allowed him to develop his interest in science. On demobilization he returned to Westcott and completed his A levels. This enabled him to apply for a special honors degree course in physics at Queen Mary College in London. In 1959 he obtained his BSc, and three years later he was awarded his PhD in physics. From 1962 to 1964 he was Research Associate at the Department of Physics at the University of Illinois, and in 1964 was appointed Lecturer at the Department of Physics at the University of Nottingham.

During a sabbatical in Heidelberg in 1972 Mansfield corresponded with his student, Peter Grannell in Nottingham, and became interested in what became MRI, presenting his first paper in 1973 at the First Specialized Colloque Ampère. Mansfield developed a line scanning technique, and this was used to scan the finger of one of one of his early research students, Dr Andrew Maudsley. The scan times required for these finger images varied between 15 and 23 minutes. These were the first images of a live human subject and they were presented to the Medical Research Council, which in 1976 was reviewing the work of various groups including those in Nottingham and Aberdeen.

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In 1977 the team at Nottingham, which included the late Brian Worthington, successfully  produced an image of a wrist. The following year Mansfield presented his first  abdominal image. In 1979 Peter Mansfield was appointed Professor of Physics at the University of Nottingham. As the Nobel Committee emphasized, the importance of the work of Peter Mansfield was that he further developed the utilization of gradients in the magnetic field. Mansfield demonstrated how the signals could be mathematically analyzed, which resulted in the development of  a practical  imaging technique. Mansfield also demonstrated how to achieve extremely fast imaging times by developing echo-planar imaging. This is all very impressive for a boy who left school at 15 with no qualifications.

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Peter Mansfield was awarded many prizes and awards including:

the Gold Medal of the Society of Magnetic Resonance in Medicine (1983); Fellow of the Royal Society (1987); the Silvanus Thompson Medal of the British Institute of Radiology (1988); the International Society of Magnetic Resonance (ISMAR) prize (jointly with Paul Lauterbur)(1992);  Knighthood (1993); Honorary Fellow of the Royal College of Radiology and Honorary Member of the British Institute of Radiology (1993);  the Gold Medal of the European Congress of Radiology and the European Association of Radiology (1995);  Honorary Fellow of the Institute of Physics (1997); the Nobel Prize for Medicine together with Paul Lauterbur (2003);   Lifetime Achievement Award presented by Prime Minister Gordon Brown (2009).

His autobiography The Long Road to Stockholm, The Story of MRI was published in 2013. This is an interesting read, particularly in relation to his early years, and is recommended reading for everyone interested in the radiological sciences. This is a revealing account of a remarkable life. Whilst we may discuss the complexities of the development of MRI and exactly who should have received the Nobel Prize, there can be no doubt about his major contributions. MRI has made, and is making major contributions to health care. He died age 83 on 8 February 2017.

The University of Nottingham has set up an online book of condolence http://www.nottingham.ac.uk/news/sir-peter-mansfield/

About Dr Adrian Thomas, Honorary Historian BIR

Dr Thomas was a medical student at University College, London. He was taught medical history by Edwin Clarke, Bill Bynum and Jonathan Miller. In the mid-1980s he was a founding member of what is now the British Society for the History of Radiology. In 1995 he organised the radiology history exhibition for the Röntgen Centenary Congress and edited his first book on radiology history.

He has published extensively on radiology history and has actively promoted radiology history throughout his career. He is currently the Chairman of the International Society for the History of Radiology.

Dr Thomas believes it is important that radiology is represented in the wider medical history community and to that end lectures on radiology history in the Diploma of the History of Medicine of the Society Apothecaries (DHMSA). He is the immediate past-president of the British Society for the History of Medicine, and the UK national representative to the International Society for the History of Medicine.

See more on the history of radiology at http://www.bshr.org.uk

 

 

The role of the radiologist when a baby dies

3-elspeth-whitby-100-x-150As we launch our Fetal MRI portfolio, Dr Elspeth Whitby explains how a research project on MRI in early-life autopsy made her realise what an impact a radiologist can have on bereaved parents.

She found that MRI images can help to create and manage a woman’s feelings during pregnancy and increased her own understanding of her role in the process.

 

End of or start of life

When a baby or infant dies, MRI can be used as a minimally invasive method to replace formal autopsy. Dr Elspeth Whitby explains how, not only does this provide scientific information, but with the interpretive and sensitive communication skills of the radiologist it helps to provide some answers and fill gaps for devastated and grieving parents. Here she talks through the unexpected learning which came out of an innovative and groundbreaking research project.

As part of my work as a consultant radiologist I am involved in a minimally invasive autopsy service where magnetic resonance imaging (MRI) is used along with a number of other investigations that can replace the formal autopsy. Over the last 12 months I have embarked on a 30-month interdisciplinary project which aims to explore the use of visual technologies in post-mortem, bringing together researchers, medical practitioners and technology manufacturers to examine how clinical applications of these technologies (such as MRI) are impacting upon professional practice and parental experiences of loss.

1a-memory-box-black-and-whiteThis project, entitled ‘End of or Start of Life?’, developed from my previous work with a medical sociologist (Dr Kate Reed) looking at the value of the fetal MRI image to patients and professionals. A published paper from this original study argues that MRI can both create and manage women’s feelings of uncertainty during pregnancy. While it may not always provide women with unequivocal answers, the detailed information provided by the MRI images combined with the interpretative and communication skills of the radiologist enables women to navigate what can be difficult and emotional issues.

We think this current research on MRI in early-life autopsy will build on the original study about pregnancy and is important for a number of reasons:

  • It will benefit bereaved parents by providing information about potential choices they may have over fetal and infant autopsy;
  • It will raise general public awareness around prenatal and neonatal loss and contribute to reducing the silence and taboo which many parents who experience early life loss experience;
  • It will contribute to the ongoing professional development of pathologists and related professionals through informing professional guidelines and educational materials on visual technology use in autopsy;
  • It will provide information about how parents and other professionals feel about the use of this technology and therefore help to ensure that UK policy on autopsy is developed and applied in a way that is sensitive to practitioners and parents.

Personally my involvement in the work has allowed me to understand the needs of my patients and their families. I have had time to explore areas neglected by medical staff due to time pressures and the lack of insight into the importance of small details. When their baby is going to have a post-mortem, families need to know about what happens, who has contact with their most precious bundle and when. They don’t always need the detail I had assumed they’d want in terms of medical information about the post-mortem process, but rather more seemingly ‘mundane’ details for example: who holds their baby, how they hold them and place them on the scanner table.

Telling a bereaved mother that I was the person who held her baby boy, carried him, dressed and wrapped in a blanket, to the scanner and talked to him as I placed him on the scan table in the required position – as I would any baby in my clinical practice – resulted in tears from his mother and father.  These were followed by a very emotional hug and a comment from mum that she could finally ‘let go’ as I had put her mind at rest that he had been well looked after when she couldn’t be with him during the post-mortem. To them this part of his ‘life’ was a blank space that they could not fill and this left them feeling helpless. Being able to tell them about the process allowed them to fill this space and to understand what had happened. They knew that he had been cared for, and that they had done all they could as his parents.

1a-pm-mriThe most frequent request for information is ‘who will look after my baby when I can’t be there?’ No parent wants to be separated from their baby. I have underestimated the importance of such detail before, assuming that medical information is more important as this is what I have been trained to provide. I am beginning to understand more about parents’ complex needs, and hopefully I now provide an opportunity for all patients and parents I am involved with to obtain this information. The conversations I have with patients have changed from a medically-centred approach to a wider, more social approach. For example I have been able to book longer appointments and build in flexibility so no one feels rushed.

And so, I hope my continued involvement with the social research work can widen my understanding further and hopefully improve the services we provide. For instance, being part of this research has helped to inform my involvement in the production of a video that talks parents through the MRI post-mortem process which they can watch whenever, if ever, it suits them.

If you are interested in this topic, you may be interested in learning more. Take a look at the new BIR Fetal MRI Portfolio

References

Visualising uncertainty: Examining women’s views on the role of Magnetic Resonance Imaging (MRI) in late pregnancy


Dr Elspeth Whitby

Dr Elspeth Whitby is a senior lecturer at the University of Sheffield and an honorary consultant at Sheffield teaching Hospitals NHS Foundation trust.

Her clinical and research interests are based around MR Imaging of the fetus and neonate. She provides a national service for Fetal MRI and is an integral part of the team at Sheffield Children’s hospital, which has set up the world’s first clinical service for minimally invasive autopsy for the fetal and neonatal age group. Her research provides the necessary data to assess the value of new MRI techniques and then to support the transitions from research to service. The multidisciplinary nature of her more recent work is changing her as well as influencing clinical practice.

She is currently Vice President for Education at the BIR, helping to improve the educational scope and methods of delivery of educational events for all BIR members.

Dr Whitby was the recipient of the first BIR/Bayer Make it Better Award for her work in minimal fetal and neonatal invasive autopsy.

 

Discover the impact of X-rays on modern medicine

Adrian Thomas

Dr Adrian Thomas

As we commemorate International Day of Radiology and World Radiography Day on 8th November 2016, Dr Adrian Thomas, BIR’s Honorary Historian gives an overview of the history of radiology and encourages anyone interested in the history of medicine to dip in to the BIR’s history of radiology web pages.

It is very difficult to put oneself into the position of someone living in the 19th century prior to the discovery of X-rays (in 1895) and radioactivity (in 1896). The early scientists had a certainty and confidence that is alien to our contemporary worldview. In science there was a feeling that everything important had basically been worked out, and that there would be no major surprises around the corner. Chemistry and physics were pretty much understood, and with some justification since the scientific achievements of the 19th century were astonishing. For example the laying of the cable across the Atlantic Ocean in 1858 was a remarkable accomplishment by any standards.

All was to change with the discoveries of 1895 and 1896. Neither X-rays nor radioactivity could be explained by contemporary physical models, The X-rays should have been predicted since it was already known that the spectrum extended invisibly beyond the infra red and ultra violet.

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The invisible rays discovered by Wilhelm Conrad Röntgen produced a sensation in both the scientific community and the general public. The sense of amazement was so great that the public needed reassurance that this was a proper discovery by a serious scientist.

There was an immediate interest by the medical community, and The X-Ray Society was founded which was the first in the world. This became the Röntgen Society and finally the British Institute of Radiology. A society needs a journal, and this has gone by many names over the years, such as Archives of Skiagraphy, Archives of the Roentgen Ray, Journal of the Röntgen Society, and currently the British Journal of Radiology. This journal is a treasure, and is a major world journal with publications by many of the major figures associated with radiology. Perhaps the main change in the journal over the years is that it is now focused on human applications of the radiological sciences. In the early years there were articles on all aspects of radiology, including radiography of paintings, X-ray astronomy, and animal radiography.

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X-ray 1897: Hand radiograph of Sebastian Gilbert Scott

The story since the 1890s can be divided into three periods. Firstly the time of the pioneers when knowledge was still very limited. The second period is that of classical radiology. This was the period of often quite invasive diagnostic tests and abnormalities were often shown indirectly, for example by the displacement of normal structures. There was an increasing knowledge of the response of tissues to radiation, with the development of a scientific approach to treatments.

The modern or third period is from the 1970s, which may be seen as a “golden decade” of radiology, and was ushered in by the CT or EMI scanner,the forerunners of our digital world. It is difficult to underestimate the role of the CT scanner, and it had profound effects on diagnosis and treatment planning.

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First image scanned on the prototype EMI scanner at Atkinson Morley’s Hospital 1971

Since the 1970s radiology has changed beyond recognition in all areas. For example not only has wet film processing disappeared but also film itself has passed away.

The BIR and its journals have been at the forefront of the advances in the radiological sciences. We have a treasure with publications by the greats in radiology, such as Peter Kerley, Ralston Patterson, Ian Donald, James Ambrose and Godfrey Hounsfield.

It is fascinating to read the words of those who came before us, and to consider the remarkable achievements in the last 120 years. I think you will find exploring our archives well worth your time.

 

 

Visit the BIR history website pages here

Visit the BJR archives here

Presidential Blog #1

2_4Well I’ve now been BIR President for nearly 6 days and it still feels slightly surreal. I have to say that taking over from David Wilson as President and having Jacqueline Fowler’s experienced hand to guide me makes me feel what could possibly go wrong!

Seriously, it is important that I focus my efforts in certain areas, notwithstanding our rolling three year strategy. These areas are crucial to the continuing upward rise of the BIR and those areas are: increasing membership, especially amongst radiographers; getting more members actively engaged in the great work we do (everyone’s time for volunteering is reduced in these days of increasing clinical workloads, and more hands enables the BIR to undertake more exciting projects) and, maybe most obviously as the new President, reaching out to both our sister organisations (to form effective collaborations to lever the most from policy makers and funders), and to BIR’s corporate partners (an integral part of the BIR ‘family’) to ensure both sides gain from the relationship and to ensure they are active participants. I also wish to reach out to similar organisations across the world to grow our international membership and, with various BIR staff, have many interesting meetings coming up at RSNA in Chicago later this year.

2_13.jpgIt’s clearly way too early to tell how successful I’ll be in my aims, but I intend to hold early discussions with all our closest allies as soon as possible and look forward to doing the same with our corporate partners – in fact this week I am visiting the factory of Midland Lead who have sponsored a PPE publication with associated poster and video material (launched at the IRMER update event, watch out on the website for more details)  – an example of an excellent project, well led by Peter Hiles and friends with excellent support from one of our newest corporate partners – thank you to all involved.

Andy Rogers

BIR President

Andy Rogers is Head of Radiation Physics, Nottingham University Hospitals

 

Reflections on two years at the helm of the BIR

David Wilson

Dr David Wilson reflects on the progress and achievements as President of the British Institute of Radiology.

As I come towards the end my two years as President of the BIR, writing for the BIR blog gives me the opportunity to review what has happened to our Institute during that period.

David Wilson and Stephen Davies 14.10.2015

My predecessors, Dr Stephen Davies and Professor Andrew Jones, had worked very hard to prepare what I now see was very fertile ground.

With the senior administrative team and Chief Executive, Jacqueline Fowler, not only had they resolved the problems of a building that was no longer fit for purpose and was a drain on the organisation’s resources, but they had set up new offices, a streamlined administrative system and a new team who were working very effectively together.

 

DW pp badge to AJ

Special interest groups had been established and it was recognised that as an organisation we needed to move out into the different regions. The sale of the building and careful financial management meant that we had the resources to start these and other projects.

Over the last two years we have developed and opened regional groups in the Midlands, and the south-west of England. These have been met with great enthusiasm by local imaging professionals and are now developing a drive of their own which we can use to create new regional groups over the next few years.

Investment in educational technology with the appointment of e-learning technologists has allowed us to start what is a very successful series of webinars with a steady increase in members connecting online. This project will continue and I can see many opportunities for educational development in the future. The BIR continues to invest not only in electronic education but also in delegate-attended courses. The BIR Annual Congress has undergone modernisation, with a new format of parallel streams, e-posters and an event app to increase delegate engagement. It also boasts internationally acclaimed keynote speakers. The annual general meeting (AGM) is now an online meeting and has proved very successful.

The education committee is to be congratulated on the expansion and success of the teaching and learning opportunities that we provide. We were concerned that the standards of education are hard to define and therefore we set up an independent accreditation committee whose duty it is to assess all the teaching that we provide against recognised educational standards. This team led by David Lindsell provides assurance that our courses and electronic learning are of the highest standard and they are also working with corporate members to assess other organisations’ events. Our collaborative work with UK Radiology Congress has led to very successful meetings in Liverpool and I’m glad to say that both UKRC and UKRO are flourishing.

 

ARRS agreementWe have expanded our breadth of corporate members and reached out to other societies in the UK and overseas including the Royal Society of Medicine, IPEM and the Institute of Physics as well as becoming a member of the American Roentgen Ray Society (ARRS) Global Partner Program which has extended benefits on offer to our members.

rsna DW and Guiseppe BJRCR

The BIR will only flourish if membership increases and we remain active and innovative. I’m glad to say that the membership numbers have increased substantially over the last two years and continue to do so. We have created new packages of membership and several healthcare organisations have now joined on behalf of large groups of their employees. I believe this is an excellent measure of our success in providing valued membership benefits. The great news from our publishing arm is the establishment of a case report-based online journal, BJR|case reports. This fills a gap in the market  and gives an opportunity for young clinicians and scientists to present their work. The standards offered by BJR have been maintained and indeed improved as judged by external measures.

The management team and the trustees of the organisation continue to provide sterling service and governance. We remain in a strong financial position despite external pressures.

President Elect 2015 Andy Rogers and David WilsonI’m honoured to have been the warden to an excellent provision of service within an organisation that is increasing in size and has very exciting prospects for the future. I am very pleased to be handing over to Andy Rogers with whom I worked for a number of years and I know will be an excellent President of the British Institute of Radiology.

Dr David Wilson

Images (top to bottom)

  1. With Dr Stephen Davies
  2. At my inauguration with my predecessor Professor Andrew Jones
  3. With Jonathan Lewin MD, President of ARRS
  4. With Editor of BJR|case reports, Professor Giuseppe Guglielmi
  5. With Andy Rogers, President of the BIR from September 2016

 

Waiting cancer patients soothed by digital art

HughTurvey_3_VL Hugh Turvey Hon FRPS FRSA, permanent artist in residence at the BIR and a pioneering creative practitioner for better healthcare environments explains how an absorbing programme of digital screen-based art is providing a welcome diversion for patients and their carers as they wait for treatment at Cheltenham Oncology Centre.

“Little as we know about the way in which we are affected by form, colour and light, we do know this: that they have an actual physical effect. Variety of form and brilliancy of colour in the objects presented to patients are actual means of recovery.” Florence Nightingale, 1860.

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Florence Nightingale was ahead of her time in realising that our environment has a physical affect on us all. Not least those who have to wait in hospital waiting areas. For patients and their carers in oncology departments up and down the country, it’s all about the waiting: waiting for consultations, waiting between treatments, waiting for their results. The nature of cancer treatment means they often have to return, time after time, over days, weeks, even months, to wait — anxious, conspicuous, unwell, often in barren, clinical, institutionalised spaces — for hours on end.

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In Cheltenham Oncology Centre, they are modelling a more positive form of waiting through an arts programme that provides service users with an absorbing rotation of art and photography digitally displayed on giant screens on the walls as well as a range of art activities for waiting patients and staff.

The latest development in the project has seen six, large, state-of-the-art digital screens installed in each of the waiting areas across the department. Funded by the Centre’s charity FOCUS (Fund for Oncology Centre Users and Supporters), the pilot is being run in partnership with specialist digital media company OOHSCREEN.

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As a photographic artist himself, Hugh has been convinced of the benefits of digital screen technology for displaying art for some time and together with co-director Lisa Moore has developed an innovative system that enables the creation of a rolling programme of remotely curated screen-based art exhibitions. The pilot project in Cheltenham Oncology Centre has already broken the cycle of dreary daytime TV with initial exhibitions that include the Royal Photographic Society’s extraordinary International Images for Science exhibition and digital images of some of the best art being made locally through arts association Cheltenham Open Studios.

Speaking about the project, Niki Whitfield, Arts Co-ordinator for Gloucestershire Hospitals NHS Trust, said, “We understand that people would rather be anywhere else than here, so through the creation of an art-enhanced environment and a rolling programme of drop-in creative workshops we are working towards making the experience more bearable”.

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Another advantage of the technology is that it also enables information and notices — from clinic times to third-party groups providing support for cancer patients and their families — to be put on the screen. This means service users can be targeted with information relevant to them. Lisa Moore, who is a specialist in digital messaging in healthcare environments, explains, “What screen-based exhibitions offer are an additional level of engagement, enabling us to also educate and inform through tailored messaging for each setting. And because the technology is updatable, the content remains current”. She continues, “NHS service users are often bombarded with information — in the form of signs, posters, leaflets, notices — all competing for their attention. It can be so overwhelming, they often don’t engage with any of it. This offers a platform that enables us to ensure that the most important messages get seen, while creating a more relaxing environment by the removal of much of the “visual noise” from the walls”.

The hope is, going forward, that the screen project will become self-financing. With over 100,000 people per year passing through the doors of the Cheltenham Oncology Centre alone, it makes the proposition of sponsorship extremely attractive for third-party service providers. As Niki Whitfield says, “By transferring key information from pop-ups, posters and leaflets onto the screens, we not only ensure more people get access to the resources and support they need, but our partners save on the production costs of these kinds of materials”.

The benefits of art in healthcare settings for patient wellbeing are well documented. In 2011, the British Medical Association published a report on “The psychological and social needs of patients” which found that:

Creating a therapeutic healthcare environment extends beyond the elimination of boredom. Arts and humanities programmes have been shown to have a positive effect on inpatients. The measured improvements include:

  • inducing positive physiological and psychological changes in clinical outcomes
  • reducing drug consumption
  • shortening length of hospital stay
  • promoting better doctor–patient relationships
  • improving mental healthcare

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Initial feedback on this programme from staff and patients is that it has helped create a calming more relaxed atmosphere. As Dr Samir Guglani, Consultant Clinical Oncologist, puts it, “For staff and patients, briefly to be looking at the same creative works together — rather than just scans or results — in the same shared space; this is powerful, engaging and ultimately culture changing”.

A more rigorous evaluation is planned to assess the impact of the screens, with a view to expanding the scope of the screens across this and other trusts across the UK.

OOHSCREEN is co-founded by Hugh Turvey Hon FRPS FRSA, permanent artist in residence at the BIR and Lisa Moore. http://www.oohscreen.com +44 20 9411 5870

Further reading

Arts and health research literature up to 2010: http://www.publicartonline.org.uk/resources/research/artsandhealthmarch2010.php

A prospectus for arts and health (20 April 2007), Department of Health and Arts Council England: http://www.paintingsinhospitals.org.uk/evidence/research

About Hugh Turvey

Hugh Turvey is an artist with an international reputation. His Xogram work is held in public and private collections throughout the world. Bridging the gap between art and science, graphic design and pure photography, it has been utilised in myriad applications, including, commercially, for marketing and advertising, in TV and film and by architects and interior designers.

Along with developing a body of work for the Science Photo Library, Hugh Turvey has collaborated on an ebook and iPad app called ‘X is for X-ray’. His Xogram work has also been widely featured in newspaper articles and magazines around the world.

Among his commercial projects, he has made six award-winning TV adverts, using ground breaking Motion X-Ray. He has worked with Waitrose UK on celebrity chef Heston Blumenthal’s ranges has had images commissioned by L’Oreal, Paris.

MRI safety: Putting staff and patients first

 

Darren Hudson

 

Darren Hudson

 

To mark MRI Safety week (25 – 31 July), Darren Hudson, MRI Clinical Lead at InHealth highlights his top tips for making the MRI environment safe for both patients and staff.

He also explains how InHealth are ensuring their multidisciplinary teams get timely reminders about MRI best practice.

 

 

 

 

MRI Safety week marks the 15th anniversary of a terrible accident.  Six-year old Michael Colombini was killed by a portable oxygen cylinder when it was inadvertently brought into the MR scan room of Westchester Hospital, in America. This tragedy sparked important discussions in the US around safety in MR. In the UK, the MHRA produced their first guidance in 1993  [1][2] produced around the requirements and training needed to safely operate MR scanning facilities. This was last updated in 2015.

What’s the danger?

The static magnetic field in which MRI staff work is over 30,000 times stronger than the earth’s own magnetic field. It is always on, 24/7, regardless of whether scanning is being performed.

MRI safety imageThe greatest impact this can have is a missile effect on ferromagnetic items which may be
taken into the MRI scan room, causing them to be accelerated at very high speed towards the centre of the scanner. Depending on the nature and size of the object, whether it’s an earring or a wheelchair, the consequences can be very dangerous, and at worst catastrophic.

InHealth safety

InHealth logo

To mark the week InHealth are sending out some daily reminders to staff covering specific MR safety topics to help serve as a refresher around some keys aspects of MR safety and to raise awareness of good practice.

Key themes covered are object management and labelling, positioning of patients to prevent burns, communication with patients to ensure they alert staff to any discomfort or concerns, keeping patients cool, protecting patients from noise,  best practice on how to get feedback from patients and making sure all medical devices and implants are regularly checked for safety in accordance with guidelines.

As corporate members to the BIR we are working together to raise awareness of, and share support for MR safety within the wider imaging community.

Radiographers and clinical support staff play a key role in implementing the safety framework established across MRI services, with their knowledge and experience of the procedures and policies in place helping to ensure we maintain the safety of patients, visitors and staff.

Importantly, it has been shown that the most significant MR accidents are as a result of a cascade effect from a number of apparent minor breaches of safety procedures rather than from a single mistake. It is therefore essential we all remain vigilant and adhere accurately to the safety policies and procedures. Any potential breach of procedure or near-miss is a warning and as such these instances should be reported to ensure lessons can be learnt and acted upon to avoid more serious untoward events.

Reporting

Reporting of incidents and near misses is vital so that we can anticipate and prempt problems that may be arise so they can be addressed before more serious incidents may occur – today it may only be some coins, tomorrow it could be something more serious!

The human factor

Our fallibilities as human beings, both as staff and our patients, can adversely impact on MRI safety. To help promote MR safety InHealth staff are encouraged to undertake e-learning modules to highlight the hazards in MRI.

By working together and maintaining a cycle of safety procedures we can ensure that the MRI room is the safest environment it can be for both patients and staff.

[1]  Safety Guidelines for Magnetic Resonance Imaging Equipment in Clinical Use

[2]   ACR Guidance Document on MR Safe Practices: 2013

InHealth logo

https://www.inhealthgroup.com/

Neuroimaging assessments in dementia

Vanessa Newman
Dr Vanessa Newman

Dementia is the leading cause of disability in people over 60 years old. Imaging is increasingly used to diagnose dementia to complement physical, cognitive and mental examinations.

Here, Dr Vanessa Newman explores the role of imaging in detecting this cruel and debilitating illness that effects over one million people in the UK.

Dementia: a global burden

Dementia is a leading cause of disability in people aged >60 years, representing a significant burden on patients in terms of quality of life, disability and mortality associated with the condition. This further impacts caregivers, health services and society in general. According to the World Alzheimer Report 2015, it is estimated there are 46.8 million people living with dementia worldwide and this number is due to double every 20 years. Of the 9.2 million people with dementia in Europe over 1.03 million live in the UK, representing a considerable health economic burden. Furthermore, general improved life expectancy of the global population is anticipated to correspond with increased prevalence of dementia.[1,2]

The impact of dementia on informal caregivers – such as family members and friends – is substantial and can result in physical and mental illness, social isolation and poor quality of life for them. Although their participation in the care of dementia patients may alleviate burden on healthcare systems and residential care homes, informal caregiving is not without societal costs caused by absenteeism from work.[2]

Different forms of dementia

Dementia is a progressive illness that affects not only a person’s memory but also their behaviour, mood, cognition and ability to perform daily activities. Progression of dementia is associated with both genetic predisposition and lifestyle factors, including smoking, alcohol, exercise and diet. There are a number of different dementia subtypes with varying incidence in the population, including vascular dementia (VaD), dementia with Lewy bodies (DLB), frontotemporal dementia (FTD), Parkinson’s dementia (PD) and mixed dementia. However, Alzheimer’s disease (AD) is the most prevalent form, representing 62% of the dementia population.[3–6]

Diagnosing dementia

Although the majority of patients are diagnosed with dementia in later life, evidence shows that irreversible, pathological changes within the brain occur long before the onset of clinical symptoms. Gradual changes within the brain lead to progressive cognitive impairment and patients often experience a transitional period of mild cognitive impairment (MCI), during which a differential diagnosis may not be possible.[3,7–10]

Formal assessment of cognitive decline, as undertaken by dementia experts, usually includes physical, cognitive and mental examinations [e.g. the Mini Mental State Examination (MMSE)], plus a review of education and functional levels, medications and health history.[4,11]

Dementia assessment using brain biomarkers and structural imaging

There are several protein deposition biomarkers that may be used to assist in a diagnosis of dementing diseases, such as the presence of TDP-43 (FTD), Lewy bodies (DLB), alpha-synuclein (Parkinson’s disease), plus tau and β-amyloid which are typical in the pathogenesis of Alzheimer’s disease (although not exclusive to this dementia subtype).[12,13] Historically, reliable diagnoses might only be made post-mortem using histopathology. However, increasingly the imaging of biomarkers or their effect on the living brain can be made earlier on in the course of disease, before evidence of memory impairment is seen.[12,13]

Piramal blog image 1

Fig 1. Source: Jovalekic et al. EJNMMI Radiopharmacy and Chemistry (2017) 1:11. doi:10.1186/s41181-016-0015-3 (Copyright held by Piramal Lifesciences).

Cerebrospinal fluid (CSF) sampling via lumbar puncture can help detect abnormal levels of soluble β‑amyloid42, total tau (T-tau) and phosphorylated tau (p-tau181), which may assist during the diagnostic workup of dementia patients being assessed for AD.[14] However, lumbar puncture is an invasive method and some patients may refuse the procedure or are contraindicated, for example, if they receive anticoagulant medications. In addition, CSF-based analyses show variability between immunoassay platforms and biomarker concentrations, which may present challenges to clinicians.[14–17]

Brain imaging in patients can assist a clinical diagnosis by examining presence of cerebral pathologies and structural changes, including MRI and CT that can detect subcortical vascular changes. Single-photon emission CT (SPECT) measuring perfusion can help differentiate AD, VaD and FTD,[4,11] while 2-(18F)Fluoro-2-deoxy-d-glucose positron emission tomography (FDG PET) may assist in detecting impaired neuronal activity by measuring the cerebral metabolic rate of glucose. This has been used to detect abnormal patterns in the brain and the potential to predict conversion from MCI to AD or the diagnosis of AD has been demonstrated.[8,9,18–20] Both SPECT-perfusion imaging and FDG-PET are indirect measures of disease that detect characteristic changes in glucose and oxygen metabolism. However, these imaging modalities show limitations in reflecting the aetiology of prodromal or mild AD.[8,9,11,19,20]

Brain β-amyloid (Aβ) deposition and plaque formation occurs early in the pathogenesis of AD, therefore offering the potential to assist in an early clinical diagnosis of patients being evaluated for Alzheimer’s dementia and other forms of cognitive impairment. Amyloid-PET is a relatively recent imaging modality and three 18F-labelled imaging agents are licensed for use in the EU that can detect the presence of β-amyloid neuritic plaques in the living brain, with validated visual assessment methods using histopathology as the standard of truth (Fig.2).[13,21] According to published appropriate use criteria, amyloid-PET is considered to have greatest utility in a subset of dementia patients:[22–24]

  • where there is an established persistent or progressive unexplained memory impairment (unclear diagnosis); or
  • where brain Aβ is a diagnostic consideration based on core clinical criteria, and where knowledge of this pathology may alter patient management; or
  • with progressive dementia and atypical age of onset (usually <65 years of age).

Piramal blog image 2

Fig 2: 18F-labelled imaging agents have the ability to detect the presence of β-amyloid neuritic plaques in the living brain (immunohistochemistry with monoclonal 6E10 Aβ antibody).[13]

Fig. 2: Source: Jovalekic et al. EJNMMI Radiopharmacy and Chemistry (2017) 1:11. doi:10.1186/s41181-016-0015-3 (Copyright held by Piramal Lifesciences).

Amyloid-PET does not alone provide a diagnosis, rather it forms part of the greater assessment workup by clinical experts, including neurologists, psychiatrists and geriatricians. The knowledge of the presence or absence of β-amyloid plaques has been shown to support a confident differential diagnosis and a tailored patient care plan, including use of medications where appropriate. There is also added value for patients and their caregivers in knowing the cause of dementia, enabling decision-making and planning for the future including the possibility of enrolling into clinical trials.[5,6,8,22–28]

 The future of diagnostic imaging

The National Institute for Health and Care Excellence (NICE) is reviewing guidance on the organisation and delivery of diagnostic services, due for publication in August 2017. The scope of the revised guidance will encompass imaging in neurodegenerative diseases, as part of the wider radiology/nuclear medicine service in the NHS. This will affect not only patients, but all staff who use, refer and interpret diagnostic services in both primary, secondary and tertiary care.[29]

Author: Vanessa Newman (MD-V, PhD), Medical Affairs Director at Piramal Imaging Ltd

References

  1. Alzheimer-Europe, The prevalence of dementia in Europe. 2015, Alzheimer Europe: Luxembourg.
  2. Prince, M., World Alzheimer Report 2015: The Global Impact of Dementia – an analysis of prevalence, incidence, cost and trends, A.s.D.I. (ADI), Editor. 1015: London.
  3. Prince, M., World Alzheimer Report 2014: Dementia and Risk Reduction – an analysis of protective and modifyable factors, A.s.D. International, Editor. 2014, Alzheimer’s Disease International (ADI): London, UK.
  4. NICE, Clinical guideline 42: Dementia: Supporting people with dementia and their carers in health and social care. 2006, National Institute for Health and Care Excellence (NICE): London, UK.
  5. Deckers, K., et al., Target risk factors for dementia prevention: a systematic review and Delphi consensus study on the evidence from observational studies. Int J Geriatr Psychiatry, 2015. 30(3): p. 234-46.
  6. Kivipelto, M. and F. Mangialasche, Alzheimer disease: To what extent can Alzheimer disease be prevented? Nat Rev Neurol, 2014. 10(10): p. 552-3.
  7. Catafau, A.M. and Bullich, S., Amyloid PET imaging: applications beyond Alzheimer’s disease. Clin Transl Imaging, 2015. 3(1): p. 39-55.
  8. Sabri, O., et al., Florbetaben PET imaging to detect amyloid beta plaques in Alzheimer’s disease: phase 3 study. Alzheimers Dement, 2015. 11(8): p. 964-74.
  9. Sabri, O., et al., Beta-amyloid imaging with florbetaben. Clin Transl Imaging, 2015. 3(1): p. 13-26.
  10. Vos, S.J., et al., Prediction of Alzheimer disease in subjects with amnestic and nonamnestic MCI. Neurology, 2013. 80(12): p. 1124-32.
  11. Bloudek, L.M., et al., Review and meta-analysis of biomarkers and diagnostic imaging in Alzheimer’s disease. J Alzheimers Dis, 2011. 26(4): p. 627-45.
  12. Sperling, R.A., Karlawish, J., and Johnson K.A., Preclinical Alzheimer disease-the challenges ahead. Nat Rev Neurol, 2013. 9(1): p. 54-8.
  13. Jovalekic, A., et al., New protein deposition tracers in the pipeline. EJNMMI Radiopharmacy and Chemistry, 2017. 1(1).
  14. Roe, C.M., et al., Amyloid imaging and CSF biomarkers in predicting cognitive impairment up to 7.5 years later. Neurology, 2013. 80(19): p. 1784-91.
  15. Dubois, B., et al., Advancing research diagnostic criteria for Alzheimer’s disease: the IWG-2 criteria. The Lancet Neurology, 2014. 13(6): p. 614-629.
  16. Perret-Liaudet, A., et al., Risk of Alzheimer’s disease biological misdiagnosis linked to cerebrospinal collection tubes. J Alzheimers Dis, 2012. 31(1): p. 13-20.
  17. Kang, J.H., et al., Clinical utility and analytical challenges in measurement of cerebrospinal fluid amyloid-beta(1-42) and tau proteins as Alzheimer disease biomarkers. Clin Chem, 2013. 59(6): p. 903-16.
  18. Ng, S., et al., Visual Assessment Versus Quantitative Assessment of 11C-PIB PET and 18F-FDG PET for Detection of Alzheimer’s Disease. Journal of Nuclear Medicine, 2007. 48(4): p. 547-552.
  19. Perani, D., et al., A survey of FDG- and amyloid-PET imaging in dementia and GRADE analysis. Biomed Res Int, 2014. 2014: p. 785039.
  20. Piramal, NeuraCeq (florbetaben 18F) Summary of Product Characteristics. 2015, Piramal Imaging Ltd.
  21. EMA. Human Medicines: European public assessment reports. 2016 [cited 2016 July]; Available from: http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/landing/epar_search.jsp&mid=WC0b01ac058001d124.
  22. Johnson, K.A., et al., Appropriate use criteria for amyloid PET: a report of the Amyloid Imaging Task Force, the Society of Nuclear Medicine and Molecular Imaging, and the Alzheimer’s Association. Alzheimers Dement, 2013. 9(1): p. e-1-16.
  23. Johnson, K.A., et al., Update on appropriate use criteria for amyloid PET imaging: dementia experts, mild cognitive impairment, and education. J Nucl Med, 2013. 54(7): p. 1011-3.
  24. Scarsbrook, A. and Barrington S., Evidence-based indications for the use of PET-CT in the United Kingdom 2016, R.C.o.P. Royal College of Radiologists, Editor. 2016, RCR, RCP: London, UK.
  25. Bang, J., Spina, S., and Miller, B.L., Frontotemporal dementia. The Lancet, 2015. 386(10004): p. 1672-1682.
  26. Kobylecki, C., et al., A Positron Emission Tomography Study of [18f]-Florbetapir in Alzheimer’s Disease and Frontotemporal Dementia. Journal of Neurology, Neurosurgery & Psychiatry, 2013. 84(11): p. e2-e2.
  27. Barthel, H., Seibyl, J., and Sabri O., The role of positron emission tomography imaging in understanding Alzheimer’s disease. Expert Rev Neurother, 2015. 15(4): p. 395-406.
  28. Pontecorvo, M.J., et al., A randomized, controlled, multicenter, international study of the impact of florbetapir (<sup>18</sup>F) PET amyloid imaging on patient management and outcome. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association. 11(7): p. P334.
  29. NICE. Dementia – assessment, management and support for people living with dementia and their carers: GUIDANCE. NICE Guidance 2016 [cited 2016 June]; Available from: https://www.nice.org.uk/guidance/indevelopment/gid-cgwave0792.

About Vanessa Newman

Vanessa’s background is in neurology (epilepsy and Down’s syndrome) and more recently in the field of neuroimaging in dementia. She has worked at Piramal Imaging since early 2015 and during this time has had the pleasure of seeing how quickly this area of medicine is moving, with increasing methods and imaging diagnostics available for use with people living with dementia.

Date of preparation: July 2016. ©Piramal Imaging Ltd. UK/FBB/1015/0021

Piramal Imaging Ltd, Langstone Technology Park, Langstone Road, Havant, Hampshire PO9 1SA, United Kingdom

Piramal Imaging Ltd medical information enquiries: Medicalaffairs.imaging@piramal.com
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Piramal is a British Institute of Radiology corporate member.

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How does a radiology trainee decide on their subspecialty?

1. NPDr Nassim Parvizi, Chair of the BIR Young Professionals and Trainee (YPAT) Special Interest Group (SIG), explores what factors influence radiology trainees to take their subspecialty path.

After listening to her local colleagues and peers from the YPAT group, Nassim conducted a national survey to find out more. Here she reflects on some personal stories and explores what might help trainees to make the right decision.

“My subspecialty interest is interventional oncology and this stems from an interest in oncological diagnostic imaging and intervention, alongside opportunities for research. I find the technical aspect challenging and stimulating. Both palliative and disease-modifying procedures such as ablation require careful planning and meticulous technique to ensure adequate destruction of the tumour and preservation of surrounding organs and tissue.”

Dr Jim Zhong, ST12 JZ

“My subspecialty choice is chest and cardiac. My reasons for choosing it were a mixture of the quality of training in the subspecialty within my deanery and the variety of work I can expect to do in that subspecialty when I’m a consultant. Work–life balance was also a consideration. I think that this subspecialty carries quite a high workload compared with other subspecialties but I do find it more interesting and I think that is more important in the long term.”

Dr Louise Wing, ST4

“My subspecialty choice is musculoskeletal radiology. I have chosen this because of the broad spectrum of diagnostic challenges it offers including sarcoma, bone infection, rheumatology and sports injury imaging. MSK radiology also provides a wide variety of established and evolving interventional procedural work.”

Dr Joseph Papanikitas, ST5

“My subspecialty interest is neuroradiology with head and neck imaging. I have always had an interest in neuro, head and neck pathology, with a background in ENT surgery prior to radiology training.

General radiology training was fantastic in exposing me to other areas, however, I always felt most enthusiastic when discussing head and neck or neuro cases! I chose a fellowship which combined both elements and this made me 100% confident I had pursued the right career choice.”

Dr Reena Dwivedi, Consultant

3.rdI decided to pursue radiology as I find diagnosing disease the most interesting and intellectually challenging aspect of clinical medicine. I also enjoy doing procedures. Now, over half-way through my specialty training as an ST3, I need to choose my subspecialty so that I tailor the rest of my training appropriately. Through reflecting on some personal and work-related factors, a mix of different modalities, intellectual challenges and geographic considerations are aspects that I prioritise.

My training has taught me that life as a future consultant will entail balancing clinical work with other responsibilities such as management and teaching albeit clouded by the uncertainty of what the future holds for our NHS. As a trainee, not only do I strive to strengthen my clinical skills, but also want to develop other skills such as leadership and management. Being part of the BIR YPAT SIG, I get to exercise such skills as part of a multidisciplinary team alongside excellent BIR colleagues discussing topical issues, doing projects, organising events and developing educational resources. This is very enjoyable and rewarding.

4. all

These are just a few examples from my peers and colleagues in the YPAT group. But I was curious to find out more about the criteria trainees use to make their decision. Together with my clinical supervisor I conducted a national survey to better understand the future aspirations of fellow radiology registrars in the UK to aid workforce planning (Royal College of Radiologists 2014 workforce report) and identify modifiable factors that may help address the areas likely to meet staffing shortfalls. We designed an online questionnaire and distributed it to all radiology trainees in the UK by social media, through the BIR and RCR junior doctor’s forum between December 2015 and January 2016.

What does everyone else think?

Most of the 232 respondents entered radiology after foundation training and were in their first few years of training. The survey responses demonstrated the most popular subspecialties are musculoskeletal radiology, abdominal imaging and neuroradiology, which combine different imaging modalities and provide intellectual challenges. The least popular subspecialties are gynaecological and oncological imaging, which may not be included as specific rotations during training to make one aware to consider them as a subspecialty. There were variations in the first choice subspecialties based on year and region of training. Factors that influenced subspecialty choices were a strong personal interest, a mix of imaging modalities and a successful rotation during training.

What can we do to make it better?

From our survey we found that, unsurprisingly, trainees’ experiences during various subspecialty rotations and positive role models can influence their perceptions and affect their future choices. Furthermore, an awareness of job prospects plays an important part. It is vital that areas with unmet need provide better engagement and training to appeal to trainees. Unfortunately, it is often in such subspecialties that staff are over-stretched, have to work long hours, and have little time to engage with and educate trainees. The BIR benefits from a mix of members from across different regions and subspecialties, which can act as a great resource to gain an insight into life outside of one’s training scheme and learn about different career pathways as well as job prospects.

At the BIR we would like to help you make your decision the right one for you. Let us know how you would like us to provide the information you need (webinar, practical role playing, in-person training?) Please let us know how we can help fill your knowledge gap.

Email sigs@bir.org.uk

About Dr Nassim Parvizi

Nassim Parvizi started her clinical training as an academic foundation trainee in the North West Thames Foundation School where she had an interest in quality improvement and patient safety. She undertook a secondment as part of the NHS Medical Director’s Clinical Fellow Scheme at the Medicines and Healthcare Products Regulatory Agency during 2012. Nassim is currently an ST3 and Academic Clinical Fellow Clinical Radiology on the Oxford Scheme. Nassim is also a member of the BIR MRI and Clinical Intelligence and Informatics Special Interest Groups.

Has imaging become too effective?

Adrian Dixon

Professor Adrian Dixon has a worldwide reputation as an academic and a radiologist and has published extensively on body and musculoskeletal CT and MR imaging.

He will deliver the BIR Toshiba Mayneord Eponymous Lecture called “Has imaging become too effective?” at UKRC on 7 June 2016 at 13:00.

Read this fascinating interview with him and get a taster of this “not-to-be-missed” presentation.

You will be delivering the BIR Toshiba Lecture at UKRC this June. Your lecture is called “Has imaging become too effective?” Can you give us a “taster” of what you mean by this?

“You should say what you mean!” as the March Hare said in “Alice’s Adventures in Wonderland”.

What do people mean by “effective”? Effectiveness is only an appropriate term if qualified. Modern imaging certainly is effective at increasing the diagnostic confidence about a diagnosis and excluding certain diagnostic possibilities. It has taken a long while to prove that it is effective in saving lives. It has become so effective that, in many conditions, an image can be rendered to make the diagnosis obvious to the man in the street.

And clinicians now tend to refer for imaging without stopping to think! It has also become so effective in demonstrating probably innocuous lesions that the worried well can become even more of a hypochondriac! In some societies this can lead to over usage, excessive radiation exposure and increased costs.

If imaging is “too effective” – is radiology still a worthwhile career choice?

Yes! It is the most fascinating of all medical careers and every day a radiologist should see something that he or she has never quite seen before. The radiologist is the ultimate medical detective and cannot conceivably get bored. Indeed radiologists get reimbursed to solve crossword puzzles on elaborate play stations!

What have been the three biggest challenges for you in your career?

Radiologists have had to learn and relearn their skills at frequent intervals during their careers. Radiology will only survive as a specialty if the radiologist knows more about the images, the technical aspects and the interpretative pitfalls than their clinical colleagues.

Did you ever meet Godfrey Hounsfield (inventor of CT imaging) and what were your memories of him?

opening of scannerI did indeed meet Sir Godfrey on numerous occasions. His humility and “boffin style” of science greatly appealed. Some of the stories at the numerous events surrounding his memorial service were truly fascinating, including his inability to accept any machine which he could not understand without taking it to bits and then reassembling it!

 

Given the financial pressures on healthcare, will the required investment in the latest imaging technology be affordable?

Some of the developments in personalised medicine may be unaffordable. Generic contrast agents will continue to be used in large volumes. The cost of creating “one off” agents may prove unjustifiable.

Why would you encourage someone to join the BIR?

Because of the fun of interdisciplinary discussion and the pride of being a small part of the oldest radiological society!

Does spending more money on equipment mean a better health service?

I passionately believe that prompt access to imaging makes a major contribution to excellent healthcare. But that does not necessarily mean that every hospital has to have every machine at the top of the range. A rolling programme of equipment replacement is an essential part of delivering a high-quality radiological service.

The most difficult thing I’ve dealt with at work is…

An electrical power cut during the middle of a tricky adrenal CT-guided biopsy!

If Wilhelm Roentgen could time travel to Addenbrooke’s hospital, what would he be most impressed with?

The sheer size and the number of staff of the radiology department!

When its 2050, what will we say is the best innovation of the 21st century in healthcare?

Data mining and health statistics.

Who has been the biggest influence on your life? What lessons did that person teach you?

All my previous bosses have influenced my career. I have learnt something from each of them. All of them stimulated me to ask the question “why are we doing things this way”? “Can it be done better”?

My proudest achievement is…

Helping to make the Addenbrooke’s Radiology department one of the most modern in the UK.

What advice would you pass on to your successor?

Never give up, try, try and try again and remember “the more you practice, the luckier you get”.

What is the best part of your job?

That I have been lucky to have had a succession of challenges in the various roles that I have held, all of which have kept me on my toes.

What is the worst part of your job?

Leaving salt of the earth friends as I have moved from role to role.

If you could go back 20 years and meet your former self, what advice would you give yourself?

Do not worry so much – it will all be alright on the night.

Adrian Dixon

Adrian Dixon

What might we be surprised to know about you?

That I support Everton Football Club.

How would you like to be remembered?

For influencing the careers of younger colleagues – hopefully to their benefit!

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Professor Dixon will deliver the BIR Toshiba Mayneord Eponymous Lecture called “Has imaging become too effective?” at UKRC on 7 June 2016 at 13:00.

Book your place at UKRC (early bird rate ends 15 April 2016)

 

Toshiba-leading-innovation-jpg-large Thank you to Toshiba for supporting the BIR Mayneord Eponymous Lecture