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

 

Advertisements

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.

oohscreen-Glos-screengrab1

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.

oohscreen-Glos-screengrab2

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.

oohscreen-Glos-screengrab3

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”.

oohscreen-Glos-screengrab4

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

oohscreen-Glos-screengrab5

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
Piramal Imaging Ltd media enquiries: inquiries.imaging@piramal.com

Piramal is a British Institute of Radiology corporate member.

Piramal logo

The Pelvic Radiation Disease Association – a voice for patients

Claire Poole

Claire Poole

Radiotherapy is an effective treatment for pelvic cancers but it is not widely known that the radiotherapy can affect healthy tissue and bone causing severe pain, incontinence and distress.

Here, Claire Poole explains what it’s like to have Pelvic Radiation Disease (PRD) and why she risked her life to raise money for the charity which has given her so much support.

 

 

Each year, in the UK, about 30,000 patients receive radiotherapy for pelvic cancers, half of whom are left with altered bowel and bladder functions that drastically impede a return to normal living.  Symptoms of severe pain, nausea and vomiting, incontinence, damage to bones, gut/stomach issues can appear shortly after treatment, or months – even years – afterwards.  Patients who report problems to their oncologists, surgeons and radiotherapists are often told that “We’ve cured your cancer so what’s the fuss about?. This response is common and also unacceptable. There are effective ways to manage late effects of pelvic radiotherapy (now recognised as PRD) and patients fortunate enough to get appropriate treatment report an average 70% improvement in symptoms.

Sky dive 1

Risking my life for PRDA

On Saturday 18th June 2016, I threw myself out of a plane at 15,000 ft. I harnessed my fearand put my life in the hands of the fantastic team at Go Skydive in Salisbury to do a tandem skydive, plummeting to earth at 125mph. I did this wacky thing to raise money for the Pelvic Radiation Disease Association (PRDA).

PRDA is a very small charity run by volunteers. The charity works so very hard trying to raise awareness of this condition among health professionals. PRD, the late effects of pelvic radiotherapy is not widely recognised by our own GPs or indeed the NHS. It has become a big part of mine, my partner, my two children, my family and friends’ lives.

I was diagnosed with cervical cancer four years ago, and had intense treatment consisting of chemotherapy, radiotherapy and internal radiotherapy. Thankfully, due to the treatment received I am still here, however, the radiotherapy treatment has changed my life. Yes it killed the cancer, but it also killed my insides.

Radiotherapy burns, it burns everything it touches. So while radiotherapy is highly effective in treating pelvic tumours, due to the nature of the treatment, it can affect tissues and other organs in the pelvic area. During my treatment not only were the cancer cells burnt and killed, but also all my healthy cells, tissues, bowel and bladder badly affected. Any cancer patient who receives radiotherapy to the pelvic area, will probably at some point experience the late effects of the cancer treatment. This could occur anything up to two to three years or longer after treatment. If this happens, as it did to myself and many other patients, we become unable to enjoy our cancer free lives. Our quality of life is hugely affected, from severe pain, nausea and vomiting, incontinence, damage to bones, gut/stomach issues. All of which can be either minor or cause you to be housebound or even hospitalised. All of which I have, and do experience.

I am a patient at the Royal Marsden and have been now for a few years. A very special man put me in touch with PRDA, a Dr Jervoise Andreyev. This wonderful man is a consultant gastroenterologist, who specialises in PRD and started PRDA. Dr Andreyev has made a huge difference to my life. Without the care of this man and his team, I would not be where I am today. I am not cured, but I am on treatments, have made lifestyle changes and I’m completing a medical trial. All with the help of Dr Andreyev, his team and PRDA.

Why did I raise money for this charity that many of you have never heard of?

I want to get PRD noticed and talked about and to publicise PRDA, to enable PRDA to help and support the thousands of other patients like me, who thought it was OK and normal, to have their quality of life taken from them just because they have had cancer. It is NOT OK. After all, we have fought so hard to beat cancer, surely we deserve to be given the best treatment and support possible, to try and live the rest of our lives happy and healthier with our families and friends?

Thank you so much for taking time in your day to read this. Please, please help me and others to raise as much money as possible to keep this wonderful charity going. To continue helping the thousands of brave, strong, beautiful women and men who need the support of PRDA in their lives”.

About the Pelvic Radiation Disease Association, (PRDA)

logo for PRDA

PRDA is  a support organisation of patients, carers and medical professionals formed in 2007 became a registered charity in 2012 (no 1147802).  We currently have 5 volunteer Trustees and 1 part-time self-employed Administrator. We publicise and increase awareness of PRD and provide support and advice to patients suffering from consequences of treatment. We inform and educate cancer nurse specialists, radiographers, oncologists, gastroenterologists, gastrointestinal surgeons, gynaecologists and urologists, about the symptoms and effects of PRD and provide clear and simple advice on how to refer patients for specialised help and treatment.

PRDA runs a telephone help line and an ‘email a nurse specialist’ advice service and are backed by a multidisciplinary team of experts to advise us on medical questions. Our website www.prda.org.uk provides support and advice for sufferers and we receive enquiries from around the world. The charity hosts support meetings covering such topics as diet, exercise, self-help, sexual health and radiography addressed by specialists on these topics – our aim is to provide help to enable people to cope better with the consequences of their treatment.

We present the charity’s work and objectives at major conferences throughout the UK via information stands and talks by patient ‘experts’ and have designed and produced literature for both patients and health professionals, working closely with other charities, particularly Macmillan Cancer support, Prostate Cancer, Beating Bowel Cancer, Bowel Cancer UK and Jo’s Trust (cervical cancer). These partnerships are essential to our work and together with Macmillan we chaired a Pan Pelvic Cancer committee of likeminded charities. In 2015 this resulted in a highly successful programme of training days for specialist helpline nurses from major cancer charities, an activity we strive to continue. We currently have an ongoing project in collaboration with Macmillan Cancer Support to list all gastroenterologists in the UK prepared to see patients with PRD.

PRDA has an active Facebook group with members both from the UK as well as other parts of the world, in particular the USA. This is a closed group and applications can be accepted via the PRDA website.

www.prda.org.uk

Registered charity number 1147802

(England & Wales) and a company limited by guarantee number 7998409

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.