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]

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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.

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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.

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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.

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!

260215 opening

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

 

 

Same day treatment system streamlines radiotherapy service

8. Aileen FlavinFor a patient with cancer, multiple hospital visits prior to radiotherapy can be stressful and inconvenient, especially for those in remote areas who have to travel long distances to each appointment. To tackle this problem, Cork University Hospital introduced a new rapid access palliative clinic (RAPC) to streamline their radiotherapy service. Dr Aileen Flavin, Consultant Radiation Oncologist explains.

Cork University Hospital (CUH) is the regional cancer centre for the south west of Ireland. The centre serves a large geographical area (16,421 km2) with a population of 664,500. A minority of the population (119,000) lives in Cork city, which means that most patients have to travel significant distances for radiotherapy (round trips of up to 260 miles).

Palliative radiotherapy plays a large role in relieving symptoms and improving quality of life in patients with advanced cancer. It is most commonly used for painful bone metastases, where high rates of pain relief are seen from a single fraction of radiotherapy. It is well documented in the literature that a major barrier to patients receiving palliative radiotherapy is distance to the radiotherapy centre. Our pathway for patients referred for palliative radiotherapy had been identical to that for those receiving radical treatment and entailed an outpatient appointment for assessment and a further appointment for treatment planning. We attempted to give people travelling large distances who were having single fractions their radiotherapy on the same day as planning. This, however, wasn’t always possible and in many cases two visits were made by patients before starting radiotherapy.

To tackle this problem, in September 2014 we initiated a rapid access palliative clinic (RAPC). The motivation was concern over timely access to palliative radiotherapy and multiple hospital visits for a patient group who could be frail and symptomatic. We also hoped that by having more streamlined pathways for patients, we would improve access to palliative radiotherapy in the region as we were aware that the percentage of patients having palliative radiotherapy in our department was low compared with other areas (25% of our total patient population versus 41% in England).

With our new system, when referral for palliative radiotherapy is received, patients are booked into the RAPC clinic, which takes place twice a week. We have four patient slots per clinic and CT planning slots are reserved for these patients. At the clinic, patients are assessed medically, any pre-treatment medication needed is given, consent is obtained and a planning CT is subsequently performed. Radiotherapy is delivered on the same day if patients live more than 32 km from the hospital and are receiving a single fraction of radiotherapy. Same day treatment necessitates the patient being in the department for several hours, as treatment planning and checking treatment plans is time consuming. For patients living locally, it is easier for them to return for treatment the next day.

As a result of our new system, patients are certainly now being treated more promptly following referral than in the past. In the first three months the clinic ran (September to December 2014), 166 patients were treated. 35% received same day treatment, 33% were treated the next day and the remainder of patients were treated within three days. There was a 13% increase in the number of patients treated when compared with the same period in 2013, and in 2015 we have increased from 8 to 10 slots each week to cope with the numbers being referred.

And when we’ve evaluated the new service the comments have been very positive both from clinicians and patients:

“I feel for the first time like palliative patients have been given their own emphasis and importance.” Radiation Oncologist

“The dedicated nursing of this clinic … point of contact person is very important.” Patient perspective

“I couldn’t go back to the old system of having to negotiate a treatment slot for these patients and then hope I would be able to find a free clinic room to assess them in first.” Radiation Oncologist

It seems that our objective of improving access to palliative radiotherapy has been met. The current status is that the RAPC is well established in our department and now runs Monday/Wednesday/Friday.

Dr Aileen Flavin and her team were runners up in the “BIR/Bayer Make it Better Service Award”

8. Aileen Flavin team

Left to right: Derry McCarthy, Radiotherapy Service Manager, Theresa O Donovan, Lead Radiation Therapist on RAPC, Clare Harman, Deputy Radiotherapy Services Manager

Front row left to right:  Katy McDonald, Staff Nurse Radiotherapy, Aileen Flavin, Consultant Radiation Oncologist, Laura Sheehan, Staff Nurse Radiotherapy.

Is your radiology department part of your hospital’s disaster management plan?

Ronald Bilow

Dr Ron Bilow

When Dr Ron Bilow experienced a major emergency in his hospital, it got him thinking about the role of the radiology department.

Here he explains what led to the radiology department becoming an integral part of the organisation’s disaster management plan.

 

Sports spectators

 

What would you do if large number of these sports spectators (right) suddenly arrived at your hospital after a disaster occurred at the event?

What arenas can you identify in your vicinity that may serve as a gathering site for a large number of people? This could be in the form of sports stadiums, performance halls or amphitheaters, schools, shopping districts, hotels, airports, even restaurants and movie theaters. Is there a public transportation system near you? Are there elevated roads or railroad tracks nearby? Do you live in an area that is prone to earthquakes, fires, tornadoes, tsunamis or landslides? Whether it be from a natural event, a faulty device or other accident, or intentional harmful acts by one or more persons (as shown in the photo below) you probably need to be prepared to handle a rapid surge in patient influx at your institution.

Crowd scene at Boston marathon bombing

Allow me to continue with this brief illustrative story: I was covering the emergency radiology service at my level one trauma center one day when the administrators received a telephone call alerting us to a roof collapse, resulting in an estimated 100 potentially injured patients. What I witnessed was, simply put, amazing…efficiently coordinated preparation for the worst scenario imaginable.

The nursing staff, emergency physicians, emergency medical technicians (EMTs), clerical staff and housekeepers began preparing the emergency center (EC) for a high volume of patients by clearing out those awaiting transfer to the operating room (OR) or hospital ward, or discharge home. Additionally, extra stretchers were brought into trauma bays and hallways, and each was stripped down, sanitized and made ready with clean linens. Equipment was organized and put away, extra IV poles and blood product pumps were brought in, and each room was either verified ready or had its depleted stock replenished. In a matter of perhaps 15-20 minutes, the EC was ready to handle the onslaught. In short, predefined protocols were rapidly implemented during the incident, and most of the people knew their role.

Boston Marathon 2

Watching rescue helicopters from my office

Throughout the process, I stood in awe, yet somewhat disappointed…and even a bit uncomfortable…that I didn’t have a role…or, if I did have a role, I didn’t know what it was.

It got me thinking…as a radiologist, what is expected of me? What am/was I supposed to be doing to help prepare? What will be my role when the patients arrive? Is it merely to read whatever imaging exams are obtained, or is there some additional way I can help manage the problem?

It is clear from the above scenario, that our hospital has a plan for how best to handle the increased load after a mass casualty incident. This is known as a disaster management plan (DMP). In order to achieve that, leaders had to consider various scenarios and determine how the workers in each department should respond. It was also clear that the planning went much further than the EC. Phone calls were made to the receiving ward’s charge nurses alerting them that patients were coming out of the EC due to the pending influx of new trauma patients, per the hospital DMP. The OR was notified that they would receive patient’s waiting for surgery in their holding area. In short, things ran very smoothly, without pushback from the receiving services. Perhaps even additional staff were called in from home by one or more departments?

Whatever the case, it was also glaringly obvious that the radiology department had been left out of the planning, and in fact, nobody in radiology services had any idea how to handle or respond to a MCI and the resultant DMP activation. And the truth is, without a radiology department DMP, the hospital’s plan will fail. Imaging services will be rapidly overwhelmed due to lack of adequate resource management, and patients will suffer. It needs to be determined ahead of time how to decrease wait time for imaging services, speed up delivery of each examination, how reports will be disseminated and to whom, and who will do what work. This simply cannot be achieved without prior analysis and planning.

It is common knowledge that imaging has been increasingly used over the past few decades in the evaluation of critically ill patients, and for the most part, has become the standard of care. Through drills and real life experiences, researchers have shown how imaging services can become a severe bottleneck in implementing care during the hospital phase of a mass casualty incident. Thus, it seems essential to include technical and physician leaders from the radiology department in planning how best to manage the surge in patient volume after a disaster occurs. In our institution, we have begun the process of being incorporated in our hospital DMP, and hope to expand our role to help facilitate further excellence in the city-wide disaster response. Is it time for you to do the same?

About Dr Ronald Bilow

After graduating from The Chicago Medical School in 1996, Dr Ronald Bilow completed his residency in diagnostic radiology at Santa Barbara Cottage Hospital (Santa Barbara, California), and subsequently underwent fellowship training in Emergency Radiology at The University of Texas, Health Science Center in Houston (now the McGovern Medical School), and Musculoskeletal Radiology at the University of California, San Diego. He currently holds the position of Assistant Professor on the McGovern Medical School faculty in Houston, Texas, where he teaches medical students and both emergency medicine and diagnostic radiology residents and fellows. Dr. Bilow performs his clinical duties primarily at a level one trauma center, Memorial Hermann Health System – TMC, in Houston, Texas. He was recently appointed as radiologist member to the joint University of Texas, McGovern Medical School – Baylor University Medical School Disaster Management Planning Committee. He has been a Fellow Member of the ASER (American Society of Emergency Radiology) since 2005, and has served in numerous leadership roles including Case of the Day Director, Education Committee Chair/Co-Chair, Director at Large, Treasurer, Bylaws Committee Chair and Member, and Strategic Planning Committee Member. He has also held membership on the Annual Meeting Program Planning and Scientific Program Committees.

IMAGES

Figure 1. Photo: Nathan Bilow Photography.

Figure 2. Open source photo.

Figure 3. Photo taken by author, Ron Bilow, from his office window

 

Making the case for radiographer reporting

SONY DSC

With a steady and sustained rise in imaging workloads driven by an ageing population, new and evolving technologies, and a drive for patient-focused care, radiology departments are turning to new ways to provide services. Nick Woznitza, Clinical Academic Reporting Radiographer at Homerton University Hospital, east London, and Canterbury Christ Church University, Kent, makes the case for radiology departments meeting these ever-increasing demands through radiographer reporting.

Using the example of his experience in the neonatal department of Homerton University Hospital he explains how, with robust research and training, and the appropriate use of skill mix, departments can offer a safe, efficient and patient-focused service.

Expansion of the neonatal medicine department at Homerton produced an increase in plain imaging workload and, coupled with a shortage of consultant paediatric radiologists, meant that the neonatal X-rays did not receive a timely definitive radiology report. The neonatal unit is a large, tertiary referral facility with 46 cots, 900 admissions and 13,600 cot/days per annum in 2013–2014. In order to provide an optimal service to these vulnerable patients, it was agreed to develop a radiographer-led plain imaging neonatal reporting service.

A bespoke, intensive training programme was designed in collaboration with radiology and neonatal medicine at Homerton, Canterbury Christ Church University and the paediatric radiology department of the Royal London Hospital. The radiographer was already an established reporting radiographer, interpreting skeletal and adult chest X-rays in clinical practice, so the training programme focused on the unique physiology and pathology of neonates. Training consisted of self-directed learning, pathology and film viewing tutorials, practice reporting, and attendance at the neonatal X-ray meeting at the Royal London Hospital. This immersive experience was achieved via secondment for one and a half days a week.
Upon qualification of the reporting radiographer, all reports were double read by a consultant paediatric radiologist, to successfully manage the transition into practice whilst maintaining patient safety in line with best practice recommendations.

To ensure that the performance of the trained reporting radiographer was comparable to that of a consultant paediatric radiologist a small research study was conducted (Woznitza et al, 2014), supported by research funding from the International Society of Radiographers and Radiographic Technologists (ISRRT). This study confirmed only a small number of clinically significant reporting radiographer discrepancies (n = 5, 95% accuracy), comparable to the performance of the paediatric radiologists. This study provided further evidence that the introduction of radiographer neonatal plain imaging reporting has not adversely impacted patient safety or care.

Activity figures (July 2011 – September 2014) were obtained from the radiology information system to determine the number of X-ray examinations performed and the proportion receiving a radiographer report. An average of 285 X-rays were performed each month, however, there was a marked increase in March 2012 from 158/month (July 2011 – February 2012) to 328/month (March 2012 – September 2014). The radiographer has made a sustained, significant contribution to the reporting service, interpreting an average of 92.5% of the X-ray examinations and responsible for >95% of examinations in 20 of the 36 months.

Building on the collaboration between radiology and neonatal medicine, a weekly neonatal X-ray meeting was introduced. Facilitated by the reporting radiographer and paediatric radiologist, this forum has increased radiology–clinician engagement and in turn patient care, facilitated discussions and acts as an excellent educational resource. Recognising the importance of this meeting, the senior neonatal clinicians requested that the reporting radiographer convene the meeting when the paediatric radiologist is absent on leave.

The introduction of a radiographer neonatal X-ray reporting service demonstrates that, with collaboration and support, novel approaches can help provide solutions to increasing activity in radiology in an effective, efficient and patient focused manner without compromise on patient safety. Collaboration and team work are fundamental when undertaking service delivery change. The support of both the radiology department, under the leadership of Dr Susan Rowe, and the neonatal unit, led by Dr Zoe Smith with mentorship from Dr Narendra Aladangady, has been essential in the success of this service.

Nick Woznitza biography
Nick qualified as a diagnostic radiographer from the University of South Australia and, following several roles in rural and remote Australia, moved to the UK in 2005.

An accredited consultant radiographer with the College of Radiographers, Nick reports a range of plain imaging examinations including skeletal, chest and neonatal X-rays. He has recently taken up a clinical academic radiography role at Homerton University Hospital and Canterbury Christ Church University, with this blended role facilitating image interpretation teaching to radiographers and other health professionals and his research into the accuracy and impact of radiographer reporting.

Reference
Woznitza N, Piper K, Iliadis K, Prakash R, Santos R, Aladangady N. Agreement In Neonatal X-ray Interpretation: A Comparison Between Consultant Paediatric Radiologists and a Reporting Radiographer. International Society of Radiographers and Radiographic Technologists 18th World Congress. June 2014; Helsinki, Finland, 2014.

Investigating the invention of the X-ray

Dr Adrian Thomas

Dr Adrian Thomas

As we publish a brand new section of history on our website and celebrate 120 years of the X-ray, Dr Adrian Thomas, the BIR’s Honorary Historian remembers the events leading up to one of the most important inventions in the medical world.

On the afternoon of Friday 8 November 1895 Wilhelm Conrad Roentgen (fig 1), a 50 year old professor of physics at the German university of Würzburg, was making his electrical experiments. He was passing electrical currents across a vacuum (Crooke’s) tube, carrying on the tradition of the great Michael Faraday.

William Roentgen

Figure 1

Roentgen was working in a completely darkened room and he covered his Crooke’s tube in lightproof cardboard. To his great surprise a barium platinocyanide screen, which was located a few feet away from the tube, was mysteriously lighting up. Roentgen realized that this was a new and previously unrecognized form of radiation and that it must be coming from the tube itself. This radiation consisted of neither visible light nor cathode rays. I love the conversation with Roentgen in 1896, recorded by HJW Dam:

The effect was one which could only be produced in ordinary parlance by the passage of light. No light could come from the tube, because the shield which covered it was impervious to and light known, even the electric arc.”

“And what did you think?”

“I did not think, I investigated. I assumed that the effect must come from the tube since its character indicated that it could come from nowhere else……..….It was clearly something new, something unrecorded.”

“Is it light?”

“No.”

“Is it electricity?”

“Not in any known form.”

“What is it?”

“I don’t know.”

So Roentgen did not make any vain speculations—he investigated the new phenomenon. Also he did not pretend to any knowledge that he did not possess—so when he did not know he had the humility to say so. The rest, of course, is history, and this discovery, which took place 120 years ago this year, transformed both our understanding of the physical world and also of ourselves. The X-rays could not be explained by classical physics; a new way of looking at the world was needed, and modern physics was born.

X-Ray van

Figure 2

Roentgen showed that a hand could be placed between the Crooke’s tube and the screen and, to Roentgen’s astonishment, it showed the bones of the hand clearly. The image of a hand could also be made as a photograph or radiograph. We saw ourselves differently from this moment.

In the UK, the news of the discovery appeared in the Manchester Guardian on 7 January 1896. The public had to be reassured that this was a serious discovery by a respected scientist and was not a joke! The prestigious science journal Nature was initially somewhat reserved about the discovery. The translation of the article On a New Kind of Rays was printed in 23 January issue of Nature, the translation being sent by Professor Arthur Schuster of Manchester.

We are now remembering the 70th anniversary of the end of World War II. By 1939, good reliable shockproof portable X-ray apparatus was available as this X-ray ambulance shows (fig 2), and the radiological services were generally well organised.

The British army was supplied with a good mobile X-ray machine, the MX-2, which was robust and easy to use for both radiography and fluoroscopy (figs 3 & 4).

Image 3

Figure 3

Figure 4

Figure 4

It could easily be put into a crate for transportation (fig 5), although care was needed! By this period radiography had developed as a profession and many radiographers entered the forces; however the overall numbers of radiologists and radiographers available were inadequate and many units were supplied with radiographers only, without medical radiologists. The numbers of radiographers meant that on average 50-100 patients could be dealt with each day, and the War Office recommended that if this number were exceeded then the lightly wounded and the prisoners of war should be asked to help the radiographer. There were no radiologists in the casualty clearing stations or in the forward area and the full responsibility for the work rested with the radiographer. These radiographers developed considerable skills in adverse conditions (fig 6) and were integral to the team, and professional skills were more important and significant than the exact military rank.

Figure 5

Figure 5

Image 6I will be in Würzburg on the 8 November 2015 to celebrate 120 years of X-rays as well as the International Day of Radiology. The 8 November is also Remembrance Sunday, and so I will be in Germany. I will remember all of the dead on opposite sides from so many countries in past conflicts. The words of John Donne, sometime Dean of St Paul’s Cathedral are apt:

No man is an island, entire of itself; every man is a piece of the continent, a part of the main. If a clod be washed away by the sea, Europe is the less, as well as if a promontory were, as well as if a manor of thy friend’s or of thine own were: any man’s death diminishes me, because I am involved in mankind, and therefore never send to know for whom the bells tolls; it tolls for thee.”

Figures:

1. Wilhelm Conrad Roentgen.
2. X-ray ambulance.
3 & 4. MX-2 in use.
5. Problems of packing illustrated in this poster!
6. Difficulty with film in the tropical sunshine!