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'The Ugly Truth'

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'State of the debate' briefing

In February 2005, Sense About Science held a ‘state of the debate’ briefing on radiodiagnostics in Westminster. The briefing was given by two leading radiologists: Professor Adrian Dixon, Honorary Consultant Radiologist at Addenbrooke’s Hospital and Professor of Radiology at University of Cambridge; and Professor Janet Husband, President of the Royal College of Radiologists.

Profs Husband and DixonThe term ‘radiodiagnostics’ embraces all forms of medical imaging including: Ultrasound, Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Angiography and Nuclear Medicine, including Positron Emission Tomography (PET). Developments in radiology have been the subject of much media and public interest over the past few years, from discussions about the implications of population screening for diseases like breast cancer, to the front-page publication of pictures of foetuses ‘walking’ in the womb. Radiodiagnostic tools have been welcomed and many are in widespread use, but concerns have also been expressed. Are people needlessly exposing themselves to radiation through defensive medicine and well-person screening? How can treatment keep pace with the diagnosis of disease? Do they create unrealistic expectations about the prevention of serious-stage diseases?

The aim of the briefing was to have an evidence-based discussion about radiodiagnostics, considering the contribution they have made to medicine, looking at the new advances that are on the horizon and addressing concerns about their use. An invited audience of civil servants, parliamentarians, academics, health professionals and company representatives discussed these issues.

Professor Dixon explained how radiodiagnostic tools are contributing to healthcare and have become an integral part of every patient’s medical journey:

  • Using X-rays, a Computed Tomography (CT) scanner is able to create cross-sectional imaging - simulating ‘slices’ through the body. Recent developments in multi-detector CT machines mean it is now possible to acquire 64 ‘slices’ simultaneously. CT is instrumental in the evaluation of common clinical problems such as acute abdominal pain and possible pulmonary embolus: three-dimensional imaging is also possible, for example in orthopaedic and facial reconstruction.
  • The range and scope of radiodiagnostic tools now available means clinicians are increasingly moving away from clinical examinations towards using imaging findings to diagnose disease. This is reducing the need for invasive investigations, for example, in the evaluation of the coronary arteries CT scanning may soon replace much diagnostic coronary arteriography.
  • MRI is making huge strides in cardiac imaging and, because it does not use ionising radiation, is especially suitable for children and patients needing long term follow up.
  • Modern imaging can contribute to improved quality of life where rapid diagnosis makes appreciable differences to health outcomes, in early recognition and intervention following a cerebrovascular incident (stroke) for example.
  • Modern imaging is far less invasive and so much kinder to the patient than the investigations of old, which often had to be repeated several times.

Professor Janet Husband explained that we are moving away from an era of symptomatic medicine to a new era of prediction and profiling, in which radiodiagnostics play an important role. Professor Husband went on to outline a new paradigm for radiodiagnostics for the 21st Century:

  • Radiology is the future of modern cancer care: PET and CT scanners allow doctors to treat cancers more effectively by helping them to detect tumours earlier, define tumour properties, target treatment and track the effects of treatment.
  • The medical focus has been on shrinking cancerous tumours, but now, using imaging, other indicators can be used to examine the characteristics of a tumour. For example, using PET scanners, we can see how tumour activity changes in response to treatment by monitoring the tumour angiogenesis (blood supply) and its uptake of glucose.
  • As a result of our improved understanding of a tumour’s life cycle, novel therapies can be developed. Many of these new therapies are less aggressive than their traditional counterparts, such as chemotherapy, helping to improve the quality of life of patients.
  • Research has shown that these new therapies are improving patient survival by up to 60% based on five year survival statistics.

In the discussion, the audience and speakers discussed pre-emptive screening for disease and also the roll-out of radiodiagnostic machines and availability of trained clinicians to operate them.

On questions about pre-emptive screening, including how effective such screening is in reducing deaths from cancer and the effects of radiation exposure from scanning, the speakers responded:

  • That all involved in screening need to abide by the edict that screening programmes, like all medical interventions, should “do more good than harm”.
  • One danger to be alert to with screening programmes and the rise in awareness of diseases is that people are becoming increasingly concerned that they may have an illness when they are actually physically well – a phenomenon referred to as the ‘worried well’.
  • That people should avoid being exposed to radiation unless they are directed to do so by their doctor. The Royal College of Radiologists produces guidelines indicating the appropriate use of radiation and it was agreed that these need to be popularised beyond the medical world (see the guidelines on the Royal College of Radiologists website).

In response to questions about the roll-out of radiodiagnostic machines throughout the NHS and the availability of trained radiologists to operate them and interpret results, it was concluded that:

  • There is a shortage of trained clinicians to operate machines, which will affect the roll-out of new radiodiagnostic machines in the NHS. However, this is not due to a lack of willing clinicians but to a shortage of training courses.
  • For radiodiagnostic tools to be introduced effectively, on the basis of the evidence of their uses and benefits, it is crucial to address the shortage of clinicians immediately.