Genesis of cancer
Knowledge continues to increase and this has been particularly the case in our understanding of the causes of disease. Eric Hall from New York gave the 1992 Silvanus Thompson Memorial Lecture in 1992 (Hall BJR 1993; 66(781): 1-11) and took as his topic “The gene as theme in the paradigm of cancer.” He reviewed how altered gene expression can be involved in the genesis of many cancers and how this held the promise that more targeted therapies must soon be available.
Image source: Hall BJR 1993; 66(781): 1-11
Whilst the newer imaging techniques produced superb images, their very quality and clinical usefulness lead to an increasing demand on the service. NR Moore and SJ Golding tackled the thorny issue of increasing patient throughput in June 1992 (Moore and Golding BJR 1992; 65(774): 470-475). MRI had become one of the most powerful diagnostic techniques in diseases on the brain, spinal cord and musculoskeletal system. The paper considered ways of optimising patient examination. By February 1996 KS Naik and others from Leeds were asking the question: “Is computed tomography of the body overused?” (Naik, Ness, Bowker and Robinson BJR 1996; 69(818): 126-131) and audit was recommended.
The balance between the clinical pressures on our departments and our resources to provide a service will always be in tension. In the BIR Bulletin of March 1992 (BIR Bulletin 1992; 65(771): B21-B30) it was pointed out by Jeffrey Tobias in an article “Radiotherapy’s ridiculous workload” that the UK had fewer consultants in clinical oncology than anywhere in the developed world apart from Portugal and Turkey. UK consultants saw twice the number of patients in a year compared to colleagues in the USA or mainland Europe.
Digital radiographic techniques were gradually introduced in conventional radiography. In an interesting paper by RM Dawood and others in January 1994 the experience at the new St. Mary’s Hospital in London were reviewed (Dawood, Craig, Todd-Pokrapek, Porter, Highman, Cunningham, Stevens, Al-Kutoubi and Crofton BJR 1994; 67(793): 1-10). This was the first commercially available digital display system in a British radiology department. This paper prefigured what was to come later, however at that time the results were not acceptable for the primary diagnosis of plain film abnormalities.
In March 1995 Nicola Strickland and David Allison from the Hammersmith Hospital (Strickland and Allison BJR 1995; 68(807): 252-260) gave an account of their experience of the display of digital images on picture archiving and communication systems (PACS) monitors. At that time the Hammersmith Hospital was installing one of the largest hospital-wide PACS in the world. By December 1996 Nicola Strickland was reviewing the cost-benefit considerations for PACS and efficient data management was discussed (Strickland BJR 1996; 69(828): 1089-1098).
Image source: Strickland BJR 1996; 69(828): 1089-1098
Reporting of plain radiographs
Attitudes were changing in the 1990s and this is most obviously illustrated by a paper by CF Loughran in October 1994 (Loughran BJR 1994; 67(802):945-950) on the reporting of plain radiographs in cases of trauma by radiographers and on the impact of a training programme in clinical reporting. He concluded that such a programme of training and certification of radiographers in fracture reporting could help alleviate the diagnostic radiologist’s workload of plain film reporting. In January 1996 R Pauli and others were recommending radiographers as second readers in screening mammography (Pauli, Hammond, Cooke and Ansell BJR 1996; 69(817): 10-14). In April 1996 the BIR Diagnostic Methods Committee organized a meeting on skill mix for radiologists and radiographers (Williams BJR 1996; 69(826): 887-888) where this whole subject was discussed and in December 1996 PJA Robinson from Leeds presented a short communication of a feasibility study of plain film reporting by radiographers (Robinson BJR 1996; 69(828): 1171-1174).
Image source: Robinson BJR 1996; 69(828): 1171-1174