Today is International Day of Radiology, a chance to celebrate the work of Radiologists up and down the country. Radiology plays a key role in the detection, diagnosis and management of cancer.
To mark the event, we sat down with Dr Nisha Sharma, Director of Breast Screening and Clinical Lead for Breast Imaging at Leeds Wakefield, and secretary of the British Society of Breast Radiology, to shed some light on what radiology is all about.
What exactly is radiology?
Radiology involves taking a picture of an area of concern on or in a patient’s body, in order to pick up subtle things that may not be obvious to the naked eye. These pictures can be simple, like X Rays, or more complex, like CT and MRI scans, where multiple pictures are taken that show what’s going on when they are put together.
The Radiologist provides a report for the GP or specialist, with enough information to either reassure a patient or decide if further investigations or treatment are needed.
When patients undergo imaging, it is often a radiographer they will meet rather than a radiologist. A radiographer is trained to take images, whereas a radiologist is trained to interpret those images.
But the way things are being done is changing. And these days many more patients get to meet their radiologists as we now do many more procedures where tissue samples are taken, or other procedures are performed, under the guidance of an X Ray or ultrasound image.
What made you decide to become a radiologist?
During my years as a junior doctor, I had never considered radiology as a career. While quizzing me about my future in medicine, a colleague suggested I spend some time shadowing her husband, who was a radiology consultant.
I spent a few days working with him, and was amazed by how varied the work was and the knowledge required. I saw that it was possible to maintain contact with patients and work in a field that covered a large amount of medical conditions.
I applied for a trainee post and I’ve never looked back. I love my job and although it can be challenging, no one day is the same which I find exciting. The profession can sometimes be undervalued, but I believe the radiology department is the hub of the hospital, and if you took imaging away, the hospital would stand still.
What’s a typical day like?
When I arrive at the hospital, I spend the first hour of the morning with patients who require biopsies of difficult-to-find areas of tissue. I also see patients who are having surgery later that day to remove a tumour or area of abnormal tissue that can’t be felt by the surgeon.
I then spend the morning in a clinic, which provides same-day tests for patients with concerning symptoms. Around 25 patients are seen in each of these clinics with the aim of carrying out all the tests they may need in one place to reduce the number of visits to the hospital.
In the afternoon I do paperwork. After this I attend meetings where surgeons, specialist nurses, pathologists, radiologists and other specialists get together to discuss their cancer patients and people with suspected cancers. I review images and tests for patients where their treatment or diagnosis plan is uncertain, to help come to a decision on what to do next.
What’s the best part of your job?
I love seeing patients. And I get the opportunity to build a relationship with them, which I really enjoy. It’s a fantastic feeling when you get to tell someone who you know has been worried, that in fact everything is OK.
But I also experience the other side of the coin. Having to explain to a patient that they have cancer, or that their cancer has returned, is emotionally very difficult. I always remain honest and factual and have been amazed by how resilient and strong patients are. In my experience, what patients want in that situation is accurate and helpful information, to help them take on board what you’re saying.
As well as the patient focus, breast radiology in particular is constantly improving. Working in a field where technology can really make a difference is very exciting. It opens up lots of opportunities for specialists like me to do research to improve the ways we diagnose patients in the future.
What are the main challenges?
The demand on radiology services is increasing, not just in terms of workload, but also because of what we are now capable of doing.
10 years ago we only carried out simple procedures, now we often take multiple biopsies from a patient, or biopsies of trickier areas such as lymph nodes in the armpit, which are then passed on to a pathologist for analysis. These technological advances mean we can provide surgeons with the most accurate information about a patient’s diagnosis, which allows them to plan the best possible treatment for each individual.
This means there is a continuous need for radiologists to undergo training to keep up with advances in imaging techniques. This can sometimes be difficult when the goal posts keep changing!
Investment in technology is the other main challenge. The NHS has a limited amount of money, and on top of my day job I spend a lot of time preparing ways to pitch for some of that money. It can be very frustrating knowing that there is new technology out there that could make a real difference to patients, but that it’s just out of reach.
How have things changed since you first started?
Communication has improved between radiologists and specialist doctors or GPs.
When the Government first set targets for cancer, it really helped highlight areas within our service that needed changing and improving. It raised awareness of how important it is to give patients a timely diagnosis and invest in the services that help make this happen.
The biggest change is the increased focus on individual patients. We have been able to build better relationships with patients because of the information we are able to provide them with. When investigating symptoms that could be linked to cancer, imaging tests can give quick and immediate answers to a patient who is anxious. We have tailored the way we see patients in clinics to make sure they are given the best information, as quickly as possible on the day that they are seen.
What needs to happen to make the most difference to patients?
Radiologists are becoming a scarce commodity as fewer junior doctors are replacing those that retire. We need to ensure that there are enough training places available to meet the changes in demand, and encourage medical students to consider radiology as a career.
We also need to continue to develop the skills of radiographers so they can carry out and interpret more and more complex procedures that were traditionally only done by the radiologist. If we use the resources and skills we already have, and encourage these developments, I believe we will be able to overcome the challenges we face.
As technology advances, we also need to make sure we only use what is best to reach an accurate diagnosis, and not ‘test for the sake of testing’. At the end of the day, this comes back to maintaining good communication between radiologists and other clinicians, and more importantly, ensuring our service remains focused on our patients.
Interview conducted by Sara Roberts, early diagnosis manager at Cancer Research UK