twrama 1990_final oc.. - AMA WA

More documents

Recommendations

Info

TOMORROW’S HEALTH The future of RADIOLOGY Super computers and enhanced nanotechnology will help move radiology into another dimension, says Professor Mark Khangure Many of the major advances in the broad fields of medicine and surgery over the last 80 years or so have occurred as a direct result of innovations in diagnostic radiology including cardiac and coronary artery surgery, neurosurgery, and many of the minimally-invasive surgical procedures. Over the last 30 years, image-guided interventional procedures – ranging from occlusion of intracranial aneurysms, ablation of liver and lung metastatic deposits, angioplasty and stenting of narrowed blood vessels to drainages of abscesses – have replaced open surgical procedures. High quality imaging (CT, MRI and ultrasound) leads to accurate diagnoses and image-guided fine needle aspirations and biopsies (common and routine procedures) allow pathological confirmation, removing the need for surgical intervention for diagnostic purposes. Radiology in its broadest terms is the cornerstone of the provision of medical services. This is the present. The future of radiology is exciting and bright with a move into another dimension as more powerful computers and nanotechnology allow integration of genomic data with the imaging findings. Accurate measurements of volume, flow, perfusion, diffusion, and tissue density, among other things, will create the ‘science (to complement the art) of radiology’. Technological advancements: Next generation CT scanners will be even faster in data acquisition with much lower radiation dose, improved spatial resolution, automated measurement tools, and ‘virtual visulisation’ of the lumina and walls of blood vessels and the walls of hollow organs as currently applied to ‘virtual colonoscopy’. Blood flow measurements of the brain, spinal cord and other organs will be obtained in a matter of a few minutes to facilitate therapeutic decisions. Portable small units will replace in-theatre fluoroscopy enabling more accurate and safer surgical interventions coupled with lower radiation dose to the patient and medical staff. Medical ultrasound scanners will be more compact with improved resolution, better tissue characterisation and measurements such as vascularity, elasticity and compressibility of tissues. Ultrasound contrast media will greatly further enhance the accuracy of diagnoses. The current high field MRI scanners (3 Tesla) will be superseded by 7 Tesla units, already installed at some locations. PET/CT will be replaced by PET/MRI. The combination of these technologies provides high-resolution structural anatomical detail, functional information at the cellular level, and metabolic information with a significant reduction in radiation dose. This technology will be crucial 38 MEDICUS October
TOMORROW’S HEALTH in screening the at-risk population for neurodegenerative disease such as Alzheimer’s and Parkinson’s disease and instituting therapy before the development of symptoms. Inflammatory diseases of the CNS such as multiple sclerosis will be more accurately defined and categorised at a much earlier stage. Cancer patients’ chemotherapy efficacy will be determined after a single dose of the drug by the ability to determine with PET/MRI whether the drug attaches to the tumor receptors and will be effective – personalising the treatment to the individual patient. MRI contrast media linked to specific antibodies will lead to definitive diagnoses without the need for invasive procedure in many organs with clinical and radiological features of a disease. High field MRI spectroscopy will supplement the imaging data and pinpoint metabolic pathways, which are deranged in various disease processes in all parts of the body to both confirm the diagnosis and aid therapeutic decisions. Angiographic assessment of very small vessels including coronary artery branches, renal artery branches, intracranial artery branches and digital artery branches will be non invasive. Imaging requests and patient appointments will be electronic and clinical details will be available to the radiologist via e-health links. This will ensure that an appropriate imaging study is carried out to answer the clinical question asked. All imaging will be digital and placed on a central server in a secure location (e.g. the Health Department) regardless of where the imaging is carried out. All imaging providers will be linked to the central server to download the imaging data and the report, with immediate access of this data when a patient provides the authority to do so. The federal e-health program will in due course allow this to come about. All metropolitan, remote and rural hospitals will be linked via PACS and e-health consultation with specific imaging specialists for an opinion on difficult cases. This opinion may be sought at a state, national or indeed at an international level. This will ensure that there is ‘value added’ to the specialist referrer in the opinion offered. Interventional radiology: Image-guided interventional procedures and developments in techniques will further reduce the need for surgical interventions. Ablation of solid tumors will be more effective than present with lasers of specific wavelengths for application in the thorax, liver, kidneys and osseous structures. Image-guided delivery of chemotherapeutic agents, via direct placement (as in vertebrae, liver and kidneys and other solid organs) or via micro catheters as in brain lesions, will increase the efficacy of these agents minimising systemic side effects. Stent placement in blood vessels, ducts and hollow viscera will be much more accurate with ‘CT/angiography’ as currently employed About 15 per cent of the in intracranial health care budget is vascular interventions. consumed by imaging, of Developments which about 20 per cent is are underway to manufacture inappropriate biodegradable and bioactive stents, associated with fewer long-term complications. Stroke management has advanced significantly in the last decade or so with the use of thrombolytic agents-administered IV. Dedicated stroke units with 24/7 service and rapid clinical and imaging triage will be the norm. Patients with large clot burdens will be managed with both IV thrombolytics and direct clot retrieval by highly-trained interventional neuroradiologists. This model is in operation at several locations worldwide and has a very significant benefit in patient outcomes. Developments in equipment and devices for intracranial aneurysm management, ruptured and unruptured, is leading to an ever-increasing occlusion of these lesions via interventional means. Treatment of intracranial vessel stenosis and acute occlusions is a challenge, but there is progress towards the design of appropriate stents. Research and training: About 15 per cent of the health care budget is consumed by imaging, of which about 20 per cent is inappropriate. In part, this is related to poor communication between referring clinicians and radiologists and in part, lack of understanding on the part of the requesting clinician as to which imaging modality is best suited to answer a particular clinical question. Medical students need to be exposed to imaging paradigms to ensure appropriate utilisation of imaging. This can be easily achieved via a Chair in imaging, which sadly is lacking in Western Australia. However, this position will come about. An academic position will stimulate research at a multidisciplinary clinical, medical student and basic science level with obvious benefit for the patients of this state. The molecule is in sight, but it is not the end game. ■ An AMA (WA) Council Member, Professor Mark Khangure is a respected clinical neuroradiologist working with SKG Radiology. He was previously head of Imaging Services at Royal Perth Hospital. October MEDICUS 39
Page 1 and 2: WESTERN AUSTRALIAMEDICUS Journal of
Page 3 and 4: Council President Dr Richard Choong
Page 5 and 6: FROM THE EDITOR AMA (WA) advances i
Page 7 and 8: GP BREAKFAST Please clarify: Dr Ste
Page 9 and 10: EVENT Walking the tightrope Maintai
Page 11 and 12: INDUSTRIAL A matter of record The A
Page 13 and 14: A good Practice to get into Benefit
Page 15 and 16: Simplify YOUR Life We can help with
Page 17 and 18: Osborne Park Volkswagen AMA Members
Page 19 and 20: Food reform on the agenda The Austr
Page 21 and 22: OPINION systems will improve what
Page 23 and 24: OPINION Some other health professio
Page 25 and 26: COVER STORY SILENCE KILLS It’s ti
Page 27 and 28: COVER STORY FIFO CONCERNS Fiona Kal
Page 29 and 30: Determined: Associate Professor Gar
Page 31 and 32: FEATURE for both health professiona
Page 33 and 34: OPINION day worked, one must contin
Page 35 and 36: Moving to Best Practice, easy as Li
Page 37 and 38: OPINION A hard-earned thirst by Ben
Page 39: OPINION Continued from page 36 A ha
Page 43 and 44: SNIPPET BREAST CANCER SURVIVAL IMPR
Page 45 and 46: HIGHER RISK OF COMPLAINTS AGAINST S
Page 47 and 48: Medfin helps make finance easy with
Page 49 and 50: DRIVE Crown Perth Casino Internatio
Page 51 and 52: EVERY JAGUAR CAN DO THINGS MACHINES
Page 53 and 54: DR YES Kimberley callinG Students a
Page 55 and 56: AMA IN THE MEDIA WHY HAY FEVER IS G
Page 57 and 58: TRAVEL Kansas City, Missouri is one
Page 59 and 60: WINE Online networks yield success
Page 61 and 62: DRIVE communication ability. We ins
Page 63 and 64: TECHNOLOGY iOS 6 Highlights Apple
Page 65 and 66: The good news is the loss of images
Page 67 and 68: On the TOWN To win a double pass to
Page 69 and 70: AMA MEDICAL PRODUCTS introduces Wel
Page 71 and 72: RADIOLOGY/NUCLEAR MEDICINE Oceanic
Page 73 and 74: BICTON MEDICAL CLINIC VR GP require
Page 75 and 76: WESTERN WESTERN AUSTRALIA AUSTRALIA
Page 77 and 78: PostgraduateNews Please forward sub
Page 79 and 80: General Ultrasound Same day appoint

twrama 1990_final oc.. - AMA WA

Create successful ePaper yourself

Delete template?

Save as template?