twrama 1990_final oc.. - AMA WA

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