January 2010, Dawn of a New Decade...
The College of Radiology has been living in its own “home” for nearly half a year now, in its own office space in the Medical Academies of Malaysia Building, Jalan Tun Razak, Kuala Lumpur. Jessie Fung jumped into the hot seat of the executive secretary and was involved in two major scientific events. Congratulations to all involved in the success of the scientific programmes – initially the Annual Scientific Meeting on Imaging Emergencies & Trauma with the pre-congress workshop of QAP in Mammography, followed by the highly praised Asian Oceanic Society of Paediatric Radiology Congress in November 2009.
This year is election year for the College of Radiology and for the first time, there will also be a Vice President in Nuclear Medicine. The College of Radiology in Malaysia has with its sister counterparts, the Hong Kong College of Radiologists (HCKR) and the Singapore College of Radiologists decided to forge closer ties and collaborations. Each respective scientific meeting will be at the “local” members’ registration fee for members of the 3 colleges. HKCR started the ball rolling by offering local registration rates for the Annual Scientific Meeting 31st Oct to 1st Nov 2009. For the CoR Malaysia’s Annual Scientific Meeting (Heart & Lungs: From Basics to Intervention) this year from 10-11th April 2009, the local members’ registration rate will apply for our corresponding members from Hong Kong and Singapore. In addition, the aim is to harness the respective country’s expertise and promote collaboration.
2009 ended with the big hoo-hah on radiation risks, especially with Computed Tomography (CT) scans. Papers published in the Archives of Internal Medicine highlighted alarming statistics. [Arch Intern Med. 2009;169(22):2049-2050 & Arch Intern Med. 2009;169(22):2071-2077 ] Everyone who requests and performs imaging investigations that involve ionising radiation should be very aware of the cumulative doses of radiation to the patient and population as a whole. Whilst on the one hand, such news might cause undue fear amongst those (the layman, the public, the patient) who really need the investigation, it also reminds all of us that there is really “no free lunch”.
Every investigation comes with pros and cons. An exponential increase in the number of CT scans performed worldwide, including those in hybrid or fusion imaging modalities such as Positron Emission Tomography-CT, or Single Photon Emission Computed Tomography (SPECT)- CT have resulted in high doses being administered to patients, in return for a presumed improvement in the diagnostic value of the images. The question remains, are these tests truly necessary to impact the management of the patient and improve outcome? Will they improve the success rate of treatment, and will this improvement be clinically significant? At what cost – to the patient in terms of other health risks, finance and other risks posed by the contrast media that may be used? What about cost to the various governments’ health budgets?
The CoR in Malaysia promotes judicious use of CT scans and that they must be justified procedures, optimised to reduce the radiation dose especially in children. It would be wise to think of the radiation risk just as we would apply it to the more radiation sensitive children. Do go to www.imagegently.com to get dose reduction protocols, and even patient /parent material for better understanding of the procedures involved. Fantastic images are not needed, but diagnostic quality images, which may be acquired even with lower doses of radiation. Fortunately the industry realises this and has been working hard in the R & D of CT scanners to design and produce CT equipment that uses less radiation for diagnostic quality images.
The other year end 2009 controversial announcement was that from the US Preventive Services Task Force Guidelines for Screening for Breast Cancer, released in Nov 2009 and updated in Dec 2009. It raised a furore in its home country, the USA, requiring the Task Force to “rephrase” their guidelines or add explanatory notes to them. Every country would be looking at the USA, but they must consider their local requirements and availability of investigations as well as the pattern of breast cancer in their own country. The ethical questions would be, is not one life saved, important enough? It is, if you are looking from the viewpoint of the patient. If you are looking at public funds, and calculating how best to utilise the funds to ensure more benefit from its allocation, it might be a different ballgame. Malaysia does not have a population based screening programme. Most of the patients who come for the mammogram have a symptom or sign – or are referred by their own doctors. The other group, who are breast aware, come for screening on their own (opportunistic) and should be made to understand the merits of the mammogram, how it is useful and where it might fail to detect small early cancers.
Challenges which surfaced in 2009 can only make 2010 even more exciting and interesting as developments and technological advances grapple with issues of controlling radiation dose, increasing the utility of investigations and therapeutic interventions and finding new frontiers to explore. Radiologists, Oncologists, Nuclear Medicine Physicians, Medical Physicists and Radiographers /Radiation Technologists must therefore keep abreast, update themselves or even revise the basics to ensure they will use their tools judiciously, appropriately and properly in the best interest of the patient.
Self-regulation, self-improvement (through continuing professional development – CPD) will ensure safe, ethical practice. Our patients must benefit – for that is our calling as physicians and allied medical professionals/paramedical professionals!
Dr Evelyn HoPresident 2008-2010
College of Radiology
Academy of Medicine of Malaysia
1 January 2010
Click here to view previous messages