The cancer patient in the radiology department: do we live up to our responsibilities?

Abstract

It is impossible to occupy the Presidential Chair of the Institute, especially in its 100th birthday year, without being acutely aware of the achievements of the last century and of the succession of great names who have held this of®ce. I make this point because I wish to express a strongly held personal view and I want my audience to feel that I do so with an apposite sense of humility, and an appropriate awareness of the long-term judgement of history. The various roles of imaging in cancer care are now well established. Radiology has been important in the diagnosis of tumours since its early days and this is a role familiar to all radiologists. In the 1980s, Godfrey Houns®eld's contribution of CT gave the subject new stimulus and spawned a new generation of radiologists skilled in issues of disease staging and treatment monitoring. This work is based on a radically different approach to that of the diagnostic radiologistÐcancer imaging begins after diagnosis has been madeÐand has been well practised in specialized centres such as the Royal Marsden Hospital, where I was privileged to work for 2 years. More recently, a planned devolution of cancer investigation to local hospitals [1] has meant that nearly all radiologists are concerned with cancer imaging in the widest sense. This has created new challenges, not least the need to standardize practice and ensure comparable standards of patient care. Cancer patients are now seen by a larger number of radiologists, many of whom may not have been trained in the way oncological imaging differs from purely diagnostic radiology. Models have been established for evaluating radiological practice, from the technical performance of equipment to the clinical outcome [2], and must form the bedrock of good clinical radiology. However, in this presentation I am not concerned with these principles, but with our wider role as caring, thinking doctors, and the implications of this to practice in our departments.