WEBVTT
00:00:31.379 --> 00:00:37.499
20 years ago, many diagnoses relied on a good story, a careful examination, and a fair bit of clinical intuition.
00:00:37.859 --> 00:00:49.653
Today, radiology has become the third hand, the extra set of eyes, and sometimes a decisive voice in patient care from lifesaving interventional procedures to high resolution imaging that reveals disease earlier than ever.
00:00:49.923 --> 00:00:52.094
Radiology now sits at the center of modern medicine.
00:00:52.874 --> 00:01:02.594
In this episode of Aussie Med Ed, we explore how imaging shapes clinical decisions, how students can better understand the tools available to them and what the future holds for this rapidly evolving specialty.
00:01:07.728 --> 00:01:09.179
Good day and welcome to Aussie Med Ed.
00:01:09.379 --> 00:01:19.849
The Aussie style Medical podcast a pragmatic and relaxed medical podcast designed for medical students and general practitioners where we explore relevant and practical medical topics with expert specialists.
00:01:20.040 --> 00:01:28.210
Hosted by myself, Gavin Nimon, an orthopaedic surgeon, this podcast provides insightful discussions to enhance your clinical knowledge without unnecessary jargon.
00:01:28.799 --> 00:01:34.359
I'd like to start the podcast by acknowledging the Kaurna people as the traditional custodians of the land on which this podcast is produced.
00:01:34.730 --> 00:01:40.930
I'd like to pay my respects to the elders, both past, present, and emerging, and recognizing their ongoing connection to land, waters, and culture.
00:01:40.930 --> 00:01:47.079
I'd like to remind you that all the information presented today is just one opinion, and there are numerous ways of treating all medical conditions.
00:01:47.265 --> 00:01:51.490
It's just general advice and may vary depending upon the region in which you're practicing or being treated.
00:01:52.150 --> 00:01:55.120
The information may not be appropriate for your situation or health condition.
00:01:55.165 --> 00:01:58.645
And you should always seek the advice from your health professionals in the area in which you live.
00:01:59.255 --> 00:02:01.605
It's my pleasure now to introduce Dr. Adam Koukourou.
00:02:01.925 --> 00:02:17.342
He's an interventional radiologist who holds position of head of interventional radiology at the Flinders Medical Center, and he is also a partner of Radiology SA he serves as head of radiology at the Flinders Private Hospital Board member and chair of the clinical governance committee.
00:02:17.793 --> 00:02:18.962
Thanks Adam for coming on board.
00:02:18.967 --> 00:02:19.627
Aussie Med Ed.
00:02:20.127 --> 00:02:20.788
Thanks Gavin.
00:02:20.788 --> 00:02:21.388
Thanks for having me.
00:02:21.448 --> 00:02:24.907
It's been a long time coming to get this podcast up and running tonight.
00:02:24.907 --> 00:02:28.397
So, as finally we managed to get the calendars lined up and get it happening.
00:02:28.877 --> 00:02:30.513
Well, it is brilliant to have you on board.
00:02:30.842 --> 00:02:32.924
Well, I thought we'd start off, over the past 20 years?
00:02:32.954 --> 00:02:38.359
How has imaging changed and how we diagnose, triage and manage patients across the hospital in primary care settings?
00:02:38.859 --> 00:02:39.278
Yeah, thanks.
00:02:39.849 --> 00:02:48.813
It's interesting you've used that 20 year timeframe because that's probably the timeframe I've been doing radiology as certainly as a consultant having graduated in 2006.
00:02:49.329 --> 00:02:49.449
I.
00:02:49.824 --> 00:02:52.914
Imaging has grown significantly in that time.
00:02:53.364 --> 00:03:11.664
In the early days of my training, there was obviously the plain x-ray was probably the most used modality and absolutely that's still used today and it serves a vital tool in some of the basic things, fractures chests for looking at pneumonia or chest pathology.
00:03:12.368 --> 00:03:15.009
Abdominal x-rays for bowel obstruction, for example.
00:03:15.009 --> 00:03:17.319
So the plain X-rays are still widely used.
00:03:18.269 --> 00:03:19.919
CT was very limited.
00:03:19.919 --> 00:03:25.528
It was the old single slice ct, which it took five minutes to get a diagnostic CT head.
00:03:26.308 --> 00:03:30.399
That information is now captured in five seconds, essentially.
00:03:30.399 --> 00:03:41.424
It's very, very quick and we've had significant improvement in other modalities, the quality of MRI has just gone from strength to strength to strength.
00:03:42.414 --> 00:03:46.764
The imaging that we can produce now in MRI has grown so much in those 20 year period.
00:03:47.264 --> 00:03:49.394
Other modalities has certainly come online as well.
00:03:49.394 --> 00:03:52.634
So there's the, the, the PET scan, positron emission tomography.
00:03:52.634 --> 00:03:56.144
That's more the role of the nuclear medicine team.
00:03:56.334 --> 00:04:03.204
But that's certainly, come on, looking at metabolic activity of parts of the body and very good in the role for tumor staging.
00:04:04.204 --> 00:04:05.774
How does radiology help the modern.
00:04:06.099 --> 00:04:13.086
Practitioner, well, it's probably a, I'm gonna be very biased here, but it's probably the forefront of patient care.
00:04:13.146 --> 00:04:20.945
It's kind of the center hub and everyone loops around that works complimentary with the clinical team, our clinical colleagues.
00:04:21.286 --> 00:04:26.450
One of my old lecturers back in the late nineties, it said history and examination was 95% of the diagnosis.
00:04:26.450 --> 00:04:37.065
but yeah, imaging is a complimentary to that and certainly it helps diagnose those weird and wonderful things that you can't necessarily work out or capture c linically, things aren't quite right.
00:04:37.966 --> 00:04:39.135
What imaging can we do?
00:04:39.706 --> 00:04:43.800
So the modern radiologist can certainly help in the spaces where.
00:04:44.534 --> 00:04:46.664
The diagnosis may not be quite clear.
00:04:46.687 --> 00:04:50.432
what do you consider the main limitations or pitfalls for imaging for clinicians?
00:04:51.432 --> 00:04:53.262
The main limitations and pitfalls?
00:04:53.262 --> 00:05:03.213
Well, some of it, depending on where you are working, there may be a little bit of a timeframe to get some imaging done.
00:05:03.603 --> 00:05:05.372
So that would be a limitation.
00:05:05.372 --> 00:05:07.023
Patients might have to wait.
00:05:07.179 --> 00:05:08.379
It's like anything you go.
00:05:08.622 --> 00:05:14.232
Ring your local tradesmen or electrician to come and do some stuff, you may have to wait.
00:05:14.742 --> 00:05:21.002
And that is a bit of a limitation'cause we know with healthcare that we don't want to wait too long at all.
00:05:21.602 --> 00:05:35.632
So getting access to some of the imaging, particularly MRI, for example, can be a little bit of a wait and some interventional procedures if they are not life threatening, they can also be a bit of a.
00:05:36.007 --> 00:05:39.336
Wait, because of the supply demand resource issues.
00:05:39.336 --> 00:05:43.326
So that would be one of the limitations, for sure.
00:05:43.374 --> 00:05:49.793
Pitfalls that may potentially fall on ordering the wrong test.
00:05:50.093 --> 00:05:54.954
A patient has a, you think this is what I'm gonna order if the patient, the patient has a test, but it's the incorrect one.
00:05:55.673 --> 00:05:59.483
So that's where conversation to avoid those pitfalls.
00:06:00.038 --> 00:06:07.939
With your local radiologist to then determine the best pathway, avoid some of those pitfalls for sure.
00:06:08.439 --> 00:06:19.809
And would there be, do you think there could also possibly be the scenario of like false negatives so you get reassurance that something's okay and it's not quite right and false positives where the opposite occurs as well?
00:06:20.093 --> 00:06:21.144
Yeah, absolutely.
00:06:21.144 --> 00:06:23.429
So sometimes we look at something and go, that's, that's abnormal.
00:06:23.929 --> 00:06:24.978
Maybe over call it.
00:06:25.338 --> 00:06:27.739
That's often where the clinical scenario needs to go in.
00:06:27.739 --> 00:06:28.879
Yeah, this isn't quite right.
00:06:28.879 --> 00:06:29.689
Dunno what it is.
00:06:29.718 --> 00:06:33.709
Maybe it's this and that cause a lot of anxiety, stress for everyone involved.
00:06:33.949 --> 00:06:35.449
Obviously Radiology's changed a lot over the years.
00:06:35.449 --> 00:06:37.309
Where do you think things are heading for the future?
00:06:37.309 --> 00:06:38.819
And what about the role of artificial intelligence
00:06:38.884 --> 00:06:46.817
Yeah, so we're already seeing artificial intelligence come into radiology, and it's an adjunct.
00:06:46.817 --> 00:06:47.958
It helps.
00:06:48.348 --> 00:07:01.473
So we know, certainly in the public sector where I work at Flinders, we have a chest X-ray AI program called Analise, which helps identify pathology.
00:07:01.973 --> 00:07:04.014
That's complimentary to your own skills.
00:07:04.584 --> 00:07:13.814
There's one coming for CT Head, so it's just a little popup that just highlights potential abnormalities to make sure that you can capture those in your review areas.
00:07:14.814 --> 00:07:15.923
It's moving fast.
00:07:15.923 --> 00:07:19.449
We have AI software to pick up lung nodules as well.
00:07:20.199 --> 00:07:24.999
And these are tiny one two millimeter nodules, so that is useful as well.
00:07:24.999 --> 00:07:29.158
But like most of these things, you can't rely on it completely.
00:07:29.278 --> 00:07:30.449
It, it's a help.
00:07:31.439 --> 00:07:36.088
The ultimate onus lies with us as the radiologist, not on the ai.
00:07:36.088 --> 00:07:42.459
So it's still, it's complimentary, but not, not the, the solution to doing the work for us.
00:07:43.348 --> 00:07:46.072
And of course, how do, the referrers and the clinicians.
00:07:46.833 --> 00:07:50.583
talk to an ai program to get the answer when they wanna discuss their patient's findings.
00:07:50.632 --> 00:07:51.802
I don't think that's quite worked yet.
00:07:52.403 --> 00:07:52.793
Yeah.
00:07:53.122 --> 00:07:57.583
there's no concern amongst the trainees that the AI might take their jobs for the future,
00:07:57.973 --> 00:07:58.242
no.
00:07:58.242 --> 00:07:59.502
Look, I don't think so.
00:07:59.593 --> 00:08:00.973
No, I don't think so.
00:08:00.973 --> 00:08:05.322
So I've seen the role of the radiologist evolve over many years.
00:08:05.822 --> 00:08:10.382
The old adage sit in the dark room, turn the lights on with the films and don't come and talk to us.
00:08:10.533 --> 00:08:30.062
Versus out of that space and into the realms of the MDTs being part of patient care, which I being bias mentioned earlier, at the center of it, we are involved with helping determine treatment pathways and advising what next follow up might be.
00:08:30.562 --> 00:08:33.622
I'm not sure AI can necessarily replace that.
00:08:34.612 --> 00:08:36.952
And there's a human side of things as well, isn't there?
00:08:36.952 --> 00:08:45.149
I think as a patient you wanna be able to see a face, so I, I don't think necessarily that that's going to be a problem at this point in time.
00:08:45.149 --> 00:08:49.698
Of course, AI can't do any of the interventional procedures that that I do.
00:08:49.698 --> 00:08:51.448
There is robotics.
00:08:52.183 --> 00:09:02.494
Machines around, but I haven't really seen them take off and do things without a human involved, so I'm not too concerned about that.
00:09:02.494 --> 00:09:08.364
I think they've been talking about AI replacing radiology for many years, but still get to see that, that,
00:09:08.453 --> 00:09:12.524
one of the things I have seen replaced over the years is the old films.
00:09:12.614 --> 00:09:15.494
So now it's all online and we can actually access them easily.
00:09:16.004 --> 00:09:19.124
In fact, the hardest part for me is actually finding out where the person actually went.
00:09:19.124 --> 00:09:21.374
So I can actually look at the correct Intelli viewer site.
00:09:21.793 --> 00:09:24.758
So I've found that a real, real help.
00:09:25.092 --> 00:09:31.812
In assessing patients both finding out what investigations they've had done and also seeing how they've changed over that time as well.
00:09:32.182 --> 00:09:34.442
What are your thoughts on the online viewing of radiology
00:09:34.538 --> 00:09:35.798
Oh, it's fabulous.
00:09:35.798 --> 00:09:37.028
It's absolutely fabulous.
00:09:37.028 --> 00:09:37.327
It's been.
00:09:37.942 --> 00:09:40.013
Game changing for everyone involved.
00:09:40.582 --> 00:09:47.952
It makes things a lot more efficient for us to be able to capture that data electronically.
00:09:47.952 --> 00:09:50.472
You're not storing a whole lot of films.
00:09:50.923 --> 00:09:53.743
You can review things quite quickly and succinctly.
00:09:54.222 --> 00:10:03.322
It's very easy to have a conversation with the referrer about images because they can just Ring you up and say, can you have a look at this for me?
00:10:03.893 --> 00:10:11.519
And as you said, you need to potentially look at multiple different platforms to try and find where these images might be.
00:10:11.519 --> 00:10:22.080
But you can do it very quickly and succinctly and get the answer that the patient needs when it's compared to previous or have the conversation with the clinical team regarding.
00:10:22.904 --> 00:10:25.725
Can you just have a look at a few of these other studies?
00:10:25.784 --> 00:10:34.935
You don't have to wait for the films to be couriered from somewhere else or the patient to bring their films, which invariably might get lost over the, over the journey.
00:10:34.935 --> 00:10:36.435
So look, it's, it's been fabulous.
00:10:36.435 --> 00:10:48.524
It's been really good in, in improving patient care, getting accurate diagnoses and producing reports which are more succinct because rather than saying.
00:10:48.914 --> 00:10:50.654
Please look at the old films in our report.
00:10:50.685 --> 00:10:52.935
'cause we don't have access to the hard copy of the films.
00:10:53.174 --> 00:11:00.225
We can easily find where they might be and then compare 'em and give the answer that's needed.
00:11:00.435 --> 00:11:02.054
There's been no change in this spot.
00:11:02.554 --> 00:11:03.274
Case closed.
00:11:03.274 --> 00:11:04.654
So it's, it's been fabulous.
00:11:04.654 --> 00:11:04.715
It.
00:11:05.450 --> 00:11:07.220
Yeah, on that basis.
00:11:07.620 --> 00:11:11.039
Adam, a couple of thoughts that come to mind about the Intel viewer type imaging.
00:11:11.269 --> 00:11:17.399
First of all, often I use the, the online measuring, to measure size of, fractures or displacement.
00:11:17.580 --> 00:11:18.419
How accurate are they?
00:11:19.060 --> 00:11:19.629
First up?
00:11:19.990 --> 00:11:20.320
Yeah.
00:11:20.950 --> 00:11:26.629
They're much more accurate than what the old crayon text, ruler drawing.
00:11:26.659 --> 00:12:10.920
'cause there's that error that you get with the x-ray and the patient and and divergence So far more accurate now Absolutely.
00:12:10.920 --> 00:12:11.639
Is fabulous.
00:12:11.940 --> 00:12:20.610
We can use some of the software to measure volumes of structures, so the respiratory physicians are quite.
00:12:21.045 --> 00:12:29.414
Keen in looking at lung nodule volume and seeing how a nodule might change in terms of volume over time.
00:12:29.805 --> 00:12:30.855
That makes it simple.
00:12:31.675 --> 00:12:35.315
that would be dead near impossible with the old films, Gavin.
00:12:35.335 --> 00:12:37.495
So, yeah, that, that is really accurate for sure.
00:12:38.485 --> 00:12:40.914
The other thing that comes to mind too is sustainability too.
00:12:40.914 --> 00:12:41.965
I'm quite into that.
00:12:42.325 --> 00:12:47.620
And the whole idea of all these films, that would've been a bit of a, impost on recycling
00:12:47.620 --> 00:12:53.740
there are companies that have, that do recycle some of the materials within the, within the films, but.
00:12:54.240 --> 00:12:56.670
The less films produced must be good.
00:12:57.539 --> 00:12:59.039
I think they must be seen as a positive.
00:12:59.159 --> 00:12:59.490
Yeah.
00:13:00.000 --> 00:13:00.210
Yeah.
00:13:00.210 --> 00:13:00.899
Excellent.
00:13:01.399 --> 00:13:01.700
Okay.
00:13:01.700 --> 00:13:04.670
What about the whole idea of over ordering too?
00:13:04.670 --> 00:13:10.210
I mean, obviously with such availability of investigations, it must be tricky not to over investigate
00:13:10.960 --> 00:13:11.110
Yeah.
00:13:11.110 --> 00:13:12.764
Look, I, I, I think so.
00:13:12.795 --> 00:13:17.774
I mean, it's very simple to obviously write a form and let's get this test, let's get that test, but.
00:13:18.274 --> 00:13:25.024
I suppose it depends on what the clinical scenario with patient, how anxious the patient might be.
00:13:25.024 --> 00:13:26.884
Are we happy with the answer we're getting?
00:13:27.425 --> 00:13:35.644
And probably the best way to get around that is to say, right, what is the exact problem that we want?
00:13:35.764 --> 00:13:38.195
What is going to be the best study?
00:13:38.195 --> 00:13:39.425
To get me that answer?
00:13:39.815 --> 00:13:45.845
We'll go to that first, and that would be a conversation with your radiologist.
00:13:46.345 --> 00:13:57.235
That can help guide you in the right direction because if you had said, I've got a patient in front of me, I just want one test to give me the answer on this problem, what would you say?
00:13:57.235 --> 00:14:04.335
So for example, if someone had clear achilles tendon inflammation, you go, should I do an MRI?
00:14:04.335 --> 00:14:05.144
You go, well.
00:14:05.985 --> 00:14:08.715
You could, but that might be a little bit of overkill.
00:14:08.745 --> 00:14:20.784
Why don't you just do an ultrasound that may give you all the information that you need and then you don't waste resources, time patient's money on an unnecessary test.
00:14:20.784 --> 00:14:27.295
So I think it's about having a clear understanding of exactly what the clinical scenario is.
00:14:28.164 --> 00:14:29.605
I think we'll find that.
00:14:30.105 --> 00:14:48.115
With some of the, obviously a lot of the musculoskeletal studies MRI is very, very useful, but there are some restrictions with access to that of course, but I think we'll find in a few years with the government releasing some of those restrictions that will become more accessible.
00:14:48.414 --> 00:14:55.134
And so you might find that less double handling of images or patient.
00:14:55.764 --> 00:14:57.144
Conditions will occur with that.
00:14:57.144 --> 00:14:58.315
So that would be very useful.
00:14:58.815 --> 00:15:08.955
Yeah, I mean, I would've thought too, the ability to actually review the Intel viewer sites and look at other imaging done at other areas would, it will help reduce the chance of double ordering as well, so.
00:15:09.519 --> 00:15:10.269
absolutely.
00:15:10.269 --> 00:15:16.779
So sometimes a patient, their GP may be right onto it get the diagnosis.
00:15:16.779 --> 00:15:23.695
But a patient may Present a hospital for another complaint, and they may then get a repeat test, which the gps already done.
00:15:24.205 --> 00:15:30.504
So yeah, Access to software where possible means that you don't reorder a test.
00:15:31.504 --> 00:15:35.855
What about a junior doctor who starts out and they're not sure where they should order an investigation.
00:15:36.430 --> 00:15:41.914
What are your thoughts what would you say to the interns when you, when they're unsure, what are their process they should go through?
00:15:42.580 --> 00:15:43.450
yeah, absolutely.
00:15:43.450 --> 00:15:53.442
So always review the patient's history, go through their notes where possible, work out what investigations they've had already.
00:15:54.042 --> 00:15:58.166
They may have had already had a test for the same presentation or the same clinical.
00:15:58.911 --> 00:15:59.451
Complaint.
00:15:59.951 --> 00:16:15.658
If that's not helping or not getting the answer that they want, then come and have a chat to us down in radiology and try and work out what's gonna be the best pathway rather than just filling out a form, putting it in, and then coming back the next day.
00:16:15.988 --> 00:16:20.311
That's gonna be the best way that we can limit resource wastage.
00:16:20.332 --> 00:16:23.093
And particularly for the interns, it's all about learning.
00:16:23.603 --> 00:16:25.462
It's all about getting education.
00:16:25.462 --> 00:16:35.113
It's all about how can we make sure that we're doing the right things, and that's an excellent way to learn about what's going to be helpful for your patient in those situations.
00:16:35.209 --> 00:16:35.658
It's interesting.
00:16:35.658 --> 00:16:39.048
So sometimes we get these request forms for, oh, can I have the CT scan?
00:16:39.418 --> 00:16:40.558
I'm worried about.
00:16:41.058 --> 00:16:44.479
Some arterial pathology in the abdomen You get the patient down, you've got any allergies?
00:16:44.629 --> 00:16:46.249
Oh yeah, I'm allergic to intravenous contrast.
00:16:46.249 --> 00:16:47.119
It's like, ah.
00:16:48.019 --> 00:16:57.269
So that information, if you'd grabbed that information prior to ordering that test, then you wouldn't have wasted the resources of actually getting 'em down to the department.
00:16:57.269 --> 00:16:59.069
So how do you work out to get to the answer?
00:16:59.569 --> 00:17:03.844
So just, yeah, do a bit of research before you put the order in.
00:17:04.344 --> 00:17:04.673
Yeah.
00:17:04.973 --> 00:17:07.134
Adam, what makes a good imaging request form then
00:17:07.384 --> 00:17:07.713
yes.
00:17:07.763 --> 00:17:10.739
what makes a good request form is having the contact details on the form.
00:17:11.739 --> 00:17:21.739
That makes a good request more because quite often we are finding a lot of pathology that needs urgent attention, and we can never find the referrer.
00:17:22.239 --> 00:17:23.558
It's a squiggle, it's not a name.
00:17:23.558 --> 00:17:24.098
It's not clear.
00:17:24.098 --> 00:17:29.798
There's no, there's no contact details on the form, so I, I think that makes a really good request form.
00:17:29.798 --> 00:17:36.578
In terms of the diagnosis, I think the information needs to be succinct.
00:17:37.078 --> 00:17:54.618
What the presentation is, a couple of brief differentials and what you're hoping to find, therefore with the imaging, and that would make a really good request for, and of course with those contact details, if you're not sure, say, can you please call me to discuss?
00:17:54.618 --> 00:17:55.578
Or something like that.
00:17:55.578 --> 00:17:57.048
So those sort of things will help.
00:17:57.508 --> 00:18:02.638
Obviously it needs to be signed and dated correctly and whatnot and need to be able to read the writing.
00:18:03.638 --> 00:18:04.718
Yeah, exactly.
00:18:05.498 --> 00:18:09.858
So, obviously I can't speak 'cause my handwriting's terrible, so I always try and type them up.
00:18:10.278 --> 00:18:11.328
But, a thought of mine.
00:18:11.718 --> 00:18:15.738
I like to make myself accessible to my referring doctors and patients.
00:18:15.948 --> 00:18:23.728
And obviously sometimes people are scared to ring some of the specialists and ask information information You've implied that that's not the case at all in radiology.
00:18:24.523 --> 00:18:28.933
Well, I, I can only speak for myself and some of my colleagues that I work closely with.
00:18:28.933 --> 00:18:31.543
And absolutely, we're always happy to take a phone call.
00:18:32.053 --> 00:18:32.688
I, I think.
00:18:33.188 --> 00:18:38.348
People are more appreciative when you do have a conversation and you make yourself accessible.
00:18:38.348 --> 00:18:38.948
I, I get it.
00:18:38.948 --> 00:18:45.128
I'm learning all the time as well, and I understand how challenging it can be with a patient across the decks saying, doc, I'm not well.
00:18:45.128 --> 00:18:45.713
What's wrong with me?
00:18:46.213 --> 00:18:47.963
I am more than happy to have a conversation.
00:18:47.963 --> 00:18:50.273
I've got a number of people that I get messages from all the time.
00:18:50.273 --> 00:18:52.433
It's, it's actually quite rewarding.
00:18:52.763 --> 00:18:55.403
It gets a bit busy sometimes, like, okay, whose message do I need to get back to?
00:18:55.953 --> 00:18:57.423
It is actually quite rewarding though.
00:18:57.423 --> 00:19:00.333
You can help and part of the patient's journey, you can help your colleagues as well.
00:19:00.363 --> 00:19:03.603
'cause at the end of the day, we're all here, here to help our patients and help each other.
00:19:03.603 --> 00:19:06.303
I don't think we're working against each other, so how can we best do that?
00:19:06.678 --> 00:19:09.948
Sometimes it can be a bit challenging getting through phone lines like a call center.
00:19:10.248 --> 00:19:13.158
Sometimes, you know, you're on hold and, and whatnot.
00:19:13.158 --> 00:19:21.848
But I, I think if you have a good relationship with your radiologist, just ask 'em if you don't mind getting their, their personal details, even email address and send an email and we'll get back to you.
00:19:21.848 --> 00:19:24.368
And I think that's probably the best way to help do that.
00:19:24.763 --> 00:19:30.343
I work mainly down at Flinders and I, and I think that the specialists that I work with there and the gps and local, they're all fabulous.
00:19:30.403 --> 00:19:36.913
They're really, really good and always happy to have a conversation either ringing me or I have a phone call with them, and I get a lot out of that too.
00:19:37.413 --> 00:19:40.353
What about trying to learn more about radiology for the young students and gps?
00:19:41.023 --> 00:19:43.513
To want to understand how to interpret the x-rays better.
00:19:44.023 --> 00:19:55.853
Obviously they can, look at the films themselves and read your reports, but is there any other resources apart from speaking to yourselves and asking advice, is there anything they could actually look at to actually try and help them understand things better?
00:19:55.853 --> 00:19:55.943
That.
00:19:55.943 --> 00:19:56.933
absolutely.
00:19:56.933 --> 00:20:06.553
There's lots of websites that do capture how to look at an X-ray, A lot of that information wasn't online when I did my training.
00:20:06.553 --> 00:20:10.123
So it was all old school, go to library, finds a book and read through the books.
00:20:10.463 --> 00:20:18.403
So that's all different now, but it's very simple to get that information And there's some great Australian websites as well that can help do that for you.
00:20:18.793 --> 00:20:22.713
But I'm always happy to take a phone call and give some advice.
00:20:22.713 --> 00:20:25.863
If someone wants to come and see me, that's, that's not a problem at all.
00:20:25.863 --> 00:20:27.468
I can help point someone in the right direction.
00:20:27.787 --> 00:20:28.267
Brilliant.
00:20:28.312 --> 00:20:35.679
Well, if we start with the basics for the medical students So if we go through a few different areas, We start with the respiratory chest x-ray versus CT chest.
00:20:36.159 --> 00:20:36.879
Chest x-ray.
00:20:36.879 --> 00:20:37.569
Absolutely.
00:20:37.569 --> 00:20:38.997
It's quick, simple.
00:20:39.271 --> 00:20:40.231
Easy to obtain.
00:20:40.291 --> 00:20:41.941
There's a chest x-ray in every street corner.
00:20:41.941 --> 00:20:44.639
Essentially it's, it's the forefront of diagnosis.
00:20:44.639 --> 00:20:49.816
You know, if someone's got shortness of breath, I don't think you'd go first and get a CT scan.
00:20:49.966 --> 00:21:01.687
It's a little bit more, I suppose, in invasive there's slightly more radiation than normal chest x-ray, normal chest x-ray, one or two days of background radiation that we all get walking around CT scans a little bit more than that.
00:21:01.687 --> 00:21:14.328
Having said that, some of the lower dose CTs that we're now producing with the advances in technology in the last few years, that does reduce the radiation dose, but shortness of breath, chest x-ray, if it shows a pneumothorax, you've got your diagnosis.
00:21:14.328 --> 00:21:16.098
There's no need to perform a CT chest.
00:21:16.370 --> 00:21:17.600
The chest x-ray is normal.
00:21:17.600 --> 00:21:18.050
It's normal.
00:21:18.050 --> 00:21:33.189
And that's when you might go, okay, what other imaging modalities do we have in the Chest imaging space to review pathology, and probably yes, correct that CT chest would be the next line investigation, but I'd certainly encourage a chest x-ray to be done first.
00:21:33.338 --> 00:21:44.769
Not only can it give you an early diagnosis, for example, of a pneumothorax, even pneumonia, it gives you a baseline to then be able to follow the disease progression during treatment.
00:21:44.769 --> 00:21:48.539
So pneumothorax, for example, if it's volume of say, 40%.
00:21:49.244 --> 00:21:53.534
Manage it conservatively, chest x-ray the next day, the volume's reducing so that it gives you a nice baseline.
00:21:53.534 --> 00:21:56.744
So it al always recommend a chest x-ray for sure.
00:21:56.744 --> 00:21:57.494
So, absolutely.
00:21:57.494 --> 00:21:59.092
It's still gold standard in my opinion.
00:22:00.087 --> 00:22:06.947
When, they're in hospital and you're worried about pulmonary embolus, what's the role of a CT pulmonary angiography versus the old VQ scans?
00:22:07.217 --> 00:22:08.807
And is there still a role for a VQ scan
00:22:08.807 --> 00:22:16.403
yeah, look, look there is, I'm not a Nuclear Medicine physician, but people go for the CTPA 'cause it's a quicker test.
00:22:16.903 --> 00:22:19.224
CT scanning is available 24/7.
00:22:19.244 --> 00:22:23.114
Nowadays, nuclear medicine may require after hours, at least an on-call process.
00:22:23.614 --> 00:22:25.221
Nuclear medicine, from my understanding.
00:22:25.247 --> 00:22:34.361
If there is some abnormalities on a chest X-ray pleural effusion or pneumonia, then it may make the diagnosis on a VQ scan a little bit challenging.
00:22:34.991 --> 00:22:40.640
And so the CT PA will give us the ability to look at the pulmonary arteries.
00:22:40.640 --> 00:22:43.415
It'll also show any other pathology.
00:22:43.415 --> 00:23:02.391
Often patients who are in in hospital do have comorbidities, which you won't necessarily pick up on a. VQ scan in isolation, and so a negative CTPA so with no pulmonary embolus, a CT will give you a look at other pathology the aorta, for example, the cardiac structures, for example, even the upper abdominal structure.
00:23:02.391 --> 00:23:04.521
So just gives you a little bit more information.
00:23:04.671 --> 00:23:09.571
The VQ scan, yes, I think there's still a role for the V/Q scan clinician's still worried about pulmonary embolus.
00:23:09.591 --> 00:23:11.121
If the CT is normal, it's chest x-ray is normal.
00:23:11.601 --> 00:23:13.221
VQ scan does have a role to play, for sure.
00:23:13.221 --> 00:23:22.296
When we, look at cardiology, obviously everyone will talk about an ECG as the first line test, but when it comes to radiology and imaging where's the role of, say, plain x-rays?
00:23:22.296 --> 00:23:29.746
Looking at the size of the heart versus an echocardiogram, versus other things like cardiac MRIs or CT coronary angiography.
00:23:30.281 --> 00:23:30.521
Yeah.
00:23:30.551 --> 00:23:33.701
Look, chest x-ray, as I said before, that's gold standard.
00:23:33.701 --> 00:23:37.301
Let's do one of those low radiation, easier to get to.
00:23:37.541 --> 00:23:43.751
Looks at the cardiac size and lung fields, and if that's all okay, then you probably tick the box if there's an abnormality on that.
00:23:43.751 --> 00:23:44.771
So a big heart.
00:23:45.551 --> 00:23:48.791
Then the cardiologist may suggest an echocardiogram to look at.
00:23:49.466 --> 00:24:00.976
Cardiac function, cardiac output flow through the valves, look at the overall size of the ventricles, what their contractility is, the next line of investigation.
00:24:00.976 --> 00:24:07.516
if it's a coronary artery problem, so you are looking at stenosis calcification, then it'd be a ct.
00:24:08.016 --> 00:24:14.496
Coronary angiogram in the right patient cohort, and that will be determined by the cardiologists, of course.
00:24:15.486 --> 00:24:23.083
Otherwise, looking at functional studies of the heart, the MRI is very, very good, but it does take a little bit of hot time.
00:24:23.083 --> 00:24:28.273
It takes up to an hour to do all the phases in the images of the.
00:24:29.068 --> 00:24:33.418
Heart looking at the ventricles and the atrium contractility and flow through the valves.
00:24:33.718 --> 00:24:36.358
Whereas an echocardiogram is very simple.
00:24:36.598 --> 00:24:40.123
It's an ultrasound underneath the sternum or underneath the chest.
00:24:40.281 --> 00:24:41.871
There's no radiation involved.
00:24:42.141 --> 00:24:47.771
And for patients that are claustrophobic or they have a pacemaker, some of the newer pacemakers.
00:24:47.786 --> 00:24:51.791
Are all MRI compatible or they have the patient have some contraindication, MRI.
00:24:51.791 --> 00:24:55.659
So echocardiogram is a very simple test to.
00:24:55.805 --> 00:24:59.075
Do as a first line to look at cardiac function.
00:24:59.575 --> 00:25:00.023
Right.
00:25:00.042 --> 00:25:06.725
What about general surgery I used to learn about doing lateral decubitus x-rays and looking for gas bubbles.
00:25:06.965 --> 00:25:11.205
I presume those things aren't quite as commonly used nowadays and there's more appropriate investigation.
00:25:11.375 --> 00:25:11.665
yeah.
00:25:11.695 --> 00:25:13.145
Look, not as common.
00:25:13.145 --> 00:25:13.905
They're still done.
00:25:14.225 --> 00:25:14.585
Absolutely.
00:25:14.585 --> 00:25:22.320
Particularly when you are looking at following the degree of bowel dilatation, the setting of a bowel obstruction, for example.
00:25:22.320 --> 00:25:37.883
But you're right, I think a clinical assessment that suggests there is some intraabdominal pathology and a CT scan would probably be the pathway to go down because the abdominal CT is going to show us a lot of pathology.
00:25:37.883 --> 00:25:40.523
It's going to look at all the abdominal organs.
00:25:40.523 --> 00:25:45.790
So someone who has right iliac fossa pain, for example, right sided abdominal pain.
00:25:45.790 --> 00:25:57.640
So you may be saying query appendicitis, looking for gallstones, inflammation of the pancreas and liver pathology, even bowel obstructions, looking for the level obstructions.
00:25:57.640 --> 00:26:00.070
The CT just gives you a little bit more information.
00:26:00.580 --> 00:26:03.940
Of course, the radiation dose is a lot more.
00:26:03.940 --> 00:26:05.260
Then what you would for an x-ray.
00:26:05.260 --> 00:26:09.850
So, CT abdomen, pelvis, probably two, two and a half years of background radiation.
00:26:10.350 --> 00:26:24.520
A normal abdominal x-ray won't necessarily exclude intrabdominal pathology, so a CT is probably certainly the general surgical space becoming more and more used And people don't seem to think twice about ordering a CT abdomen pelvis.
00:26:24.540 --> 00:26:27.630
It just does give us so much information.
00:26:28.020 --> 00:26:40.460
Also looks at the vascular structures and quite commonly we do find some incidental findings that, oh, that's the answer we've never found that on an abdominal x-ray bowel ischemia, mesenteric thrombosis, for example.
00:26:40.460 --> 00:26:42.260
So it gives us a lot of information.
00:26:42.760 --> 00:26:45.220
How does that compare to an ultrasound in that scenario?
00:26:45.490 --> 00:26:46.646
Is that being less used
00:26:46.696 --> 00:26:47.656
Complementary.
00:26:47.686 --> 00:26:52.606
So I talked about before appendicitis or gallstone.
00:26:52.606 --> 00:26:57.836
So in young kids, absolutely we want to try and avoid radiation where possible.
00:26:57.836 --> 00:27:08.211
And ultrasound would be the f irst pathway we would go to, but we don't always see the appendix on ultrasound because of the bowel gas gets in the way.
00:27:08.211 --> 00:27:12.141
Depending on where the appendix is sitting, if it's behind the caecum, for example, you won't see it.
00:27:12.141 --> 00:27:20.301
So a negative or an ultrasound that doesn't show the appendix can't rule out appendicitis, but it still has a role.
00:27:20.301 --> 00:27:26.931
And I'll definitely suggest that, particularly in the young patients gallstones I talked about earlier, won't necessarily see.
00:27:27.576 --> 00:27:30.426
All gallstones on ct.
00:27:30.426 --> 00:27:37.206
Some of them aren't radio opaque, so they won't show up on the ct, so an ultrasound is required for that.
00:27:37.626 --> 00:27:45.966
That also gives us a better review of the gall bladder wall, which you won't necessarily appreciate on ct.
00:27:46.506 --> 00:27:49.656
So it's a complimentary study.
00:27:50.136 --> 00:27:53.136
We know that liver lesions are quite common.
00:27:53.766 --> 00:27:55.416
Be that incidental or.
00:27:55.916 --> 00:28:03.416
Liver lesions that we are following, and so ultrasound can help to determine whether something might be solid or cystic.
00:28:03.416 --> 00:28:04.856
For example, a simple cyst.
00:28:05.356 --> 00:28:13.226
I think if you're purely looking for renal pathology, renal function decreasing, you probably wouldn't go for a ct.
00:28:13.226 --> 00:28:25.226
First up, you'd go for an ultrasound in that instance, because we know that some of the contrast dye that we use, we call it contrast dye, it's a, a intravenous medium that is used to highlight intrabdominal structures.
00:28:25.226 --> 00:28:38.746
We know that can have an effect on renal function and is contraindicated in patients have poor renal function and so we're definitely do an ultrasound, look for any structural abnormalities, obstruction, for example, renal stones perhaps.
00:28:38.746 --> 00:28:40.306
So it's complimentary to that.
00:28:40.806 --> 00:28:57.056
Having talked about renal stones, that then goes back to if someone's got a good history of renal colic, right sided flank pain, haematuria, then the modality of choice for investigation would be a ct because that will show us the stones nicely.
00:28:57.266 --> 00:29:00.806
And in those instances, we don't often give the intravenous contrast eye.
00:29:00.806 --> 00:29:03.826
So if the renal function was a bit off, then that wouldn't cause a problem.
00:29:04.326 --> 00:29:04.806
Brilliant.
00:29:05.586 --> 00:29:15.036
Well, when it comes to my area of musculoskeletal medicine, I like to Think of things like plain x-rays and ultrasounds and axial imaging and CT and MRI what are your thoughts on muo skeletal imaging?
00:29:15.211 --> 00:29:15.501
Yeah.
00:29:15.501 --> 00:29:18.561
Look, I think it goes back to what I said at the start, history and examination.
00:29:18.561 --> 00:29:29.961
I suspect Gavin someone like yourself, you know, patient comes in with shoulder pain or whatnot, and you can probably get a pretty good idea of what the pathology is and absolutely, you don't want to be caught by anything.
00:29:29.961 --> 00:29:30.321
So.
00:29:30.696 --> 00:29:32.526
Plan Xray, ultrasound's a fabulous start.
00:29:32.586 --> 00:29:33.576
Low radiation.
00:29:33.936 --> 00:29:38.376
Simple tests relatively easy to get and it will probably give us all the information.
00:29:38.376 --> 00:29:45.946
We know that ultrasound, is fabulous at looking at moving parts, moving tendons, ligaments, looking for joint fluid.
00:29:45.946 --> 00:29:47.026
It's fabulous in that.
00:29:47.506 --> 00:29:50.926
Probably gives enough information to go down your treatment pathway.
00:29:51.426 --> 00:29:54.096
We use ultrasound as well for.
00:29:54.096 --> 00:29:55.596
Therapeutic interventions.
00:29:55.926 --> 00:30:00.276
It's how we do a lot of our injections for bursal inflammation, for example.
00:30:00.776 --> 00:30:02.306
So that's Certainly the first line.
00:30:02.726 --> 00:30:11.726
The only challenges are that the intraarticular pathology, we won't necessarily appreciate accurately with plain x-ray or ultrasound.
00:30:11.831 --> 00:30:14.921
So plain x-ray will show us all the bony structures.
00:30:14.921 --> 00:30:16.421
It won't show the intrinsic.
00:30:16.421 --> 00:30:18.251
Cartilage and ligaments.
00:30:18.751 --> 00:30:24.914
Ultrasound shows the extrinsic soft tissue structures, tendons, bursa, but won't also show us internally.
00:30:24.914 --> 00:30:29.685
So then we need to look at what other modalities may be available to us now.
00:30:29.685 --> 00:30:33.491
Years ago, we used to go for CT Arthrography.
00:30:33.991 --> 00:30:44.094
To look at internal structures, just show us the outline of what the ligaments might look like or outlines of what the labrum, for example, in the hip shoulder might look like.
00:30:44.094 --> 00:30:46.824
And that was quite good, but it's semi invasive.
00:30:46.824 --> 00:30:55.314
It's a needle into a joint space, which does run the risk of causing further intraarticular problems inflammation or infection, for example.
00:30:55.314 --> 00:30:57.114
So with MRI.
00:30:57.114 --> 00:31:01.404
Improving its ability to image these body parts.
00:31:01.404 --> 00:31:11.544
As I said earlier, then we've moved more from, rather than doing ct, CT, arthrography moved more to MRI to look at the intrinsic structures.
00:31:12.384 --> 00:31:22.344
Knees, probably one of the more common musculoskeletal referred body part that we get, and the MRI is the gold standard for looking at what I'll call internal derangement.
00:31:23.274 --> 00:31:29.604
Cartilage defects, meniscal injuries, cruciate injuries, and that's probably the pathway you'd go.
00:31:29.604 --> 00:31:39.521
You'd also, if someone had a history of significant trauma, then you would probably still, you would do an x-ray first, just to make sure that there wasn't a fracture, for example.
00:31:40.021 --> 00:31:47.821
In those settings where there is a fracture, CT is fabulous for that really shows the extent of the fracture, the articular surfaces.
00:31:48.321 --> 00:31:50.211
So in that space, that's where CT is.
00:31:50.211 --> 00:31:53.646
But if you're looking at intraarticular pathology, MRI's definitely the way to go.
00:31:54.146 --> 00:31:55.976
What about the role of MR mri Arthogram?
00:31:55.976 --> 00:31:56.036
Hmm.
00:31:56.536 --> 00:32:03.711
So once again, we, when MRI, quality wasn't as great, now I'm probably going back eight to 10 years.
00:32:03.711 --> 00:32:08.901
We used to do MR Arthrography for the hip and shoulder quite a lot, even the wrist.
00:32:09.891 --> 00:32:22.893
It shows some fabulous pictures, but I think with the stronger magnets that are being produced now that we really get a good understanding of what's going inside joint spaces without performing the arthrography.
00:32:22.893 --> 00:32:26.763
So I think the indication for that is probably a little bit less.
00:32:27.513 --> 00:32:34.323
You may consider that if the MRI without Arthrography was inconclusive and you are still.
00:32:34.616 --> 00:32:39.026
Clinically worried about intraarticular pathology like in the shoulder for a small labral tear.
00:32:39.026 --> 00:32:40.766
That's when you'd probably do arthrography.
00:32:40.766 --> 00:32:48.714
But I think that would probably be a discussion with the radiologist regarding, these are my clinical concerns I have with this patient.
00:32:49.224 --> 00:32:50.604
Let's have a look at the imaging.
00:32:50.634 --> 00:32:51.654
Can we go through that?
00:32:51.654 --> 00:32:53.064
Is this something you can see?
00:32:53.394 --> 00:32:56.544
Do we, they need to go onto an arthrogram to further review that.
00:32:57.044 --> 00:32:57.434
Right.
00:32:57.934 --> 00:33:04.984
the scenario of emergency medicine, the old trauma scenario, the old trauma x-ray, the chest, x-ray pelvis, and cervical spine.
00:33:05.344 --> 00:33:08.124
I see that more and more being replaced by a rapid CT scan.
00:33:09.114 --> 00:33:09.984
Is that the scenario?
00:33:10.619 --> 00:33:10.979
it is.
00:33:10.979 --> 00:33:11.459
Absolutely.
00:33:11.459 --> 00:33:18.059
Look, we still do, you know, a quick survey because most of the trauma rooms have an x-ray.
00:33:18.614 --> 00:33:31.439
In, built in the resuscitation room, so a quick survey with a lateral C spine, chest x-ray, and pelvic x-ray still does occur because it may help guide a pathway if someone, for example, is.
00:33:31.785 --> 00:33:33.555
Hemodynamically unstable.
00:33:33.975 --> 00:33:38.235
They have a significant pelvic fracture, then you can stabilize that.
00:33:38.235 --> 00:33:52.245
Or if they've had a chest x-ray, they've got a hemothorax, then you'll deal with that in the Resus, help stabilize the patient and absolutely the lateral cervical spine in cases significant distraction injury.
00:33:52.245 --> 00:33:57.664
So all those acute problems can be managed at the bedside, if so to speak, in the resus room.
00:33:57.842 --> 00:34:06.122
Before the patient then goes to have a ct, and of course we only do multi-trauma cts in a stable patient because you don't wanna have an unstable patient in your CT scan.
00:34:06.362 --> 00:34:08.342
It becomes a bit of a challenge for everyone.
00:34:08.342 --> 00:34:12.496
So they're complimentary, like most of things complimentary, but not necessarily being replaced.
00:34:12.496 --> 00:34:19.396
But we are seeing more what you call multi-trauma cts head chest.
00:34:19.440 --> 00:34:24.630
the pelvis and neck, it gives us a lot of information in a short period of time.
00:34:25.411 --> 00:34:29.760
Going back to what I mentioned 20 years ago, one slice cts, five minutes for a CT head.
00:34:29.760 --> 00:34:32.365
There's no way we could have done multi-region cts.
00:34:33.135 --> 00:34:38.775
In a short period of time, it would take two, two hours and for the image reconstruction, now things a lot faster.
00:34:38.956 --> 00:34:46.006
We can get all that information and find out exactly what the pathology is to help then guide the patient management.
00:34:46.006 --> 00:34:48.195
So it's a, it's yeah, crucial.
00:34:48.195 --> 00:34:53.626
The multi-trauma cts, now, it's a bane of our existence 'cause the number of images is significant.
00:34:53.626 --> 00:34:55.516
But it certainly helps for sure.
00:34:56.266 --> 00:34:56.925
Excellent.
00:34:57.256 --> 00:35:01.576
And I'm a young medical student coming through and watching Aussie Med Ed inspired by yourself.
00:35:01.576 --> 00:35:03.706
Speaking today on, on the YouTube.
00:35:04.016 --> 00:35:07.436
what's the pathway of becoming a radiologist in, in Australia?
00:35:07.466 --> 00:35:09.236
How does it actually work from medical school?
00:35:09.951 --> 00:35:10.311
Yeah.
00:35:10.311 --> 00:35:26.932
So the training is a five year program, which is a general radiology program capturing all parts of the body, all modalities, all away from kids It, it captures everything.
00:35:26.932 --> 00:35:30.293
So it's a five year program for those.
00:35:30.302 --> 00:35:36.523
Wanting to do a fellowship or subspecialty, so example, interventional radiology.
00:35:36.523 --> 00:35:38.992
So it might be an extra couple of years on top of that.
00:35:38.992 --> 00:35:44.871
So you could be looking it up to seven years training in radiology to get to where you need to get to.
00:35:45.371 --> 00:35:46.721
And exams along the way.
00:35:47.420 --> 00:35:49.771
Yeah, look, there are long time since I did them.
00:35:49.771 --> 00:35:53.851
Of course it's all changed nowadays, but I think there's a anatomy physics.
00:35:54.351 --> 00:35:56.690
Pathology radio diagnosis.
00:35:56.690 --> 00:36:02.998
There may be some that might be a combination of oral and written exams as well, but I'm not close to the.
00:36:02.998 --> 00:36:08.498
Training program or the exam pathway seems to keep changing and changing for, for, for the good.
00:36:08.498 --> 00:36:14.409
Of course, there's reasons why all education changes as the journey, but yes, absolutely there's certain exams along, the way
00:36:15.028 --> 00:36:17.349
What would be the most rewarding part of being a radiologist, do you think?
00:36:18.349 --> 00:36:30.608
For mine, it's just seeing the patient smile at the end of the bed when for me, for the interventional side of things, when they've had a great outcome and they come back and see you in two years time and say, look, I had a fabulous outcome and I'm just here to have another injection, for example.
00:36:30.608 --> 00:36:32.760
So you get a lot out of that.
00:36:32.889 --> 00:36:35.019
I think that's really rewarding.
00:36:35.500 --> 00:36:50.050
When you get a diagnosis that's crucial to the patient's pathway from the diagnostic space you don't necessarily get that feedback unless you are speaking with your clinical colleagues or they might let you know.
00:36:50.079 --> 00:37:06.596
I had a patient the other night, I was doing a, some reporting on Friday night and had some significant pathology and I luckily managed to Onto the GP after hours, which I was thrilled with, and a patient had, yeah, almost life-threatening pathology or if it wasn't treated, would've become life-threatening.
00:37:07.096 --> 00:37:16.925
And to be able to pass that information on, look at the images, know that that patient was going to get the correct care at a short period of time was, yeah.
00:37:17.016 --> 00:37:19.115
I find that fabulous as well.
00:37:20.166 --> 00:37:32.476
It's interesting, you're saying very similar things that I say about orthopedics as well, and it sounds like the evolving role of the radiologist is becoming more as part of the whole team as opposed to being separate on the sidelines
00:37:32.806 --> 00:37:33.135
Yeah.
00:37:33.195 --> 00:37:33.945
Look it, it is.
00:37:33.945 --> 00:37:34.635
That's right.
00:37:34.635 --> 00:37:40.275
And so we, we keep getting told all the time, and rightly, if you find a significant abnormality.
00:37:41.146 --> 00:37:42.916
Then you need to phone it through.
00:37:43.425 --> 00:37:46.815
And even incidental findings that may or may not be significant, you need to phone it through.
00:37:46.815 --> 00:37:55.045
And so we are always, and more and more moving to that space of becoming primarily involved in the patient's care.
00:37:55.076 --> 00:37:56.965
'cause we just don't want anything to slip through the system.
00:37:56.965 --> 00:37:58.795
We don't want anything to slip through the cracks.
00:37:59.306 --> 00:38:02.565
The MDTs have evolved for sure that.
00:38:03.065 --> 00:38:11.849
It's a multidisciplinary team, and if I look at my role at Flinders, a HCC, hepatocellular carcinoma liver transplant unit.
00:38:11.849 --> 00:38:13.829
And that's obviously what we've got.
00:38:13.829 --> 00:38:21.539
The hepatologist, the surgeons, the radiation oncologist, the oncologist, and that's just grown over the number of years.
00:38:21.539 --> 00:38:26.175
And so we're kind of sitting there in the, in the middle going, right, this is what the imaging is showing.
00:38:27.175 --> 00:38:30.025
This is what the potential treatment pathways might be.
00:38:31.025 --> 00:38:33.394
What do we all think about about this?
00:38:33.394 --> 00:38:40.344
So you're almost like the the chair, but you're not of the meeting because if you don't give the right information, the imaging, the patient's not gonna need the right treatment.
00:38:41.275 --> 00:38:42.474
So it's a really important role.
00:38:43.474 --> 00:38:44.704
it must be very rewarding
00:38:44.849 --> 00:38:46.275
Oh look, it is absolutely, it.
00:38:46.275 --> 00:38:53.514
It gets a bit busy sometimes, but yeah, everyone else speak to, just finds how rewarding those MDTs are and how how reliant they are on RA are in radiology.
00:38:53.514 --> 00:39:06.014
I think over time patient care has significantly improved so that multiple people are giving an opinion and guiding what the pathway of treatment is so the patient gets the right treatment.
00:39:06.014 --> 00:39:07.184
I think that's really important.
00:39:08.168 --> 00:39:08.769
Excellent.
00:39:09.699 --> 00:39:10.449
That's brilliant.
00:39:10.949 --> 00:39:13.759
Well, it's interesting hearing how Radiology's changed.
00:39:13.759 --> 00:39:16.398
Where do you think things will head for the radiologists in the future?
00:39:16.498 --> 00:39:19.949
any extra things that are on the pipeline in radiology in technology.
00:39:20.449 --> 00:39:25.009
Well, interventional spaces always new little tools and tricks and.
00:39:25.744 --> 00:39:29.103
Doing newer procedures that might come around.
00:39:29.554 --> 00:39:35.724
So I think that will continue to grow the minimally invasive treatment pathways.
00:39:36.063 --> 00:39:39.813
We've certainly seen the growth of interventional neuroradiology.
00:39:41.577 --> 00:39:43.418
In the last, 15 years.
00:39:43.418 --> 00:39:53.018
And that's been a, a massive uptick in terms of what can be done neurovascularly by a pinhole essentially.
00:39:53.398 --> 00:39:54.088
That's been really good.
00:39:54.088 --> 00:39:56.038
And there probably some more growth in that space.
00:39:56.728 --> 00:40:04.288
I do a lot of body intervention at work, so kidneys and liver stuff and yeah, we're seeing new treatment pathways.
00:40:04.992 --> 00:40:05.262
As well.
00:40:05.262 --> 00:40:06.673
So I think that's where there'll be some growth.
00:40:06.673 --> 00:40:14.742
And as we talked about earlier, probably AI making things a little bit easier for the diagnostic realm.
00:40:15.282 --> 00:40:23.655
Technology is always going to get a little bit faster, a little bit quicker, and the resolution of images are going to be better.
00:40:23.655 --> 00:40:29.657
So we're going to see the ability to see more parts of the body at a closer level.
00:40:30.157 --> 00:40:34.626
To make it easier to get a diagnosis so I think that's where it's going to to go.
00:40:35.601 --> 00:40:40.041
Yeah, I saw a wrist MRI the other day and I was just in awe how good the quality was
00:40:40.432 --> 00:40:46.746
yeah, you certainly do notice good quality versus a. Suboptimal quality, you notice a difference for sure.
00:40:46.746 --> 00:40:50.197
It makes it very easy for the clinicians to go, well, you know what?
00:40:50.197 --> 00:40:51.996
I can actually see exactly what that looks like.
00:40:51.996 --> 00:40:53.887
And you can picture that in your head.
00:40:53.887 --> 00:40:56.527
If you're doing the operation, you go, well, this is exactly what it's look like.
00:40:56.887 --> 00:40:59.766
And you can cross reference, which is certainly what I do with interventional space.
00:40:59.766 --> 00:41:01.027
I can look at the imaging and go, righto.
00:41:01.356 --> 00:41:02.797
I know exactly where that's gonna be.
00:41:02.797 --> 00:41:07.057
I know exactly what that's gonna look like, and you get that 3D dimensional thing ahead from the images from that.
00:41:07.057 --> 00:41:08.286
So I think that's really helpful.
00:41:08.527 --> 00:41:08.827
For sure.
00:41:09.327 --> 00:41:09.536
Yeah.
00:41:09.626 --> 00:41:10.737
Now showing my age here.
00:41:10.737 --> 00:41:12.987
I remember this new thing that had just been invented called MRI.00:41:13.947 --> 00:41:16.817
And we're talking about how it might influence medicine.00:41:17.186 --> 00:41:18.746
is there anything like that coming out?00:41:18.746 --> 00:41:26.797
Obviously AI is probably the equivalent in that sense, but anything more in investigational that, apart from AI that might be on the horizon?00:41:27.157 --> 00:41:33.157
Yeah, look, I think some molecular imaging getting down to the, the molecular level is probably gonna be where things are.00:41:33.157 --> 00:41:38.586
Further growth in pet scanning, looking at functionality of, of lesions for tumors, for example, the biology of the tumors.00:41:38.586 --> 00:41:40.626
I reckon that's probably where it will, will go.00:41:40.956 --> 00:41:51.016
And we know that some of the newer immunotherapies treatment pathways are being used in conjunction with imaging to then.00:41:51.436 --> 00:41:52.246
Help guide treatment.00:41:52.246 --> 00:42:04.536
So it's gonna be a combination of treatment with current imaging and the molecular stuff I think is probably where it's going to be the, the new bastion, I would've thought, in terms of new technology.00:42:05.536 --> 00:42:06.797
Well, Adam, it's been fantastic.00:42:06.797 --> 00:42:10.266
Having you on tonight on Aussie Med Ed, and thank you very much for giving up your time.00:42:10.487 --> 00:42:12.137
So thank you very much for coming on Aussie Med Ed.00:42:12.916 --> 00:42:13.786
Thanks for having me, Gavin.00:42:13.786 --> 00:42:15.646
It's been a fabulous evening, fabulous discussion.00:42:15.646 --> 00:42:20.307
I hope your listeners get something out of it tonight and I'm happy to help out No problems at all.00:42:20.952 --> 00:42:21.641
No worries.00:42:21.641 --> 00:42:22.541
thanks very much.00:42:22.871 --> 00:42:23.202
Thank you.00:42:23.217 --> 00:42:23.516
Gavin.00:42:24.067 --> 00:42:28.186
Thanks again for listening to the podcast and please subscribe to the podcast for the next episode.00:42:28.577 --> 00:42:30.496
Until then, please stay safe.
