Select Committee on Health Written Evidence

Memorandum by Christopher Wiltshir (PS 28)



  Given the increasing use of radiological imaging for diagnostic purposes, patient safety is compromised by:

    resort to imaging without due consideration of cumulative effects (para 3)

    lack of adequate staffing for on-call and out-of-hours imaging services (para 4)

    deficiencies in the transmission of images and reports using teleradiology (para 5)

    insufficient regulation of teleradiology reporting services operating outside the UK but reporting the images of UK patients (para 6).


  1.  This evidence is submitted by me as an individual. I serve as the volunteer Chair of the Clinical Radiology Patients' Liaison Group of the Royal College of Radiologists, and am in my fourth year in that role. I have been deeply involved in preparation of the standards for a proposed scheme to accredit imaging services, including discussion of safety standards.

  2.  In the course of my work for the College I have attended many meetings and talked with many patients and staff in both NHS and private providers. While certain aspects of patient safety, such as protecting the patient from harmful doses of ionising radiation in any one scan, are regulated by statute and carefully monitored, other aspects are given less attention. All the following remarks depend on anecdotal evidence because so far no steps have been taken to gather relevant data.

  3.  Imaging technology has developed very rapidly, and makes possible many things which were impossible only a few years ago. One effect of this is a tendency by clinicians to order more imaging investigations. However, the clinicians do not always have a good knowledge of the range of imaging technology and methodology; they do not always have access to the previous imaging record of the patient; and they do not necessarily have the knowledge to recognise the cumulative effect of imaging on the patient. Radiologists do have the relevant knowledge, but often are not consulted, or are too busy to question the request for an investigation. As a result, patients are given scans which increase their exposure to risk, including that of radiation, when a different imaging investigation might provide the necessary information.

  4.  The increasing use of imaging for diagnostic purposes means that imaging services are required on a 24 hour basis. This means that not only must staff be available to take the images, but there must also be qualified staff available to report the images. In many places, it seems, these services are severely restricted on non-existent out of "normal" working hours. In consequence, patients may have to be transferred from one unit to another, or may have to wait a long time for their images to be reported. Services have minimum time targets to meet for emergency reporting, but these are often met by having on call radiologists who have already worked a very long day. It is inevitable that the quality of reporting will suffer, with consequent risk for the patient.

  5.  Teleradiology involves the electronic transmission of images and associated patient data. The benefits to patients of teleradiology are widely agreed. However, current systems for recording, storing and transmitting data are problematic. There is no simple way of associating patient images and other clinical information, so it is possible for the images of different patients to become confused. The systems do not talk to each other easily, so images and reports can be mis-transmitted or lost. The systems do not make it easy for a reporting radiologist to access previous scans on the patient or relevant clinical data. All these problems compromise patient safety.

  6.  Increasing use is made of services based outside the U.K. to report the images of patients based and treated with the U.K., using teleradiology. There are great benefits for patients in this. However, it is important that those outside the U.K. undertaking reporting are subject to the same regulation as those undertaking reporting within the U.K. While all those undertaking reporting in these services must be on the U.K specialist register, this guarantees only their basic qualifications. It is the responsibility of the teleradiology service to ensure that reporting staff maintain their skills and operate at an adequate level. Some of this can be checked using contract mechanisms. However, with revalidation on the horizon for U.K. based staff, greater regulation is needed if public confidence is to be maintained in teleradiology services. I understand that this is also an issue for patient safety in other specialist areas.

C.D. Wiltsher

September 2008

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