Memorandum by Christopher Wiltshir (PS
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
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.