My specialist training was in basic, standard radiology, understanding the subtleties of a chest X-ray, how the image relates to anatomy and pathology. Understanding the physics of the shadow pictures before me. I was taught to observe carefully, analyse and deduce, and come to a diagnosis based on what I saw. I have taught this approach for over 35 years. I see the work of the radiologist as an intellectual challenge. Inevitably progress has occurred. When I started, CT (head) scanning and ultrasound techniques were in their infancy and it was exciting playing with these new images and working out from first principles what they mean. Cross sectional imaging; CT body scanning and Magnetic Resonance (MRI) were unheard of. Trainees now have a huge range of technology to call upon, all are expensive. Cross sectional imaging provides such direct access to information about internal structures of the body. It has replaced many of the “old” techniques. Many contrast methods used until relatively recently have simply disappeared, and with that disappearance a lot of the associated pain and patient discomfort related to the investigation have gone too. I rejoice in that.
Progress, however comes with some retrogression. Simple plain radiography is being ignored in favour of more high-falutin’ techniques. A good example is diagnosis of pneumonia; this is a disease that can be diagnosed clinically, and only needs a simple X-ray to confirm the diagnosis. Nevertheless the default investigation more frequently now is a CT scan delivering considerably more radiation and taking more time to interpret. The images are obvious and there is little skill in interpretation. Our trainees are becoming deskilled in plain X-ray interpretation and in diagnostic deduction. I mourn the loss of this skill, and in the long run I worry that we are delivering greater and greater doses of X-radiation to our population.
This image of a man with an easily diagnosed tumour in the lung is more than 50% hidden behind the grey curtain which looks like etched galvanised steel.