A radiographer's view on the new NICE cancer guidelines
In response to a previous article written by our Clinical Content Editor Dr Hayley Willacy, this month we asked subscribers to our newsletter for healthcare professionals the following question: 'What's your opinion of the new cancer guidelines recently issued by the National Institute for Health and Care Excellence (NICE)?' Here is one of the responses we received, written by a radiographer.
As a radiographer, I understand the need for quicker diagnosis of cancer. I feel that it is important to remember that correct referral for diagnostic testing needs to be made.
Though it is necessary for patients with suspected cancer to be seen quickly there is still a need to be aware of the level of radiation dose a patient receives as one of the major diagnostic tests is CT which is inherently a high-dose test. It is therefore necessary that those requesting scans are requesting the correct test initially in order to minimise the amount of exposure to radiation, as there may be a non-ionising examination which the patient can receive initially as opposed to a scan which involves radiation. Once this initial diagnosis is made the patient will then be referred for staging which will involve the use of contrast-enhanced CT in most cases and possibly the use of MRI for certain types of cancer.
Therefore it is important that the referrer of the diagnostic tests refer to the guidance available from the Royal College of Radiologists either via the text, 'Making Best use of a Radiology Department' or by using the online guide iRefer which both provide guidance on the best diagnostic imaging to use and for which symptoms. This will therefore take into account both ALARP (As Low As Reasonably Possible) principles and IR(ME)R 2000/2006 [Ionising Radiation (Medical Exposure) Regulations] and will help minimise dose creep.
At the end of the day, staff and radiology departments within both the NHS and private sector are stretched to provide diagnostic imaging to the current workload. For example, the department where I work are carrying up to 80 CT scans per day on both inpatient and outpatients (between the hours of 8am - 8pm) 7 days a week, plus providing 24/7 emergency coverage in addition. Therefore, an increase in demand for imaging will require an increase in both staff and facilities, which will mean an increase in overall costs (in terms of further radiographers, radiologists and support staff) will be required to cover this additional level of work, and so further increase in funding will be required in order to facilitate not only quicker imaging but also reporting of the images, as the imaging generated from said diagnostic tests are useless without the reports.
As has already been highlighted by both the RCR and Society of Radiographers, and acknowledged by government, there is currently a shortfall of both radiologists and radiographers (with radiographers being on the skills shortage list alongside nurses and other allied health professionals). Therefore, without the correct investment in staff and equipment, the result will be delays in the diagnosis of other conditions which rely upon imaging to provide diagnosis (eg, dementia/Alzheimer's, stroke and rheumatology to name but a few), which will lead to increased delays and anxiety both for patients and their families.
Ian Jones - BSc (Hons) Radiography