September Seminar Report

Advances in Radiology: It's Not All Black and White

If only our eyes were equipped to see more than skin-deep, our examining hands more discriminatory, then many a diagnostic dilemma would be circumvented. Were Mr Roentgen and Ms Curie to teleport to this modern day, perhaps they would be awed by the new stuff, but sentimentally relieved that the humble radiograph is alive and well.

In mid-September, the ACMAV gathered over a hearty nine-course meal at Taipan Restaurant to hear from Drs Anthony Taranto and Paul Lau (FMIG radiologists), and Dr Kean Soon (cardiologist) about less common but increasingly useful imaging techniques. Traditionally, one does not go to a radiologist for surgery, but how things change. Enter magnetic resonance-guided focused ultrasound surgery (MRgFUS) for treating fibroids. Affecting up to 30% of women in reproductive age, fibroids cause a multitude of problems such as pain, menorrhagia, and anaemia. Conventional treatment includes hormonal interference and surgery. With MRgFUS, repetitive ultrasound pulses result in significant fibroid shrinkage with sustained results. It is relatively noninvasive, and has a fast recovery time, but candidate selection is important as not all cases of fibroids are suitable.

Early cancer detection is another area of interest, particularly in the wake of the recent bowel cancer screening program. Colonoscopy is currently the gold standard but clearly has its own drawbacks. Meanwhile, CT colonography may be a viable alternative as it is non-invasive whilst giving the operator real-time 3D images, and has no anaesthetic risk. It is particularly suited to patients who do not have polyps and who have average cancer risk.

Breast cancer affects one in eleven Australian women before the age of 75, and early detection undoubtedly saves lives. Mammography and ultrasound have been the faithful tools for many decades, but are less useful in the denser breasts of younger women. Breast MRI avoids this problem and has a high sensitivity of up to 95%.

Patients presenting with chest pain make up a large proportion of emergency department presentations each year. Given the current burden of coronary heart disease, it is important to correctly identify ischaemic pain yet it is not feasible to subject all patients to invasive tests such as cardiac catheterisation. Cardiac CT is a quick way to determine if there are substantial coronary lesions that require further investigations. It is well suited for screening low to medium risk patients, but not for high-risk patients eg males >60y with other cardiovascular risk factors. It is also unsuitable for patients with chronic renal impairment due to the extensive presence of vascular calcification.

Many thanks to Investec and Future Medical Imaging Group for their generous support, and to Taipan Restaurant for providing an excellent banquet.