Westmead Private Hospital & Westmead Public Hospital, Sydney
The burgeoning development of new computer applications and increased funding from venture capitalists has lead to an explosion of new innovations in radiology and interventional radiology.
The articles in this edition of Cancer Forum cover many of the new developments. Importantly, in terms of breadth of new developments this volume is ‘barely scraping the surface’ so to speak.
Radiology and especially interventional radiology continues to expand its role in diagnosis and follow-up in cancer patients. Minimally invasive image-guided therapies have developed increasing importance as a modality of treatment.
Annually in Australia, about 80,000 people are diagnosed with an aggressive form of cancer. We know that the incidence of cancer is increasing and this generates more responsibility and an increased workload for both diagnostic and interventional radiologists.
We have assembled an expert panel of radiologists to discuss the evolution, and in some instances, revolution, in cancer imaging.
Rathan Subramaniam and Murali Guduguntla highlight the role played by the higher field strength MRI scanners and discusses in depth their application in various oncological scenarios.
It is of little use having sophisticated CT and MRI scanners for diagnosis and management of chemotherapy patients if it is difficult to administer the chemotherapeutic agents effectively. With an ever increasing workload and longer waiting lists, our surgical colleagues have found it increasingly difficult to place venous access devices. Additionally, this takes no account of other logistical problems such as hospital bed shortages. Therefore insertion of venous access devices, especially chest and brachial ports have become a procedure performed by the interventional radiologist. It neither requires hospital admission nor general anaesthesia. Stuart Lyons’ article reviews the management of the ports and explains why they malfunction. He has included an extensive list of references in his bibliography.
The management of pain, once entirely the domain of a pain or anaesthetic specialist has also become part of the daily workload of the interventional radiologist. Clearly, the interventional radiologist is now a member of the multi-disciplinary oncological team. Glen Schlaphoff describes ‘cementoplasty’ which is a procedure used for treating bone pain in patients with metastatic bone disease. Not only does cementoplasty stabilise and strengthen the weakened bone, in some instances it will immediately alleviate pain because the heat of the bone cement can destroy the sensory fibres.
Palliative care has advanced considerably and performs an admirable task in caring for the terminally ill patient. But obviously there is ongoing demand for novel cancer therapies, many of which will be developed by other members of the multi-disciplinary team. Your editor has contributed an article to this edition of Cancer Forum, detailing how the interventional radiologist can assist in bettering the quality of life of the terminally ill patient with intractable ascites. The paper describes the image-guided placement of peritoneal ports in the radiology department. This allows the palliative care nursing team to aspirate the ascites with the patient at home; obviating the need for frequent visits to the radiological department for paracentesis.
The papers presented may seem esoteric to some clinicians and radiologists who have become comfortable with the concept that radiology is purely a diagnostic tool. This truism is no longer valid. This edition of Cancer Forum dispels that and shows the road ahead – radiology offering diagnostic and therapeutic services.
It is hoped that the articles provide two benefits for the reader. Firstly, to reflect upon and admire the speed and breadth of development within diagnostic and interventional radiology. But probably more importantly, to act as a springboard for curious minds such that they might follow the lead and contribute to improving the management of cancer.