As a lung oncologist, without diagnostic imaging I would have no idea of the stage of my patients’ cancer or be able to manage and tailor their care.
Radiology is fundamental to how we detect and stage cancer, and techniques are constantly advancing. Examples include multi-parametric MRI (mpMRI) scanning, which is revolutionising the detection of prostate cancer, and the use of whole-body MRI scanning to identify and treat multiple myeloma (bone marrow cancer).
Despite technical innovations, the UK as a whole lags behind European countries on cancer survival rates and patients are not being diagnosed early enough to get the best treatment.
However, politicians are starting to act. The UK government has made a commitment to diagnosing three quarters of cancers at an early stage by 2028 and next year hospitals in England will have a new target to ensure patients have a cancer diagnosis within 28 days of referral.
Piloting rapid diagnostic centres
NHS England is in the process of scoping the rollout of rapid diagnostic centres, with pilot centres already up and running, which would see patients with vague cancer symptoms scanned quickly after a GP referral. Welsh pilot centres have shown these clinics can detect three times as many cancers as usual diagnostic pathways.
Excitingly for my area of practice, England is piloting targeted lung cancer screening, where patients at risk are called directly for chest CT scans to flag disease. Meanwhile, existing cancer screening programmes are under review, with recommendations to boost services and increase uptake expected imminently.
Attempts to better connect hospitals so scans can be read by available staff are also ongoing, and there are a number of pioneering imaging networks in England and Scotland. However, the implementation of new radiology IT solutions is currently piecemeal and dependent on local hospital impetus.
Government is investing heavily in the commercial development of artificial intelligence (AI) to detect cancer. Research has shown AI has significant promise in spotting lung and breast cancer on scans. When this technology is proven reliable, it will be rapidly rolled out to help patients by prioritising urgent cancer scan results and supporting radiologists as a second pair of eyes.
We also need scanning equipment that is fit for purpose. Older machines break down more frequently and cannot perform modern scans such as prostate mpMRI. Last month, imaging equipment received a welcome boost when the prime minister announced £200 million for new CT, MRI and mammography scanners in England.
Funding is needed for people as well as pilots
But despite topical funding for equipment and innovative pilots, cancer detection will not improve without investment in the vital ingredient: imaging staff.
Complex hospital imaging is increasing in volume by 10 per cent every year, but annual studies by the Royal College of Radiologists show the UK radiologist workforce is expanding at less than half that. Meanwhile, patients are waiting for scan results and hospitals are spending millions outsourcing scans.
Unless we get more expert imaging doctors in the system, by 2023 the NHS will be missing a third of the diagnostic radiologists it needs to detect cancer. There simply won’t be the doctors needed to look at mpMRI scans and spot prostate cancer or staff rapid diagnostic centres and new lung screening services.
There is genuine progress in cancer imaging, from better networked expertise and new centres to fast-track referrals, to the promise of intelligent diagnosis by computer. These innovations are fantastic, but they will only take us so far without the basics. For UK cancer patients to receive the speedy diagnosis and treatment they deserve, we must see sustainable investment in networked hospital imaging and, fundamentally, more radiologists.
