The Radiology department and the services they provide play an integral, and ever increasing, role in the diagnosis and management of patients that pass through a hospitals door. This is reflected in national statistics that show each year the number of Radiological examinations performed increases by at least 5%. It is also known that over 80% of patients shall require the services of the Radiology department at some point in their care pathway. These services include the likes of X-Ray, CT, MRI, Ultrasound, Fluoroscopy, Interventional Radiology, PET/CT and Nuclear Medicine.
Given the role of Radiology in so many different patient journeys it would seem logical for there to be a role for it to play in any research looking at the diagnosis, treatment or management of these patients and their disease. This is true at least in that we have, and are, involved in a wide range of research Trials looking into a variety of diseases or conditions and their treatment.
So what do we actually do for research trials?
Diagnostic imaging investigations are utilised in a number of ways by research studies. It may be that for a patient to be eligible for a trial that they must have a confirmed diagnosis. In this circumstance a scan, X-Ray or other investigation may be performed at the screening stage to confirm the patient is eligible to be enrolled onto the study. In the same manner it is also quite common for imaging to be performed at the screening phase to rule out the patient having certain exclusion criteria. In a similar way occasionally Radiological examinations may be used towards the end of a study to ensure that a known side effect of a study treatment hasn’t caused an untoward effect.
Imaging is also used during a wide range of surgical procedures to give the surgeon detailed and real time information and guidance during the procedure. As such Radiology can often be involved in research studies that are looking at new surgical procedures or devices. Aside from just producing images; the Radiology Department are also involved in providing a range of therapies and interventional procedures, and are often involved in studies looking directly at these. An example of this would be a cancer trial comparing various cancer treatments to some of the procedures we perform in Interventional Radiology, where we use imaging guidance to deliver therapies directly into a tumour.
Probably the most common use for Imaging in research is as a consistent, unbiased, and reproducible tool, to track and evaluate the response in a patient’s body to a particular drug or treatment. A prime example of this would be a cancer trial where we would perform a baseline scan at the start of a trial and take measurements of the patient’s tumour/s. Then at periodic intervals, or perhaps just the end of the treatment period we shall repeat the scan and measure and compare the patient’s response to the treatment.
Despite seeing a small drop in the overall number of research examinations we performed in the last year, as you can see from the graph below we still show research activity across all Imaging Modalities. Even with the reduction in numbers this last year, it still means we are performing on average 10-15 research examinations each week.
Our department also act as a central review service for a small number of international research trials. What this means is if one of the other research sites believe they have found an eligible patient, they send a copy of their patients scan to us and within a very short time frame one of a team of our Radiologists shall sit down with another member of the lead study team and review the patients scan and confirm the patient is indeed eligible for the trial.
Our trust is fortunate to have access to a wide range of specialist radiological services. Where a neighbouring hospital identify a research Trial that they feel would benefit their patients, but do not have access to some of the Radiological examinations or procedures that are required, we have systems in place for the two trusts to collaborate and they can gain access the radiological services they require for the study.
Aside from simply just undertaking and reporting on the research examinations we also help support the local study team and RD&I through the set-up phase of a trial. The legislation that governs the safe use of radiation in medicine (IR(ME)R 2000) sets out specific requirements that each site must undertake for all research studies that involve exposing patients to radiation. As such each of these studies has to go through a formal review and approval process by the Radiology Department. Apart from just fulfilling our legal obligations, this review also ensures that we have both the capability and capacity to undertake the Radiology components of the study at our trust. As well as to engage at an early stage with the study team, to discuss the logistical challenges that may have to be overcome to ensure that the study runs smoothly at our site.
But what research do RADIOLOGY do?
We currently have 7 active and recruiting studies where a Radiologist is the Principal Investigator. With another 3 studies that are in set-up and are due to open imminently and another 3-4 projects still at an early planning phase. In addition to these there are many other studies where a Radiologist is a Co-Investigator on the study team, for studies being led by other Departments.
The types of study we are involved in locally include:
- Studies exploring the efficacy and role of specific types of imaging involved in the management of cancer.
- Studies exploring the safety and efficacy of various intravascular medical devices used in Interventional Radiology to treat a range of medical conditions.
- Studies exploring the efficacy of various Cancer therapies offered via both Interventional Theatres and Nuclear Medicine.
In summary we are a large department with a wide range of specialist interests and services. We are keen to be involved in any research projects that may offer benefit to the patients we serve. We will wherever possible seek to engage with any departments or research teams that require Radiology support as part of their research trial.