{"version":"1.0.0","segments":[{"startTime":0.21,"endTime":1.92,"body":"- Today's lecture really"},{"startTime":1.92,"endTime":4.56,"body":"is about imaging in a very broad context,"},{"startTime":4.56,"endTime":6.87,"body":"looking at why there's been"},{"startTime":4.56,"endTime":6.87,"body":"such a massive increase"},{"startTime":6.87,"endTime":9.06,"body":"in demand in imaging in recent years,"},{"startTime":9.06,"endTime":11.67,"body":"whether we're using our"},{"startTime":9.06,"endTime":11.67,"body":"resources in the right way,"},{"startTime":11.67,"endTime":15.3,"body":"and if we keep on doing so,"},{"startTime":11.67,"endTime":15.3,"body":"what the future will look like."},{"startTime":15.3,"endTime":17.4,"body":"So this is a controversial question."},{"startTime":17.4,"endTime":21.0,"body":"Have we become too reliant"},{"startTime":17.4,"endTime":21.0,"body":"on medical imaging?"},{"startTime":21.0,"endTime":23.28,"body":"So what I'm going to talk"},{"startTime":21.0,"endTime":23.28,"body":"about is what imaging is,"},{"startTime":23.28,"endTime":25.56,"body":"how we currently employ"},{"startTime":23.28,"endTime":25.56,"body":"it in different ways"},{"startTime":25.56,"endTime":27.48,"body":"in terms of diagnosis, screening,"},{"startTime":27.48,"endTime":29.64,"body":"and treatment, why it's so important"},{"startTime":29.64,"endTime":31.17,"body":"to be doing those things,"},{"startTime":31.17,"endTime":34.8,"body":"but what the relative"},{"startTime":31.17,"endTime":34.8,"body":"risks are of over scanning"},{"startTime":34.8,"endTime":36.12,"body":"or under scanning,"},{"startTime":36.12,"endTime":38.01,"body":"and whether we've learned anything at all"},{"startTime":38.01,"endTime":39.543,"body":"from the COVID pandemic?"},{"startTime":40.71,"endTime":43.62,"body":"Some of you may be familiar"},{"startTime":40.71,"endTime":43.62,"body":"with normal x-rays."},{"startTime":43.62,"endTime":46.08,"body":"This is a chest x-ray to"},{"startTime":43.62,"endTime":46.08,"body":"look at the heart and lungs,"},{"startTime":46.08,"endTime":47.763,"body":"and an ultrasound scan,"},{"startTime":47.763,"endTime":50.76,"body":"this is a gallstone within a gallbladder."},{"startTime":50.76,"endTime":52.59,"body":"Some of you may not be"},{"startTime":50.76,"endTime":52.59,"body":"aware that we now use"},{"startTime":52.59,"endTime":54.72,"body":"much more advanced imaging techniques,"},{"startTime":54.72,"endTime":57.45,"body":"particularly with contrast being"},{"startTime":54.72,"endTime":57.45,"body":"swallowed on a chest x-ray,"},{"startTime":57.45,"endTime":59.64,"body":"for example, to look at the esophagus."},{"startTime":59.64,"endTime":64.64,"body":"There's a CT scan of an appendix,"},{"startTime":59.64,"endTime":64.64,"body":"a brain tumor on an MRI,"},{"startTime":65.01,"endTime":67.23,"body":"and we're now doing even"},{"startTime":65.01,"endTime":67.23,"body":"more advanced techniques"},{"startTime":67.23,"endTime":70.86,"body":"looking at glucose, delivery"},{"startTime":67.23,"endTime":70.86,"body":"on a PET scan in the brain,"},{"startTime":70.86,"endTime":73.95,"body":"and even more specific"},{"startTime":70.86,"endTime":73.95,"body":"targeted molecular imaging"},{"startTime":73.95,"endTime":75.48,"body":"in the liver."},{"startTime":75.48,"endTime":77.82,"body":"So as a quick show of hands,"},{"startTime":75.48,"endTime":77.82,"body":"how many of you actually"},{"startTime":77.82,"endTime":80.703,"body":"have had any form of imaging"},{"startTime":77.82,"endTime":80.703,"body":"at all in your lives?"},{"startTime":82.41,"endTime":84.0,"body":"Interesting, almost everyone."},{"startTime":84.0,"endTime":87.0,"body":"And that tells you a little"},{"startTime":84.0,"endTime":87.0,"body":"bit about how we use imaging."},{"startTime":87.0,"endTime":89.31,"body":"Even the young people who"},{"startTime":87.0,"endTime":89.31,"body":"didn't put their hands up"},{"startTime":89.31,"endTime":90.9,"body":"have actually inadvertently probably"},{"startTime":90.9,"endTime":93.75,"body":"still been imaged before they were born."},{"startTime":93.75,"endTime":96.48,"body":"'Cause in the 1980s we"},{"startTime":93.75,"endTime":96.48,"body":"started ubiquitous scanning"},{"startTime":96.48,"endTime":97.593,"body":"during pregnancy."},{"startTime":98.46,"endTime":100.41,"body":"Here you can see ultrasound"},{"startTime":100.41,"endTime":102.993,"body":"and there's clearly a fetus there."},{"startTime":104.7,"endTime":105.84,"body":"We can talk a little bit"},{"startTime":105.84,"endTime":108.9,"body":"about the historical"},{"startTime":105.84,"endTime":108.9,"body":"developments that have happened,"},{"startTime":108.9,"endTime":112.35,"body":"but really not much has"},{"startTime":108.9,"endTime":112.35,"body":"happened in the last 40 years"},{"startTime":112.35,"endTime":114.9,"body":"or so since CT and MR was invented,"},{"startTime":114.9,"endTime":117.81,"body":"apart from a massive"},{"startTime":114.9,"endTime":117.81,"body":"expansion of availability."},{"startTime":117.81,"endTime":119.67,"body":"So most hospitals now have almost"},{"startTime":119.67,"endTime":123.33,"body":"all of these techniques available"},{"startTime":119.67,"endTime":123.33,"body":"there at their practice."},{"startTime":123.33,"endTime":124.95,"body":"I'm not sure if we're quite at the point"},{"startTime":124.95,"endTime":128.55,"body":"where we're able to diagnose"},{"startTime":124.95,"endTime":128.55,"body":"things on iPhones, nearly,"},{"startTime":128.55,"endTime":130.26,"body":"and I dunno whether"},{"startTime":128.55,"endTime":130.26,"body":"we're quite at the point"},{"startTime":130.26,"endTime":131.85,"body":"where we're scanning and showing people"},{"startTime":131.85,"endTime":133.92,"body":"what they see on iPhones."},{"startTime":133.92,"endTime":136.62,"body":"But what I'd like to suggest"},{"startTime":133.92,"endTime":136.62,"body":"to you is by some of the images"},{"startTime":136.62,"endTime":138.12,"body":"that I show you and some of the things"},{"startTime":138.12,"endTime":139.71,"body":"that you're familiar with, or not,"},{"startTime":139.71,"endTime":142.02,"body":"this evening, is you should"},{"startTime":139.71,"endTime":142.02,"body":"try and ask yourself,"},{"startTime":142.02,"endTime":145.26,"body":"are these essential healthcare"},{"startTime":145.26,"endTime":148.53,"body":"or are these luxuries and nice to have?"},{"startTime":148.53,"endTime":150.93,"body":"So for example, screening during pregnancy"},{"startTime":150.93,"endTime":153.33,"body":"to pick up any complications"},{"startTime":150.93,"endTime":153.33,"body":"in the baby or the mother"},{"startTime":153.33,"endTime":155.31,"body":"is clearly quite sensible"},{"startTime":155.31,"endTime":157.68,"body":"and an advisable screening program."},{"startTime":157.68,"endTime":162.18,"body":"This is a four dimensional"},{"startTime":157.68,"endTime":162.18,"body":"scan of a baby's face"},{"startTime":162.18,"endTime":163.44,"body":"and we can do that through time,"},{"startTime":163.44,"endTime":165.93,"body":"showing how the baby moves in utero."},{"startTime":165.93,"endTime":169.38,"body":"Is that essential imaging that"},{"startTime":165.93,"endTime":169.38,"body":"the NHS should be supporting"},{"startTime":169.38,"endTime":171.54,"body":"and is that best use of our resources,"},{"startTime":171.54,"endTime":175.71,"body":"or is that nice to have and"},{"startTime":171.54,"endTime":175.71,"body":"reassuring for the parent?"},{"startTime":175.71,"endTime":177.723,"body":"And this is where the dilemma comes."},{"startTime":178.83,"endTime":179.663,"body":"So there's no doubt at all"},{"startTime":179.663,"endTime":182.01,"body":"that medical imaging improves healthcare."},{"startTime":182.01,"endTime":182.843,"body":"You will all have had a scan,"},{"startTime":182.843,"endTime":185.46,"body":"you all have benefited from"},{"startTime":182.843,"endTime":185.46,"body":"it in one way or another."},{"startTime":185.46,"endTime":188.16,"body":"And radiology now is part of almost"},{"startTime":188.16,"endTime":191.16,"body":"every diagnostic pathway"},{"startTime":188.16,"endTime":191.16,"body":"in every specialty."},{"startTime":191.16,"endTime":194.22,"body":"Rapid access to that"},{"startTime":191.16,"endTime":194.22,"body":"imaging is really the key."},{"startTime":194.22,"endTime":196.65,"body":"So if you are unfortunate"},{"startTime":194.22,"endTime":196.65,"body":"enough to trip and you think"},{"startTime":196.65,"endTime":199.17,"body":"you might have fractured"},{"startTime":196.65,"endTime":199.17,"body":"a bone in your ankle,"},{"startTime":199.17,"endTime":202.41,"body":"getting to A\u0026E, getting"},{"startTime":199.17,"endTime":202.41,"body":"an X-ray is the key part"},{"startTime":202.41,"endTime":205.3,"body":"to triaging whether or not"},{"startTime":202.41,"endTime":205.3,"body":"you have had a fracture"},{"startTime":206.167,"endTime":207.78,"body":"or not and what you should do about it."},{"startTime":207.78,"endTime":209.61,"body":"Alright, it might take"},{"startTime":207.78,"endTime":209.61,"body":"several hours in A\u0026E,"},{"startTime":209.61,"endTime":210.75,"body":"but there we are."},{"startTime":210.75,"endTime":213.0,"body":"You will leave either with a cast or not"},{"startTime":213.0,"endTime":214.98,"body":"and you will have been"},{"startTime":213.0,"endTime":214.98,"body":"managed appropriately."},{"startTime":214.98,"endTime":217.293,"body":"And we know that for"},{"startTime":214.98,"endTime":217.293,"body":"things like stroke imaging,"},{"startTime":217.293,"endTime":220.08,"body":"that time it takes for you to get a scan"},{"startTime":220.08,"endTime":223.11,"body":"is one of the best predictors"},{"startTime":220.08,"endTime":223.11,"body":"of what the outcome will be."},{"startTime":223.11,"endTime":226.44,"body":"So rapid access to that imaging"},{"startTime":223.11,"endTime":226.44,"body":"to tell you what's happened"},{"startTime":226.44,"endTime":229.08,"body":"inside the body is a really good predictor"},{"startTime":229.08,"endTime":230.94,"body":"of how well you will do afterwards."},{"startTime":230.94,"endTime":233.19,"body":"And I'm going to talk"},{"startTime":230.94,"endTime":233.19,"body":"a little bit more about"},{"startTime":234.339,"endTime":236.73,"body":"the importance of early"},{"startTime":234.339,"endTime":236.73,"body":"diagnosis in terms of cancer,"},{"startTime":236.73,"endTime":238.38,"body":"and then monitoring and surveillance"},{"startTime":238.38,"endTime":241.38,"body":"and a little bit of the"},{"startTime":238.38,"endTime":241.38,"body":"softer side of imaging"},{"startTime":241.38,"endTime":244.143,"body":"and how we use that in current practice."},{"startTime":245.7,"endTime":247.44,"body":"So what is medical imaging?"},{"startTime":247.44,"endTime":248.97,"body":"You'll be used to thinking"},{"startTime":248.97,"endTime":253.62,"body":"that actually what you"},{"startTime":248.97,"endTime":253.62,"body":"need is a complex scanner."},{"startTime":253.62,"endTime":256.143,"body":"First you need the scanner,"},{"startTime":253.62,"endTime":256.143,"body":"at significant cost."},{"startTime":258.69,"endTime":261.39,"body":"Excuse me, you need much"},{"startTime":258.69,"endTime":261.39,"body":"more than just a scanner."},{"startTime":261.39,"endTime":263.67,"body":"You need highly trained technicians,"},{"startTime":263.67,"endTime":267.45,"body":"sonographers and radiographers"},{"startTime":263.67,"endTime":267.45,"body":"to run that scanner."},{"startTime":267.45,"endTime":269.76,"body":"And then radiologists to be able to advise"},{"startTime":269.76,"endTime":272.613,"body":"on who's best to be scanned"},{"startTime":269.76,"endTime":272.613,"body":"and to interpret the images."},{"startTime":273.45,"endTime":276.9,"body":"They're supported of"},{"startTime":273.45,"endTime":276.9,"body":"course by a big admin team"},{"startTime":276.9,"endTime":278.37,"body":"who are making sure that you get"},{"startTime":278.37,"endTime":281.49,"body":"the right appointment at the right time,"},{"startTime":281.49,"endTime":283.86,"body":"physics support to make"},{"startTime":281.49,"endTime":283.86,"body":"sure the scanner runs,"},{"startTime":283.86,"endTime":285.57,"body":"there's a governance aspect, all of that."},{"startTime":285.57,"endTime":287.37,"body":"And then people to help make sure"},{"startTime":287.37,"endTime":289.8,"body":"that you get the right scan appropriately."},{"startTime":289.8,"endTime":292.08,"body":"You might need"},{"startTime":289.8,"endTime":292.08,"body":"anesthetizing for your scan."},{"startTime":292.08,"endTime":293.46,"body":"So there's a whole team of people."},{"startTime":293.46,"endTime":295.92,"body":"So even though you might"},{"startTime":293.46,"endTime":295.92,"body":"only see one person"},{"startTime":295.92,"endTime":297.9,"body":"when you go to hospital for a scan,"},{"startTime":297.9,"endTime":300.84,"body":"there's a whole team of people"},{"startTime":297.9,"endTime":300.84,"body":"making sure that everything"},{"startTime":300.84,"endTime":304.02,"body":"that happens to you is"},{"startTime":300.84,"endTime":304.02,"body":"as correct as it can be."},{"startTime":304.02,"endTime":307.02,"body":"And there are entire"},{"startTime":304.02,"endTime":307.02,"body":"departments now in hospitals."},{"startTime":307.02,"endTime":308.19,"body":"So radiology department"},{"startTime":308.19,"endTime":310.68,"body":"is being redeveloped in"},{"startTime":308.19,"endTime":310.68,"body":"a hospital in Sweden."},{"startTime":310.68,"endTime":313.68,"body":"You can see that in fact"},{"startTime":310.68,"endTime":313.68,"body":"there are specialist areas now"},{"startTime":313.68,"endTime":316.14,"body":"for CT scanners, MRI scanners,"},{"startTime":316.14,"endTime":319.35,"body":"ultrasound scanners, and making"},{"startTime":316.14,"endTime":319.35,"body":"sure that the patient flow"},{"startTime":319.35,"endTime":322.323,"body":"through these departments"},{"startTime":319.35,"endTime":322.323,"body":"is as easy as possible."},{"startTime":323.94,"endTime":327.39,"body":"What is becoming too reliant on something?"},{"startTime":327.39,"endTime":329.67,"body":"So part of the initial question,"},{"startTime":327.39,"endTime":329.67,"body":"too reliant on something,"},{"startTime":329.67,"endTime":331.29,"body":"like to me it sort of means,"},{"startTime":331.29,"endTime":334.113,"body":"you are unable to continue without it."},{"startTime":334.95,"endTime":336.69,"body":"So we need to think a little bit about"},{"startTime":336.69,"endTime":340.53,"body":"what are the risks of not"},{"startTime":336.69,"endTime":340.53,"body":"scanning enough, under imaging,"},{"startTime":340.53,"endTime":343.53,"body":"and what are the risks"},{"startTime":340.53,"endTime":343.53,"body":"of scanning too much,"},{"startTime":343.53,"endTime":345.09,"body":"or over imaging?"},{"startTime":345.09,"endTime":347.1,"body":"Well, not scanning enough is clearly bad,"},{"startTime":347.1,"endTime":350.01,"body":"we would make mistakes,"},{"startTime":347.1,"endTime":350.01,"body":"we would miss diagnosis."},{"startTime":350.01,"endTime":351.87,"body":"That would be bad for the patient,"},{"startTime":351.87,"endTime":353.73,"body":"either in terms of"},{"startTime":351.87,"endTime":353.73,"body":"completely missing things"},{"startTime":353.73,"endTime":355.38,"body":"or delays in treatment,"},{"startTime":355.38,"endTime":357.21,"body":"and that would be bad for the doctor,"},{"startTime":357.21,"endTime":359.703,"body":"and they get worried about missing things."},{"startTime":360.87,"endTime":363.27,"body":"So is every scan necessary?"},{"startTime":363.27,"endTime":364.98,"body":"Can we over scan?"},{"startTime":364.98,"endTime":366.6,"body":"Can we over image?"},{"startTime":366.6,"endTime":367.62,"body":"Well actually, if we're scanning"},{"startTime":367.62,"endTime":368.97,"body":"where there's no clinical benefit"},{"startTime":368.97,"endTime":371.04,"body":"and it makes no difference to you,"},{"startTime":371.04,"endTime":374.1,"body":"then actually we haven't"},{"startTime":371.04,"endTime":374.1,"body":"helped in your pathway."},{"startTime":374.1,"endTime":375.15,"body":"We might have exposed you"},{"startTime":375.15,"endTime":377.7,"body":"to a small amount of"},{"startTime":375.15,"endTime":377.7,"body":"radiation unnecessarily,"},{"startTime":377.7,"endTime":380.79,"body":"and actually incidental findings"},{"startTime":377.7,"endTime":380.79,"body":"are becoming a big problem,"},{"startTime":380.79,"endTime":383.13,"body":"and I'll touch on on this later."},{"startTime":383.13,"endTime":385.83,"body":"What we're effectively"},{"startTime":383.13,"endTime":385.83,"body":"doing by over scanning"},{"startTime":385.83,"endTime":387.33,"body":"is clogging up the system,"},{"startTime":387.33,"endTime":389.25,"body":"scanning patients unnecessarily,"},{"startTime":389.25,"endTime":391.08,"body":"and what that does is"},{"startTime":389.25,"endTime":391.08,"body":"generate waiting lists,"},{"startTime":391.08,"endTime":392.984,"body":"and you'll all have heard a little bit"},{"startTime":392.984,"endTime":395.19,"body":"about waiting lists in the media recently,"},{"startTime":395.19,"endTime":397.56,"body":"and I'll explain to"},{"startTime":395.19,"endTime":397.56,"body":"you why they are so big"},{"startTime":397.56,"endTime":399.84,"body":"and what we're going to"},{"startTime":397.56,"endTime":399.84,"body":"try and do about them."},{"startTime":399.84,"endTime":401.55,"body":"So the radiologist historically"},{"startTime":401.55,"endTime":404.01,"body":"was a bit like Gandalf"},{"startTime":401.55,"endTime":404.01,"body":"in \"Lord of the Rings\"."},{"startTime":404.01,"endTime":407.25,"body":"They were the gatekeepers"},{"startTime":404.01,"endTime":407.25,"body":"of who accessed imaging."},{"startTime":407.25,"endTime":408.083,"body":"In fact, 20,"},{"startTime":408.083,"endTime":409.92,"body":"30 years ago when when I was in training,"},{"startTime":409.92,"endTime":411.81,"body":"the radiologist was very much like this,"},{"startTime":411.81,"endTime":415.08,"body":"stopping a lot of unnecessary"},{"startTime":411.81,"endTime":415.08,"body":"scanning going ahead."},{"startTime":415.08,"endTime":418.23,"body":"I think the expansion"},{"startTime":415.08,"endTime":418.23,"body":"of imaging availability"},{"startTime":418.23,"endTime":421.02,"body":"really means that we've"},{"startTime":418.23,"endTime":421.02,"body":"relaxed that a little bit,"},{"startTime":421.02,"endTime":423.72,"body":"and I think now a lots"},{"startTime":421.02,"endTime":423.72,"body":"of scans are happening"},{"startTime":423.72,"endTime":425.643,"body":"where they might be unnecessary."},{"startTime":427.14,"endTime":428.97,"body":"How many scans do we do?"},{"startTime":428.97,"endTime":431.04,"body":"How big is this problem?"},{"startTime":431.04,"endTime":431.91,"body":"So can you believe"},{"startTime":431.91,"endTime":435.09,"body":"that we do 43 million"},{"startTime":431.91,"endTime":435.09,"body":"radiological procedures"},{"startTime":435.09,"endTime":436.77,"body":"a year in the NHS?"},{"startTime":436.77,"endTime":440.28,"body":"That's 120,000 scans a day,"},{"startTime":440.28,"endTime":443.013,"body":"and that's increasing by"},{"startTime":440.28,"endTime":443.013,"body":"about a million per year."},{"startTime":444.18,"endTime":445.86,"body":"So these figures are quite interesting"},{"startTime":445.86,"endTime":449.01,"body":"because the demand for"},{"startTime":445.86,"endTime":449.01,"body":"CT and the demand for MRI"},{"startTime":449.01,"endTime":452.85,"body":"has doubled in about a"},{"startTime":449.01,"endTime":452.85,"body":"six or seven year period."},{"startTime":452.85,"endTime":454.74,"body":"So the biggest problem for us is that now"},{"startTime":454.74,"endTime":457.14,"body":"that demand outstrips our capacity"},{"startTime":457.14,"endTime":458.883,"body":"to be able to supply that demand."},{"startTime":460.26,"endTime":461.7,"body":"So if you look at how things"},{"startTime":461.7,"endTime":465.24,"body":"have changed even from 2012 to 2018,"},{"startTime":465.24,"endTime":467.52,"body":"whilst the majority of what"},{"startTime":465.24,"endTime":467.52,"body":"we scan here at the bottom"},{"startTime":467.52,"endTime":470.79,"body":"in the blue is x-rays and"},{"startTime":467.52,"endTime":470.79,"body":"the dark blue is ultrasound,"},{"startTime":470.79,"endTime":472.8,"body":"this middle part, CT and MRI,"},{"startTime":472.8,"endTime":475.29,"body":"more complex imaging techniques,"},{"startTime":475.29,"endTime":478.83,"body":"has also grown massively"},{"startTime":475.29,"endTime":478.83,"body":"over that time period,"},{"startTime":478.83,"endTime":480.45,"body":"and by about a million a year."},{"startTime":480.45,"endTime":483.33,"body":"So that's about 8 million more scans."},{"startTime":483.33,"endTime":486.03,"body":"Who are all these people we're scanning?"},{"startTime":486.03,"endTime":488.43,"body":"They're you, as you said at the beginning."},{"startTime":488.43,"endTime":489.45,"body":"But why are we doing it?"},{"startTime":489.45,"endTime":492.27,"body":"Where does imaging fit"},{"startTime":489.45,"endTime":492.27,"body":"to the patient pathway?"},{"startTime":492.27,"endTime":494.64,"body":"And actually, imaging now"},{"startTime":492.27,"endTime":494.64,"body":"fits in almost everywhere"},{"startTime":494.64,"endTime":495.87,"body":"at every step."},{"startTime":495.87,"endTime":498.57,"body":"So in terms of if you have"},{"startTime":495.87,"endTime":498.57,"body":"risk factors for a disease"},{"startTime":498.57,"endTime":500.64,"body":"or we think that there might be a purpose"},{"startTime":500.64,"endTime":503.49,"body":"in early detection, that's"},{"startTime":500.64,"endTime":503.49,"body":"effectively screening,"},{"startTime":503.49,"endTime":506.13,"body":"and we screen for diseases using imaging."},{"startTime":506.13,"endTime":508.29,"body":"We use imaging to diagnose disease"},{"startTime":508.29,"endTime":510.477,"body":"and we use the same imaging to prognose"},{"startTime":510.477,"endTime":513.75,"body":"and to say how well you're"},{"startTime":510.477,"endTime":513.75,"body":"going to do as a result."},{"startTime":513.75,"endTime":515.19,"body":"We use imaging a lot in treatment,"},{"startTime":515.19,"endTime":516.99,"body":"and you may not be aware"},{"startTime":515.19,"endTime":516.99,"body":"of all the advances"},{"startTime":516.99,"endTime":519.6,"body":"in interventional radiology"},{"startTime":516.99,"endTime":519.6,"body":"that have been there."},{"startTime":519.6,"endTime":522.09,"body":"And we now use imaging"},{"startTime":519.6,"endTime":522.09,"body":"to see how successful"},{"startTime":522.09,"endTime":525.6,"body":"the treatment has been"},{"startTime":522.09,"endTime":525.6,"body":"and to survey on whether"},{"startTime":525.6,"endTime":526.53,"body":"or not the treatment has worked"},{"startTime":526.53,"endTime":528.933,"body":"and whether or not disease has returned."},{"startTime":529.92,"endTime":533.61,"body":"So I'm going to talk about"},{"startTime":529.92,"endTime":533.61,"body":"each of those in stages,"},{"startTime":533.61,"endTime":535.77,"body":"each of them one at a time"},{"startTime":533.61,"endTime":535.77,"body":"to try and explain to you"},{"startTime":535.77,"endTime":538.05,"body":"why imaging is so important,"},{"startTime":538.05,"endTime":540.78,"body":"and therefore the problems"},{"startTime":538.05,"endTime":540.78,"body":"with having to deliver"},{"startTime":540.78,"endTime":542.7,"body":"all of this imaging will be."},{"startTime":542.7,"endTime":545.22,"body":"So let's start with diagnostic imaging."},{"startTime":545.22,"endTime":548.61,"body":"Let's take a very simple"},{"startTime":545.22,"endTime":548.61,"body":"example, appendicitis."},{"startTime":548.61,"endTime":550.56,"body":"Everybody knows what appendicitis is,"},{"startTime":550.56,"endTime":553.38,"body":"the appendix at the end of the"},{"startTime":550.56,"endTime":553.38,"body":"colon is a vestigial organ."},{"startTime":553.38,"endTime":555.63,"body":"It doesn't do anything,"},{"startTime":553.38,"endTime":555.63,"body":"but it gets inflamed."},{"startTime":555.63,"endTime":558.3,"body":"When it does, it gives"},{"startTime":555.63,"endTime":558.3,"body":"you right iliac fossa pain"},{"startTime":558.3,"endTime":560.55,"body":"in a characteristic location"},{"startTime":560.55,"endTime":563.46,"body":"with a bit of fever and"},{"startTime":560.55,"endTime":563.46,"body":"some bowel problems,"},{"startTime":563.46,"endTime":566.643,"body":"and characteristic symptoms and signs."},{"startTime":567.78,"endTime":571.233,"body":"Do you need a scan to"},{"startTime":567.78,"endTime":571.233,"body":"confirm what that would be?"},{"startTime":572.31,"endTime":574.2,"body":"This is an American slide"},{"startTime":572.31,"endTime":574.2,"body":"that was taken, obviously,"},{"startTime":574.2,"endTime":575.64,"body":"'cause actually CT and ultrasound"},{"startTime":575.64,"endTime":577.56,"body":"are down there at the bottom."},{"startTime":577.56,"endTime":580.35,"body":"Well, what happened in the good old days"},{"startTime":580.35,"endTime":581.91,"body":"when imaging didn't exist?"},{"startTime":581.91,"endTime":584.52,"body":"What happened before ultrasound and CT?"},{"startTime":584.52,"endTime":586.53,"body":"Does anybody know the"},{"startTime":584.52,"endTime":586.53,"body":"significance of this picture?"},{"startTime":586.53,"endTime":587.973,"body":"This is a white lily."},{"startTime":590.28,"endTime":591.84,"body":"No, not at all."},{"startTime":591.84,"endTime":592.953,"body":"No?"},{"startTime":592.953,"endTime":593.786,"body":"Okay."},{"startTime":594.69,"endTime":598.05,"body":"So a lily white appendix"},{"startTime":594.69,"endTime":598.05,"body":"is a normal appendix"},{"startTime":598.05,"endTime":599.7,"body":"that has been taken out in error."},{"startTime":601.56,"endTime":604.65,"body":"So surgeons 30, 40 years ago talked"},{"startTime":604.65,"endTime":607.59,"body":"about their negative appendectomy rate."},{"startTime":607.59,"endTime":609.96,"body":"The rate at which they did an appendix,"},{"startTime":609.96,"endTime":611.847,"body":"I can't say it, appendicectomy"},{"startTime":611.847,"endTime":614.94,"body":"and removed a normal appendix,"},{"startTime":611.847,"endTime":614.94,"body":"a lily white appendix."},{"startTime":614.94,"endTime":616.44,"body":"So it wasn't red, it wasn't inflamed,"},{"startTime":616.44,"endTime":617.73,"body":"there was nothing into it."},{"startTime":617.73,"endTime":620.01,"body":"And those rates of normal appendices"},{"startTime":620.01,"endTime":622.08,"body":"being taken out during appendix operation"},{"startTime":622.08,"endTime":624.383,"body":"were as high as 30-40%."},{"startTime":625.44,"endTime":628.68,"body":"So clearly, using ultrasound to say,"},{"startTime":628.68,"endTime":630.93,"body":"hang on, this appendix is inflamed,"},{"startTime":630.93,"endTime":633.81,"body":"there's clearly distended, elongated,"},{"startTime":633.81,"endTime":636.33,"body":"and lots of blood supply going to it"},{"startTime":636.33,"endTime":637.773,"body":"is clearly advantageous."},{"startTime":638.76,"endTime":640.65,"body":"Ultrasound can't always see the appendix,"},{"startTime":640.65,"endTime":642.6,"body":"so sometimes we use CT scans."},{"startTime":642.6,"endTime":645.72,"body":"So as you can see here,"},{"startTime":642.6,"endTime":645.72,"body":"ultrasound can't go through gas"},{"startTime":645.72,"endTime":648.75,"body":"in the bowel, and therefore"},{"startTime":645.72,"endTime":648.75,"body":"sometimes appendix hide."},{"startTime":648.75,"endTime":651.5,"body":"So you sometimes need more"},{"startTime":648.75,"endTime":651.5,"body":"advanced imaging to do that."},{"startTime":652.59,"endTime":655.41,"body":"So this is the ethos that"},{"startTime":652.59,"endTime":655.41,"body":"actually a scan is better"},{"startTime":655.41,"endTime":657.24,"body":"than a unnecessary operation."},{"startTime":657.24,"endTime":659.04,"body":"We would all accept that."},{"startTime":659.04,"endTime":664.04,"body":"So we'd now expect in"},{"startTime":659.04,"endTime":664.04,"body":"2021, 2022 that actually"},{"startTime":664.35,"endTime":667.143,"body":"the negative appendicectomy"},{"startTime":664.35,"endTime":667.143,"body":"rate should be pretty low."},{"startTime":668.13,"endTime":671.13,"body":"Very interesting recent"},{"startTime":668.13,"endTime":671.13,"body":"study showing that actually,"},{"startTime":671.13,"endTime":672.75,"body":"unnecessary appendix surgery"},{"startTime":672.75,"endTime":675.81,"body":"is still performed quite a lot in the UK."},{"startTime":675.81,"endTime":677.01,"body":"Why is that exactly?"},{"startTime":677.01,"endTime":680.22,"body":"So if you're a man, your"},{"startTime":677.01,"endTime":680.22,"body":"negative appendicectomy rate"},{"startTime":680.22,"endTime":682.86,"body":"is likely to be about 10%."},{"startTime":682.86,"endTime":687.035,"body":"If you are a woman it's"},{"startTime":682.86,"endTime":687.035,"body":"likely to be about 30%."},{"startTime":687.035,"endTime":688.35,"body":"There are other organs in the pelvis"},{"startTime":688.35,"endTime":691.53,"body":"that can mimic appendix type pain."},{"startTime":691.53,"endTime":693.48,"body":"But why aren't you then getting a scan?"},{"startTime":695.516,"endTime":696.57,"body":"So this recent study is very interesting"},{"startTime":696.57,"endTime":699.99,"body":"of over 5,000 patients in UK hospitals,"},{"startTime":699.99,"endTime":702.27,"body":"and this study tells us two things,"},{"startTime":702.27,"endTime":705.03,"body":"quite a lot were women, two"},{"startTime":702.27,"endTime":705.03,"body":"thirds of patients were women,"},{"startTime":705.03,"endTime":708.07,"body":"and actually only 32"},{"startTime":705.03,"endTime":708.07,"body":"were given a risk score"},{"startTime":709.05,"endTime":713.43,"body":"based on some clinical index"},{"startTime":709.05,"endTime":713.43,"body":"of of suspicion that we have."},{"startTime":713.43,"endTime":715.773,"body":"And here's an example of a scoring table."},{"startTime":717.09,"endTime":719.91,"body":"We're not very good at using"},{"startTime":717.09,"endTime":719.91,"body":"scoring tables that tell us"},{"startTime":719.91,"endTime":723.57,"body":"who's likely to have appendicitis"},{"startTime":719.91,"endTime":723.57,"body":"or not without a scan."},{"startTime":723.57,"endTime":726.36,"body":"The other issue here was"},{"startTime":723.57,"endTime":726.36,"body":"that actually most women"},{"startTime":726.36,"endTime":729.663,"body":"didn't have the right scan,"},{"startTime":726.36,"endTime":729.663,"body":"didn't have a CT scan."},{"startTime":730.68,"endTime":733.44,"body":"People are a little bit afraid of CT scans"},{"startTime":733.44,"endTime":737.25,"body":"because of the small"},{"startTime":733.44,"endTime":737.25,"body":"increased risk of radiation."},{"startTime":737.25,"endTime":739.98,"body":"So we are not doing the"},{"startTime":737.25,"endTime":739.98,"body":"best for our patients"},{"startTime":739.98,"endTime":742.77,"body":"even in a simple setting"},{"startTime":739.98,"endTime":742.77,"body":"because there are issues"},{"startTime":742.77,"endTime":745.17,"body":"about what people think about scanning."},{"startTime":745.17,"endTime":749.13,"body":"So is it really true that"},{"startTime":745.17,"endTime":749.13,"body":"ionizing radiation is bad for you"},{"startTime":749.13,"endTime":750.9,"body":"and that we shouldn't"},{"startTime":749.13,"endTime":750.9,"body":"be scanning as a result?"},{"startTime":750.9,"endTime":753.99,"body":"Well, it's very difficult"},{"startTime":750.9,"endTime":753.99,"body":"to try and explain to people"},{"startTime":753.99,"endTime":756.54,"body":"what radiation dose associated"},{"startTime":756.54,"endTime":758.25,"body":"with some of the medical imaging is."},{"startTime":758.25,"endTime":760.71,"body":"And people try and compare it to"},{"startTime":760.71,"endTime":763.11,"body":"the number of hours of"},{"startTime":760.71,"endTime":763.11,"body":"flying you might have"},{"startTime":763.11,"endTime":767.07,"body":"or your exposure to natural"},{"startTime":763.11,"endTime":767.07,"body":"background radiation."},{"startTime":767.07,"endTime":769.71,"body":"We're all exposed to"},{"startTime":767.07,"endTime":769.71,"body":"radiation all of the time,"},{"startTime":769.71,"endTime":772.17,"body":"and of course, some scans"},{"startTime":769.71,"endTime":772.17,"body":"like ultrasound and MRI,"},{"startTime":772.17,"endTime":775.38,"body":"don't involve radiation,"},{"startTime":772.17,"endTime":775.38,"body":"but some x-rays and CT do."},{"startTime":775.38,"endTime":777.93,"body":"But trying to contextualize"},{"startTime":775.38,"endTime":777.93,"body":"and quantify that"},{"startTime":777.93,"endTime":779.13,"body":"is quite difficult,"},{"startTime":779.13,"endTime":781.44,"body":"and you probably haven't"},{"startTime":779.13,"endTime":781.44,"body":"quite got the idea yet"},{"startTime":781.44,"endTime":784.35,"body":"from this diagram what a CT scan involves."},{"startTime":784.35,"endTime":786.33,"body":"Well, what about bananas?"},{"startTime":786.33,"endTime":787.56,"body":"People eat bananas,"},{"startTime":787.56,"endTime":791.19,"body":"we can equivalent the"},{"startTime":787.56,"endTime":791.19,"body":"number of bananas you eat"},{"startTime":791.19,"endTime":794.97,"body":"to the amount of dose you"},{"startTime":791.19,"endTime":794.97,"body":"would get from a CT scanner."},{"startTime":794.97,"endTime":796.11,"body":"How many bananas do you need"},{"startTime":796.11,"endTime":798.363,"body":"to eat to make yourself"},{"startTime":796.11,"endTime":798.363,"body":"slightly radioactive?"},{"startTime":800.22,"endTime":801.57,"body":"One."},{"startTime":801.57,"endTime":804.056,"body":"So there's natural"},{"startTime":801.57,"endTime":804.056,"body":"radiation in every banana,"},{"startTime":804.056,"endTime":805.077,"body":"and Brazil nuts are the same, for example."},{"startTime":805.077,"endTime":808.17,"body":"And of course, there'll be"},{"startTime":805.077,"endTime":808.17,"body":"a lethal dose of bananas"},{"startTime":808.17,"endTime":810.42,"body":"that you could eat, but it's a bit silly"},{"startTime":810.42,"endTime":811.92,"body":"to talk about these things in these terms."},{"startTime":811.92,"endTime":815.91,"body":"So CT scans and and normal x-rays"},{"startTime":815.91,"endTime":817.89,"body":"do have a small amount"},{"startTime":815.91,"endTime":817.89,"body":"of ionizing radiation,"},{"startTime":817.89,"endTime":819.57,"body":"but because we're exposed to these things"},{"startTime":819.57,"endTime":821.94,"body":"all day in everyday life,"},{"startTime":821.94,"endTime":824.37,"body":"the small increase you get from a scan"},{"startTime":824.37,"endTime":825.96,"body":"shouldn't really be contextualized"},{"startTime":825.96,"endTime":827.43,"body":"in terms of how much radiation."},{"startTime":827.43,"endTime":830.04,"body":"It's really about, do you need the scan,"},{"startTime":830.04,"endTime":832.83,"body":"versus what happens if"},{"startTime":830.04,"endTime":832.83,"body":"you don't have the scan?"},{"startTime":832.83,"endTime":835.11,"body":"So really it's a risk benefit analysis"},{"startTime":835.11,"endTime":836.853,"body":"about what the scan will show."},{"startTime":839.04,"endTime":840.84,"body":"And there's been a huge campaign recently,"},{"startTime":840.84,"endTime":843.93,"body":"a large piece of work"},{"startTime":840.84,"endTime":843.93,"body":"done by Kath Halliday,"},{"startTime":843.93,"endTime":847.47,"body":"who is the current Royal"},{"startTime":843.93,"endTime":847.47,"body":"College of Radiology president,"},{"startTime":847.47,"endTime":849.87,"body":"talking about getting it right first time."},{"startTime":849.87,"endTime":850.77,"body":"That's what we need to do."},{"startTime":850.77,"endTime":853.08,"body":"If you need a scan, that's"},{"startTime":850.77,"endTime":853.08,"body":"what you should have."},{"startTime":853.08,"endTime":855.36,"body":"If you need a CT scan,"},{"startTime":853.08,"endTime":855.36,"body":"that's what you should have."},{"startTime":855.36,"endTime":857.91,"body":"And her and her team have"},{"startTime":855.36,"endTime":857.91,"body":"made lots of recommendations"},{"startTime":857.91,"endTime":860.04,"body":"about how we get the right patient,"},{"startTime":860.04,"endTime":862.173,"body":"to have the right scan, at the right time."},{"startTime":863.04,"endTime":865.62,"body":"Some of those things"},{"startTime":863.04,"endTime":865.62,"body":"are about the facilities"},{"startTime":865.62,"endTime":868.11,"body":"and the infrastructure"},{"startTime":865.62,"endTime":868.11,"body":"different hospitals can offer,"},{"startTime":868.11,"endTime":869.19,"body":"but actually most of it is"},{"startTime":869.19,"endTime":871.95,"body":"about a clinical decision support tool."},{"startTime":871.95,"endTime":874.56,"body":"So when you think, does"},{"startTime":871.95,"endTime":874.56,"body":"this patient need a scan,"},{"startTime":874.56,"endTime":876.15,"body":"actually there's a risk of factors,"},{"startTime":876.15,"endTime":878.52,"body":"there's a range of things"},{"startTime":878.52,"endTime":881.82,"body":"we need to take into"},{"startTime":878.52,"endTime":881.82,"body":"consideration to try and work out"},{"startTime":881.82,"endTime":884.91,"body":"what the probability of helping people is."},{"startTime":884.91,"endTime":886.92,"body":"And again, this is all"},{"startTime":884.91,"endTime":886.92,"body":"about the ethos here,"},{"startTime":886.92,"endTime":888.87,"body":"is getting the right"},{"startTime":886.92,"endTime":888.87,"body":"person, the right scan,"},{"startTime":888.87,"endTime":890.94,"body":"at the right time, and we'd all agree with"},{"startTime":890.94,"endTime":893.373,"body":"that as an idea of what"},{"startTime":890.94,"endTime":893.373,"body":"we should be doing."},{"startTime":894.69,"endTime":897.32,"body":"Some of the things you may"},{"startTime":894.69,"endTime":897.32,"body":"not be aware of is how imaging"},{"startTime":897.32,"endTime":899.7,"body":"is now being used as part of treatment."},{"startTime":899.7,"endTime":902.61,"body":"So not as part of a diagnosis,"},{"startTime":902.61,"endTime":904.11,"body":"but as part of a treatment"},{"startTime":904.11,"endTime":906.84,"body":"for helping you in your patient pathway."},{"startTime":906.84,"endTime":910.02,"body":"So if you have a kidney abnormality,"},{"startTime":910.02,"endTime":911.82,"body":"diagnosed maybe on a blood test,"},{"startTime":911.82,"endTime":913.77,"body":"and we need a sample of the kidney"},{"startTime":913.77,"endTime":915.54,"body":"to look at it under the microscope,"},{"startTime":915.54,"endTime":918.54,"body":"we can now, using an"},{"startTime":915.54,"endTime":918.54,"body":"ultrasound probe and a needle,"},{"startTime":918.54,"endTime":921.27,"body":"take a sample of the kidney"},{"startTime":918.54,"endTime":921.27,"body":"fairly straightforwardly."},{"startTime":921.27,"endTime":924.18,"body":"So a kidney biopsy is"},{"startTime":921.27,"endTime":924.18,"body":"a routine procedure now"},{"startTime":924.18,"endTime":927.477,"body":"happening every day up"},{"startTime":924.18,"endTime":927.477,"body":"and down the hospital"},{"startTime":927.477,"endTime":928.503,"body":"and the country."},{"startTime":929.52,"endTime":931.74,"body":"You might have a slightly"},{"startTime":929.52,"endTime":931.74,"body":"more complicated problem."},{"startTime":931.74,"endTime":933.24,"body":"So this CT scan shows that this person"},{"startTime":933.24,"endTime":934.983,"body":"has an abscess in their kidney."},{"startTime":936.0,"endTime":939.24,"body":"So in fact by turning them"},{"startTime":936.0,"endTime":939.24,"body":"upside down on the CT scanner,"},{"startTime":939.24,"endTime":941.85,"body":"we can actually put a small"},{"startTime":939.24,"endTime":941.85,"body":"needle through into there,"},{"startTime":941.85,"endTime":943.68,"body":"we can take a sample"},{"startTime":941.85,"endTime":943.68,"body":"of the pus to make sure"},{"startTime":943.68,"endTime":945.84,"body":"that's what it is, and we"},{"startTime":943.68,"endTime":945.84,"body":"can now put a drain in,"},{"startTime":945.84,"endTime":948.6,"body":"a small plastic tube into the kidney,"},{"startTime":948.6,"endTime":951.06,"body":"using imaging, to try and drain that."},{"startTime":951.06,"endTime":953.01,"body":"So in fact this idea is about"},{"startTime":953.01,"endTime":955.35,"body":"a scan really preventing an operation."},{"startTime":955.35,"endTime":959.52,"body":"The scan becomes part of"},{"startTime":955.35,"endTime":959.52,"body":"the operation to treat you."},{"startTime":959.52,"endTime":960.84,"body":"And if you take that a step further,"},{"startTime":960.84,"endTime":964.35,"body":"everyone who's had laparoscopic"},{"startTime":960.84,"endTime":964.35,"body":"surgery where things"},{"startTime":964.35,"endTime":966.46,"body":"like laparoscopic surgery of the bowel"},{"startTime":967.636,"endTime":968.64,"body":"or maybe to take the gallbladder out,"},{"startTime":968.64,"endTime":971.61,"body":"there's a number of gallstones"},{"startTime":968.64,"endTime":971.61,"body":"here in this gallbladder."},{"startTime":971.61,"endTime":973.5,"body":"Actually every laparoscopic surgery"},{"startTime":973.5,"endTime":974.91,"body":"must have had a scan beforehand"},{"startTime":974.91,"endTime":976.59,"body":"to know what they're dealing with."},{"startTime":976.59,"endTime":979.38,"body":"So imaging is helping push people towards"},{"startTime":979.38,"endTime":981.123,"body":"the right treatment."},{"startTime":982.65,"endTime":985.05,"body":"Ultrasound heats things up very slightly."},{"startTime":985.05,"endTime":988.47,"body":"So if we can get a very small"},{"startTime":985.05,"endTime":988.47,"body":"ultrasound probe at very,"},{"startTime":988.47,"endTime":990.0,"body":"very high intensity,"},{"startTime":990.0,"endTime":993.15,"body":"we can actually use the"},{"startTime":990.0,"endTime":993.15,"body":"heat that it produces"},{"startTime":993.15,"endTime":994.77,"body":"to treat problems."},{"startTime":994.77,"endTime":998.73,"body":"So this is an example of high"},{"startTime":994.77,"endTime":998.73,"body":"intensity focused ultrasound"},{"startTime":998.73,"endTime":1000.89,"body":"where somebody's got a liver lesion,"},{"startTime":1000.89,"endTime":1002.3,"body":"and actually using a very,"},{"startTime":1002.3,"endTime":1004.97,"body":"very small focused beam of of ultrasound,"},{"startTime":1004.97,"endTime":1007.43,"body":"we can actually use"},{"startTime":1004.97,"endTime":1007.43,"body":"that to treat the lesion"},{"startTime":1007.43,"endTime":1009.29,"body":"without the patient needing an operation"},{"startTime":1009.29,"endTime":1010.583,"body":"or needing anything else."},{"startTime":1011.51,"endTime":1014.09,"body":"And we've come a long way"},{"startTime":1011.51,"endTime":1014.09,"body":"from using stethoscopes"},{"startTime":1014.09,"endTime":1015.41,"body":"to listen to hearts."},{"startTime":1015.41,"endTime":1019.07,"body":"We now use a lot of ultrasound"},{"startTime":1015.41,"endTime":1019.07,"body":"and echocardiography"},{"startTime":1019.07,"endTime":1021.29,"body":"to look at hearts and how they function,"},{"startTime":1021.29,"endTime":1022.7,"body":"how the valves work,"},{"startTime":1022.7,"endTime":1025.46,"body":"what the severity of the"},{"startTime":1022.7,"endTime":1025.46,"body":"valve disease might be."},{"startTime":1025.46,"endTime":1026.54,"body":"And now steps further,"},{"startTime":1026.54,"endTime":1029.06,"body":"we're now able to use"},{"startTime":1026.54,"endTime":1029.06,"body":"3D imaging of the heart,"},{"startTime":1029.06,"endTime":1030.83,"body":"in terms of CT and MRI,"},{"startTime":1030.83,"endTime":1033.08,"body":"to look at how ventricles pump,"},{"startTime":1033.08,"endTime":1036.32,"body":"to look at how the heart"},{"startTime":1033.08,"endTime":1036.32,"body":"function as a completely."},{"startTime":1036.32,"endTime":1037.79,"body":"And on the basis of that,"},{"startTime":1037.79,"endTime":1040.16,"body":"you may know that"},{"startTime":1037.79,"endTime":1040.16,"body":"interventional angiography"},{"startTime":1040.16,"endTime":1041.72,"body":"is now the art, if you like,"},{"startTime":1041.72,"endTime":1046.25,"body":"or the skill of putting a"},{"startTime":1041.72,"endTime":1046.25,"body":"catheter in the femoral artery,"},{"startTime":1046.25,"endTime":1048.71,"body":"feeding a catheter up"},{"startTime":1046.25,"endTime":1048.71,"body":"to look at the heart,"},{"startTime":1048.71,"endTime":1052.4,"body":"and then by injecting a small"},{"startTime":1048.71,"endTime":1052.4,"body":"amount of dye, using imaging,"},{"startTime":1052.4,"endTime":1054.56,"body":"we can see where the problems are"},{"startTime":1054.56,"endTime":1057.08,"body":"in some of the coronary vessels."},{"startTime":1057.08,"endTime":1060.29,"body":"Can you see the area the"},{"startTime":1057.08,"endTime":1060.29,"body":"red arrow is pointing to"},{"startTime":1060.29,"endTime":1062.72,"body":"where there's a blockage in that vessel?"},{"startTime":1062.72,"endTime":1064.61,"body":"Not only that, we can put balloons"},{"startTime":1064.61,"endTime":1065.87,"body":"in through the same access"},{"startTime":1065.87,"endTime":1069.17,"body":"and we can balloon up those"},{"startTime":1065.87,"endTime":1069.17,"body":"areas, or can put a stent in,"},{"startTime":1069.17,"endTime":1071.99,"body":"a metal stent, to keep those areas open."},{"startTime":1071.99,"endTime":1074.84,"body":"So imaging is now not only"},{"startTime":1071.99,"endTime":1074.84,"body":"forming part of the diagnosis"},{"startTime":1074.84,"endTime":1077.0,"body":"but for a part of the"},{"startTime":1074.84,"endTime":1077.0,"body":"treatment, and again,"},{"startTime":1077.0,"endTime":1080.18,"body":"saving people an invasive operation."},{"startTime":1080.18,"endTime":1083.93,"body":"And no more so than in"},{"startTime":1080.18,"endTime":1083.93,"body":"endovascular treatment of stroke."},{"startTime":1083.93,"endTime":1086.13,"body":"So this is where if you"},{"startTime":1083.93,"endTime":1086.13,"body":"have an acute stroke"},{"startTime":1087.12,"endTime":1089.84,"body":"and a plaque blocks one of the"},{"startTime":1087.12,"endTime":1089.84,"body":"blood vessels in the brain,"},{"startTime":1089.84,"endTime":1093.17,"body":"using the same approach through"},{"startTime":1089.84,"endTime":1093.17,"body":"a blood vessel in the groin,"},{"startTime":1093.17,"endTime":1096.11,"body":"we can now put catheters"},{"startTime":1093.17,"endTime":1096.11,"body":"all the way up into the head"},{"startTime":1096.11,"endTime":1098.36,"body":"and actually destroy"},{"startTime":1096.11,"endTime":1098.36,"body":"the plaque where it is,"},{"startTime":1098.36,"endTime":1101.33,"body":"or in fact put a coil"},{"startTime":1098.36,"endTime":1101.33,"body":"through and remove it."},{"startTime":1101.33,"endTime":1105.41,"body":"So that to me is one of the"},{"startTime":1101.33,"endTime":1105.41,"body":"miracles of modern medicine,"},{"startTime":1105.41,"endTime":1109.34,"body":"to be able to look inside"},{"startTime":1105.41,"endTime":1109.34,"body":"the body, send in catheters,"},{"startTime":1109.34,"endTime":1113.57,"body":"wires, stents and give treatment,"},{"startTime":1113.57,"endTime":1115.82,"body":"if you like, in real time,"},{"startTime":1115.82,"endTime":1120.11,"body":"operated from outside, using"},{"startTime":1115.82,"endTime":1120.11,"body":"imaging to get the patient"},{"startTime":1120.11,"endTime":1123.05,"body":"to avoid an operation and"},{"startTime":1120.11,"endTime":1123.05,"body":"therefore to get home quicker,"},{"startTime":1123.05,"endTime":1125.45,"body":"without side effects, etcetera, etcetera."},{"startTime":1125.45,"endTime":1128.87,"body":"That I think is one of the"},{"startTime":1125.45,"endTime":1128.87,"body":"major advances of imaging."},{"startTime":1128.87,"endTime":1129.703,"body":"But of course there"},{"startTime":1129.703,"endTime":1131.87,"body":"are massive resource"},{"startTime":1129.703,"endTime":1131.87,"body":"implications in doing this."},{"startTime":1133.13,"endTime":1135.59,"body":"Some of the softer side"},{"startTime":1133.13,"endTime":1135.59,"body":"of imaging, I would say,"},{"startTime":1135.59,"endTime":1139.82,"body":"is about follow up and monitoring"},{"startTime":1135.59,"endTime":1139.82,"body":"what happens to patients."},{"startTime":1139.82,"endTime":1142.13,"body":"So they are things like surveillance."},{"startTime":1142.13,"endTime":1144.29,"body":"What happens if you have an"},{"startTime":1142.13,"endTime":1144.29,"body":"illness that we haven't treated"},{"startTime":1144.29,"endTime":1146.0,"body":"or we maybe treated a little bit,"},{"startTime":1146.0,"endTime":1147.62,"body":"but we need to know"},{"startTime":1146.0,"endTime":1147.62,"body":"whether it's coming back?"},{"startTime":1147.62,"endTime":1149.09,"body":"We might use imaging to follow up"},{"startTime":1149.09,"endTime":1151.1,"body":"and see what happens there."},{"startTime":1151.1,"endTime":1155.21,"body":"And monitoring, we need"},{"startTime":1151.1,"endTime":1155.21,"body":"to know what happens"},{"startTime":1155.21,"endTime":1156.71,"body":"to a diagnosis you have"},{"startTime":1156.71,"endTime":1159.08,"body":"and look at how that changes over time."},{"startTime":1159.08,"endTime":1162.08,"body":"So examples of that are after an operation"},{"startTime":1162.08,"endTime":1164.57,"body":"you might have a scan that"},{"startTime":1162.08,"endTime":1164.57,"body":"shows here a brain tumor,"},{"startTime":1164.57,"endTime":1165.68,"body":"immediately postop,"},{"startTime":1165.68,"endTime":1167.69,"body":"there's still a bit of"},{"startTime":1165.68,"endTime":1167.69,"body":"swelling around there."},{"startTime":1167.69,"endTime":1169.71,"body":"So you might have a couple further scans"},{"startTime":1170.726,"endTime":1171.95,"body":"to show that that's resolved."},{"startTime":1171.95,"endTime":1172.82,"body":"But what's interesting here"},{"startTime":1172.82,"endTime":1176.71,"body":"is a scan begets another scan effectively."},{"startTime":1176.71,"endTime":1177.99,"body":"So you came in for one scan"},{"startTime":1177.99,"endTime":1179.0,"body":"and actually your whole treatment pathway"},{"startTime":1179.0,"endTime":1181.703,"body":"is going to be four or five scans."},{"startTime":1182.75,"endTime":1184.34,"body":"What happens if you have a smaller"},{"startTime":1184.34,"endTime":1186.65,"body":"but slightly more complicated brain tumor?"},{"startTime":1186.65,"endTime":1188.69,"body":"Before you are given a"},{"startTime":1186.65,"endTime":1188.69,"body":"smaller amount of treatment,"},{"startTime":1188.69,"endTime":1190.8,"body":"actually you might get a scan every year"},{"startTime":1191.72,"endTime":1193.79,"body":"to see whether or not"},{"startTime":1191.72,"endTime":1193.79,"body":"that tumor has changed"},{"startTime":1193.79,"endTime":1195.59,"body":"so that we can stand in."},{"startTime":1195.59,"endTime":1199.16,"body":"So we are using scanning to"},{"startTime":1195.59,"endTime":1199.16,"body":"assess disease progression."},{"startTime":1199.16,"endTime":1201.11,"body":"Perhaps the question for you is,"},{"startTime":1201.11,"endTime":1203.213,"body":"how many of those scans are unnecessary?"},{"startTime":1204.56,"endTime":1206.87,"body":"Are they unnecessary in retrospect"},{"startTime":1206.87,"endTime":1209.36,"body":"or actually are they"},{"startTime":1206.87,"endTime":1209.36,"body":"reassuring in confirming"},{"startTime":1209.36,"endTime":1211.333,"body":"that actually we don't"},{"startTime":1209.36,"endTime":1211.333,"body":"need to do anything?"},{"startTime":1211.333,"endTime":1214.7,"body":"Are they vital for that patient"},{"startTime":1211.333,"endTime":1214.7,"body":"going through the pathway?"},{"startTime":1214.7,"endTime":1217.16,"body":"For that particular"},{"startTime":1214.7,"endTime":1217.16,"body":"patient, they would say yes."},{"startTime":1217.16,"endTime":1219.44,"body":"For society and the NHS as a whole,"},{"startTime":1219.44,"endTime":1222.293,"body":"I'm not sure where that decision is made."},{"startTime":1223.34,"endTime":1224.81,"body":"And we talk a little bit about screening."},{"startTime":1224.81,"endTime":1227.51,"body":"Imaging is used quite a lot in screening,"},{"startTime":1227.51,"endTime":1229.19,"body":"and screening is a different approach,"},{"startTime":1229.19,"endTime":1232.64,"body":"because screening is about"},{"startTime":1229.19,"endTime":1232.64,"body":"investigating patients,"},{"startTime":1232.64,"endTime":1236.153,"body":"people without symptoms, for"},{"startTime":1232.64,"endTime":1236.153,"body":"the potential for disease."},{"startTime":1237.62,"endTime":1241.16,"body":"So we're trying to find"},{"startTime":1237.62,"endTime":1241.16,"body":"hidden important disease"},{"startTime":1241.16,"endTime":1242.39,"body":"in a population."},{"startTime":1242.39,"endTime":1244.43,"body":"Some of you might have"},{"startTime":1242.39,"endTime":1244.43,"body":"slightly more risk factors"},{"startTime":1244.43,"endTime":1247.67,"body":"than others, but trying"},{"startTime":1244.43,"endTime":1247.67,"body":"to find a hidden disease,"},{"startTime":1247.67,"endTime":1251.12,"body":"there's got to be a risk"},{"startTime":1247.67,"endTime":1251.12,"body":"benefit analysis to doing that."},{"startTime":1251.12,"endTime":1254.45,"body":"So we know that cancer"},{"startTime":1251.12,"endTime":1254.45,"body":"screening programs work,"},{"startTime":1254.45,"endTime":1256.79,"body":"we know that they save"},{"startTime":1254.45,"endTime":1256.79,"body":"lives and the breast,"},{"startTime":1256.79,"endTime":1259.522,"body":"cervical, and bowel"},{"startTime":1256.79,"endTime":1259.522,"body":"cancer screening program"},{"startTime":1259.522,"endTime":1262.19,"body":"in the UK saves about"},{"startTime":1259.522,"endTime":1262.19,"body":"10,000 lives every year."},{"startTime":1262.19,"endTime":1264.29,"body":"But the benefits for the"},{"startTime":1262.19,"endTime":1264.29,"body":"individual patient versus"},{"startTime":1264.29,"endTime":1266.96,"body":"the population need to"},{"startTime":1264.29,"endTime":1266.96,"body":"be taken into account."},{"startTime":1266.96,"endTime":1268.25,"body":"And there's a question about screening,"},{"startTime":1268.25,"endTime":1270.983,"body":"which is, should we be doing more or less?"},{"startTime":1272.45,"endTime":1274.91,"body":"Let's take breast cancer"},{"startTime":1272.45,"endTime":1274.91,"body":"screening as an example,"},{"startTime":1274.91,"endTime":1278.54,"body":"because breast cancer screening"},{"startTime":1274.91,"endTime":1278.54,"body":"is done by a mammogram"},{"startTime":1278.54,"endTime":1280.94,"body":"and it's fairly rapid access"},{"startTime":1280.94,"endTime":1283.4,"body":"and can quite easily"},{"startTime":1280.94,"endTime":1283.4,"body":"tell you whether or not"},{"startTime":1283.4,"endTime":1285.26,"body":"there's a cancer there or not."},{"startTime":1285.26,"endTime":1287.693,"body":"The difficulty is that"},{"startTime":1285.26,"endTime":1287.693,"body":"cancer's unpredictable."},{"startTime":1288.744,"endTime":1290.15,"body":"So it's hard to know"},{"startTime":1288.744,"endTime":1290.15,"body":"what would've happened"},{"startTime":1290.15,"endTime":1291.77,"body":"had we not screened for it."},{"startTime":1291.77,"endTime":1295.13,"body":"Some cancers will grow very"},{"startTime":1291.77,"endTime":1295.13,"body":"quickly and spread and be fatal."},{"startTime":1295.13,"endTime":1296.42,"body":"Others will grow very slowly"},{"startTime":1296.42,"endTime":1299.36,"body":"and actually maybe never cause any harm."},{"startTime":1299.36,"endTime":1303.023,"body":"So are you better off knowing"},{"startTime":1299.36,"endTime":1303.023,"body":"about those cancers or not?"},{"startTime":1304.1,"endTime":1306.98,"body":"So if we take the example"},{"startTime":1304.1,"endTime":1306.98,"body":"on the left there of,"},{"startTime":1306.98,"endTime":1309.83,"body":"for a thousand women who go"},{"startTime":1306.98,"endTime":1309.83,"body":"through the screening program,"},{"startTime":1309.83,"endTime":1312.65,"body":"without screening, 21"},{"startTime":1309.83,"endTime":1312.65,"body":"would die of breast cancer"},{"startTime":1312.65,"endTime":1317.42,"body":"and 37 would be treated and"},{"startTime":1312.65,"endTime":1317.42,"body":"survive their cancer treatment."},{"startTime":1317.42,"endTime":1321.11,"body":"With screening there"},{"startTime":1317.42,"endTime":1321.11,"body":"would be more diagnoses,"},{"startTime":1321.11,"endTime":1324.02,"body":"fewer deaths, which is great,"},{"startTime":1324.02,"endTime":1328.55,"body":"but actually there would"},{"startTime":1324.02,"endTime":1328.55,"body":"be about 17 over diagnoses."},{"startTime":1328.55,"endTime":1330.74,"body":"So we're identifying abnormalities,"},{"startTime":1330.74,"endTime":1332.6,"body":"which actually have no impact"},{"startTime":1332.6,"endTime":1335.81,"body":"on the life of of the patients,"},{"startTime":1332.6,"endTime":1335.81,"body":"and all we're doing really"},{"startTime":1335.81,"endTime":1338.12,"body":"is generating anxiety."},{"startTime":1338.12,"endTime":1339.86,"body":"So screening programs work,"},{"startTime":1339.86,"endTime":1343.763,"body":"they do say save lives, but"},{"startTime":1339.86,"endTime":1343.763,"body":"they don't come at zero cost."},{"startTime":1344.78,"endTime":1347.03,"body":"So put very simply, for"},{"startTime":1344.78,"endTime":1347.03,"body":"every a hundred women"},{"startTime":1348.589,"endTime":1350.182,"body":"who go through the breast"},{"startTime":1348.589,"endTime":1350.182,"body":"cancer screening program,"},{"startTime":1350.182,"endTime":1352.82,"body":"the vast majority are normal"},{"startTime":1350.182,"endTime":1352.82,"body":"and don't need anything doing,"},{"startTime":1352.82,"endTime":1356.57,"body":"but to find one cancer"},{"startTime":1352.82,"endTime":1356.57,"body":"there will be four or so"},{"startTime":1356.57,"endTime":1358.88,"body":"that actually need further tests."},{"startTime":1358.88,"endTime":1361.49,"body":"We've created anxiety,"},{"startTime":1358.88,"endTime":1361.49,"body":"we've found an abnormality,"},{"startTime":1361.49,"endTime":1365.12,"body":"often need more imaging,"},{"startTime":1361.49,"endTime":1365.12,"body":"to discover what that is,"},{"startTime":1365.12,"endTime":1368.33,"body":"and so we've added to the"},{"startTime":1365.12,"endTime":1368.33,"body":"system rather than subtracted."},{"startTime":1368.33,"endTime":1369.59,"body":"So you might think that's okay,"},{"startTime":1369.59,"endTime":1371.63,"body":"that's a small price to pay."},{"startTime":1371.63,"endTime":1375.86,"body":"But we screen over a"},{"startTime":1371.63,"endTime":1375.86,"body":"million women every year."},{"startTime":1375.86,"endTime":1380.6,"body":"So a million women every"},{"startTime":1375.86,"endTime":1380.6,"body":"year to find 10,000 cancers,"},{"startTime":1380.6,"endTime":1383.87,"body":"which means there are about"},{"startTime":1380.6,"endTime":1383.87,"body":"40,000 women who go through"},{"startTime":1383.87,"endTime":1387.023,"body":"that process and don't have"},{"startTime":1383.87,"endTime":1387.023,"body":"a cancer at the end of it."},{"startTime":1389.21,"endTime":1391.1,"body":"Lung cancer screening is another area"},{"startTime":1391.1,"endTime":1393.59,"body":"where we should be looking"},{"startTime":1391.1,"endTime":1393.59,"body":"into because actually"},{"startTime":1393.59,"endTime":1396.23,"body":"the vast majority of patients"},{"startTime":1393.59,"endTime":1396.23,"body":"diagnosed with lung cancer"},{"startTime":1396.23,"endTime":1398.99,"body":"at diagnosis have"},{"startTime":1396.23,"endTime":1398.99,"body":"relatively advanced disease,"},{"startTime":1398.99,"endTime":1401.21,"body":"and the survival is very poor."},{"startTime":1401.21,"endTime":1405.44,"body":"There's a big trial just been"},{"startTime":1401.21,"endTime":1405.44,"body":"carried out in the Netherlands"},{"startTime":1405.44,"endTime":1409.19,"body":"of high risk patients, so"},{"startTime":1405.44,"endTime":1409.19,"body":"former or current smokers,"},{"startTime":1409.19,"endTime":1412.55,"body":"where they were offered CT"},{"startTime":1409.19,"endTime":1412.55,"body":"scans at two yearly intervals."},{"startTime":1412.55,"endTime":1414.71,"body":"And actually after 10 years of screening,"},{"startTime":1414.71,"endTime":1417.17,"body":"in the screening group they"},{"startTime":1414.71,"endTime":1417.17,"body":"picked up lots of cancers"},{"startTime":1417.17,"endTime":1418.7,"body":"that were very early stage"},{"startTime":1418.7,"endTime":1421.79,"body":"and they did better than"},{"startTime":1418.7,"endTime":1421.79,"body":"the non-screen group."},{"startTime":1421.79,"endTime":1424.88,"body":"So your survival from"},{"startTime":1421.79,"endTime":1424.88,"body":"lung cancer is better"},{"startTime":1424.88,"endTime":1429.88,"body":"if we screen you using CT scans"},{"startTime":1424.88,"endTime":1429.88,"body":"throughout your risk period."},{"startTime":1430.01,"endTime":1432.68,"body":"So maybe we're not doing enough screening"},{"startTime":1432.68,"endTime":1436.46,"body":"or maybe we're not getting"},{"startTime":1432.68,"endTime":1436.46,"body":"the right target populations."},{"startTime":1436.46,"endTime":1438.11,"body":"And there was a vogue"},{"startTime":1436.46,"endTime":1438.11,"body":"a couple of years ago"},{"startTime":1438.11,"endTime":1441.26,"body":"for cancer scanning rolling"},{"startTime":1438.11,"endTime":1441.26,"body":"out at the supermarket."},{"startTime":1441.26,"endTime":1444.41,"body":"Has anybody seen this or"},{"startTime":1441.26,"endTime":1444.41,"body":"participated in these?"},{"startTime":1444.41,"endTime":1446.93,"body":"Yeah, trying to get patients"},{"startTime":1446.93,"endTime":1450.2,"body":"to come forward for screening"},{"startTime":1446.93,"endTime":1450.2,"body":"tests like CT and MRI"},{"startTime":1450.2,"endTime":1452.273,"body":"to diagnose disease early."},{"startTime":1453.95,"endTime":1456.95,"body":"But the more you scan, the more you find,"},{"startTime":1456.95,"endTime":1460.94,"body":"and finding incidental"},{"startTime":1456.95,"endTime":1460.94,"body":"things can be problematic."},{"startTime":1460.94,"endTime":1463.22,"body":"Are you aware of this idea"},{"startTime":1460.94,"endTime":1463.22,"body":"of incidental findings?"},{"startTime":1463.22,"endTime":1466.25,"body":"So finding things that we"},{"startTime":1463.22,"endTime":1466.25,"body":"weren't expecting to find,"},{"startTime":1466.25,"endTime":1467.9,"body":"because we've done a scan."},{"startTime":1467.9,"endTime":1470.21,"body":"So that can be helpful,"},{"startTime":1467.9,"endTime":1470.21,"body":"that's serendipitous."},{"startTime":1470.21,"endTime":1471.08,"body":"That's great, thank you,"},{"startTime":1471.08,"endTime":1472.49,"body":"I didn't know that already."},{"startTime":1472.49,"endTime":1474.86,"body":"Or it can be extremely unhelpful."},{"startTime":1474.86,"endTime":1477.26,"body":"So let's take for example a woman"},{"startTime":1477.26,"endTime":1480.53,"body":"who comes off a a long haul flight"},{"startTime":1480.53,"endTime":1484.22,"body":"and she becomes breathless and"},{"startTime":1480.53,"endTime":1484.22,"body":"has a swelling in her calf."},{"startTime":1484.22,"endTime":1488.538,"body":"So that could be a DVT,"},{"startTime":1484.22,"endTime":1488.538,"body":"a deep vein thrombosis,"},{"startTime":1488.538,"endTime":1489.74,"body":"and it could be that her breathlessness"},{"startTime":1489.74,"endTime":1491.6,"body":"is due to a pulmonary embolism."},{"startTime":1491.6,"endTime":1493.61,"body":"So the right scan for that is a CT scan."},{"startTime":1493.61,"endTime":1496.28,"body":"She comes to hospital,"},{"startTime":1493.61,"endTime":1496.28,"body":"she has her CT scan,"},{"startTime":1496.28,"endTime":1498.2,"body":"she doesn't have a pulmonary embolism,"},{"startTime":1498.2,"endTime":1501.833,"body":"but she does have a tumor in her breast."},{"startTime":1503.09,"endTime":1504.68,"body":"So what happens as a result of that"},{"startTime":1504.68,"endTime":1507.32,"body":"is she goes into the"},{"startTime":1504.68,"endTime":1507.32,"body":"breast cancer program,"},{"startTime":1507.32,"endTime":1510.19,"body":"she would have a mammogram"},{"startTime":1507.32,"endTime":1510.19,"body":"to confirm that diagnosis,"},{"startTime":1510.19,"endTime":1512.15,"body":"an ultrasound and a biopsy,"},{"startTime":1512.15,"endTime":1514.31,"body":"and she would be very relieved"},{"startTime":1512.15,"endTime":1514.31,"body":"that her breast cancer"},{"startTime":1514.31,"endTime":1516.11,"body":"that she wasn't aware of previously"},{"startTime":1516.11,"endTime":1519.833,"body":"has now been detected and she's"},{"startTime":1516.11,"endTime":1519.833,"body":"been treated appropriately."},{"startTime":1521.0,"endTime":1523.19,"body":"But how often does that happen?"},{"startTime":1523.19,"endTime":1526.79,"body":"Well, in her survey of"},{"startTime":1523.19,"endTime":1526.79,"body":"about 35,000 chest scans,"},{"startTime":1526.79,"endTime":1530.27,"body":"actually about 25 breast"},{"startTime":1526.79,"endTime":1530.27,"body":"lesions were identified."},{"startTime":1530.27,"endTime":1533.48,"body":"So this is going to happen less"},{"startTime":1530.27,"endTime":1533.48,"body":"than one in a thousand times."},{"startTime":1533.48,"endTime":1535.7,"body":"So actually that isn't"},{"startTime":1533.48,"endTime":1535.7,"body":"the right way of going"},{"startTime":1535.7,"endTime":1536.63,"body":"about doing things."},{"startTime":1536.63,"endTime":1538.76,"body":"And in fact, what's more likely"},{"startTime":1538.76,"endTime":1542.03,"body":"is that we find a tiny"},{"startTime":1538.76,"endTime":1542.03,"body":"little nodule of something"},{"startTime":1542.03,"endTime":1544.85,"body":"that we don't really know what to do with."},{"startTime":1544.85,"endTime":1547.76,"body":"So if you come for a chest"},{"startTime":1544.85,"endTime":1547.76,"body":"CT scan for another reason"},{"startTime":1547.76,"endTime":1550.04,"body":"and we find a tiny little nodule,"},{"startTime":1550.04,"endTime":1551.81,"body":"we are not sure how to manage that."},{"startTime":1551.81,"endTime":1554.39,"body":"We're not sure what to tell"},{"startTime":1551.81,"endTime":1554.39,"body":"you about what that means."},{"startTime":1554.39,"endTime":1556.73,"body":"We're not sure what the"},{"startTime":1554.39,"endTime":1556.73,"body":"best thing to do is next."},{"startTime":1556.73,"endTime":1559.73,"body":"What you probably need is another scan."},{"startTime":1559.73,"endTime":1562.25,"body":"So if you're at high risk"},{"startTime":1562.25,"endTime":1563.36,"body":"and actually you're a smoker or something,"},{"startTime":1563.36,"endTime":1565.04,"body":"actually you're probably"},{"startTime":1563.36,"endTime":1565.04,"body":"need a biopsy to check"},{"startTime":1565.04,"endTime":1565.88,"body":"that that isn't cancer."},{"startTime":1565.88,"endTime":1568.19,"body":"If you're at low risk,"},{"startTime":1565.88,"endTime":1568.19,"body":"you might either need"},{"startTime":1568.19,"endTime":1571.19,"body":"a particular scan or maybe"},{"startTime":1568.19,"endTime":1571.19,"body":"scan you in three months"},{"startTime":1571.19,"endTime":1573.74,"body":"or six months to see whether"},{"startTime":1571.19,"endTime":1573.74,"body":"anything has changed."},{"startTime":1573.74,"endTime":1576.41,"body":"So from a single scan that"},{"startTime":1573.74,"endTime":1576.41,"body":"you weren't really expecting"},{"startTime":1576.41,"endTime":1578.3,"body":"to have that problem from, now,"},{"startTime":1578.3,"endTime":1579.44,"body":"knowing you have that problem,"},{"startTime":1579.44,"endTime":1581.45,"body":"you are now buying into two,"},{"startTime":1581.45,"endTime":1583.1,"body":"three, four further scans."},{"startTime":1583.1,"endTime":1586.76,"body":"And that's not just lungs"},{"startTime":1583.1,"endTime":1586.76,"body":"that that's relevant for,"},{"startTime":1586.76,"endTime":1588.35,"body":"it's also relevant for liver."},{"startTime":1588.35,"endTime":1590.24,"body":"So a small liver lesion."},{"startTime":1590.24,"endTime":1592.67,"body":"Here's a small liver lesion,"},{"startTime":1590.24,"endTime":1592.67,"body":"picked up incidentally"},{"startTime":1592.67,"endTime":1594.77,"body":"when we were scanning for"},{"startTime":1592.67,"endTime":1594.77,"body":"something else in an adult,"},{"startTime":1594.77,"endTime":1596.06,"body":"what do we do?"},{"startTime":1596.06,"endTime":1599.75,"body":"Well, we've got quite"},{"startTime":1596.06,"endTime":1599.75,"body":"complicated ways in MRI scanning"},{"startTime":1599.75,"endTime":1602.15,"body":"of identifying how that lesion behaves"},{"startTime":1602.15,"endTime":1603.53,"body":"to different contrast that we give."},{"startTime":1603.53,"endTime":1607.28,"body":"But you've effectively"},{"startTime":1603.53,"endTime":1607.28,"body":"bought yourself another scan,"},{"startTime":1607.28,"endTime":1608.96,"body":"and if that is normal or abnormal,"},{"startTime":1608.96,"endTime":1610.94,"body":"in order to find out what's happening"},{"startTime":1610.94,"endTime":1613.94,"body":"to that lesion over time,"},{"startTime":1610.94,"endTime":1613.94,"body":"we need to scan you again."},{"startTime":1613.94,"endTime":1616.55,"body":"So you'll come back after three"},{"startTime":1613.94,"endTime":1616.55,"body":"months or after six months,"},{"startTime":1616.55,"endTime":1618.92,"body":"or perhaps more regularly."},{"startTime":1618.92,"endTime":1622.58,"body":"So we're effectively one"},{"startTime":1618.92,"endTime":1622.58,"body":"scan of an unexpected finding"},{"startTime":1622.58,"endTime":1624.05,"body":"often results in more scans."},{"startTime":1624.05,"endTime":1627.41,"body":"And we fairly effectively"},{"startTime":1624.05,"endTime":1627.41,"body":"don't have capacity"},{"startTime":1627.41,"endTime":1628.673,"body":"to do all of these scans."},{"startTime":1629.93,"endTime":1632.36,"body":"The commonest incidental"},{"startTime":1629.93,"endTime":1632.36,"body":"finding is an adrenal problem."},{"startTime":1632.36,"endTime":1634.52,"body":"So the adrenal is a small gland that sits"},{"startTime":1634.52,"endTime":1635.6,"body":"just above the kidneys,"},{"startTime":1635.6,"endTime":1637.76,"body":"it produces lots of important hormones,"},{"startTime":1637.76,"endTime":1638.933,"body":"including adrenaline."},{"startTime":1640.07,"endTime":1642.95,"body":"And about 10% of people when they die"},{"startTime":1642.95,"endTime":1645.837,"body":"have completely asymptomatic,"},{"startTime":1645.837,"endTime":1648.71,"body":"completely inactive adrenal lesions."},{"startTime":1648.71,"endTime":1649.82,"body":"And they're so common,"},{"startTime":1649.82,"endTime":1652.97,"body":"they're called adrenals or incidentalomas."},{"startTime":1652.97,"endTime":1654.26,"body":"So if we scan the population,"},{"startTime":1654.26,"endTime":1657.02,"body":"10% of you would have these small lesions."},{"startTime":1657.02,"endTime":1658.52,"body":"They're very rarely malignant,"},{"startTime":1658.52,"endTime":1661.22,"body":"they very rarely do"},{"startTime":1658.52,"endTime":1661.22,"body":"anything exciting at all."},{"startTime":1661.22,"endTime":1664.19,"body":"But once we've scanned, what"},{"startTime":1661.22,"endTime":1664.19,"body":"do we do with the information?"},{"startTime":1664.19,"endTime":1665.69,"body":"What do we tell you?"},{"startTime":1665.69,"endTime":1667.94,"body":"Actually, should we measure the hormones?"},{"startTime":1667.94,"endTime":1670.156,"body":"But actually that won't tell us whether"},{"startTime":1670.156,"endTime":1671.158,"body":"or not it's malignant."},{"startTime":1671.158,"endTime":1672.95,"body":"So you end up getting, you've guessed it,"},{"startTime":1672.95,"endTime":1675.113,"body":"another scan in a little while to see."},{"startTime":1676.434,"endTime":1677.78,"body":"And where does all this"},{"startTime":1676.434,"endTime":1677.78,"body":"scanning now come from?"},{"startTime":1677.78,"endTime":1680.48,"body":"And I think one of the"},{"startTime":1677.78,"endTime":1680.48,"body":"things driving this is fear."},{"startTime":1680.48,"endTime":1683.54,"body":"I think we're afraid of"},{"startTime":1680.48,"endTime":1683.54,"body":"doing the wrong thing."},{"startTime":1683.54,"endTime":1685.58,"body":"Some of that is justified,"},{"startTime":1683.54,"endTime":1685.58,"body":"'cause if you look"},{"startTime":1685.58,"endTime":1689.003,"body":"at the misdiagnosis"},{"startTime":1685.58,"endTime":1689.003,"body":"claims in NHS hospitals,"},{"startTime":1690.169,"endTime":1691.28,"body":"actually most of the misdiagnosis"},{"startTime":1691.28,"endTime":1695.12,"body":"and the litigation claims are"},{"startTime":1691.28,"endTime":1695.12,"body":"about the wrong diagnosis,"},{"startTime":1695.12,"endTime":1698.84,"body":"missing the diagnosis, or"},{"startTime":1695.12,"endTime":1698.84,"body":"finding a diagnosis too late,"},{"startTime":1698.84,"endTime":1701.0,"body":"and it's too late to"},{"startTime":1698.84,"endTime":1701.0,"body":"do something about it."},{"startTime":1701.0,"endTime":1704.18,"body":"And the five top areas"},{"startTime":1701.0,"endTime":1704.18,"body":"where that's problematic for"},{"startTime":1704.18,"endTime":1706.4,"body":"are fractures, which we know imaging"},{"startTime":1706.4,"endTime":1708.77,"body":"can pick up fairly easily, and cancer,"},{"startTime":1708.77,"endTime":1710.9,"body":"which we've just described in quite detail"},{"startTime":1710.9,"endTime":1713.24,"body":"how imaging can pick up."},{"startTime":1713.24,"endTime":1717.8,"body":"So failure or a delay to send for a scan"},{"startTime":1717.8,"endTime":1720.02,"body":"can often mean a misdiagnosis."},{"startTime":1720.02,"endTime":1721.82,"body":"A failure to see the abnormality"},{"startTime":1721.82,"endTime":1724.61,"body":"as a radiologist often is problematic."},{"startTime":1724.61,"endTime":1726.89,"body":"And then a failure to follow up correctly"},{"startTime":1726.89,"endTime":1728.21,"body":"and do the right thing afterwards,"},{"startTime":1728.21,"endTime":1731.24,"body":"and make sure that you're"},{"startTime":1728.21,"endTime":1731.24,"body":"scanned three or six months later"},{"startTime":1731.24,"endTime":1736.24,"body":"is really what's driving all"},{"startTime":1731.24,"endTime":1736.24,"body":"of this force behind imaging."},{"startTime":1738.41,"endTime":1740.69,"body":"So whilst we all agree"},{"startTime":1738.41,"endTime":1740.69,"body":"that an unnecessary scan"},{"startTime":1740.69,"endTime":1743.39,"body":"is better than an unnecessary operation,"},{"startTime":1743.39,"endTime":1745.52,"body":"would you agree that an unnecessary scan"},{"startTime":1745.52,"endTime":1747.86,"body":"is better than an unnecessary lawsuit?"},{"startTime":1747.86,"endTime":1749.09,"body":"'Cause I think this is where"},{"startTime":1749.09,"endTime":1751.39,"body":"some of the referral"},{"startTime":1749.09,"endTime":1751.39,"body":"patterns are coming from."},{"startTime":1752.45,"endTime":1755.21,"body":"What is an unnecessary scan, by the way?"},{"startTime":1755.21,"endTime":1757.37,"body":"Because if I send you for a scan"},{"startTime":1757.37,"endTime":1758.9,"body":"for something you are"},{"startTime":1757.37,"endTime":1758.9,"body":"never likely to have,"},{"startTime":1758.9,"endTime":1760.46,"body":"you'll go, oh, that's a relief,"},{"startTime":1760.46,"endTime":1762.26,"body":"I haven't got that."},{"startTime":1762.26,"endTime":1764.18,"body":"Was that unnecessary?"},{"startTime":1764.18,"endTime":1766.01,"body":"You won't think so necessarily."},{"startTime":1766.01,"endTime":1767.96,"body":"So I think medical imaging has become"},{"startTime":1767.96,"endTime":1770.75,"body":"a little bit of a comfort blanket."},{"startTime":1770.75,"endTime":1773.81,"body":"We've become victims of our own success."},{"startTime":1773.81,"endTime":1775.43,"body":"We've made things available,"},{"startTime":1775.43,"endTime":1777.05,"body":"we've shown that things are possible,"},{"startTime":1777.05,"endTime":1779.24,"body":"and so people have"},{"startTime":1777.05,"endTime":1779.24,"body":"become a bit reliant now"},{"startTime":1779.24,"endTime":1780.53,"body":"on needing to have the imaging"},{"startTime":1780.53,"endTime":1782.09,"body":"in order to be be able to proceed."},{"startTime":1782.09,"endTime":1783.56,"body":"And it's become a little bit"},{"startTime":1783.56,"endTime":1786.26,"body":"like a path of least resistance."},{"startTime":1786.26,"endTime":1789.56,"body":"And I have great sympathy"},{"startTime":1786.26,"endTime":1789.56,"body":"for GPs seeing patients for,"},{"startTime":1789.56,"endTime":1791.09,"body":"I dunno, 5 minutes or 10 minutes"},{"startTime":1791.09,"endTime":1793.73,"body":"and trying to decide"},{"startTime":1791.09,"endTime":1793.73,"body":"who needs a scan or not."},{"startTime":1793.73,"endTime":1795.14,"body":"It's very difficult to decide."},{"startTime":1795.14,"endTime":1798.41,"body":"So it's easier to send"},{"startTime":1795.14,"endTime":1798.41,"body":"than it is not, isn't it?"},{"startTime":1798.41,"endTime":1802.64,"body":"So this idea of scanning just in case"},{"startTime":1802.64,"endTime":1804.26,"body":"is a reasonable approach,"},{"startTime":1804.26,"endTime":1807.35,"body":"but it's generated a"},{"startTime":1804.26,"endTime":1807.35,"body":"massive amount of work."},{"startTime":1807.35,"endTime":1808.58,"body":"So we have a quandary here,"},{"startTime":1808.58,"endTime":1811.52,"body":"which we have lots of"},{"startTime":1808.58,"endTime":1811.52,"body":"people that need imaging"},{"startTime":1811.52,"endTime":1814.67,"body":"and we don't have enough"},{"startTime":1811.52,"endTime":1814.67,"body":"resources to meet that demand."},{"startTime":1814.67,"endTime":1817.373,"body":"So how would we test the system?"},{"startTime":1818.63,"endTime":1819.92,"body":"Can we test it?"},{"startTime":1819.92,"endTime":1821.54,"body":"Can we suddenly stop imaging everybody"},{"startTime":1821.54,"endTime":1823.43,"body":"we don't want to image?"},{"startTime":1823.43,"endTime":1825.337,"body":"Well, that's really interesting"},{"startTime":1825.337,"endTime":1826.46,"body":"because that's sort of what happened"},{"startTime":1826.46,"endTime":1829.52,"body":"during the COVID pandemic."},{"startTime":1829.52,"endTime":1831.77,"body":"So I'm not going to talk"},{"startTime":1829.52,"endTime":1831.77,"body":"anything about the patients"},{"startTime":1831.77,"endTime":1834.74,"body":"who had COVID and the medical workforce,"},{"startTime":1834.74,"endTime":1838.52,"body":"and how they were all affected"},{"startTime":1834.74,"endTime":1838.52,"body":"through the COVID pandemic."},{"startTime":1838.52,"endTime":1841.4,"body":"But in March, 2020 elective imaging"},{"startTime":1841.4,"endTime":1843.95,"body":"effectively stopped overnight."},{"startTime":1843.95,"endTime":1845.09,"body":"You were only allowed into hospital"},{"startTime":1845.09,"endTime":1848.42,"body":"if you had a true emergency"},{"startTime":1845.09,"endTime":1848.42,"body":"or it was COVID related."},{"startTime":1848.42,"endTime":1851.03,"body":"That's entirely reasonable at the time."},{"startTime":1851.03,"endTime":1853.85,"body":"But the effects then"},{"startTime":1851.03,"endTime":1853.85,"body":"on imaging departments"},{"startTime":1853.85,"endTime":1856.7,"body":"in terms of the added social distancing,"},{"startTime":1856.7,"endTime":1860.0,"body":"the infection control, needing"},{"startTime":1856.7,"endTime":1860.0,"body":"to deep clean after patients,"},{"startTime":1860.0,"endTime":1862.94,"body":"and some imaging stuff"},{"startTime":1860.0,"endTime":1862.94,"body":"were redeployed elsewhere,"},{"startTime":1862.94,"endTime":1865.34,"body":"meant that you couldn't"},{"startTime":1862.94,"endTime":1865.34,"body":"provide the imaging service"},{"startTime":1865.34,"endTime":1867.413,"body":"you were normally expected to do so."},{"startTime":1868.31,"endTime":1869.75,"body":"So one of the key questions here"},{"startTime":1869.75,"endTime":1873.53,"body":"is about who didn't get"},{"startTime":1869.75,"endTime":1873.53,"body":"scanned during COVID?"},{"startTime":1873.53,"endTime":1875.48,"body":"So this concept is,"},{"startTime":1875.48,"endTime":1879.203,"body":"what was the pandemic effect"},{"startTime":1875.48,"endTime":1879.203,"body":"on patients without COVID?"},{"startTime":1880.49,"endTime":1883.58,"body":"So our diagnostic imaging"},{"startTime":1880.49,"endTime":1883.58,"body":"at the point of entry"},{"startTime":1883.58,"endTime":1886.22,"body":"actually continued, but was"},{"startTime":1883.58,"endTime":1886.22,"body":"obviously massively reduced,"},{"startTime":1886.22,"endTime":1888.08,"body":"less people came to hospital."},{"startTime":1888.08,"endTime":1890.45,"body":"Our interventional radiology"},{"startTime":1888.08,"endTime":1890.45,"body":"continued, but again,"},{"startTime":1890.45,"endTime":1892.64,"body":"massively reduced 'cause we weren't able"},{"startTime":1892.64,"endTime":1894.56,"body":"to provide that service."},{"startTime":1894.56,"endTime":1896.603,"body":"Screening was reduced,"},{"startTime":1894.56,"endTime":1896.603,"body":"people didn't go to hospital"},{"startTime":1896.603,"endTime":1898.67,"body":"for their screening test,"},{"startTime":1898.67,"endTime":1900.413,"body":"and surveillance, in terms"},{"startTime":1898.67,"endTime":1900.413,"body":"of checking how people"},{"startTime":1900.413,"endTime":1902.3,"body":"were doing month or"},{"startTime":1900.413,"endTime":1902.3,"body":"month, or year on year,"},{"startTime":1902.3,"endTime":1903.353,"body":"pretty much stopped."},{"startTime":1904.73,"endTime":1906.563,"body":"So what was the net effect of that?"},{"startTime":1907.58,"endTime":1909.02,"body":"Well, there's been a massive reduction"},{"startTime":1909.02,"endTime":1911.72,"body":"in the new breast cancer diagnoses,"},{"startTime":1911.72,"endTime":1914.33,"body":"and of course there's been"},{"startTime":1911.72,"endTime":1914.33,"body":"a lot fewer heart operations"},{"startTime":1914.33,"endTime":1917.15,"body":"and bowel cancer operations,"},{"startTime":1914.33,"endTime":1917.15,"body":"which would've happened anyway."},{"startTime":1917.15,"endTime":1920.87,"body":"But those people with those"},{"startTime":1917.15,"endTime":1920.87,"body":"diseases haven't disappeared."},{"startTime":1920.87,"endTime":1923.03,"body":"So they're simply out"},{"startTime":1920.87,"endTime":1923.03,"body":"there in the community now,"},{"startTime":1923.03,"endTime":1925.07,"body":"and I think we're only now, two years on,"},{"startTime":1925.07,"endTime":1928.58,"body":"starting to realize what the"},{"startTime":1925.07,"endTime":1928.58,"body":"effect of the pandemic was"},{"startTime":1928.58,"endTime":1931.34,"body":"on all of the diseases"},{"startTime":1928.58,"endTime":1931.34,"body":"that we didn't diagnose"},{"startTime":1931.34,"endTime":1932.393,"body":"during that time."},{"startTime":1933.83,"endTime":1935.06,"body":"So you might think that's fine,"},{"startTime":1935.06,"endTime":1938.39,"body":"because now we can catch up,"},{"startTime":1935.06,"endTime":1938.39,"body":"and now when you're diagnosed,"},{"startTime":1938.39,"endTime":1940.34,"body":"everything will be okay again."},{"startTime":1940.34,"endTime":1942.74,"body":"But actually there's a"},{"startTime":1940.34,"endTime":1942.74,"body":"serious quality of life issue"},{"startTime":1942.74,"endTime":1945.17,"body":"here about delay in diagnosis."},{"startTime":1945.17,"endTime":1948.35,"body":"And if we take hip"},{"startTime":1945.17,"endTime":1948.35,"body":"replacements as an example,"},{"startTime":1948.35,"endTime":1950.87,"body":"because there are 330 hip replacements"},{"startTime":1950.87,"endTime":1953.15,"body":"done every day in the NHS."},{"startTime":1953.15,"endTime":1957.86,"body":"So 60,000 people waited"},{"startTime":1953.15,"endTime":1957.86,"body":"an extra six months or so"},{"startTime":1957.86,"endTime":1962.33,"body":"for a hip replacement because"},{"startTime":1957.86,"endTime":1962.33,"body":"of the pandemic effect."},{"startTime":1962.33,"endTime":1963.648,"body":"So that's fine."},{"startTime":1963.648,"endTime":1964.55,"body":"You might think that's okay,"},{"startTime":1963.648,"endTime":1964.55,"body":"because actually there's"},{"startTime":1964.55,"endTime":1966.23,"body":"a quality of life lost"},{"startTime":1966.23,"endTime":1968.6,"body":"whilst the operation wasn't happening,"},{"startTime":1968.6,"endTime":1970.88,"body":"but in fact, with hip replacements,"},{"startTime":1970.88,"endTime":1973.67,"body":"operations are not as effective"},{"startTime":1973.67,"endTime":1974.503,"body":"if there's been such a delay."},{"startTime":1974.503,"endTime":1976.1,"body":"So actually the quality of life"},{"startTime":1976.1,"endTime":1977.57,"body":"once you've had your operation"},{"startTime":1977.57,"endTime":1979.49,"body":"can be significantly reduced"},{"startTime":1979.49,"endTime":1982.703,"body":"to actually outweigh any"},{"startTime":1979.49,"endTime":1982.703,"body":"benefit that you would've had."},{"startTime":1984.334,"endTime":1986.57,"body":"And we did a small study"},{"startTime":1984.334,"endTime":1986.57,"body":"in our own hospital,"},{"startTime":1986.57,"endTime":1990.32,"body":"children's imaging, about"},{"startTime":1986.57,"endTime":1990.32,"body":"how many patients came"},{"startTime":1990.32,"endTime":1992.9,"body":"and what happened during the pandemic?"},{"startTime":1992.9,"endTime":1994.28,"body":"The dotted line in the middle here"},{"startTime":1994.28,"endTime":1996.68,"body":"is the number of inpatients we saw during,"},{"startTime":1996.68,"endTime":2000.49,"body":"and the top line is the"},{"startTime":1996.68,"endTime":2000.49,"body":"number of outpatients."},{"startTime":2000.49,"endTime":2002.35,"body":"So you can see that the inpatient line,"},{"startTime":2002.35,"endTime":2005.41,"body":"the line in the middle actually"},{"startTime":2002.35,"endTime":2005.41,"body":"didn't change very much"},{"startTime":2005.41,"endTime":2007.27,"body":"during the lockdown"},{"startTime":2005.41,"endTime":2007.27,"body":"tiers and during COVID."},{"startTime":2007.27,"endTime":2009.73,"body":"So the sickest patients"},{"startTime":2007.27,"endTime":2009.73,"body":"were still in hospital,"},{"startTime":2009.73,"endTime":2012.31,"body":"still getting the treatment they needed."},{"startTime":2012.31,"endTime":2014.56,"body":"But those patients who are"},{"startTime":2012.31,"endTime":2014.56,"body":"still being seen as outpatient,"},{"startTime":2014.56,"endTime":2016.75,"body":"so these are children"},{"startTime":2014.56,"endTime":2016.75,"body":"that we are monitoring,"},{"startTime":2016.75,"endTime":2019.54,"body":"we're surveillance, and"},{"startTime":2016.75,"endTime":2019.54,"body":"using imaging to check"},{"startTime":2019.54,"endTime":2021.07,"body":"on the progression of disease,"},{"startTime":2021.07,"endTime":2025.0,"body":"actually that dropped"},{"startTime":2021.07,"endTime":2025.0,"body":"massively during the lockdown."},{"startTime":2025.0,"endTime":2026.11,"body":"Patients were encouraged"},{"startTime":2026.11,"endTime":2028.27,"body":"not to bring their children to hospital."},{"startTime":2028.27,"endTime":2030.16,"body":"But what was the effect then"},{"startTime":2030.16,"endTime":2033.33,"body":"on all of these patient groups over time?"},{"startTime":2033.33,"endTime":2035.813,"body":"So in fact, what we've"},{"startTime":2033.33,"endTime":2035.813,"body":"calculated is that we had about"},{"startTime":2035.813,"endTime":2038.2,"body":"a 40% reduction in all the patients"},{"startTime":2038.2,"endTime":2039.97,"body":"that we saw during the tier four lockdown,"},{"startTime":2039.97,"endTime":2042.37,"body":"and about a 25% reduction overall."},{"startTime":2042.37,"endTime":2045.37,"body":"So instead of seeing about"},{"startTime":2042.37,"endTime":2045.37,"body":"70,000 patients a year,"},{"startTime":2045.37,"endTime":2047.117,"body":"we saw about 50,000."},{"startTime":2048.07,"endTime":2049.42,"body":"So what's happened"},{"startTime":2049.42,"endTime":2053.32,"body":"to those 18,000 missed"},{"startTime":2049.42,"endTime":2053.32,"body":"outpatient appointments?"},{"startTime":2053.32,"endTime":2056.26,"body":"And this is just about imaging."},{"startTime":2056.26,"endTime":2059.47,"body":"Well, if we assume that"},{"startTime":2056.26,"endTime":2059.47,"body":"we had a 10% increase"},{"startTime":2059.47,"endTime":2061.96,"body":"in working capacity,"},{"startTime":2059.47,"endTime":2061.96,"body":"actually it would take us two"},{"startTime":2061.96,"endTime":2064.72,"body":"and a half years to catch"},{"startTime":2061.96,"endTime":2064.72,"body":"up on all of that activity,"},{"startTime":2064.72,"endTime":2066.82,"body":"to see all of those patients."},{"startTime":2066.82,"endTime":2069.22,"body":"So the two critical questions"},{"startTime":2066.82,"endTime":2069.22,"body":"for the hospital at the time"},{"startTime":2069.22,"endTime":2072.1,"body":"that we realized this and"},{"startTime":2069.22,"endTime":2072.1,"body":"were going through trying"},{"startTime":2072.1,"endTime":2073.99,"body":"to get things back to normal is, one,"},{"startTime":2073.99,"endTime":2075.46,"body":"is how do we recover that activity?"},{"startTime":2075.46,"endTime":2077.17,"body":"How do we get to see"},{"startTime":2075.46,"endTime":2077.17,"body":"all of those children?"},{"startTime":2077.17,"endTime":2078.28,"body":"Secondly, do we need to,"},{"startTime":2078.28,"endTime":2079.543,"body":"what have we missed?"},{"startTime":2080.38,"endTime":2082.18,"body":"And I think we genuinely don't know."},{"startTime":2083.26,"endTime":2087.49,"body":"What we do know is that NHS"},{"startTime":2083.26,"endTime":2087.49,"body":"waiting lists are three times"},{"startTime":2087.49,"endTime":2090.4,"body":"as large now as they were 10 years ago."},{"startTime":2090.4,"endTime":2092.83,"body":"So in 2012 there were 2"},{"startTime":2090.4,"endTime":2092.83,"body":"and a half million people"},{"startTime":2092.83,"endTime":2094.84,"body":"waiting for routine hospital treatment"},{"startTime":2094.84,"endTime":2097.51,"body":"and there are now six, seven million."},{"startTime":2097.51,"endTime":2099.61,"body":"There were about half a"},{"startTime":2097.51,"endTime":2099.61,"body":"million people waiting"},{"startTime":2099.61,"endTime":2102.94,"body":"for an MRI or CT scan, there"},{"startTime":2099.61,"endTime":2102.94,"body":"are now one and a half million."},{"startTime":2102.94,"endTime":2106.783,"body":"So the queue is getting longer and longer."},{"startTime":2108.19,"endTime":2111.13,"body":"If you combine that with"},{"startTime":2108.19,"endTime":2111.13,"body":"the fact that actually"},{"startTime":2111.13,"endTime":2114.82,"body":"we have some of the lowest"},{"startTime":2111.13,"endTime":2114.82,"body":"numbers of CT scanners"},{"startTime":2114.82,"endTime":2116.32,"body":"per head of population,"},{"startTime":2116.32,"endTime":2118.9,"body":"and some of the lowest"},{"startTime":2116.32,"endTime":2118.9,"body":"numbers of radiologists"},{"startTime":2118.9,"endTime":2120.43,"body":"per head of population."},{"startTime":2120.43,"endTime":2122.89,"body":"So we're not starting"},{"startTime":2120.43,"endTime":2122.89,"body":"from a good place in order"},{"startTime":2122.89,"endTime":2124.31,"body":"to be able to play catch up"},{"startTime":2125.583,"endTime":2127.99,"body":"with some of the appointments"},{"startTime":2125.583,"endTime":2127.99,"body":"that we've missed."},{"startTime":2127.99,"endTime":2130.84,"body":"And overall, in terms"},{"startTime":2127.99,"endTime":2130.84,"body":"of the number of doctors"},{"startTime":2130.84,"endTime":2133.54,"body":"and nurses we have, the UK is,"},{"startTime":2133.54,"endTime":2136.27,"body":"what, just below Lithuania"},{"startTime":2133.54,"endTime":2136.27,"body":"and the Czech Republic"},{"startTime":2136.27,"endTime":2137.62,"body":"in terms of Western Europe,"},{"startTime":2138.608,"endTime":2139.51,"body":"in terms of how well staffed we are,"},{"startTime":2139.51,"endTime":2143.413,"body":"purely in terms of people"},{"startTime":2139.51,"endTime":2143.413,"body":"able to offer that service."},{"startTime":2144.37,"endTime":2145.66,"body":"And again, if you look at the shortage,"},{"startTime":2145.66,"endTime":2148.27,"body":"the availability of CT"},{"startTime":2145.66,"endTime":2148.27,"body":"scanners by country."},{"startTime":2148.27,"endTime":2151.66,"body":"So the UK is here, and"},{"startTime":2148.27,"endTime":2151.66,"body":"MRI scanners similarly,"},{"startTime":2151.66,"endTime":2155.11,"body":"we started off on a low baseline in 2011,"},{"startTime":2155.11,"endTime":2158.62,"body":"and actually by 2016 we don't"},{"startTime":2155.11,"endTime":2158.62,"body":"have many more scanners."},{"startTime":2158.62,"endTime":2160.9,"body":"In 2022 it doesn't look"},{"startTime":2158.62,"endTime":2160.9,"body":"any better than this."},{"startTime":2160.9,"endTime":2163.57,"body":"And other countries have clearly invested"},{"startTime":2163.57,"endTime":2165.253,"body":"in their technology."},{"startTime":2166.87,"endTime":2168.19,"body":"So the quandary gets worse."},{"startTime":2168.19,"endTime":2170.26,"body":"We've got lots of people needing imaging,"},{"startTime":2170.26,"endTime":2172.99,"body":"we haven't got enough"},{"startTime":2170.26,"endTime":2172.99,"body":"resources to meet the demand,"},{"startTime":2172.99,"endTime":2175.0,"body":"and now we've got a backlog due"},{"startTime":2175.0,"endTime":2178.267,"body":"to a chronic shortage"},{"startTime":2175.0,"endTime":2178.267,"body":"and the COVID pandemic."},{"startTime":2178.267,"endTime":2180.73,"body":"And some people are arguing,"},{"startTime":2178.267,"endTime":2180.73,"body":"actually forget the pandemic,"},{"startTime":2180.73,"endTime":2183.46,"body":"the NHS decline was happening for years"},{"startTime":2183.46,"endTime":2184.71,"body":"before we even got there."},{"startTime":2185.98,"endTime":2187.628,"body":"So what are we to do?"},{"startTime":2187.628,"endTime":2191.05,"body":"What are the potential solutions"},{"startTime":2187.628,"endTime":2191.05,"body":"to solving this problem?"},{"startTime":2191.05,"endTime":2193.99,"body":"Do we just need more machines, more staff,"},{"startTime":2193.99,"endTime":2196.15,"body":"bigger hospitals, more throughput?"},{"startTime":2196.15,"endTime":2197.77,"body":"Or do we need to be slightly cleverer"},{"startTime":2197.77,"endTime":2198.7,"body":"about how we do things?"},{"startTime":2198.7,"endTime":2200.65,"body":"And actually, I think we need"},{"startTime":2198.7,"endTime":2200.65,"body":"to be a bit more judicious"},{"startTime":2200.65,"endTime":2202.51,"body":"about the use of imaging that we have"},{"startTime":2202.51,"endTime":2206.2,"body":"and to try and adapt"},{"startTime":2202.51,"endTime":2206.2,"body":"things slightly cleverer."},{"startTime":2206.2,"endTime":2207.88,"body":"What about home imaging"},{"startTime":2207.88,"endTime":2209.83,"body":"and what about artificial intelligence?"},{"startTime":2210.94,"endTime":2212.59,"body":"Home imaging, I dunno if you saw this,"},{"startTime":2212.59,"endTime":2216.04,"body":"so this device won the James Dyson Award"},{"startTime":2216.04,"endTime":2217.15,"body":"in the UK this year."},{"startTime":2217.15,"endTime":2219.82,"body":"This is a tool to spot"},{"startTime":2217.15,"endTime":2219.82,"body":"breast cancer at home."},{"startTime":2219.82,"endTime":2223.18,"body":"This is a very simple"},{"startTime":2219.82,"endTime":2223.18,"body":"superficial ultrasound machine"},{"startTime":2223.18,"endTime":2226.33,"body":"that can bluetooth to your mobile device,"},{"startTime":2226.33,"endTime":2228.58,"body":"and it can pick up any"},{"startTime":2226.33,"endTime":2228.58,"body":"abnormalities under the skin."},{"startTime":2228.58,"endTime":2231.61,"body":"So because several breast"},{"startTime":2228.58,"endTime":2231.61,"body":"cancers are superficial,"},{"startTime":2231.61,"endTime":2234.892,"body":"this is not a bad way of"},{"startTime":2231.61,"endTime":2234.892,"body":"trying to pick those up."},{"startTime":2234.892,"endTime":2236.44,"body":"This is very much at"},{"startTime":2234.892,"endTime":2236.44,"body":"the developmental stage."},{"startTime":2236.44,"endTime":2238.42,"body":"And I dunno how many of"},{"startTime":2236.44,"endTime":2238.42,"body":"you would feel comfortable"},{"startTime":2238.42,"endTime":2240.12,"body":"using something like this at home."},{"startTime":2242.02,"endTime":2245.23,"body":"In 2016, one of the AI pioneers,"},{"startTime":2245.23,"endTime":2246.97,"body":"Geoffrey Hinton,"},{"startTime":2246.97,"endTime":2250.12,"body":"said that we should stop"},{"startTime":2246.97,"endTime":2250.12,"body":"training radiologists completely."},{"startTime":2250.12,"endTime":2252.13,"body":"He said, \"It was completely obvious to him"},{"startTime":2252.13,"endTime":2256.03,"body":"that within five years deep"},{"startTime":2252.13,"endTime":2256.03,"body":"learning\", computer technology,"},{"startTime":2256.03,"endTime":2257.237,"body":"artificial intelligence,"},{"startTime":2257.237,"endTime":2259.24,"body":"\"Would do much better than radiology.\""},{"startTime":2259.24,"endTime":2260.53,"body":"And if you want to watch him say that,"},{"startTime":2260.53,"endTime":2263.443,"body":"there's a YouTube link to his video."},{"startTime":2264.4,"endTime":2265.6,"body":"So what did he mean by that?"},{"startTime":2265.6,"endTime":2268.63,"body":"So can you train machines"},{"startTime":2265.6,"endTime":2268.63,"body":"to do what radiologists do?"},{"startTime":2268.63,"endTime":2270.73,"body":"Well, if we ask a simpler question,"},{"startTime":2270.73,"endTime":2271.93,"body":"can computers help us?"},{"startTime":2271.93,"endTime":2275.08,"body":"Can computers help us identify"},{"startTime":2271.93,"endTime":2275.08,"body":"abnormalities on images?"},{"startTime":2275.08,"endTime":2278.53,"body":"Well, yes they can, once we train them."},{"startTime":2278.53,"endTime":2281.38,"body":"So if we train an algorithm to say, look,"},{"startTime":2281.38,"endTime":2283.3,"body":"there might be fractures in this bone"},{"startTime":2283.3,"endTime":2286.33,"body":"and look there might be"},{"startTime":2283.3,"endTime":2286.33,"body":"abnormalities on this chest x-ray,"},{"startTime":2286.33,"endTime":2288.43,"body":"then the next image it comes across,"},{"startTime":2288.43,"endTime":2290.44,"body":"it could help identify those."},{"startTime":2290.44,"endTime":2291.76,"body":"So it's very sensible to think"},{"startTime":2291.76,"endTime":2293.89,"body":"about developing artificial intelligence"},{"startTime":2293.89,"endTime":2297.67,"body":"as a way of accompanying medical imaging."},{"startTime":2297.67,"endTime":2299.74,"body":"But in fact, deep neural networks"},{"startTime":2299.74,"endTime":2300.64,"body":"and artificial intelligence"},{"startTime":2300.64,"endTime":2302.92,"body":"are actually also really easy to fool."},{"startTime":2302.92,"endTime":2305.38,"body":"So with the simple"},{"startTime":2302.92,"endTime":2305.38,"body":"addition of some stickers"},{"startTime":2305.38,"endTime":2307.75,"body":"on this stop sign, that"},{"startTime":2305.38,"endTime":2307.75,"body":"computer interprets"},{"startTime":2307.75,"endTime":2310.3,"body":"that as a completely different image."},{"startTime":2310.3,"endTime":2313.33,"body":"Computers can also see"},{"startTime":2310.3,"endTime":2313.33,"body":"images of, what's that,"},{"startTime":2313.33,"endTime":2315.88,"body":"a king penguin and a starfish,"},{"startTime":2315.88,"endTime":2317.86,"body":"where we wouldn't interpret that,"},{"startTime":2317.86,"endTime":2320.05,"body":"and can make lots of different mistakes"},{"startTime":2320.05,"endTime":2321.61,"body":"about what different imaging are,"},{"startTime":2321.61,"endTime":2323.23,"body":"depending on what we show it."},{"startTime":2323.23,"endTime":2325.96,"body":"So they're too easy to fool at the moment."},{"startTime":2325.96,"endTime":2327.64,"body":"And where you or I might recognize"},{"startTime":2327.64,"endTime":2330.97,"body":"that actually this is a scan"},{"startTime":2327.64,"endTime":2330.97,"body":"of a patient with a spine,"},{"startTime":2330.97,"endTime":2332.451,"body":"a liver, and things,"},{"startTime":2332.451,"endTime":2335.26,"body":"and actually all they've done"},{"startTime":2332.451,"endTime":2335.26,"body":"is breathed during the scan,"},{"startTime":2335.26,"endTime":2337.578,"body":"actually that completely fools"},{"startTime":2337.578,"endTime":2338.92,"body":"an artificial intelligence machine,"},{"startTime":2338.92,"endTime":2342.25,"body":"and they make mistakes,"},{"startTime":2338.92,"endTime":2342.25,"body":"finding tiny blobs of things"},{"startTime":2342.25,"endTime":2345.97,"body":"which radiologists trained to"},{"startTime":2342.25,"endTime":2345.97,"body":"look at those would disregard,"},{"startTime":2345.97,"endTime":2348.22,"body":"and artificial intelligence picks up."},{"startTime":2348.22,"endTime":2350.32,"body":"So we are not quite there yet."},{"startTime":2350.32,"endTime":2352.63,"body":"But if we think about where computers"},{"startTime":2352.63,"endTime":2355.27,"body":"could help us in this pathway, actually,"},{"startTime":2355.27,"endTime":2358.84,"body":"I think there's a lot of work"},{"startTime":2355.27,"endTime":2358.84,"body":"to be done on risk factors."},{"startTime":2358.84,"endTime":2362.2,"body":"So it might well be that"},{"startTime":2358.84,"endTime":2362.2,"body":"your genetic makeup,"},{"startTime":2362.2,"endTime":2364.54,"body":"together with your lifestyle choices,"},{"startTime":2364.54,"endTime":2366.94,"body":"actually would push you"},{"startTime":2364.54,"endTime":2366.94,"body":"into receiving imaging"},{"startTime":2366.94,"endTime":2369.43,"body":"for early detection of different diseases"},{"startTime":2369.43,"endTime":2372.4,"body":"that an artificial intelligence algorithm"},{"startTime":2372.4,"endTime":2375.52,"body":"could tell us much"},{"startTime":2372.4,"endTime":2375.52,"body":"earlier than a radiologist"},{"startTime":2375.52,"endTime":2376.9,"body":"would pick up on a scan."},{"startTime":2376.9,"endTime":2379.06,"body":"So I think there's a place"},{"startTime":2376.9,"endTime":2379.06,"body":"for artificial intelligence"},{"startTime":2379.06,"endTime":2381.67,"body":"to help funnel people, perhaps,"},{"startTime":2381.67,"endTime":2383.44,"body":"into the most appropriate imaging,"},{"startTime":2383.44,"endTime":2386.92,"body":"but maybe it's not in"},{"startTime":2383.44,"endTime":2386.92,"body":"interpreting imaging themselves."},{"startTime":2386.92,"endTime":2390.22,"body":"And of course, by the time"},{"startTime":2386.92,"endTime":2390.22,"body":"you've got to have a scan"},{"startTime":2390.22,"endTime":2391.81,"body":"that isn't really part of the problem,"},{"startTime":2391.81,"endTime":2393.34,"body":"the part of the problem here is access"},{"startTime":2393.34,"endTime":2394.89,"body":"to scanners in the first place."},{"startTime":2396.16,"endTime":2398.8,"body":"So artificial intelligence"},{"startTime":2396.16,"endTime":2398.8,"body":"might be able to help us"},{"startTime":2398.8,"endTime":2401.32,"body":"become more efficient in"},{"startTime":2398.8,"endTime":2401.32,"body":"the way that we do things,"},{"startTime":2401.32,"endTime":2404.71,"body":"helping people through the"},{"startTime":2401.32,"endTime":2404.71,"body":"patient pathway a bit better,"},{"startTime":2404.71,"endTime":2406.72,"body":"making sure that things are"},{"startTime":2404.71,"endTime":2406.72,"body":"done in a timely fashion,"},{"startTime":2406.72,"endTime":2407.98,"body":"or maybe interpreting the results,"},{"startTime":2407.98,"endTime":2409.48,"body":"sending you the results back"},{"startTime":2409.48,"endTime":2410.44,"body":"and making sure that you're seen"},{"startTime":2410.44,"endTime":2412.34,"body":"in the clinic appropriately next time."},{"startTime":2414.64,"endTime":2417.28,"body":"So what is the answer to the question,"},{"startTime":2417.28,"endTime":2419.353,"body":"are we too reliant on medical imaging?"},{"startTime":2420.64,"endTime":2422.08,"body":"Well, clearly there's a balance here,"},{"startTime":2422.08,"endTime":2424.45,"body":"isn't there, between over-diagnosing"},{"startTime":2424.45,"endTime":2428.29,"body":"and over scanning versus"},{"startTime":2424.45,"endTime":2428.29,"body":"underdiagnosing and under scanning."},{"startTime":2428.29,"endTime":2431.68,"body":"So if fear is pushing to scan a bit more,"},{"startTime":2431.68,"endTime":2434.356,"body":"what we're going to do"},{"startTime":2431.68,"endTime":2434.356,"body":"is we're going to find"},{"startTime":2434.356,"endTime":2437.68,"body":"more incidental findings in an"},{"startTime":2434.356,"endTime":2437.68,"body":"otherwise normal population."},{"startTime":2437.68,"endTime":2439.96,"body":"I think the bigger problem"},{"startTime":2437.68,"endTime":2439.96,"body":"here is that we've got"},{"startTime":2439.96,"endTime":2443.83,"body":"a very limited resource"},{"startTime":2439.96,"endTime":2443.83,"body":"in an ailing population."},{"startTime":2443.83,"endTime":2446.47,"body":"So I don't think there is a quick fix,"},{"startTime":2446.47,"endTime":2448.6,"body":"but what we're trying to"},{"startTime":2446.47,"endTime":2448.6,"body":"look for is, of course,"},{"startTime":2448.6,"endTime":2450.87,"body":"we're trying to aim for the right test,"},{"startTime":2450.87,"endTime":2453.58,"body":"at the right person, at the right time."},{"startTime":2453.58,"endTime":2455.68,"body":"So maybe I should push"},{"startTime":2453.58,"endTime":2455.68,"body":"the question back to you"},{"startTime":2455.68,"endTime":2458.98,"body":"and ask you, do you"},{"startTime":2455.68,"endTime":2458.98,"body":"think we are too reliant"},{"startTime":2458.98,"endTime":2462.343,"body":"or are we just reliant"},{"startTime":2458.98,"endTime":2462.343,"body":"enough on medical imaging?"},{"startTime":2463.18,"endTime":2464.77,"body":"The question really here,"},{"startTime":2464.77,"endTime":2466.663,"body":"who doesn't need to be in this queue?"},{"startTime":2468.85,"endTime":2470.345,"body":"Thank you."},{"startTime":2470.345,"endTime":2473.713,"body":"(audience applauding)"},{"startTime":2473.713,"endTime":2474.546,"body":"- I've got a couple of questions"},{"startTime":2474.546,"endTime":2476.65,"body":"from the online audience if, I may,"},{"startTime":2476.65,"endTime":2478.183,"body":"to begin with?"},{"startTime":2476.65,"endTime":2478.183,"body":"- Of course."},{"startTime":2479.08,"endTime":2481.153,"body":"- So the first one I've got here is,"},{"startTime":2482.14,"endTime":2485.35,"body":"assuming we can't simply print more money,"},{"startTime":2485.35,"endTime":2490.35,"body":"what would reduce any overuse"},{"startTime":2485.35,"endTime":2490.35,"body":"of medical imaging the most?"},{"startTime":2491.05,"endTime":2494.38,"body":"- So there's the so-called worried well,"},{"startTime":2494.38,"endTime":2495.97,"body":"I dunno if you've heard of this concept?"},{"startTime":2495.97,"endTime":2497.41,"body":"So those are people who are anxious,"},{"startTime":2497.41,"endTime":2499.21,"body":"they're worried about"},{"startTime":2497.41,"endTime":2499.21,"body":"something happening to them,"},{"startTime":2499.21,"endTime":2501.19,"body":"and they might go and seek medical advice"},{"startTime":2501.19,"endTime":2504.04,"body":"over less important symptoms."},{"startTime":2504.04,"endTime":2506.17,"body":"And of course we have the opposite,"},{"startTime":2506.17,"endTime":2508.18,"body":"which are people who actually"},{"startTime":2506.17,"endTime":2508.18,"body":"need urgent healthcare"},{"startTime":2508.18,"endTime":2510.07,"body":"who don't come to medical attention."},{"startTime":2510.07,"endTime":2512.95,"body":"That's always the dilemma,"},{"startTime":2510.07,"endTime":2512.95,"body":"and I think GPs are seeing"},{"startTime":2512.95,"endTime":2516.16,"body":"both of those populations, but"},{"startTime":2512.95,"endTime":2516.16,"body":"far more of the worried well"},{"startTime":2516.16,"endTime":2518.5,"body":"than they are of the people"},{"startTime":2516.16,"endTime":2518.5,"body":"who really need them."},{"startTime":2518.5,"endTime":2523.21,"body":"So how would we diagnose"},{"startTime":2518.5,"endTime":2523.21,"body":"those people is interesting."},{"startTime":2523.21,"endTime":2525.437,"body":"I think they're often sent for a scan"},{"startTime":2525.437,"endTime":2528.94,"body":"\"just in case\" or as a reassurance."},{"startTime":2528.94,"endTime":2532.3,"body":"But I think reducing"},{"startTime":2528.94,"endTime":2532.3,"body":"that would really help."},{"startTime":2532.3,"endTime":2535.06,"body":"I think the other thing that"},{"startTime":2532.3,"endTime":2535.06,"body":"we have a problem with is"},{"startTime":2535.06,"endTime":2538.39,"body":"those patients who don't"},{"startTime":2535.06,"endTime":2538.39,"body":"attend their appointments."},{"startTime":2538.39,"endTime":2541.99,"body":"So this is true for GPs as well"},{"startTime":2538.39,"endTime":2541.99,"body":"as in hospitals and clinics."},{"startTime":2541.99,"endTime":2546.49,"body":"And I think that's the point"},{"startTime":2541.99,"endTime":2546.49,"body":"at which I suspect somebody"},{"startTime":2546.49,"endTime":2548.05,"body":"from a political standpoint"},{"startTime":2548.05,"endTime":2550.3,"body":"might want to start charging for."},{"startTime":2550.3,"endTime":2553.6,"body":"So the most inefficient"},{"startTime":2550.3,"endTime":2553.6,"body":"use of medical resources"},{"startTime":2553.6,"endTime":2555.28,"body":"is not to turn up."},{"startTime":2555.28,"endTime":2557.881,"body":"So that might be another area"},{"startTime":2557.881,"endTime":2559.72,"body":"where we can become a bit more efficient."},{"startTime":2559.72,"endTime":2560.89,"body":"- Professor Arthurs,"},{"startTime":2560.89,"endTime":2563.71,"body":"I've got a question here"},{"startTime":2560.89,"endTime":2563.71,"body":"from the online audience."},{"startTime":2563.71,"endTime":2565.9,"body":"Would there be issues on waiting lists"},{"startTime":2565.9,"endTime":2567.64,"body":"if we haven't had a pandemic?"},{"startTime":2567.64,"endTime":2569.29,"body":"I think you've sort of"},{"startTime":2567.64,"endTime":2569.29,"body":"answered that, haven't you,"},{"startTime":2569.29,"endTime":2570.76,"body":"there would be."},{"startTime":2569.29,"endTime":2570.76,"body":"- Yes, I think so."},{"startTime":2570.76,"endTime":2573.49,"body":"And the argument is that"},{"startTime":2570.76,"endTime":2573.49,"body":"actually before the pandemic,"},{"startTime":2573.49,"endTime":2575.83,"body":"I think, that the waiting"},{"startTime":2573.49,"endTime":2575.83,"body":"lists were about double"},{"startTime":2575.83,"endTime":2577.96,"body":"what they were 5 or 10 years ago,"},{"startTime":2577.96,"endTime":2579.25,"body":"and now they're triple."},{"startTime":2579.25,"endTime":2583.0,"body":"So we had a problem before"},{"startTime":2579.25,"endTime":2583.0,"body":"the pandemic existed."},{"startTime":2583.0,"endTime":2584.5,"body":"Some people are saying that actually"},{"startTime":2584.5,"endTime":2587.83,"body":"what the pandemic did"},{"startTime":2584.5,"endTime":2587.83,"body":"in terms of this context"},{"startTime":2587.83,"endTime":2589.6,"body":"was really just to accelerate things"},{"startTime":2589.6,"endTime":2591.73,"body":"and brought forward two years, probably,"},{"startTime":2591.73,"endTime":2594.1,"body":"of of change into about a month."},{"startTime":2594.1,"endTime":2596.08,"body":"So yeah."},{"startTime":2594.1,"endTime":2596.08,"body":"- Thanks."},{"startTime":2596.08,"endTime":2598.12,"body":"Great lecture, you covered lots."},{"startTime":2598.12,"endTime":2599.71,"body":"So there seems to be correlation"},{"startTime":2599.71,"endTime":2602.69,"body":"between how good the"},{"startTime":2599.71,"endTime":2602.69,"body":"medical imaging quality"},{"startTime":2603.557,"endTime":2605.461,"body":"is over time and the number"},{"startTime":2603.557,"endTime":2605.461,"body":"of people who are scanned."},{"startTime":2605.461,"endTime":2607.66,"body":"So should we just stop trying"},{"startTime":2605.461,"endTime":2607.66,"body":"to improve medical imaging?"},{"startTime":2607.66,"endTime":2609.64,"body":"- That's an excellent question, isn't it?"},{"startTime":2609.64,"endTime":2611.47,"body":"So the natural progression is to try"},{"startTime":2611.47,"endTime":2613.93,"body":"and improve everything, and"},{"startTime":2611.47,"endTime":2613.93,"body":"we'll continue to do that,"},{"startTime":2613.93,"endTime":2616.39,"body":"'cause actually we make better diagnoses"},{"startTime":2616.39,"endTime":2617.89,"body":"that are better for patients,"},{"startTime":2617.89,"endTime":2622.57,"body":"and patients will get"},{"startTime":2617.89,"endTime":2622.57,"body":"better access to healthcare"},{"startTime":2622.57,"endTime":2624.25,"body":"and recover better as a result of those."},{"startTime":2624.25,"endTime":2628.03,"body":"So holding back technology"},{"startTime":2624.25,"endTime":2628.03,"body":"isn't one of the solutions here."},{"startTime":2628.03,"endTime":2630.73,"body":"I think more judicious"},{"startTime":2628.03,"endTime":2630.73,"body":"use of that technology"},{"startTime":2630.73,"endTime":2632.68,"body":"is really where we're going to improve."},{"startTime":2633.676,"endTime":2635.47,"body":"- [Audience Member #1]"},{"startTime":2633.676,"endTime":2635.47,"body":"I think read last week"},{"startTime":2635.47,"endTime":2637.63,"body":"that there is a plan, potentially,"},{"startTime":2637.63,"endTime":2640.27,"body":"for national screening for lung cancer,"},{"startTime":2640.27,"endTime":2642.25,"body":"particularly for those who are ex-smokers"},{"startTime":2642.25,"endTime":2643.78,"body":"or current smokers."},{"startTime":2643.78,"endTime":2646.69,"body":"Do you believe that that"},{"startTime":2643.78,"endTime":2646.69,"body":"is a good use of resources"},{"startTime":2646.69,"endTime":2650.113,"body":"given the shortage of scanning capacity?"},{"startTime":2652.09,"endTime":2655.66,"body":"- So with every new idea and"},{"startTime":2652.09,"endTime":2655.66,"body":"new plan that comes along,"},{"startTime":2655.66,"endTime":2658.03,"body":"it usually requires additional resource."},{"startTime":2658.03,"endTime":2661.84,"body":"So if it's going to be occupying scanners"},{"startTime":2661.84,"endTime":2663.94,"body":"that are currently used for other things,"},{"startTime":2663.94,"endTime":2665.53,"body":"then actually all we've done there"},{"startTime":2665.53,"endTime":2668.14,"body":"is just generate a larger waiting list."},{"startTime":2668.14,"endTime":2669.91,"body":"If that's going to be resourced outside,"},{"startTime":2669.91,"endTime":2672.37,"body":"either with mobile scanners"},{"startTime":2669.91,"endTime":2672.37,"body":"or those sort of clinics,"},{"startTime":2672.37,"endTime":2674.62,"body":"then yes, I think that would be good."},{"startTime":2674.62,"endTime":2677.59,"body":"The end results to try and improve"},{"startTime":2677.59,"endTime":2680.14,"body":"the health of the patients"},{"startTime":2677.59,"endTime":2680.14,"body":"and the population"},{"startTime":2680.14,"endTime":2681.61,"body":"is exactly what we're trying to do."},{"startTime":2681.61,"endTime":2683.14,"body":"So if imaging can help doing that,"},{"startTime":2683.14,"endTime":2685.18,"body":"I think that's what we should be doing."},{"startTime":2685.18,"endTime":2687.7,"body":"The difficulty is the"},{"startTime":2685.18,"endTime":2687.7,"body":"sheer volume of things"},{"startTime":2687.7,"endTime":2689.56,"body":"we now need to try and cope with"},{"startTime":2689.56,"endTime":2691.9,"body":"because of the illnesses out there,"},{"startTime":2691.9,"endTime":2693.67,"body":"and we are unable to try and cope"},{"startTime":2693.67,"endTime":2695.32,"body":"with all of that effectively to try and,"},{"startTime":2695.32,"endTime":2696.47,"body":"yeah, meet that demand."},{"startTime":2697.662,"endTime":2698.89,"body":"- I've got couple more"},{"startTime":2697.662,"endTime":2698.89,"body":"questions for online,"},{"startTime":2698.89,"endTime":2701.79,"body":"and then we can go back"},{"startTime":2698.89,"endTime":2701.79,"body":"to the in-person audience."},{"startTime":2701.79,"endTime":2703.36,"body":"So there's one here on,"},{"startTime":2703.36,"endTime":2707.05,"body":"how do we take the rationing"},{"startTime":2703.36,"endTime":2707.05,"body":"decision in an ethical way"},{"startTime":2707.05,"endTime":2709.93,"body":"in the public health system"},{"startTime":2707.05,"endTime":2709.93,"body":"rather than private money,"},{"startTime":2709.93,"endTime":2713.47,"body":"ensuring they're seen"},{"startTime":2709.93,"endTime":2713.47,"body":"when they want to be seen?"},{"startTime":2713.47,"endTime":2715.39,"body":"- Yeah, so some people can buy themselves"},{"startTime":2715.39,"endTime":2717.52,"body":"out of waiting list by going private,"},{"startTime":2717.52,"endTime":2720.85,"body":"but actually that's still"},{"startTime":2717.52,"endTime":2720.85,"body":"a resource of people"},{"startTime":2720.85,"endTime":2722.8,"body":"who are running scanners,"},{"startTime":2720.85,"endTime":2722.8,"body":"of technologists,"},{"startTime":2722.8,"endTime":2723.633,"body":"of radiologists."},{"startTime":2723.633,"endTime":2725.29,"body":"So we haven't really solved the problem"},{"startTime":2725.29,"endTime":2727.63,"body":"by just moving that slightly."},{"startTime":2727.63,"endTime":2729.603,"body":"And if you could say the question again?"},{"startTime":2730.57,"endTime":2732.866,"body":"It was about?"},{"startTime":2730.57,"endTime":2732.866,"body":"- The rationing decision."},{"startTime":2732.866,"endTime":2734.86,"body":"- Yes."},{"startTime":2732.866,"endTime":2734.86,"body":"- In an ethical way?"},{"startTime":2734.86,"endTime":2737.47,"body":"- So let's imagine all of"},{"startTime":2734.86,"endTime":2737.47,"body":"you were on a waiting list"},{"startTime":2737.47,"endTime":2741.04,"body":"for a particular operation to"},{"startTime":2737.47,"endTime":2741.04,"body":"happen in the next six months."},{"startTime":2741.04,"endTime":2742.39,"body":"How many of you would say"},{"startTime":2742.39,"endTime":2744.64,"body":"that you would be happy"},{"startTime":2742.39,"endTime":2744.64,"body":"to wait a bit longer?"},{"startTime":2747.16,"endTime":2748.21,"body":"Couple of you, okay."},{"startTime":2748.21,"endTime":2750.73,"body":"If the effect of waiting"},{"startTime":2748.21,"endTime":2750.73,"body":"longer was that you would have"},{"startTime":2750.73,"endTime":2752.77,"body":"a worse outcome so then the treatment"},{"startTime":2752.77,"endTime":2754.09,"body":"would be less effective,"},{"startTime":2754.09,"endTime":2756.22,"body":"so if you think about the hip"},{"startTime":2754.09,"endTime":2756.22,"body":"operations we talked about,"},{"startTime":2756.22,"endTime":2758.17,"body":"how many of them would offer"},{"startTime":2758.17,"endTime":2759.92,"body":"to give up your place in the queue?"},{"startTime":2761.18,"endTime":2762.013,"body":"So this is very difficult."},{"startTime":2762.013,"endTime":2763.72,"body":"So these judgements won't be made probably"},{"startTime":2763.72,"endTime":2766.06,"body":"at the patient level, and of course,"},{"startTime":2766.06,"endTime":2768.34,"body":"it's very difficult to do that as a doctor"},{"startTime":2768.34,"endTime":2770.08,"body":"with a patient in front of you."},{"startTime":2770.08,"endTime":2773.05,"body":"So it happens at the population"},{"startTime":2770.08,"endTime":2773.05,"body":"level where waiting lists,"},{"startTime":2773.05,"endTime":2775.84,"body":"you simply get added to a list"},{"startTime":2773.05,"endTime":2775.84,"body":"that actually doesn't move."},{"startTime":2775.84,"endTime":2777.04,"body":"So I think they're very difficult."},{"startTime":2777.04,"endTime":2778.93,"body":"I think they are policy decisions"},{"startTime":2778.93,"endTime":2781.66,"body":"and they're government decisions"},{"startTime":2778.93,"endTime":2781.66,"body":"about how much resource"},{"startTime":2781.66,"endTime":2785.53,"body":"we want to put in to trying"},{"startTime":2781.66,"endTime":2785.53,"body":"to get rid of a backlog."},{"startTime":2785.53,"endTime":2787.9,"body":"- There's another question"},{"startTime":2785.53,"endTime":2787.9,"body":"here on is there a point"},{"startTime":2787.9,"endTime":2790.96,"body":"where blood tests could replace scanning?"},{"startTime":2790.96,"endTime":2791.86,"body":"- Yeah, absolutely."},{"startTime":2791.86,"endTime":2796.86,"body":"So all of the technologies we"},{"startTime":2791.86,"endTime":2796.86,"body":"have are evolving in parallel."},{"startTime":2796.93,"endTime":2798.64,"body":"So if you could have a"},{"startTime":2796.93,"endTime":2798.64,"body":"blood test that told you"},{"startTime":2798.64,"endTime":2800.86,"body":"you had a cancer marker or not,"},{"startTime":2800.86,"endTime":2802.15,"body":"and then we would have to scan you"},{"startTime":2802.15,"endTime":2803.53,"body":"to see where the cancer was,"},{"startTime":2803.53,"endTime":2805.48,"body":"that could very easily refine"},{"startTime":2805.48,"endTime":2808.06,"body":"a lot of the screening"},{"startTime":2805.48,"endTime":2808.06,"body":"programs we have, couldn't it?"},{"startTime":2808.06,"endTime":2809.92,"body":"So instead of coming for a scan"},{"startTime":2809.92,"endTime":2811.39,"body":"to see whether you've got a cancer,"},{"startTime":2811.39,"endTime":2813.67,"body":"if a blood test would give"},{"startTime":2811.39,"endTime":2813.67,"body":"us the same information,"},{"startTime":2813.67,"endTime":2816.7,"body":"and may well be able to"},{"startTime":2813.67,"endTime":2816.7,"body":"detect earlier disease"},{"startTime":2816.7,"endTime":2818.77,"body":"or tiny molecules of disease,"},{"startTime":2818.77,"endTime":2821.71,"body":"then I think those advances"},{"startTime":2818.77,"endTime":2821.71,"body":"would be really beneficial."},{"startTime":2821.71,"endTime":2823.66,"body":"It probably wouldn't reduce"},{"startTime":2821.71,"endTime":2823.66,"body":"the amount of scanning"},{"startTime":2823.66,"endTime":2826.33,"body":"we need to do, but it'll be"},{"startTime":2823.66,"endTime":2826.33,"body":"better use of the resource"},{"startTime":2826.33,"endTime":2827.923,"body":"for those who need it most."},{"startTime":2828.93,"endTime":2829.87,"body":"- [Audience Member #2]"},{"startTime":2828.93,"endTime":2829.87,"body":"So you spoke about being"},{"startTime":2829.87,"endTime":2832.63,"body":"more judicious with"},{"startTime":2829.87,"endTime":2832.63,"body":"choosing who gets screening"},{"startTime":2832.63,"endTime":2834.67,"body":"and who doesn't, but"},{"startTime":2832.63,"endTime":2834.67,"body":"what about the problems"},{"startTime":2834.67,"endTime":2837.34,"body":"that arise on a case by case basis,"},{"startTime":2837.34,"endTime":2839.74,"body":"the reputation of the"},{"startTime":2837.34,"endTime":2839.74,"body":"public healthcare system,"},{"startTime":2839.74,"endTime":2840.89,"body":"and how people view it?"},{"startTime":2842.2,"endTime":2845.486,"body":"- And what do you mean by"},{"startTime":2842.2,"endTime":2845.486,"body":"on a case by case basis?"},{"startTime":2845.486,"endTime":2847.09,"body":"- [Audience Member #2] As in,"},{"startTime":2845.486,"endTime":2847.09,"body":"people aren't going to be happy"},{"startTime":2847.09,"endTime":2850.24,"body":"if they're denied scanning."},{"startTime":2847.09,"endTime":2850.24,"body":"- Yeah."},{"startTime":2850.24,"endTime":2851.53,"body":"So it's quite difficult,"},{"startTime":2851.53,"endTime":2853.69,"body":"'cause I'm not sure that"},{"startTime":2851.53,"endTime":2853.69,"body":"you have much of a voice"},{"startTime":2853.69,"endTime":2855.43,"body":"when you're on a waiting list."},{"startTime":2855.43,"endTime":2858.34,"body":"And people are being denied"},{"startTime":2855.43,"endTime":2858.34,"body":"treatment effectively"},{"startTime":2858.34,"endTime":2860.17,"body":"by drawing out the wait that they have"},{"startTime":2860.17,"endTime":2861.43,"body":"to try and get something."},{"startTime":2861.43,"endTime":2864.25,"body":"If you need emergency"},{"startTime":2861.43,"endTime":2864.25,"body":"treatment and you go to A\u0026E,"},{"startTime":2864.25,"endTime":2865.96,"body":"the chances are you'll"},{"startTime":2864.25,"endTime":2865.96,"body":"receive that treatment"},{"startTime":2865.96,"endTime":2868.21,"body":"within hours or days."},{"startTime":2868.21,"endTime":2871.3,"body":"So we are prioritizing urgent care."},{"startTime":2871.3,"endTime":2873.19,"body":"What we're not prioritizing"},{"startTime":2871.3,"endTime":2873.19,"body":"is those things"},{"startTime":2873.19,"endTime":2876.7,"body":"that we think as a population \"can wait\","},{"startTime":2876.7,"endTime":2878.26,"body":"and I'm not sure that they're decisions"},{"startTime":2878.26,"endTime":2879.913,"body":"that we necessarily are making."},{"startTime":2881.766,"endTime":2882.97,"body":"- [Audience Member #3] I'm"},{"startTime":2881.766,"endTime":2882.97,"body":"glad a previous question"},{"startTime":2882.97,"endTime":2885.16,"body":"had mentioned blood test,"},{"startTime":2882.97,"endTime":2885.16,"body":"'cause I was thinking,"},{"startTime":2885.16,"endTime":2889.06,"body":"is there a risk for displacing,"},{"startTime":2889.06,"endTime":2891.667,"body":"kind of saving radiologists the time,"},{"startTime":2891.667,"endTime":2893.478,"body":"and then you've just"},{"startTime":2891.667,"endTime":2893.478,"body":"got extra pathologists"},{"startTime":2893.478,"endTime":2895.03,"body":"who have too many blood"},{"startTime":2893.478,"endTime":2895.03,"body":"tests to do as well?"},{"startTime":2895.03,"endTime":2895.99,"body":"And linked to that,"},{"startTime":2895.99,"endTime":2899.72,"body":"if the fear of a lawsuit is motivating"},{"startTime":2900.596,"endTime":2905.08,"body":"a lot of this scanning,"},{"startTime":2900.596,"endTime":2905.08,"body":"like what's the situation"},{"startTime":2905.08,"endTime":2907.21,"body":"with qualified immunity?"},{"startTime":2907.21,"endTime":2909.01,"body":"Is there some way of escaping"},{"startTime":2909.01,"endTime":2911.08,"body":"or at least preventing legal jeopardy,"},{"startTime":2911.08,"endTime":2914.62,"body":"which might give some doctors"},{"startTime":2911.08,"endTime":2914.62,"body":"the courage not to scan?"},{"startTime":2914.62,"endTime":2917.203,"body":"- Hmm, so if I take their"},{"startTime":2914.62,"endTime":2917.203,"body":"second question first,"},{"startTime":2919.75,"endTime":2921.46,"body":"wow, would it be nice if there was"},{"startTime":2921.46,"endTime":2922.9,"body":"some sort of protection for doctors"},{"startTime":2922.9,"endTime":2925.3,"body":"so that if they made mistakes"},{"startTime":2922.9,"endTime":2925.3,"body":"they were indemnified?"},{"startTime":2925.3,"endTime":2926.533,"body":"There sort of is."},{"startTime":2927.661,"endTime":2929.5,"body":"But many of the lawsuits in America,"},{"startTime":2929.5,"endTime":2931.99,"body":"which fuel a lot of the fear in the UK,"},{"startTime":2931.99,"endTime":2934.63,"body":"are about people not being sent for a scan"},{"startTime":2934.63,"endTime":2937.18,"body":"or the abnormality being missed on a scan."},{"startTime":2937.18,"endTime":2938.38,"body":"And that happens repeatedly,"},{"startTime":2938.38,"endTime":2940.45,"body":"the commonest example is of a lung cancer"},{"startTime":2940.45,"endTime":2943.12,"body":"that was on a chest x-ray"},{"startTime":2940.45,"endTime":2943.12,"body":"that was done a while ago,"},{"startTime":2943.12,"endTime":2945.34,"body":"and people didn't look at it"},{"startTime":2943.12,"endTime":2945.34,"body":"and people didn't pick it up."},{"startTime":2945.34,"endTime":2947.5,"body":"So by people, radiologists didn't do that."},{"startTime":2947.5,"endTime":2951.643,"body":"So I think you'll never be"},{"startTime":2947.5,"endTime":2951.643,"body":"able to remove the fear."},{"startTime":2952.84,"endTime":2955.45,"body":"But scanning just in case is very much"},{"startTime":2955.45,"endTime":2958.06,"body":"a luxury of western healthcare."},{"startTime":2958.06,"endTime":2961.81,"body":"So in the developing countries,"},{"startTime":2958.06,"endTime":2961.81,"body":"you can't scan just in case."},{"startTime":2961.81,"endTime":2962.8,"body":"So if we start to look"},{"startTime":2962.8,"endTime":2965.08,"body":"at the way they model their healthcare,"},{"startTime":2965.08,"endTime":2968.47,"body":"we could learn quite a lot"},{"startTime":2965.08,"endTime":2968.47,"body":"from how they prioritize"},{"startTime":2968.47,"endTime":2971.53,"body":"their cases and which are"},{"startTime":2968.47,"endTime":2971.53,"body":"perhaps the populations"},{"startTime":2971.53,"endTime":2974.71,"body":"that we are starting to image"},{"startTime":2971.53,"endTime":2974.71,"body":"and starting to look at."},{"startTime":2974.71,"endTime":2978.91,"body":"And perhaps the risk"},{"startTime":2974.71,"endTime":2978.91,"body":"benefit isn't really there."},{"startTime":2978.91,"endTime":2981.367,"body":"What was your first question again, sorry?"},{"startTime":2981.367,"endTime":2983.17,"body":"- [Audience Member #3] It was"},{"startTime":2981.367,"endTime":2983.17,"body":"about displacing radiologists"},{"startTime":2983.17,"endTime":2985.42,"body":"with."},{"startTime":2983.17,"endTime":2985.42,"body":"- Yeah, so you could argue"},{"startTime":2985.42,"endTime":2988.06,"body":"that computers could help quite a lot"},{"startTime":2988.06,"endTime":2989.98,"body":"in automated blood test reading."},{"startTime":2989.98,"endTime":2993.79,"body":"We've already automated quite"},{"startTime":2989.98,"endTime":2993.79,"body":"a lot of blood test analysis."},{"startTime":2993.79,"endTime":2996.07,"body":"And so actually, to add"},{"startTime":2993.79,"endTime":2996.07,"body":"another one of those"},{"startTime":2996.07,"endTime":3000.18,"body":"in terms of DNA or tiny fragments"},{"startTime":2996.07,"endTime":3000.18,"body":"of potentially cancer DNA,"},{"startTime":3000.18,"endTime":3001.92,"body":"I think you could automate"},{"startTime":3000.18,"endTime":3001.92,"body":"quite a lot of that,"},{"startTime":3001.92,"endTime":3003.21,"body":"but I'm not a pathologist."},{"startTime":3003.21,"endTime":3006.81,"body":"I think you would end up"},{"startTime":3003.21,"endTime":3006.81,"body":"displacing a small amount of it"},{"startTime":3006.81,"endTime":3009.36,"body":"and hopefully you would"},{"startTime":3006.81,"endTime":3009.36,"body":"recover that in the sense"},{"startTime":3009.36,"endTime":3011.91,"body":"of reduced numbers of those"},{"startTime":3009.36,"endTime":3011.91,"body":"people going for tests."},{"startTime":3013.11,"endTime":3015.034,"body":"- I think we have a question from there."},{"startTime":3015.034,"endTime":3015.93,"body":"- [Audience Member #4]"},{"startTime":3015.034,"endTime":3015.93,"body":"Although it wouldn't be solving"},{"startTime":3015.93,"endTime":3017.16,"body":"the actual problem of what's causing"},{"startTime":3017.16,"endTime":3018.6,"body":"the increased amount of scans,"},{"startTime":3018.6,"endTime":3023.6,"body":"would you think opening"},{"startTime":3018.6,"endTime":3023.6,"body":"more scans in GP practices,"},{"startTime":3023.82,"endTime":3025.14,"body":"such as, you know,"},{"startTime":3025.14,"endTime":3026.363,"body":"CT, MRI, PET,"},{"startTime":3026.363,"endTime":3027.78,"body":"and all that, X-rays,"},{"startTime":3027.78,"endTime":3029.07,"body":"would that help reduce the volume,"},{"startTime":3029.07,"endTime":3031.17,"body":"although it's not treating"},{"startTime":3029.07,"endTime":3031.17,"body":"the original course?"},{"startTime":3031.17,"endTime":3032.58,"body":"- Yeah, so I'm going to borrow"},{"startTime":3032.58,"endTime":3037.06,"body":"from Professor Helen Stokes-Lampard,"},{"startTime":3038.04,"endTime":3041.67,"body":"who's the Chair of the Academy"},{"startTime":3038.04,"endTime":3041.67,"body":"of Medical Royal Colleges,"},{"startTime":3041.67,"endTime":3043.92,"body":"who wrote a very nice article"},{"startTime":3041.67,"endTime":3043.92,"body":"in \"The Times\" recently"},{"startTime":3043.92,"endTime":3046.56,"body":"who said, \"It would be naive to think"},{"startTime":3046.56,"endTime":3049.44,"body":"that just money would solve this problem."},{"startTime":3049.44,"endTime":3051.717,"body":"But it would be equally naive"},{"startTime":3049.44,"endTime":3051.717,"body":"to think that we can solve"},{"startTime":3051.717,"endTime":3054.6,"body":"this problem without"},{"startTime":3051.717,"endTime":3054.6,"body":"money and the resources.\""},{"startTime":3054.6,"endTime":3058.62,"body":"So by moving some of those"},{"startTime":3054.6,"endTime":3058.62,"body":"imagings into primary care,"},{"startTime":3058.62,"endTime":3062.34,"body":"into a GP setting, we"},{"startTime":3058.62,"endTime":3062.34,"body":"still have the problems"},{"startTime":3062.34,"endTime":3064.5,"body":"of staffing them and making sure we have"},{"startTime":3064.5,"endTime":3067.672,"body":"the right qualified people"},{"startTime":3064.5,"endTime":3067.672,"body":"there to look at them,"},{"startTime":3067.672,"endTime":3068.795,"body":"and then radiologists to look at them."},{"startTime":3068.795,"endTime":3070.26,"body":"So there's currently a 10% vacancy rate"},{"startTime":3070.26,"endTime":3071.13,"body":"for all radiographers"},{"startTime":3071.13,"endTime":3073.05,"body":"and all radiologists across the country."},{"startTime":3073.05,"endTime":3076.17,"body":"So if we had 20 new scanners tomorrow,"},{"startTime":3076.17,"endTime":3077.79,"body":"we simply wouldn't be able to staff them"},{"startTime":3077.79,"endTime":3080.253,"body":"rather than run them"},{"startTime":3077.79,"endTime":3080.253,"body":"for the right reasons."},{"startTime":3081.15,"endTime":3085.194,"body":"So you'd almost just be"},{"startTime":3081.15,"endTime":3085.194,"body":"moving the problem around."},{"startTime":3085.194,"endTime":3086.34,"body":"- [Audience Member #5] I think"},{"startTime":3085.194,"endTime":3086.34,"body":"at the beginning you said"},{"startTime":3086.34,"endTime":3091.34,"body":"that the radiologist was the gatekeeper."},{"startTime":3091.86,"endTime":3093.78,"body":"I've had a few scans in my day,"},{"startTime":3093.78,"endTime":3097.05,"body":"I've never had a radiologist say no."},{"startTime":3097.05,"endTime":3101.88,"body":"So my question would be, should"},{"startTime":3097.05,"endTime":3101.88,"body":"radiologists be saying no?"},{"startTime":3101.88,"endTime":3104.94,"body":"Are radiologists really"},{"startTime":3101.88,"endTime":3104.94,"body":"the people who know best"},{"startTime":3104.94,"endTime":3106.95,"body":"whether the scans would be useful,"},{"startTime":3106.95,"endTime":3111.45,"body":"and are they in the role today"},{"startTime":3111.45,"endTime":3113.31,"body":"where they're able to say, no,"},{"startTime":3113.31,"endTime":3114.33,"body":"we're not going to do those cause"},{"startTime":3114.33,"endTime":3116.055,"body":"they're not going to help"},{"startTime":3116.055,"endTime":3117.291,"body":"- Yeah."},{"startTime":3116.055,"endTime":3117.291,"body":"- your diagnosis"},{"startTime":3117.291,"endTime":3120.131,"body":"or are not going to help"},{"startTime":3117.291,"endTime":3120.131,"body":"the quality of life,"},{"startTime":3120.131,"endTime":3120.964,"body":"we'll take that one instead?"},{"startTime":3120.131,"endTime":3120.964,"body":"- Yep."},{"startTime":3120.964,"endTime":3121.98,"body":"So as a radiologist,"},{"startTime":3121.98,"endTime":3124.28,"body":"I'm clearly biased in what"},{"startTime":3121.98,"endTime":3124.28,"body":"I'm going to say next."},{"startTime":3125.919,"endTime":3126.9,"body":"I think they are the right"},{"startTime":3125.919,"endTime":3126.9,"body":"people to make those decisions"},{"startTime":3126.9,"endTime":3130.11,"body":"because they often have the"},{"startTime":3126.9,"endTime":3130.11,"body":"overview of the entirety"},{"startTime":3130.11,"endTime":3131.88,"body":"of the population that they're scanning"},{"startTime":3131.88,"endTime":3134.82,"body":"and the majority of"},{"startTime":3131.88,"endTime":3134.82,"body":"symptoms that patients get."},{"startTime":3134.82,"endTime":3136.68,"body":"Often people ask for a scan,"},{"startTime":3136.68,"endTime":3138.878,"body":"so they might send you for an ultrasound,"},{"startTime":3138.878,"endTime":3139.711,"body":"when in fact a radiologist will know"},{"startTime":3139.711,"endTime":3141.54,"body":"that isn't the right test"},{"startTime":3139.711,"endTime":3141.54,"body":"for the suspected symptoms"},{"startTime":3141.54,"endTime":3143.64,"body":"you have, and in fact"},{"startTime":3141.54,"endTime":3143.64,"body":"what you need is a CT."},{"startTime":3143.64,"endTime":3146.67,"body":"So we are very much are doing"},{"startTime":3143.64,"endTime":3146.67,"body":"that on a day-to-day basis"},{"startTime":3146.67,"endTime":3148.95,"body":"and actually changing"},{"startTime":3146.67,"endTime":3148.95,"body":"around what people need"},{"startTime":3148.95,"endTime":3151.86,"body":"in order to make sure that"},{"startTime":3148.95,"endTime":3151.86,"body":"they get the right test."},{"startTime":3151.86,"endTime":3155.04,"body":"Historically, we were gatekeepers"},{"startTime":3151.86,"endTime":3155.04,"body":"because there was quite"},{"startTime":3155.04,"endTime":3157.47,"body":"a lot more fear about ionizing radiation,"},{"startTime":3157.47,"endTime":3159.72,"body":"doses of CT scans, and things 10,"},{"startTime":3159.72,"endTime":3162.42,"body":"20 years ago were much"},{"startTime":3159.72,"endTime":3162.42,"body":"higher than they are now."},{"startTime":3162.42,"endTime":3165.12,"body":"And I think what we've"},{"startTime":3162.42,"endTime":3165.12,"body":"caught up with a little bit"},{"startTime":3165.12,"endTime":3167.61,"body":"is we haven't exactly"},{"startTime":3165.12,"endTime":3167.61,"body":"opened the floodgate,"},{"startTime":3167.61,"endTime":3170.22,"body":"but we've certainly"},{"startTime":3167.61,"endTime":3170.22,"body":"become a lot more relaxed"},{"startTime":3170.22,"endTime":3171.93,"body":"about needing scans."},{"startTime":3171.93,"endTime":3175.44,"body":"I think we've become more"},{"startTime":3171.93,"endTime":3175.44,"body":"sympathetic to pressures"},{"startTime":3175.44,"endTime":3179.43,"body":"in other parts of the NHS"},{"startTime":3175.44,"endTime":3179.43,"body":"where A\u0026E doctors and GPs"},{"startTime":3179.43,"endTime":3182.25,"body":"are also pushed to try and"},{"startTime":3179.43,"endTime":3182.25,"body":"make the right diagnosis"},{"startTime":3182.25,"endTime":3183.6,"body":"for the patients they see."},{"startTime":3183.6,"endTime":3187.68,"body":"So I think we've become more"},{"startTime":3183.6,"endTime":3187.68,"body":"sympathetic to recognizing"},{"startTime":3187.68,"endTime":3189.51,"body":"that we may not have all of the symptoms"},{"startTime":3189.51,"endTime":3193.05,"body":"and all of the right information, perhaps,"},{"startTime":3193.05,"endTime":3195.33,"body":"for the patients to have a scan,"},{"startTime":3195.33,"endTime":3197.91,"body":"but probably a scan of some"},{"startTime":3195.33,"endTime":3197.91,"body":"sort is the best thing to do."},{"startTime":3197.91,"endTime":3199.29,"body":"And once they start in the pathway"},{"startTime":3199.29,"endTime":3201.39,"body":"we'll be able to triage them accordingly."},{"startTime":3201.39,"endTime":3204.003,"body":"The difficulty with that"},{"startTime":3201.39,"endTime":3204.003,"body":"is incidental findings."},{"startTime":3204.93,"endTime":3206.01,"body":"- Thank you."},{"startTime":3206.01,"endTime":3211.01,"body":"What scans are easier to"},{"startTime":3206.01,"endTime":3211.01,"body":"interpret abnormalities, please?"},{"startTime":3212.49,"endTime":3214.32,"body":"- I'm not sure that any scans"},{"startTime":3214.32,"endTime":3216.45,"body":"are easier than others to interpret."},{"startTime":3216.45,"endTime":3220.02,"body":"I think the skill and"},{"startTime":3216.45,"endTime":3220.02,"body":"training of a radiologist"},{"startTime":3220.02,"endTime":3222.45,"body":"is to be able to cope"},{"startTime":3220.02,"endTime":3222.45,"body":"with all of the images"},{"startTime":3222.45,"endTime":3223.55,"body":"that they come across."},{"startTime":3224.49,"endTime":3228.18,"body":"There are issues with the"},{"startTime":3224.49,"endTime":3228.18,"body":"right specialist seeing"},{"startTime":3228.18,"endTime":3231.24,"body":"the right scan, and that"},{"startTime":3228.18,"endTime":3231.24,"body":"is particularly a problem"},{"startTime":3231.24,"endTime":3233.22,"body":"in less specialist hospitals."},{"startTime":3233.22,"endTime":3234.81,"body":"So in my specialty, for example,"},{"startTime":3234.81,"endTime":3236.07,"body":"in children's medicine,"},{"startTime":3236.07,"endTime":3239.13,"body":"we know that most children's"},{"startTime":3236.07,"endTime":3239.13,"body":"scans across the NHS"},{"startTime":3239.13,"endTime":3243.27,"body":"are not interpreted by"},{"startTime":3239.13,"endTime":3243.27,"body":"specialist in children's imaging."},{"startTime":3243.27,"endTime":3246.543,"body":"So that causes about a 30-40% error rate."},{"startTime":3247.8,"endTime":3249.66,"body":"So if the same were true for, say,"},{"startTime":3249.66,"endTime":3252.522,"body":"brain imaging that wasn't seen by a neuro,"},{"startTime":3252.522,"endTime":3255.0,"body":"or pancreatic imaging that"},{"startTime":3252.522,"endTime":3255.0,"body":"wasn't seen by a specialist,"},{"startTime":3255.0,"endTime":3256.35,"body":"across the country,"},{"startTime":3256.35,"endTime":3259.23,"body":"that would lead to a reasonable"},{"startTime":3256.35,"endTime":3259.23,"body":"amount of misdiagnosis."},{"startTime":3259.23,"endTime":3261.39,"body":"So I don't think anything is harder"},{"startTime":3261.39,"endTime":3263.91,"body":"or easier to interpret than anything else."},{"startTime":3263.91,"endTime":3266.67,"body":"But not everybody has the same"},{"startTime":3263.91,"endTime":3266.67,"body":"skill set to be able to do"},{"startTime":3266.67,"endTime":3268.35,"body":"that on a local level."},{"startTime":3268.35,"endTime":3270.51,"body":"And that that's not doing"},{"startTime":3268.35,"endTime":3270.51,"body":"anybody a disservice,"},{"startTime":3270.51,"endTime":3274.65,"body":"that's trying to provide"},{"startTime":3270.51,"endTime":3274.65,"body":"the right imaging service"},{"startTime":3274.65,"endTime":3276.7,"body":"for the population that you have at hand."},{"startTime":3277.871,"endTime":3279.75,"body":"- [Audience Member #6] So one"},{"startTime":3277.871,"endTime":3279.75,"body":"of the figures you showed,"},{"startTime":3279.75,"endTime":3282.39,"body":"it showed that Greece had"},{"startTime":3279.75,"endTime":3282.39,"body":"many more radiologists"},{"startTime":3282.39,"endTime":3285.18,"body":"than anywhere else, any idea why that is?"},{"startTime":3285.18,"endTime":3288.24,"body":"- I think there are a lot"},{"startTime":3285.18,"endTime":3288.24,"body":"of private clinics in Greece"},{"startTime":3288.24,"endTime":3291.0,"body":"and I think there's a lot of"},{"startTime":3288.24,"endTime":3291.0,"body":"money in medicine in Greece,"},{"startTime":3291.0,"endTime":3294.63,"body":"but that would probably be"},{"startTime":3291.0,"endTime":3294.63,"body":"speculation on my behalf, yeah."},{"startTime":3294.63,"endTime":3299.49,"body":"- Please join us again"},{"startTime":3294.63,"endTime":3299.49,"body":"when Professor Owen Arthurs"},{"startTime":3299.49,"endTime":3303.42,"body":"returns for a lecture with"},{"startTime":3299.49,"endTime":3303.42,"body":"Professor Joe Delehanty Casey,"},{"speaker":"Medical Experts in the Family Court","startTime":3305.88,"endTime":3307.41,"body":"Where Two Worlds Collide"},{"speaker":"Medical Experts in the Family Court","startTime":3307.41,"endTime":3310.313,"body":"on Thursday the 19th of January, 2023."},{"speaker":"Medical Experts in the Family Court","startTime":3310.313,"endTime":3312.12,"body":"- Yeah."},{"speaker":"Medical Experts in the Family Court","startTime":3310.313,"endTime":3312.12,"body":"- 6:00 PM."},{"speaker":"Medical Experts in the Family Court","startTime":3312.12,"endTime":3313.23,"body":"Thanks so much, Professor Arthurs."},{"speaker":"Medical Experts in the Family Court","startTime":3313.23,"endTime":3314.33,"body":"- Pleasure, thank you."}]}