An interview with Dr Naren Chetty, Consultant Radiologist
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Q#1 - Please tell us about your professional background and career
I qualified in medicine at Manchester University in 1982 and then spent 3 years working as a junior doctor in general medicine. I then embarked on a six year program to specialise in Radiology, first at Leeds and then at Hammersmith Hospital in London. After passing my exams I was appointed Consultant Radiologist at Hillingdon Hospital in 1992.
Q#2 - Why did you choose this profession?
I’ve always been interested in imaging and photography, so when I saw that radiology was going to play an increasingly important role in the management of patients, I looked into it further and after speaking to the radiologists where I was working, I decided that this was going to be the specialty for me.
Q#3 - How would you describe radiology in simple terms and what is its role in cancer detection and prevention?
Diagnostic radiology is imaging the inside of the body non-invasively through a range of different techniques - looking at the tissues and organs in a particular patient and seeing if and how they differ from healthy people’s organs. It has become essential in the diagnosis and monitoring of treatment of many conditions, especially cancer. Over the last few decades, the variety of types of scan and their sophistication has increased immeasurably. In addition to X-rays, we now also have ultrasound, CT and MRI scans, mammograms, nuclear medicine and PET scans. Using this range of scans, we can, along with clinical assessment and blood tests, go a long way towards arriving at the most likely diagnosis and then deciding the most suitable treatment. Some cancers rely considerably on imaging tests to diagnose and monitor them during treatment. Others, such as skin cancer do not usually need imaging to make the initial diagnosis but it may be used to see if it has spread within the body. Cancers of the lung, breast and prostate are examples of those which use a lot of imaging.
Q#4 - How common is it to find cancer in patients being investigated for other conditions? (e.g. when they experience general symptoms, depending on the age)?
It’s not uncommon to find cancer incidentally when the patient is being investigated for something else entirely. A patient may be getting a scan to address another issue, and we might see a tumour that has so far not been producing any symptoms.
Q#5 - How does imaging help with monitoring response to treatment?
The treatment plan for each patient is tailored to their individual situation, based on the type of cancer (as assessed by microscopic assessment and its individual biochemical characteristics), the grade (how aggressive the cancer is) and its stage (how far it may have spread). Other factors such as the age and overall fitness of the patient and whether they have other medical conditions is also taken into account. Once treatment has been decided, how successfully it is working is often monitored by imaging. In the longer term, monitoring is done with imaging to make sure there isn’t a recurrence, for example in the case of a treated breast cancer, typically with an annual mammogram.
Q#6 - What are the safety concerns for patients from radiation during imaging tests?
Some imaging techniques such as ultrasound are completely safe. Where safety concerns may come in is with scans using radiation, so PET scans, CT scans, X-rays and nuclear medical scanning. The increased use of scans such as CT has, over time, increased the radiation burden on the general population. This is thought to cause a small increase in the incidence of cancer in the population, although it is not possible to say which individual has developed a cancer as a result of radiation. In general, younger peoples’ tissues are more sensitive to the harmful effects of radiation, so extra care is taken to ensure that radiation based scans in the young are only performed when absolutely necessary, when the likely benefit from having the scan outweighs the risk from the radiation itself. As a rule of thumb, a CT scan of the chest and abdomen is equivalent to about 300 chest X-rays. It has been estimated that about 2% of cancer in the US is due to radiation from previous scans.
Q#7 - As an experienced radiologist, what would be your number one advice to people living with cancer and beyond?
The major decisions regarding the diagnosis and treatment of cancer are made by a multidisciplinary team (MDT) comprised of the different medical and nursing specialists involved in treating a particular type of cancer. Such a team would include physicians, surgeons, radiologists, oncologists, radiotherapists, pathologists, specialist nurses and an MDT coordinator. A team approach is employed so that the expertise of each specialty is utilised to arrive at the best treatment plan. This is itself guided by evidence of best practice. All decisions taken are documented and must be justified on subsequent review. Any departure from standard recommended practice must be agreed by the whole MDT. This is important to ensure consistent best practice. So my advice is to ask your specialist all the questions you have, even if you think they are too simple and make sure you are satisfied with the answers you are given.