1975, British Journal of Radiology, 48, 610

Correspondence (The Editors do not hold themselves responsible for opinions expressed by correspondents) THE EDITOR—SIR, MUST RADIOLOGISTS DO ALL THE REPORTING?

Radiologists must be almost unique among specialists in insisting that every film taken shall be viewed and reported upon by one of their members. In other disciplines delegation of varying degree has been attempted—usually with success. Pathologists pass on some of their reporting to technicians; dermatologists appear happy to see those cases which are selected for referral by general practitioners and have never laid claim to a monopoly of all skin conditions. Anyone foolhardy enough to challenge the attitude of radiologists will be told that: (1) The accurate reading of X-ray films is not possible for anyone without special experience. (2) It is necessary for radiologists to examine all films in order to ensure high standards of radiography. (3) Experienced radiologists occasionally spot some unsuspected (and possibly unrelated) condition. (4) Personal reporting is necessary, anyway, on medico-legal grounds. Superficially these arguments seem unassailable, even if adherence to their ruling may lead to intense fatigue in overworked radiologists. In other specialties the consultant tries to reserve his skills for those cases which really need them. The dermatologist, for instance, who saw every case of skin disease in his parish would have no time to pursue his subject in greater depth. The reason for my raising the subject of total specialist X-ray reporting at this moment is its relevance to the future of X-ray services in Community Hospitals. The provision of X-ray facilities is looked upon by the Association of General Practitioner Hospitals as of great importance. The extent of facilities should vary according to the size and needs of the hospital, ranging from simply-operated machines in the smallest hospitals to those of wide capability at the larger Community Hospitals. At many of these hospitals, radiography will be done on a sessional basis of a few hours daily or even less. Arrangements for reporting will involve either the transfer of films to the District General Hospital or the occasional visit of the radiologist. Meantime the general practitioner will on many occasions have to reach a tentative decision on his personal reading of the films. In reading such films the general practitioner has the advantage of having examined the patient and knowing, particularly with minor injuries, where to look. In 25 years of working with a General Practitioner Hospital I have come to believe that in a very substantial number of cases the subsequent reading of films by a radiologist has been an unnecessary formality and a waste of his valuable time, quite apart from the time and effort involved in clerical work. Is it really necessary for instance, to send for reporting every film of finger injuries or crushed toes? To challenge this accepted procedure is to commit heresy, but with the increasing need for economy in all aspects of medical care it is a very important question. The immediate reaction of many radiologists is likely to be based upon emotion, custom and litigophobia, but I believe that there may be a solution which will be advantageous to the profession of radiology as well as to the service given to patients. Yours, etc., R. M. EMRYS-ROBERTS.

Chairman, Association of General Practitioners Hospitals, 1 Red House Lane, Walton-on-Thames, Surrey.

THE EDITOR—SIR, STORAGE OF RADIATION DOSE DATA IN A SMALL DIGITAL COMPUTER FOR RADIOTHERAPY UNITS WITH COLLIMATORCOUPLED WEDGE FILTERS

The interactive digital computer system for radiotherapy treatment planning (RAD-8, Digital Equipment Company and S.H.M. Nuclear Inc.) described by Bentley and Milan (1971, 1974) has been found extremely useful in this department. This system assumes that the central axis wedge transmission ratio is constant for all fields of the same equivalent square, which implies that the wedge is in a fixed position relative to the radiation source. For collimatorcoupled wedge filters as fitted to the cobalt units in this hospital (Mobaltron-80, T.E.M.) this assumption is not valid and it was necessary to modify the storage of radiation data in the system. A data-manipulation program has been produced which normalizes the tabulated off-axis ratios to the relevant central axis wedge transmission ratio for profiles at five depths for each field width. The effect of a wedge filter is thus included in the data tabulated against field width. The wedged field central axis data are made identical to that for unwedged fields. The wedge transmission ratios are thus excluded from the data tabulated against the equivalent square field size. With these modifications to the data storage, the standard programs in the original system will calculate treatment plans for units with collimatorcoupled wedge filters. Yours, etc., J. L. DEAVILLE.

Department of Medical Physics, St. Luke's Hospital, Guildford, Surrey. REFERENCES BENTLEY, R. E., and MILAN, J., 1971. An interactive digital

computer system for radiotherapy treatment planning. British Journal of Radiology, 44, 826-833. MILAN, J., and BENTLEY, R. E., 1974. The storage and

manipulation of radiation dose data in a small digital computer. British Journal of Radiology, 47, 115-121.

THE EDITOR—SIR, TERMINOLOGY IN RADIATION PROTECTION

It is widely known that there is a high probability that the Euratom Treaty will shortly affect radiological protection (otherwise known as health physics or radiation safety) in hospitals, research establishments and medical schools throughout the United Kingdom. It is hoped that the various organizations concerned, which include the British Institute of Radiology, will take advantage of the opportunity and adopt a more uniform terminology in place of the variations used at present in the two "Codes of Practice", one issued by the Department of Health and Social Security and the other by the Department of Employment, and also the Universities Handbook (Committee of Vice-Chancellors and Principals). Although the three publications advocate very similar administrative structures, most of the possible combinations of relevant words are used (Table I). Notwithstanding the connotations of the 1920s, to most readers of your Journal, "radiology" is the work undertaken in diagnostic X-ray departments and does not refer to saturation analysis, radiotherapy and the safe disposal of radioactive waste. The word "radiation" includes these topics and many others.

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Letter: Must radiologists do all the reporting?

1975, British Journal of Radiology, 48, 610 Correspondence (The Editors do not hold themselves responsible for opinions expressed by correspondents)...
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