Welcoming the Medical Council's review of doctors and health-related commercial organisations: more is needed to ensure financial factors never influence patient care.

Nil.

Does positron emission tomography/computed tomography change management in colorectal cancer?

BACKGROUND: Positron emission tomography/computed tomography (PET/CT) is used pre-operatively in patients with metastatic or recurrent colorectal cancer to identify those who have potentially curative disease. However, a recent randomized trial questioned the added benefit of PET/CT over conventional imaging in patients with liver metastases. The aim of this study was to determine the proportion of patients with colorectal cancer in whom PET/CT altered surgical management, in a single tertiary centre. METHODS: This was a retrospective study of all patients with colorectal cancer who had a PET/CT for colorectal cancer, funded by the Canterbury District Health Board between 2010 and 2014. RESULTS: Some 111 PET/CT scans were performed on 105 patients. A total of 38% of PET/CT were for patients with known or suspected liver metastases, 23% for suspected local recurrence and 18% for known or suspected lung metastases. Five scans were for post-operative patients with a rising carcinoembryonic antigen and no attributable source on conventional imaging. PET/CT identified additional extrahepatic sites of disease in 19 of 111 (17%) scans in patients deemed to have potentially operable disease. Overall, PET/CT altered surgical management following six of 42 (14%) scans for patients with liver metastases, four of 20 (20%) scans for patients with lung metastases and six of 26 (23%) scans for patients with local recurrence. CONCLUSION: PET/CT remains a useful adjunct to conventional imaging in the pre-operative workup of patients with colorectal cancer.

Retrospective analysis of computed tomographic colonography in a rural hospital.

INTRODUCTION: The aims of this study were to investigate the diagnostic performance of computed tomography colonography (CTC) performed in a rural secondary hospital, and to describe the local pattern of CTC service provision. METHOD: A single site, retrospective observational analysis was conducted for all patients undergoing CTC during the 12-month period from 1st of January to 31st of December 2014 with comparison to available colonoscopy. RESULTS: There were 639 CTCs performed during the 12-months period. The average time from referral to performance of CTC scan was 21.3 days. The diagnostic yield of CTC for CRC was 5.8%; and for large polyps ≥10 mm was 8.0%. The sensitivity and specificity of CTC for detecting CRC were 97.1% and 88.2% respectively. The most predictive symptoms for finding colorectal lesions were rectal bleeding and anaemia. The referral rate from CTC to colonoscopy was 16.9%. 63 patients (9.9%) had follow up recommendations made in their reports due to extracolonic findings. CONCLUSION: Computed tomography colonography performed in a rural secondary hospital provided sufficient sensitivity to detect large polyps or CRC. The specificity for CRC was lower than reported figures in the literature. Technical issue of CTC performance due to poor insufflation techniques was identified as a main contributing factor reducing CTC accuracy. CTCs were performed with acceptable waiting time and showed high overall diagnostic yield for colorectal neoplasm in a rural hospital.

Radiology in the Christchurch earthquake of 22 February 2011: Challenges, interim processes and clinical priorities.

INTRODUCTION: The Canterbury earthquake of 22 February 2011 initiated a mass casualty event for Christchurch Hospital, which suffered damage itself, and faced logistical difficulties in continued operation. Radiology was part of the hospital-wide response. This paper reviews the radiology department response and surveys opinions of emergency doctors to provide an overview of events of the day and thoughts regarding any potential future response. METHODS: Two main approaches were undertaken: (i) informal data gathering and discussions with staff including radiographers, sonographers, radiologists, emergency doctors and others present on the day regarding their experiences; and (ii) survey of emergency doctors regarding their experiences and recommendations. A comparison with other similar events was also conducted. RESULTS: (1) Diagnostic radiology services were initially constrained by a lack of power and lift access. Usual imaging and reporting pathways were interrupted. Alternative processes were initiated to ensure an ongoing radiology service with available resources. Lessons were learned and changes implemented locally.(2) Survey data confirmed several primary outcomes: (i) Ultrasound was crucial while CT was down; (ii) all available imaging modalities remain important in a disaster response; and (iii) preliminary reports from radiologists in the emergency department (ED) were useful in the immediate post-earthquake period. CONCLUSION: Although resources were limited, a diagnostic radiology service remained operational. The Christchurch experience reinforces the need for disaster planning and rehearsal of plans.

Rectal cancer: future directions and priorities for treatment, research and policy in New Zealand.

New Zealand has one of the highest incidences of rectal cancer in the world, and its optimal management requires a multidisciplinary approach. A National Rectal Cancer Summit was convened in August 2013 to discuss management of rectal cancer in the New Zealand context, to highlight controversies and discuss domestic priorities for the future. This paper summarises the priorities for treatment, research and policy for rectal cancer services in New Zealand identified as part of the Summit in August. The following priorities were identified: - Access to high-quality information for service planning, review of outcomes, identification of inequities and gaps in provision, and quality improvement; - Engagement with the entire sector, including private providers; - Focus on equity; - Emerging technologies; - Harmonisation of best practice; - Importance of multidisciplinary team meetings. In conclusion, improvements in outcomes for patients with rectal cancer in New Zealand will require significant engagement between policy makers, providers, researchers, and patients in order to ensure equitable access to high quality treatment, and strategic incorporation of emerging technologies into clinical practice. A robust clinical information framework is required in order to facilitate monitoring of quality improvements and to ensure that equitable care is delivered.

Summary of guidance for the management of early bowel cancer.

Colorectal cancer is an important public health problem and one of the most common cancers registered in New Zealand. In 2009 the New Zealand Guidelines Group were commissioned to produce and evidence-based summary of current New Zealand and international data to inform best practice in the management of people with early bowel cancer. A guideline development team was convened, representing a range of stakeholder groups who met to discuss and agree on the recommendations for a clinical practice guideline. This article summarises the guideline methods and reports the recommendations from the Management of Early Bowel Cancer guideline, published in 2011.

Triphasic MRI of pelvic organ descent: sources of measurement error.

PURPOSE: To identify sources of error when measuring pelvic organ displacement during straining using triphasic dynamic magnetic resonance imaging (MRI). MATERIALS AND METHODS: Ten healthy nulliparous woman underwent triphasic dynamic 1.5 T pelvic MRI twice with 1 week between studies. The bladder was filled with 200 ml of a saline solution, the vagina and rectum were opacified with ultrasound gel. T2 weighted images in the sagittal plane were analysed twice by each of the two observers in a blinded fashion. Horizontal and vertical displacement of the bladder neck, bladder base, introitus vaginae, posterior fornix, cul-de sac, pouch of Douglas, anterior rectal wall, anorectal junction and change of the vaginal axis were measured eight times in each volunteer (two images, each read twice by two observers). Variance components were calculated for subject, observer, week, interactions of these three factors, and pure error. An overall standard error of measurement was calculated for a single observation by one observer on a film from one woman at one visit. RESULTS: For the majority of anatomical reference points, the range of displacements measured was wide and the overall measurement error was large. Intra-observer error and week-to-week variation within a subject were important sources of measurement error. CONCLUSION: Important sources of measurement error when using triphasic dynamic MRI to measure pelvic organ displacement during straining were identified. Recommendations to minimize those errors are made.