Can surgeons assist with the imaging of emergency surgical admissions?

Results of the ElYSIuM national questionnaire survey

J. Read1, J.E.F. Fitzgerald2
1

Croydon University Hospital, London

Royal Marsden Hospital, Fulham, London

Aims

Further Results

Quantify the confidence of UK general surgical trainees in CT reporting Investigate the current use of diagnostic or interventional ultrasound by UK general surgical trainees Ascertain current sources and levels of radiological education in surgical training Gather opinion regarding introducing such formal radiological training into the surgical curriculum
Introduction

Hospital PACS systems are available to 98%.of respondents. 91% of trainees were routinely present cases and/or imaging at MDT meetings at the time of survey. 48% were examined in radiology by Deanery assessments 81% had previously used ultrasound for interventional or diagnostic purposes, with extent of experience positively correlated with time in training (r=0.230, p<0.01). The reported confidence in diagnosing a sample range of acute intraabdominal conditions positively correlated with time in training (r=0.456, p<0.01). Only 4% of respondents did not feel confident in diagnosing any acute intra-abdominal condition on CT. Despite this engagement with radiological imaging, only 19% had received formal training in plain film reporting, 12% in interventional ultrasound, 11% in diagnostic ultrasound, and 8% in CT reporting.
34% 56%

The first CT scan of a human was a grainy image of a head performed in 1972. Within the last 3 decades ultrasound (US) and computerised tomography (CT) have proven their worth in the diagnosis of the acute abdomen. General surgeons now place heavy demands on radiologists for abdominal imaging. Guidelines specify that all trusts taking emergency surgical admissions must offer 24 hour 7 days a week CT and US with immediate reporting[1]. Radiology departments in many hospitals struggle to provide a timely service. Worldwide the delivery of point of care ultrasound by non radiologists is increasing.[2] The Royal College of Radiologists have drafted a curricula in ultrasound for medics and surgeons to follow [3].Trainees in other specialities such as O&G already receive formal diagnostic ultrasound training within their curricula [4] .
Methods

Results: Trainee use of ultrasound

None of the below To do another procedure To perform another diagnostic or therapeutic task To place a central venous line To diagnose pathology in trauma To assess bladder volume To aspirate a breast abscess
0% 10% 15% 16% 11% 19%

53%

Overall 85% of respondents felt surgeons should receive more formal radiological training in the use of US and CT reporting; this varied significantly by grade (p=0.004) with 91% of core trainees, 82% of higher trainees and 58% of consultants supporting this.
Conclusions

20%

30%

40%

50%

60%

Results: Trainees reviewing CT scans whilst on call

Never review the CT images
26%

1%

5%

The positive correlation between time in surgical training and both use of US and confidence in CT diagnosis suggests modern trainees are acquiring radiological skills informally. Such experience has led to a significant level of confidence in radiology that is independent of formal training, assessment and accreditation for general surgery trainees. The majority of surgeons in training now review emergency abdominal CT scan images and utilise US which represents an underused resource in the NHS. The overwhelming majority of surgical trainees support the introduction of radiological teaching to their curriculum. There is therefore a basis for surgical trainees undertaking extended roles traditionally reserved for radiologists. Such training may improve quality of care and provide an efficient and timely pathway for diagnostic or interventional imaging in acutely ill surgical patients
References
[1] NCEPOD, Executive summary "Emergency Admissions: A Journey in the right direction?", in A report into the National Confidential Enquiry into Patient Outcome and Death. 2007. [2] Moore, C.L. and J.A. Copel, Point-of-Care Ultrasonography. New England Journal of Medicine, 2011. 364(8): p. 749-757. [3] Board_of_the_faculty_of_clinical_radiology, Ultrasound Training Recommendations for Medical and Surgical Specialities. 2004, Royal College of Radiologists [4] R.C.O.G. Trainee Curriculum. Ultrasound 2010 [cited 2010 10/08/2010]; Available from: http://www.rcog.org.uk/education-and-exams/curriculum/ultrasound.

Electronic, 11-item, self-administered, non-mandatory, anonymous questionnaire survey distributed via UK national and regional surgical mailing lists and websites. Results were collated and analysed with SPSS v17.0 for Windows (SPSS, Inc, Chicago, IL).
Results :

Rarely review the CT images Often review the CT images Always review the CT images

68%

515 surveys were returned fully completed 21% core surgical trainees, 47% higher surgical trainees, 8% Consultants, 24% other (e.g. staff grade, research).
Results: Trainees support formal radiological teaching in use of ultrasound and reporting of CT scans as part of training

Results: The % of trainees that feel confident to diagnose the following conditions on CT imaging
Answer Options Abdominal aortic aneurysm Small bowel dilatation Free intra-peritoneal air Hepatic lesions Large bowel dilatation Free fluid in the pelvis Pancreatitis Cholecystitis Mesenteric stranding Oedematous walled small bowel Appendicitis None of the above Response Percent 90% 82% 78% 64% 76% 60% 44% 41% 33% 33% 26% 4%

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