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Hi everyone thank you for waiting and being patient very sorry for the delay. We're just we're just struggling with a night issue and now it's completely sorted. Um I just want to say, welcome everyone. Um Thank you for joining the meeting. I'm josh from the events team of w p. M. N. Um Today, we are very honored to have dr richard these, who is a consultant radiologist with a Passionflower for uh pointed to ultrasound and medical education. He will be talking us through um uh radiology as a carrier as well as the future of radiology and um what makes it uh an exciting and in credible carrier. Um So before we move on just a bit of housekeeping rules. Um um We will be recording these sessions or by staying in the meeting, means that you consented to be recorded. Um If you have any questions throughout the session, if you free to pop in the chat box, we'll try to address them at the end of uh the webinar, so I'm certainly pass it on to uh Doctor Peas now, Thank you okay well, thank you for asking me, I hope you can all hear me, so we'll go on, so radiology and actions the first slide, we're going to the second slide background. Have you got that. Yes, yeah just a very brief back kind of myself and people like me. Uh This is not about me this about radiology, but I just I was a medical registrar uh membership m. R. C. P uh and that really was a symptom based medicine looking superficial and absolutely using the stethoscope with various treatments uh. And then I moved into radiology, I was attracted by various things, but certainly the intervention was attracted, attractive, uh and radiologists really about anatomy and pathology based practices. It's visual medicine and they don't look at the superficial anatomy, We look at the deep anatomy, so we have a hybrid really clinical which of the m. R. C. P. And the radiology and I personally run rapid diagnostic clinics in the health service based on ultrasound point of care and also do intervention. I do an awful lot of work in i. T. U. And in recess um and kind of practicing nordic and european medicine wet we see the patient's we image them and we get to diagnose it and ultrasound is brilliant for that, so, I'm going to talk about that, So just go to the second side you got that, yeah look, I'm sorry, I just had a call from um uh let's go and have a look, we went up together to remember, so let's go and see what's on i. T. U. We've got 50 year old man in crashing, renal failure, and we're going to take our small handheld ultrasound up to the unit, let's go on to the next slide. Meet Cathy ana, you have you got her well as she is doctor Tatiana. She's an eye doctor who's learning ultrasound and there, she has her a handheld iphone ultrasound. We're going to go up and see this patient on to the next slide, you can see the ultrasounds, uh sorry we can see the ultrasound now, So here we have a chapin, acute renal failure. We've done an ultrasound. There is uh top and his his ultrasound. His kidneys here on the left are obstructive. He's got hydronephrosis and he's got a large bladder mass, so the reason for him going to renal failure, it's got obstruction and so we called surgeons and that would be decompressed using naproxen is an interventional radiology and so then we'd move on and we just had a call from his vascular surgeon about a patient with acute painful leg and we're just an angiogram you can see his legs at the top, his right leg is blue. His pale pulse was para, thet, ick and uh paralysis. It's a acute ischemic leg is in sinus rhythm. That's very important because in atrial fibrillation, be worried about what would be really worried about an embolus. We'll be, but anyway he's in size rooms, it's most likely a thrombus, and here's his angiogram on the left and he has an occlusion in his essay and we put a wire down, and we've angioplastied that lesion and re perfused his limb. We're going to the next one can you see the child. He's vomiting and there's a 10 week old child and is persistently vomiting, losing weight, is hyperkalemic. We've done an ultrasound, an urgent ultrasound, and we've got looking through the left lobe of the liver. We've got a map which is actually a paralytic canal and there's fluid, which is the black area in the stomach and this is a paralytic stenosis and that's an old sound diagnosis that patient will be sent off to the Evelina or a tertiary center for pediatrics. Surgeries have a minamata me and relief of that gastric capital obstruction, let's see who else has got just been called to amy, and there's a patient acute right sided weakness. There's there is pronator drift on the right, the can't hold up the right arm. We've done a ct scan and on the right towards the basil system that identity, um if I could unfortunately can't show you with a narrow but there is a density, a linear density, and that is thrombus in the middle cerebral artery and this is a very damp tended praecis, 10% of strokes that are nonhemorrhagic, a severe proximal thrombotic and these are these can be intervened, and they said the newer surgeon the neurosurgery center, had an angiogram which showed an emcee occlusion and then re perfused and the function returned, so the patient was looking at a lifetime of disability now, has ability because you've re perfused that m. C. A, let's see what else so. The next slide is on that the exciting future of medicine, handheld iphone ultrasounds and a big area that I'm interested in preventative medicine, preventative medicine. I'm going to talk very briefly about, but there is some imaging findings and we'll go into that, so let's talk about Iphone ultrasound or point of carol, to kind of go to the next slide. You'll see the evolution of technology have you got that yeah and you can see how imaging has evolved from these huge machines on the left, on your left down two laptops in 2003 and down to the smaller handle machines and we have in the bottom corner on the left. We have these iphone ultrasounds, which have you know you can see the deep anatomy, so you take a short history and you look at the superficial anatomy of the clinical and then you add on the deep anatomy and all of a sudden you have a possible diagnosis. You turn differentials into diagnosis and let's see how that can be used on to the next slide. If you don't mind yes, very austere ultrasound in the developing world, so doctors in remote areas, they don't have access to x rays that have access to ct scans or, or MRI, but they can have pocket hand held ultrasound and they're using ultrasound in injuries in minor trauma to determine between soft tissue injury and bone injury in there's a rib fracture the most and they're in their tents, they can diagnosed TV using clinical history examination, then some ultrasound, which for notes and fluid they can examine the heart uh with ultrasound and they can examine the abdomen in the acute abdomen. Have you gone to the next slide. Then we see where it's really useful is in obstetrics pointed curb, step tricks you can triage patient's of the late state of pregnancy into high risk and low risk by just simple ultrasound tell you how many children you've got inside. I mean babies are they dead or alive and the right way up is the placenta previa. A local center uh is the plan, center of rupture is the blood behind the placenta um and all of these so, if it's low risk, the you see the village, they will have their child in the village, and if it's high risk, they will be transferred to 200 miles to a hospital for intervention and the first utility of ultrasounds. The next slide you have the picture of the london marathon, you can have it pitch side roadside um and you there's a picture of an ultrasound of a stress factor of the metatarsal uh in a london mass and uh somebody who's pulled up with 4 ft pain, you can do an ultrasound and you can diagnose it straight away. On the next slide, we on to the next slide point of care echo so we were looking at Paseana and I went to this british medical old sandwiches, a national meeting and presented some work, and we presented this work, which is point of care echo with one image. You can assess the heart in three ways and it's called a short acting parasternal view. There's a little probe on a man at the top and it can demonstrate with the heart is failing heart failure. You can see if so you can assess LV function, left ventricular function with one image that same image can tell you where there's a pericardial effusion fluid around the heart, which is the bottom image and the middle image can tell you there's a bright heart dilatation and if there is right hart palpitation, the patient is chest pain and breathlessness, you've got to think about prom, embolus. Again, just adding the clinical, adding some deep anatomy, some anatomical information sort of functional information that can take you huge steps forward at the point of care in the recess within seconds, and so the next slide yes which we presented this about how we could use ultrasound in recess, looking at hearts, looking in trauma for fluid in the abdomen and pelvis, looking for pneumothorax, looking at the lung, for lung. Covid when Covid was around, old, sounds, extremely sensitive too early Covid because the Covid was a peripheral problem and you could see it on ultrasound. As these, these lines you can look for pleural effusions, pericardial effusions. You do dVT scans, you can do a sketch. Emmick leg scans look for aortic aneurysm, hugely versatile, so I kind of so, I really enjoy that kind of work. It's dynamic, it's about patient's uh it's all speciality sided pediatrics. I do care the elderly, from cardiology to chest to orthopedics all sound colors, all those topics because I can see the deep anatomy uh in all age group, so hugely versatile. Um When I was a medical, I just did medical things like chest pain and breathlessness and various other things but with the advent you know, I'm very good at acute shoulders, you've got cute shoulder pain. I can tell you whether it's septic arthritis or or tendonitis or a bursitis or even a frozen shoulder, so so useful. So the next thing I think is quite exciting because that really came out in 2019, the Iphone office and just before the pandemic is preventative medicine, um and then the Chapel Roy taylor. If you go into the next slide is very brief um about prevention and here we have an mri, showing patient's who are type two diabetic and if they can lose 10% of their weight, they can go into remission and that is now an accepted door standard. This is mainstream Roy taylor is a professor up in new capital. All the all the endocrinologists have been briefed on this and and I've seen the scans and it was after seeing what happened to patients who have bariatric surgery. They lost huge amounts of weight and the glucose normalized before that. We thought the type two diabetes was irreversible, nobody seemed to get better and just deteriorating and he there's been lots of books. Him and Michael mosley have been excellent, telling people that it can actually improve it. Not everybody wants to do it. Not everybody can do it, but if you lose 10% of weight that's fat loss with muscle maintenance, 10% you can put your type two diabetes into remission and you've got to think what are we actually preventing or preventing this long term amputation and sepsis of the foot. We're talking about blindness, diabetic retinopathy. If we go on to the next slide, that is yes, we're also preventing renal failure, high blood sugars utter, misery, you've got really 10 years once you become diabetic, the complications the last six years are horrendous, We've gone to the next slide. Um It's an epidemic of obesity and 14 since about 1980 Going to the BMJ top your see chronic disease has taken over all the other quarters of morbidity, mortality, and there's a little picture here from 1941 showing 10 lean men in 10 overweight men going through life and and how they the lien men seem to go through life uh with less mortality and less morbidity, less walking sticks, it's actually worse than that now because about half of our children are obese, so um something has to happen and uh Roy, taylor and Michael mosley really trying to improve the situation. Um When I qualified in 19 nineties, it was pre obesity um and also pre polypharmaceutical. I didn't care the elderly. We had 80 year olds and there are no drugs at all and they just came out of the Second World War, not just but they came out of the Second World War and after 15 years of rationing, these people were in good shape and uh touch of diabetes. Really wasn't it was present, but it wasn't uh as prolific it is today, so um next slide, I was going to play some music now, but then I can see clearly now, but I can't play that music, so we've done to the next slide. What do you enjoy about medicine and radiology well. You can sort out date. It's with imaging really effectively really quickly. I've got a very short attention span and the scallop about five minutes is about it uh With imaging and seeing the deep anatomy, you've got diagnostic certainty, uh we've got high notes of predictive value. When we do the imaging, normal is normal and we've got some excellent clinical colleagues that help us Radiology is nothing without our clinical colleagues. It cannot be understated that I'm so lucky, I've got some excellent supported equally. I support them, lots of a, any doctors are excellent and the consultants in the hospital and, and the medical registrars. So um it's not about imaging, believe me the clinical is still the number one, but radiology does help and I personally enjoy it uh really enjoy the diagnostic challenge and the, and the intervention you know you can drain things, so they're septic and they're not septic. You can embolize bleeding points, where they're hemorrhaging blood and you can embolize it from the inside, So so, yeah it's an exciting and it's only going to get better and it's gonna we just um the government has just invested in diagnostic centers and so we're about to double our imaging capacity uh and try and catch disease early particularly malignancy, So I want to thank you for listening. I've I've gone through a bit quicker than normal. I hope so because the last slide it says, thank you. It's any questions. I know you don't get any exposed to radiology. It's a different way of practicing medicine and people don't quite get it some of the doctors that come into my office and say all sorts of things particularly like Odefsey patient's, but I see patients with ultrasounds tens of thousands of them. I would have seen them all with stethoscopes before, but now I use older sally's intervention. CT is unbelievable, so quick, so accurate and mri, just a joy in some uh some areas, so it really does benefit patient's and and so do our clinical colleagues. Uh So it's it's not all about the imaging, believe me any questions, thanks very much, Doctor lisa, we just waiting for the questions to come through on a chat box. Uh Did you get all the images, did you get all the information the information yes, it was really well done and thank you so much for joining us today. I think having somebody who has experience of seeing all of these images and seeing the other side of the clinical presentations actually really useful and one of those skills that everyone's going to need. Regardless of which branch of medicine you go into um one of the questions I had was so you're talking about this feature about point of care testing and when we're talking about the future, I just wondered what sort of timescale you're thinking about and what you see the future being. Beyond that well, the timescale really was 20 years ago. It started in america usa, They really ran with it. Europe have been doing it for many years and some parts of the third world or developing world. They really use point of care. Ultrasound were slightly behind in the uk, but we are catching up uh personally. If I was starting my career again, I'd get mrc piece so I knew what everybody looked like from the outside when they were unwell, and then I was doing that the masters in ultrasound. I have the inside information and all of a sudden you've got two very powerful, um, two very powerful uh tools, clinical and then the imaging uh and that's what a lot of doctors are doing actually uh Certainly in the uk, there's lots of i t. U. Doctors learning old sound were teaching old sound actually queen, elizabeth on i. T. U. Um and it looks like they need doctors, so the future is here, It's just whether you see this or not and unfortunately it's up to the individuals in time. It will go into medical schools and certain of that the technology is taking us there you know. Um I think it's when I find to doctor having diagnostic, certainly I'm not guessing about anything it's fantastic you know I can, when it's normal, it's normal, I'm not saying well, I'm not sure it could be, this could be that I'm actually going well. Actually there's no masses. There's no fluid uh You know, patient sorted out that's what they want to hear they want to hear that their child has got no no serious illness, so uh I mean the future is here, It's whether you see that really um other part of the world have and are doing and we will, but we're just um it's a little bit slow but uh um yeah, I'm seeing the anatomy. All the major specialties see the anatomy. This urgency has been after me to his laparoscope, the gastroenterologist ceases anatomy, do the endoscope, um and so when you see these people, you know, they're definitive because they can they can say. It's normal. Um So yeah very exciting I think breaks, I'd still excites me and I've I've been doing, I look forward to coming to work. I look forward to doing the work and nothing is a problem. I can fit patient's in. Um There's no long clerking for me. I just go and take short history, examine the patient and come out with some information. So yeah it's um it's not for everybody but you know, um So, yeah Pizza, I think it's already here today uh and for those of the viewers who have actually already started thinking about a career in radiology. What would you say is the number one thing that they should take away from this talk and also what should they be doing to prepare for a career in radiology. I watch what uh quite different to change that you will used to have to get placed my ownership and now will you have to apply the philip, portfolio have do some. We often have week experience for these people uh You got, I think the exam is crucial as an example that that you have to take and if you do well in that you have a colleague, my jennifer, you can't top in the examined you could choose where she wanted to do the radiology uh It's a bit demoralizing, first because you don't actually you're not able to do anything, but after a while you know after about a year and a half, you can get into it and, and then um and then just uh yeah I personally enjoy that and enjoy the intervention, I enjoyed the diagnostic challenge, uh what was the other question, um, but it's not for everybody so um uh It's a brilliant the great thing about radial to training programs five years. There are loads of jobs. The only thing I've been concerned about now is possible a, I may have an impact in the future. Um At the moment you know, there's an awful lot of work and uh it's easy to get a job wherever you want to be wherever you want to be in the country. You're not limited by geography. I've been lucky, I've I've literally what I've lived in village uh most of my adult life, and I've worked in some big centers around London, so uh it's a five year training program and it gets you off the medical uh rat race. You're not doing phds, you're not doing running around the country, doing all sorts of things to try and get that job as it were then, look, that's all, I can say really yeah, it looks very unattractive, but actually it's quite attractive because you really can sort out patient's pretty quickly and see some incredibly pathology and all were imaging is anatomy and pathology and uh and there's a an eviction the BMJ this week as a professor And he said if you understand pathology, you understand medicine and all that kind of where I'm at, if you understand the pathology, you can understand the symptoms, you can understand how the patient is and also the treatment uh we just image pathology. Any other questions, I think that's all the ones that we've had in the chat um that have a message to me, so, I just want to reiterate thank you so much for joining us today and thank you to all of our viewers as well. Please do fill out feedback for doctor be, so that we can give him plenty of compliments to tell him how much we appreciated his time uh look it's thanks for asking me it's uh yeah I do a lot of I was teaching this morning at King's on the, on, the uh radiology program uh teaching pakistan and uh yeah there's a great energy and uh it's a great energy in medicine. It's a great job, it's not about money, it's about people, uh it's not about places about people, so um yeah, good luck in your careers, whatever you decide. Thank you. Bye, Thank you bye.