Friday, 28 February 2014

Radiologists are perspicacious!

I found this great picture on The YUNiversity of Righteous Grammar website last week. It shows Benedict Cumberbatch in the role of Sherlock Holmes, the detective famous from the novels by Arthur Conan Doyle.

I happen to think that "perspicacious" is the perfect descriptor of radiologists (but then again, I am biased!). 

Just like the famous detective, radiologists are tasked with solving complex problems, picking up clues from imaging tests and putting together seemingly unrelated pieces of data to synthesise a unifying diagnosis. Observation skills and lateral thinking are key weapons in the radiologist's armoury, and being able to gaze through the mist of information and noise to identify a key single finding is what makes radiologists perspicacious.

So the next time I'm asked to use a word to describe myself, I think I'll use perspicacious!

Friday, 21 February 2014

Pelvic floor imaging part 4: what is a rectal prolapse?

So far in this series, I have covered what is involved in having a proctogram (variously known as defaecating, defecating, voiding or evacuating proctogram), and what a rectocoele looks like.

This post focusses on another important finding: a rectal prolapse.

A rectal prolapse is suspected when people complain of a feeling of a lump coming out of the back passage. The problem starts with the lining of the bowel becoming thicker and looser (rectal mucosal thickening) and starting to droop down. This is known as mucosal thickening and intussusception. This by itself will not cause a feeling of a lump coming out but commonly makes people feel a fullness in their back passage even when they don't need to go to the toilet. 
The intussusception - prolapse spectrum

Thursday, 20 February 2014

My new role with APOPS

I am absolutely delighted to announce that I am now a member of the Medical Advisory Board of APOPS: The Association For Pelvic Organ Prolapse Support. This is headed up by Sherrie Palm; she has shown immense enthusiasm and energy in raising awareness of pelvic organ prolapse (POP) and enabling a shift in attitudes amongst both the general public and the healthcare community. 

Monday, 17 February 2014

Why CT colonography is better than PillCam

Last week, a device named PillCam was approved by the U.S. FDA, to be used for looking at the colon. I've seen blog posts comparing this to the future as predicted in The Jetsons. The idea is that the PillCam is an alternative to a traditional colonoscopy. 

But what is not being widely mentioned is that this will still require people to have full bowel preparation (which means unpleasant diarrhoea and unsafe for people with cardiac and kidney problems) because otherwise the device will simply float through a lot of faecal matter in the colon. Infact, it requires more bowel preparation than a colonoscopy, which means that the most unpleasant part of the whole experience is magnified further.

So what if you need your colon investigating but don't fancy having a colonoscopy? Is there a test which is far more pleasant and proven to work?

Wednesday, 12 February 2014

My YouTube channel and playlists

Radiology is a very visual specialty, and a lot of my work and educational material is present in video format.

You can find all the videos featured on this website, and a lot more, on my YouTube channel.

I have also created playlists of videos related to CT colonography and proctograms.

Click the "Subscribe" button on the YouTube site to be notified about new videos.

The video below is an example; this is a 3D reconstruction of the data from a CT scan showing the bones (ribs, spine and pelvis) and the major blood vessels. The data from a CT scan can be manipulated in a number of ways to provide useful information for diagnosis and also to aid treatment such as planning complex surgery.

Dr Vikas Shah
Consultant Radiologist

Saturday, 1 February 2014

Pelvic floor imaging part 3: what is a rectocoele?

In the first two posts of this series, I covered the symptoms that might indicate you need a pelvic floor test called a proctogram, and what this test involves. In this post, I will describe what is seen on a proctogram when someone has a rectocoele (pronounced rek-tow-seal and spelt rectocele for North American readers). 

A rectocoele is bulge of the front wall of the back passage (the rectum) into the back wall of the vagina. The typical symptoms that this causes are:
  • feeling of a lump or fullness in the back of the vagina
  • needing to press from inside the vagina to empty bowels
  • feeling of stool being trapped and needing to go to the toilet repeatedly

The image above is typical for how a rectocoele looks at the end of a proctogram test. There is barium within the rectum but also in a pouch (seen to the left of the rectum).