Lives 'put at risk by lack of new X-ray facilities'

Britain's most senior radiologist calls for urgent review of funding

Patients are dying unnecessarily because hospitals fail to provide modern X-ray facilities that enable the safest treatments to be delivered, Britain's most senior radiology specialist has warned.

Nine out of 10 hospitals lack round-the-clock access to staff and equipment capable of providing interventional radiology, which has been shown to save lives, even though the facilities are cheaper and less risky than conventional surgery, Professor Andy Adam, president of the Royal College of Radiologists, said.

The technique can be used to halt internal bleeding, destroy tumours and open up blocked arteries. X-rays, ultrasound or a CT scan are used to guide instruments to the site of the problem through an incision so small it is known as "pinhole" surgery. (Keyhole surgery requires the insertion of a telescope alongside the instruments, involving an extra incision.)

Speaking to The Independent, Professor Adam said that the technique allows radiologists to treat injuries and diseases as well as diagnose them, thereby avoiding the risks of surgery.

But funding problems and a lack of posts for qualified personnel mean interventional radiology is not widely used, even though it cuts costs and prevents deaths, particularly among new mothers with postnatal bleeding.

"Thousands of lives a year would be put at much less risk and millions of pounds could be saved if [these techniques] were used more widely," he said.

"Somewhere in the country someone is either going to have a serious injury or die because [the facilities] are not available and they will either get conventional surgery or nothing. It is an accident waiting to happen."

Professor Adam said: "If you have a patient with severe internal bleeding they will be in shock. If the surgeon opens their tummy up, the procedure adds to the shock. The risk is increased by the surgery itself.

"Using interventional radiology, you can insert an instrument through an artery in the groin, find the bleeding point using a [radio-opaque] dye and block the artery much more easily."

Two years ago, an investigation by the Healthcare Commission into a disaster involving the deaths of 10 mothers following childbirth at Northwick Park Hospital in Harrow, north London, concluded that interventional radiology should be made available in all hospitals with delivery units to "save the lives of mothers with catastrophic postnatal bleeding".

"We are nowhere near achieving that," Professor Adam said. "We are going to have more deaths from post-partum haemorrhage [bleeding following childbirth] as a result."

Presenting evidence to the Commons Health Select Committee's inquiry into patient safety last week, Professor Adam said an urgent review of funding for interventional radiology was required. "There is no other discipline in the health service where the gap between the potential to increase patient safety and the reality is greater," he told MPs.

The financial savings were demonstrated by treatment for fibroids, the common gynaecological condition involving benign growths in the womb. A hysterectomy – the conventional surgical treatment – costs £3,200. An alternative treatment involving embolisation (blocking the blood supply to the fibroids causing them to shrink) using interventional radiology costs half that amount.

Professor Adam said investment in the technique was restricted because funds had to come from within the radiology budget, a diagnostic specialty, rather than competing for funds alongside surgery and gynaecology, which are treatment specialties.

"The lack of availability [of interventional radiology] is putting patients' lives at risk," he said. "Some patients have died because the service isn't there and patients will go on dying."

Modern medicine: The groundbreaking technique

When a car crash victim is brought in with serious internal bleeding, doctors have two options. In the conventional approach, surgeons open the abdomen, find the severed blood vessel and repair it. There is a danger that the patient, already in shock, will be unable to withstand the operation and that the surgeon's view may be obscured by the bleeding. In the alternative approach, the interventional radiologist inserts a catheter through a pinhole incision in the groin, and threads it through the blood vessels to the site of the injury. A radio-opaque dye is released, which reveals on screen exactly where the bleeding is occurring and a stent (thin metal tube) is applied to effect the repair. The patient suffers less shock, has a better chance of survival and the treatment is cheaper.