IRMER regulations: compliance rate of radiograph reporting by non-radiology clinicians.

AIM: To assess compliance with regulation 7(8) of Ionizing Radiation Medical Exposure Regulations (IRMER) 2000 legislation amongst non-radiologists reporting radiographs in a large district general hospital. MATERIALS AND METHODS: A prospective review of 100 consecutive radiography request cards from five different departments undertaking their specialty radiograph reporting were collected over 4 weeks. The requests were then traced to their respective case notes to assess documentation of radiographs. The five departments included chest, maxillo-facial, rheumatology, orthopaedics, and inpatients. Twenty-two case notes were gathered from chest clinics, 21 from maxillo-facial, 15 from rheumatology, 23 from orthopaedics fracture clinics, and 19 were taken from inpatients. RESULTS: Only 53% of radiographs undertaken by non-radiologists had a documented report. The specialty most compliant with IRMER was orthopaedics 17/23 (74%) and the specialty least compliant was maxilla-facial 8/21 (38%). Of the documented radiographs, the consultant grade was the largest group of doctors [36% (19/53)] that undertook documentation, and for the undocumented radiographs, they were also the largest group of clinicians that did not document radiographs [77% (36/47)]. All radiographs that were documented in the notes also had documented interpretation of the radiograph. CONCLUSION: Only 53% of plain radiographs were documented and reported by non-radiology clinicians even though IRMER legislation applies to all clinicians undertaking radiograph interpretation. All clinicians undertaking interpretation of radiographs should be made aware of this legislation and the responsibility to document their findings.

Isolated non-hepatic metastasis from upper gastrointestinal adenocarcinoma: A case for surgical resection.

INTRODUCTION: Upper Gastrointestinal Tract (UGIT) malignancy is an increasing problem in western society and its prognosis is generally poor. The prognosis dims even further with the presence of loco regional recurrences or distant metastasis. This article looks at the feasibility and potential benefit from resection of non-hepatic, non-nodal metastases and recurrences. PRESENTATION OF CASE: Case 1. A 72-year-old male who underwent total gastrectomy for a gastric adenocarcinoma presented with a splenic mass 40 months later and underwent a splenectomy. He is disease free at 30 months post-metastectomy. Case 2. A 54-year-old male with oesophagogastric junctional adenocarcinoma, underwent an Ivor-Lewis oesophagectomy. He developed a distal pancreatic mass at 24 months follow-up and underwent distal pancreatectomy and splenectomy. He is disease free at 12 months post-metastectomy. Case 3. A 75-year-old male underwent subtotal gastrectomy for lesser curvature adenocarcinoma. At 42 months follow-up, he developed solitary abdominal wall recurrence. This was locally resected with clear margins. After 12 months, he developed another full thickness abdominal wall recurrence with involvement of the hepatic flexure. Enbloc resection including right hemicolectomy was performed and he is disease free at 3 months. DISCUSSION: There is very scarce literature on resection of non-hepatic, non-nodal recurrences/distant metastasis in oesophagogastric cancers. Based on these cases, a surgical resection in selected cases may provide prolonged survival with good quality of life. CONCLUSION: Resection for isolated recurrences and metachronous metastasis from UGIT cancers may be worthwhile, especially if patients have minimal co-morbidities.