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EUROPEAN HOSPITAL Vol 24 Issue 2/15 24 RADIOLOGY Communication with the neurologically impaired Drawing radiology and nuclear medicine together Tips to eliminate barriers ‘Let’s work as a team!’ Manuela Messmer-Wullen awoke in her hotel room one morning, during a business trip, and realised she was hemiplegic. There were also cogni- tive impairments and she could not articulate. Diagnosis: Stroke. ‘In the very first period after the stroke, contact with radiologists was very strange and mysteri- ous for me.’ Messmer-Wullen became a board member of the European Federation of Neurological Associations (EFNA), which campaigns on behalf of people with neurological diseases. In March, at the European Congress of Radiology (ECR 2015), she spoke during a session of the ESR Patient Advisory Group, which focused on particular communication problems between radiologists and patients with neurological diseases. ‘Communication between the radiologist and patient can be quite challenging – and is even more complicated if the patient has a brain disorder,’ explained Donna Walsh, Executive Director of the EFNA. Neurology patients can suffer language disorders (aphasia), motor speech disorders (dysarthria) and difficulties with coordination (dys- praxia). Communication with the patient is made even more difficult when they have problems with their short-term memory or personality disorders, such as aggressiveness or paranoia. A survey amongst patients with multiple sclerosis and their neurolo- gists has shown that both groups are surprisingly pleased with their communication. More than eight in ten patients who saw a neu- rologist in the past year said they felt comfortable talking about their MS with their neurologists, characterising their relationship as honest, open, comprehensive and helpful. Nearly all neurologists (96%) felt that they had an open dialogue with their patients, and 90 percent indicated that they have a good understand- ing of all aspects of a patient’s disease. When asked if his or her neurologist is accessible and spends enough time with them, close to three-quarters of surveyed patients responded positively. However, the survey also uncov- ered some less positive facts: 47% of doctors stated that they did not have enough time for communication with their patients. Interestingly, though, only 21% of patients shared this view. Doctors were also more cautious when it came to the sub- ject of communication barriers: 15% felt there were no barriers with patients at all, whilst the figure rose to 37% among patients. ‘But that means 60% feel barriers exist,’ Walsh emphasises. ‘How do I know if my patient is satisfied with communication?’ she asks, quickly following with her answer: ‘Ask!’ She also offers three more tips for communication between doctors and neuro- logical patients: Give the patient at least 30 seconds to speak uninterrupted and during that time minimise note tak- ing and maintain eye contact. Touch the patient; touch makes them feel that the conversa- tion is about some- thing real. Involve family mem- bers – but don’t ignore the patient. The patient is the person you are treating and should not be dismissed or ignored. Often this is not easy. ‘The radiologist is usually consid- ered to be a poor communica- tor,’ admits Dr Lorenzo E Derchi, Head of Emergency Radiology at San Martino University Hospital in Genoa (Italy). ‘It’s possible that some medical students choose radiology because they’re afraid of close contact with patients.’ Derchi believes there should be more emphasis on communication in medical training. Source Shutterstock/©PathDoc Source:Siemens Report: Marcel Rasch Dr Gerald Antoch, professor of radiol- ogy and chairman of the department of diagnostic and interventional radiology at Düsseldorf University Hospital and active member of sev- eral scientific societies, delivered the prestigious Wilhelm Conrad Röntgen Honorary Lecture at ECR 2015 on ‘Hybrid imaging: Let the two worlds of radiology and nuclear medicine come together’. ‘A hybrid in medicine has nothing to do with hybrid cars, hybrid bicy- cles or hybrid golf clubs,’ Professor Antoch emphasised by way of intro- duction. ‘It is the combination of two imaging modalities, such as PET/CT or PET/MRI, adding that a good imaging system is basically nothing more than a good comput- er. ‘PET/CT technology, developed to show tumours and metastases that went undetected before, has seen many enhancements since the first system was installed in 2001. However, while in the early days clinicians would say “PET is easy: where it’s light, it’s bad”, today we know that it is not that easy.’ Read image data accurately The best technology is useless if not supported by people who can read – interpret – the images gener- ated by the technology. ‘You need as much morphology as you can get, but you also need the expertise to read these images,’ Antoch stressed. ‘This expertise has to be available not only for the morphological but also the functional side,’ he added, to avoid misinterpreting findings in different images, because ‘accurate hybrid imaging is a question of knowledge’. The term ‘Theranostics’ describes the combination of therapy and diagnostics, which requires accurate hybrid interpretation by specialists as a basis. New standards and comprehensive training For ‘Theranostics’ to be implement- ed properly, Dr Antoch said, it must be clear who is responsible for scans and who provides them but, even more importantly, ‘who reads and interprets hybrid F-FDG PET studies’. Often, today, two specialists – a radiologist and a nuclear medicine physician – cooperate on each scan and to ensure that the images were read correctly and to avoid misin- terpretation. ‘We need to adapt the workflow to real life,’ Antoch said – with ‘real life’, meaning ‘limited resourc- es’. He proposes the implementa- tion of new training programmes where nuclear medicine specialists familiarise themselves with neces- sary radiology knowledge and vice versa, depending on the local or country-specific regulations. What we need for the future Antoch’s vision for the future is very clear: ‘We must move from separate departments towards one imaging centre. We need new training pro- grammes, a flat organisation, inter- linked reimbursements and no turf battles. Let’s work as a team.’ Dr Gerald Antoch, professor of radiology at the department of diagnostic and interventional radiology, Düsseldorf University Hospital, Germany The combination of PET to visualise the biological processes of life and the anatomical imaging capabilities of CT, provides finest resolution. Nuclear medicine physicians and radiologists need an elaborate training with detailed knowledge of all facets of PET/CT to interpret hybrid images accurately

EH 2_2015

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