Ashley Shaw

Radiological surveillance in multiple endocrine neoplasia type 1: a double-edged sword?

Context Multiple endocrine neoplasia type 1 (MEN1) is a hereditary condition characterised by the predisposition to hyperplasia/tumours of endocrine glands. MEN1-related disease, moreover, malignancy related to MEN1, is increasingly responsible for death in up to two-thirds of patients. Although patients undergo radiological and biochemical surveillance, current recommendations for radiological monitoring are based on non-prospective data with little consensus or evidence demonstrating improved outcome from this approach. Here, we sought to determine whether cumulative radiation exposure as part of the recommended radiological screening programme posed a distinct risk in a cohort of patients with MEN1. Patients and study design A retrospective review of 43 patients with MEN1 attending our institution between 2007 and 2015 was performed. Demographic and clinical information including phenotype was obtained for all patients. We also obtained details regarding all radiological procedures performed as part of MEN1 surveillance or disease localisation. An estimated effective radiation dose (ED) for each individual patient was calculated. Results The mean ED for the total patient cohort was 121 mSv, and the estimated mean lifetime risk of cancer secondary to radiation exposure was 0.49%. Patients with malignant neuroendocrine tumours (NETS) had significantly higher ED levels compared to patients without metastatic disease (P < 0.0022). Conclusions In MEN1, radiological surveillance is associated with clinically significant exposure to ionising radiation. In patients with MEN1, multi-modality imaging strategies designed to minimise this exposure should be considered.

Radiology Provision in the United Kingdom: An Overview

The UK National Health Service (NHS) came into being in 1948, offering health care for all, free at the point of access. Over the past 6 decades, the NHS has grown to become the worlds largest publicly funded health service. The authors present an overview of the NHS, from its conception to the present day, with a particular emphasis on how the changing environment of the NHS has affected the provision of radiologic services. The authors review the current landscape of the NHS with regard to radiology provision, from training and research to funding and the private sector, and touch on the likely future of the service.

Audit of patients with multiple endocrine neoplasia type 1 in a tertiary referral centre

• Mean age of diagnosis 43 years (16 – 72 years) Mean size of tumour was 1.5cm Insulinomas (n=4) • Mean age of diagnosis 25 years (16 – 34 years) • Glucose mean level 2.4mmol/l (range 1.7 – 3.5) • Insulin mean level 57pmol/l (range 32 – 101) • Proinsulin mean level 18pmol/l (range 15 – 20) • 100% underwent surgery, with 100% currently in remission Gastrinomas (n=16) • Mean age of diagnosis 46 years (19 – 72 years) • Gastrin mean level 339pmol/l (range 9 – 2483) • 5 patients underwent surgery due to enlargement or worsening symptoms (2 Whipple’s procedures, 2 total pancreatectomies, 1 distal pancreatectomy) • 3 patients who underwent surgery were found to have positive lymph node metastases on histology • PPIs were given to 73% of patients with gastrinomas Glucagonoma and non-functioning PNETs have been managed with surveillance only Somatostatin analogues given to 4 patients Multiple endocrine neoplasia type 1 (MEN1) is characterised by parathyroid, pituitary and pancreatic tumours in association with neoplasia of intra-thoracic endocrine tissue, adrenal glands and cutaneous manifestations. We reviewed patients in our centre attending a dedicated MEN1 clinic, where detailed radiological and biochemical surveillance is undertaken (Thakker et al. 2012).

Two-year audit of computed tomographic colonography in a teaching hospital: are we meeting the standard?

Objective  We aimed to determine whether adopting the published recommendations has led to successful implementation of computed tomographic colonography (CTC) in a teaching hospital setting outside the context of a clinical trial.