Radiological training and staffing in the Birmingham region and elsewhere.

In every specialty, including general practice, good radiology is essential to the achievement of high standards of work. Many of the diagnostic and therapeutic advances that have been won during the past two decades involve complicated and time-consuming radiological techniques. The precise diagnosis and surgical treatment of congenital cardiac abnormalities, the investigation of severe hypertension, and the assessment and treatment of arterial insufficiency in the legs are obvious examples. The enormous increase in the scope and value of neuroradiology and the radiology of the alimentary tract must have added greatly to the work of diagnostic radiological departments, and the advent of a rational form of surgical treatment for coronary artery disease poses an incalculable further demand on radiological services. In the Queen Elizabeth Hospital, Birmingham, the number of patients seen has not altered appreciably over the past 20 years. On the other hand, the number of radiological examinations has increased from 21,612 in 1950 to 29,735 in 1970, while the character of the work has altered out of all recognition. In the earlier years of the two decades all nurses and many other sections of the hospital staff had a chest radiograph twice each year to exclude pulmonary tuberculosis. Such examinations, involving only a few moments of time of a consultant radiologist, have long been discontinued, and in their place aortography, femoral arteriography, carotid and vertebral angiography, angiocardiography, and cineangiocardiographyall of which demand hours of exacting work-have developed. In 1960 only 14 patients had angiocardiography performed, but by 1970 this number had increased to 271, while over the same period arteriograms more than doubled. General practitioners very rightly ask for open access to radiological departments. Without this they cannot hope to do first-class work, and with the increasing general and medical education of the public there is a growing demand from patients for radiological examination which even when not appropriate is difficult to refuse. This enormous and ever-increasing demand on radiological departments is difficult to measure exactly, but Bull's assessment' of an 8% rise every year is certainly not an overestimate. At this level work would more than double every 10 years.