288 CLINICAL RADIOLOGY

V/Q lung scans were performed but only 490 pulmonary angiograms. The PIOPED study (The PIOPED Investigators, 1990) indicated that clinical assessment combined with V/Q scan excluded the diagnosis of pulmonary embolus in only a minority of patients. Bilateral selective conventional pulmonary angiography can be simply and safely per- formed by any experienced angiographer using standard angiographic equipment. It is standard practice in our institution for most patients with intermediate-probability scans to undergo pulmonary angiogra- phy since approximately one-third of these patients have pulmonary embolism. In addition, we frequently perform pulmonary angiography on patients with low-probability scans and with a strong clinical suspicion of pulmonary embolism, since approximately 10% of these patients have had a pulmonary embolism. Consequently, we perform approximately 100 pulmonary angiograms per year in our 900 bed hospital.

Cooper et al. (1991) indicated that the use of pulmonary angiography is declining and that the examination is difficult to interpret. We believe that if the angiogram is performed as soon after the suspected embolism as possible (we perform them at night and at the weekends) the examination is usually straightforward to interpret. We strongly believe that selective pulmonary angiography is an under-used test and would advocate its use in all patients with equivocal V/Q scans.

S. F. MILLWARD Department of Radiological Sciences R. A. PETERSON Ottawa Civic Hospital

1053 Carling Avenue Ottawa, Ontario, Canada KlY 4E9

References

Cooper, TJ, Hayward, WJ & Hartog, M (1991). Survey on the use of pulmonary scintigraphy and angiography for suspected pulmonary thromboembolism in the UK. Clinical Radiology, 43, 243-245.

The PIOPED Investigators (1990). Value of the venti]atioff/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). Journal o f the American Medical Association, 263, 2753-2759.

To achieve success and credibility for those who enroll into such courses, the education of radiographers will need to be completely restructured, and embrace anatomy, physiology and pathology, along with Health Studies and Imaging Sciences. The changing culture of the Health Service will need to be reflected by instruction and guidance into the management issues, concerning the Health Service, and it will be necessary for undergraduates to undertake research in a topic of their own choice.

At the same time, as radiographic training is altering Professor Rhys Davies also notes the changing role of radiologists. Graduate radiogra- phers, having completed an appropriately validated degree course, will be a different entity from the current trained technicians, and will seek professional fulfilment by taking on new tasks and responsibilities. Already in ultrasound, radiographers perform and report examinations independently, and I see a possibility that graduate radiographers might engage in some plain film reporting and also some contrast examin- ations. It is essential that the opportunity of establishing degree courses for radiographers is fully exploited. Tinkering with the D C R course to produce a cosmetic degree will not find support from radiologists and will lead to disappointment and resentment amongst graduate radiogra- phers who will not be given the responsibilities they believe their degree should entitle them to. Confidence in the degree will enable radiologists to accept the value and worth of tl~e new graduate radiographer.

It is beyond the scope of my reply to indulge in premonitions, other than perhaps to state that radiographers' expectations will extend beyond plain film reporting towards the end of the coming decade, but I make a confident prediction that graduate radiographers will be undertaking some plain film reporting by the mid 1990s.

T. S. BROWN Bradford Royal Infirmary Duckworth Lane

Bradford W Yorkshire BD9 6RJ

Reference

Davies, ER (1991). Knox Lecture: Predictions and premonitions. Clinical Radiology, 43, 234-237.

THE KNOX LECTURE: PREDICTIONS AND PREMONITIONS

SIR - - Professor Rhys Davies' essay, 'The Knox Lecture: Predictions and Premonitions' (1991) made interesting reading.

He confined his discussions and arguments to radiologists and, I think, fails to acknowledge significant changes that are taking place in radiographic education, by so doing. He refers within his essay to the 'whole team', but fails to mention the part that radiographers play in the team; he refers to education, but confines his discussion to the education of radiologists.

In a policy document from the College of Radiographers 'Radiogra- phy Education and Training for the Future: A New Policy', dated September 1990, it is stated clearly that all DCR courses will be devolved by July 1995; no new entrants for DCR training courses will be accepted after 1992. The change in radiographic education from a training diploma-based course to an educational degree course will be upon us within 18 months. There will be a significant change in expectation of tasks and responsibilities from these new graduate radiographers.

'ACADEMIC'

SiR I am perplexed by the use of the word 'Academic' to describe some Departments of Clinical Radiology. I take it the word is meant in its Oxford Dictionary meaning of scholarly, rather than the alternative 'abstract, unpractical, cold, merely logical, of the philosophy of Plato, sceptical'. Should we infer that all other departments are non-academic or non-scholarly? The potential of such elitism makes me nervous.

But perhaps it is in the meaning 'of the University' that the word is used, in which case would it not be better to call them University Departments?

E. RHYS DAVIES University Department of Clinical Radiology University of Bristol

Bristol BS2 8HW