Scan it be done? The doctor revolutionising arthritis care in a hospital near you
- Credit: Dr Tom Turmezei
40pc of us will suffer from osteoarthritis of the knee – a painful disease treated with burdensome operations that don’t always work. Surely there’s a better option for helping our ageing population? Consultant radiologist Dr Tom Turmezei thinks so, and he’s spent years testing his theory.
Each month, those working at the pioneering heart of Norwich Research Park tell us how their work is shaping the world we live in. Read their stories here.
You’re a consultant radiologist – what sort of work does that involve?
I work at the Norfolk and Norwich University Hospital, and my primary role as a radiologist is reporting patient scans involving tissues such as bones, joints, ligaments and muscles.
Every time you do a scan, you’re faced with a challenge and it can be quite cryptic. You have to interpret the scan using your knowledge, as well as information about the patient’s case so that it’s useful to the patient and the doctor looking after them.
I see a lot of patients with joint diseases like osteoarthritis. Pretty much anyone can get osteoarthritis through the lifelong use of a joint, a bad injury, or known or unknown genetic factors.
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The problem is that there’s only one thing we can currently do about osteoarthritis once the function of the joint has been lost – and that’s replacement surgery. We do at least 200,000 of these operations every year in the UK; hip and knee being the most common. My mum is actually about to have her hip replaced for this reason.
How successful are these operations?
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Broadly they’re good operations, but they still come with physical burdens to the patients and financial burdens to the NHS, and with complications – up to one in 10 operations won’t go as well as we’d hope, with a second operation needed to replace part or all of the original joint replacement.
Although a lot of people gain huge benefits from these operations, we’d ultimately like them to not need these operations at all, and for us to be able to prevent high-risk arthritis earlier. As the population grows older we want people to remain mobile and pain free.
How easy is it to spot that risk early on?
We can identify at-risk patients, but x-rays aren’t always sensitive or accurate enough for us to definitively tell a patient that they’re at risk of a joint replacement within a certain amount of years because of specific factors.
It was through everyday practice that about 12 years ago I started to think: “There must be a better way of looking at this”.
The technique we’re developing looks at the whole joint in 3D, so it shows things that x-rays can’t. We use a CT (computer tomography) scanner which is very good at looking at structures containing minerals like calcium, like you find in bones. Then we use a computer algorithm that takes measurements of the joint much more reliably and accurately than a human could.
We just had a paper accepted that proves that this technology is better than x-ray measures at predicting who will have a total hip replacement in healthy older adults in an Icelandic population cohort – that’s a really significant step!
What is it about this area of medicine that’s fascinated you for so long?
I think I have a personality that needs to be occupied! The fact that osteoarthritis was such a big problem that no one could really answer attracted me to wanting to research it.
Did you always know you wanted to work in medicine?
My mum worked in a hospital and used to let me sit under her desk when I was young. That wouldn’t happen today!
I spent a lot of time in the hospital and got to watch open heart surgery when I was 16. Seeing someone’s heart being operated on and watching the bypass machine was amazing. It made me want to do a job in which I could use incredible technology for the benefit of patients.
It seems like junior doctors are under a lot of pressure today. Is medicine a career that you’d recommend to others?
I’ve found myself continually engaged by medicine because it’s not just about the rewarding aspects of being a doctor – it opens so many other doors, too.
I’m also the imaging editor for the textbook Gray’s Anatomy, and I have friends who have worked in the armed forces and in television.
I’m even a member of the coffin analysis team at the Fitzwilliam Museum, Cambridge! That’s because we used the CT scanner to analyse ancient artefacts such as mummy coffins and skeletons. I’ve done some bizarre stuff and I think that medicine has so much to offer someone who wants to be challenged in different ways
With research like this, you’re at the vanguard of an area that takes so many people – from medical research volunteers to scientists, researchers and supporters – to make it work. It is never a single individual’s game.
Dr Tom Turmezei is a consultant radiologist at Norfolk and Norwich University Hospital at Norwich Research Park. You can follow his osteoarthritis research on Twitter at @3djointspace and much of his other work @tomturmezei.