Dr. David Wilson is a consultant musculoskeletal radiologist, and President of the British Institute of Radiology 2014-2016.
1. What are your key areas of interest and research?
Occult fractures and outcome in acute ankle injuries. When someone sprains their ankle, if a fracture is suspected they are x-rayed and treated. If there is no fracture, patients are sent home with what I call the “go away” treatment - take aspirin, put the foot up, put ice on. However, of those, between 4-5 percent have long-term problems, and never get ankle stability back. I wanted to find out how many were affected and if there was something about their injury that was worse that would predict who would do badly. Until we know we can’t even begin to think about treatment.
In this project first we use a low dose CT system to check if there is a fracture and what the nature of the injury is. If there is no fracture we use ultrasound (US) to scan the injury, following up at three and six months repeating the US. We recruited 100 patients, and found that 19 had serious fractures - more than expected, and looking back at the x-rays you cannot see the fracture. So with other groups we are conducting a prospective study and trying to predict outcome based on the initial findings. One of the limitations in the first ankle study was that if somebody actually had a fracture, we send them back for treatment, but in real life they would have just walked around. In the new study the first assessment is at three months at which point if they are doing badly we will scan them and count the number of fractures. If it’s the same – 19-20 percent - that means it makes no difference if you have the fracture or not, if you treat it or not. If it’s 50 percent then the fracture is obviously a problem.
My other area of research is using MR-Ultrasound to treat nerve root pain - putting anaesthetic steroids around the nerve. This has the advantage of no radiation, and I can get much closer to the nerve, within plus or minus 2mm.
Education is a key area of interest for me in my role as President of the British Institute of Radiology and in my own practice. The best way to learn is to get on and do it. I am trying to develop new ideas about how we can teach and train.
2. What are the major challenges in your field?
One of my passions is getting radiologists working as doctors. The biggest challenge is working out whether the things we are doing are changing healthcare, impacting on patients’ wellbeing and altering the eventual outcome.
With my ankle research, for example, it’s all very well saying you’ve discovered occult fractures, but does outcome differ as a result? In radiology we tend to see the “I have found this lesion, I have made this diagnosis” as the endpoint. If you treat the patient the same way anyway is the test altering the management of the patient? It is an area where many radiologists are weak, because their input is literally issuing a report, and they are not following up patients after seeing them. Radiologists should be looking at what the eventual outcome of that patient’s treatment is and their outcomes in terms of health – either preventative or curative and how that links into doing a test. We should be measuring value not counting the numbers.
3. What is your top management tip?
Get a good management team! It is really easy for me to do this job as President of the British Institute of Radiology. We have a superb management team, who are very motivated. So my tip is: “Choose the right people”.
4. What would you single out as a career highlight?
Hard to single out one - I was a travelling professor for the Royal College of Radiologists. I also received an award for teaching medical students at the University of Oxford, which was a nice surprise. Lastly is writing the first paper on musculoskeletal ultrasound in the world (Wilson et al. 1984).
5. If you had not chosen this career path you would have become a…?
6. What are your personal interests outside of work?
Playing the viola, rowing and cycling.
7. Your favourite quote?
“I refuse to join any club that would have me as a member” – Groucho Marx.