Giles Maskell: Scanxiety

We are all going to be feeling more of it in the future

You might not have come across the word “scanxiety” before but you will have no trouble getting its meaning. It doesn’t yet have a formal dictionary definition but it’s a word used by people treated for cancer to describe the feeling of dread associated with their follow-up imaging. Even someone who feels entirely well and knows that the chance of anything bad appearing on the scan is remote can suffer from profound apprehension around the time of the scan“scanxiety.” Some patients describe severe physical symptoms connected entirely with the process of undergoing an ultrasound, CT, or MRI scan and waiting for the results.

Radiologists are very familiar with this. A colleague who regularly performs follow-up ultrasound scans on children with cancer describes how just the process of making a measurement on the screenpart of the protocol for any normal ultrasound examinationcan induce panic in the watching family.

Rightly or wrongly, patients attach ever greater importance to the role of imaging in their management. In that context, the recent report from the Care Quality Commission into radiology reporting delays in the English NHS makes for depressing reading. The CQC found that in some areas thousands of patients were waiting weeks or longer for the results of their x-rays and scans. Not all of these are patients with cancer of course, but many of them are and a great many more will be worried that the scan might show cancer, even if that is not the specific concern.

Radiologists have our own form of “scanxiety”the experience of being faced with hundreds of studies waiting for a report, knowing that each one represents an individual whose life is on hold while waiting for the result. Knowing too that amongst themneedles in the digital haystackwill be some for whom an urgent report would make a real difference and others for whom a delay could be disastrous.

One anticipated contribution of artificial intelligence to radiology is the possibility of smart prioritizationindicating which studies contain significant abnormalities and prompting the radiologist to report them first. If I am a little cautious about the potential for reliable automated sifting of normal studies from abnormal, it is because I remember that one of the catchphrases of the whole body CT screening industry in the USA was: “We haven’t found a normal yet.”

The thrust of almost every current initiative in cancer management, whether it is targeted screening, faster diagnosis or personalized medicine is that more people will require more imaging more often. The UK is woefully under-prepared for this predictable surge in demand. If you haven’t come across it before, get used to the idea of scanxietywe are all going to be feeling more of it in the future.

Giles Maskell is a radiologist in Truro. He is past president of the Royal College of Radiologists.

Competing interests: None declared.