The presenting features of colorectal carcinoma in the African patient are not different from reports worldwide although the majority present late with features of advanced disease (1). Increasing frequency of diagnosis may be attributed the twin effects of changing diets and easier access particularly by the elite population to modern diagnostic imaging tools.
A 72 year old African male presented to a private practitioner with a 2 week history hematuria, frequency, nocturia and subsequently a 2 day history of retention of urine (AUR). Imaging studies demonstrated a tumour mass invading the roof of the urinary bladder. Following surgical extirpation the mass was subjected to histopathological evaluation.
The birth of radiology in 1895 was accidental. However its place in disease investigation is sealed. The ground breaking discovery invited awe and indignation in almost equal measure. The medical operative of the day was quick to recognize the potential it possessed in the investigation of medical ailments. To the less technically endowed, the development represented an assault on human dignity and privacy. No human mortal they argued was entitled to know what lay beyond the skin. To them the discovery was a bad omen.
Fast forward to 1971 and computed tomography was to explode on the medical scene. This discovery considered by many the most important discovery since the establishment of X rays allowed the evaluation of the 3rd dimension in human anatomy. In coming decades the technology would evolve immeasurably. Today computed tomography finds relevant applications in imaging of virtually all body regions.
So robust was CT in its diversity of uses that the protracted development of MRI technology caught manufacturers and doctors alike napping. In any event Sir Peter Hounsfield stumbled on MRI as he attempted to find a suitable replacement to X ray radiodiagnosis. To this end his efforts came to a cropper. His persistence and that of coworkers was to unleash the incomparable imaging tool that it has become..
Today the twin technologies of CT and MRI straddle the imaging field like a colossus. The pace of innovation is mind boggling. Even imaging specialists find it challenging to remain up to date on more than one front of diagnostic radiology. The dilemma of the clinician in being able to identify the most cost effective imaging study then becomes obvious.
The most important question for them is to ask whether regional biases exist. Are there pathoanatomic regions in which one tool holds sway? Can a simple “cook book” be developed to guide the doctor who has the patient in his surgery on the most appropriate imaging approach? Knowing the general ball park diagnostic avenue would profoundly reduce the number of supporting investigations apart the study of choice lowering costs to the patient. Waiting lists would shorten as would idiosyncrasies.