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The Royal College of Physicians has recently published guidance on supporting people with eating and drinking difficulties. Although much of the advice in the guidance is sensible and helpful, in this paper we argue that the recommendations regarding ‘risk feeding’ decisions are flawed. In particular, there is a failure to clearly identify the nature, frequency and severity of different risks. There is an undue emphasis on aspiration as a risk and as a potential cause of pneumonia, and the limited evidence base for many interventions to manage risk is not adequately acknowledged. There is an emphasis on multidisciplinary team decision making at the expense of individual professional responsibility. We conclude that this guidance regarding risk feeding supports an unduly defensive approach to oral intake and should not be adopted as a standard of medical practice.

Introduction Cardiac Implantable Electronic Devices (CIEDs) are increasing in prevalence. Exposing patients with CIEDs to MRI can lead to adverse outcomes. This has led certain radiology departments to not accept MRI referrals related to patients with CIEDs. Patients with MR-conditional CIEDs can be safely scanned under specific conditions. Our institution has accepted such referrals since 2014. The aim of this study was to systematically identify and reduce risk in our CIED-MRI protocol using Failure Mode and Effects Analysis (FMEA). Methods A multidisciplinary FMEA team was assembled and included senior stakeholders from the CIED-MRI protocol. A process map was constructed followed by risk analysis and scoring. Targeted interventions were formulated and implemented, high-risk failure modes were prioritized. A new process map and protocol were drafted and repeat risk analysis performed. Monitoring and re-evaluation of the CIED-MRI pathway were instigated at departmental QA meetings. Results Interventions included direct CIED characterisation using wireless technology pre-MRI, CIED programming and reprogramming in the MRI suite before and immediately after MRI reducing device downtime and continuous patient monitoring during MRI by a cardiac physiologist. The cumulative risk priority number decreased from 1190 pre FMEA to 492 post FMEA. Discussion Despite the risk of exposing CIEDs to the MR environment, patients with MR-conditional CIEDs can be safely scanned with appropriate multidisciplinary support. We found FMEA an indispensable tool in identifying and minimizing risk with no adverse events recorded since FMEA recommendations were implemented.

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Musculoskeletal radiology's role in the recent and continued evolution of sports medicine is an exciting and expanding one. In this article we explore a variety of the ways that musculoskeletal radiology contributes to current practices in modern sports medicine, discussing advances across a variety of imaging modalities in the care of both elite athletes and so-called weekend warriors. We describe the technical and ethical factors pertaining to image-guided therapeutic intervention in athletes and speculate on the potential for future developments in the role of imaging in deciding when an athlete may return to participation. We also explore the recent shift to the delivery of imaging facilities at sporting events and in stadiums.