A colleague of Ian Paterson has told an inquest he could have reported the disgraced breast surgeon’s “unusual” operating technique, but said he “didn’t feel in a position to take things further”.

Dr Adrian Parnell, a radiologist who worked at the Good Hope Hospital in Birmingham and also privately at the Spire Little Aston Hospital until he retired in 2014, said he was “surprised” when, in around 2005, he was asked to carry out repeat mammograms for some of Paterson’s patients who had previously undergone a complete mastectomy to see if cancer had returned.

Previous inquests have heard Paterson carried out unapproved “cleavage-sparing mastectomies” which left behind breast tissue in some patients who later died.

Paterson, 66, is currently serving a 20-year prison sentence after being convicted of wounding 10 patients in 2017.

A string of inquests are being held at Birmingham and Solihull Coroners Court over an eight-month period touching upon the deaths of 62 of his former patients where their deaths may have been unnatural.

At the sixth inquest, into the death of 56-year-old Rosemarie Blake, on Wednesday, Dr Parnell said he believed he could see lobular tissue left behind on the repeat mammograms that he carried out – something that should be removed during a traditional mastectomy.

Asked by counsel to the inquest Jonathan Jones KC whether he was concerned to see tissue left behind that could become cancerous, Dr Parnell said: “It certainly was unusual.

“I wasn’t a surgeon and knowledge of changing surgical technique wasn’t available to me.

“I was unaware what additional treatment these ladies were receiving. I didn’t feel in a position to take things further.”

Dr Parnell said it prompted him to do some research and found that in the US, some patients who had previously had a complete mastectomy were undergoing mammograms so he felt it “didn’t seem completely unreasonable”.

He said while it was an “extremely small number” of private cases that he was asked to carry out repeat mammograms for, they were only Paterson’s patients and he never had a similar request from any other breast surgeon.

When asked by Mr Jones if there was a system in the private sector where he could have escalated any concerns about Paterson’s actions, Dr Parnell said an avenue he “could have followed” was contacting the consultant body that had governance over practice at the hospital.

Asked why he did not do that, Dr Parnell replied: “At the time I wasn’t sure why Paterson had decided to commence an unusual surgical approach and I didn’t have enough surgical training to know how exceptional his practice was at the time.”

The inquest also heard that Dr Parnell did not have a close working relationship with Paterson and he described him as “forceful” and “strong-willed”.

He said: “The number of times I met him was actually quite limited because he did not usually come down to the X-ray department in the time that I worked there over the eight-year period to speak to me.

“I think he would be much happier to accept his own view of events. All I could say is, many other clinicians, if there were doubts, would come down to the department to discuss the situation.

“I can’t remember that ever happening with Ian Paterson.”

Dr Parnell said he was not aware of any concerns raised about Paterson’s behaviour other than “hospital rumours”.

He said: “I understood there had been an enquiry at Heartlands Hospital into his practice, for which there were recommendations for his future practice, and the feeling was that there was uncertainty about whether they were being adequately enforced or implemented.

“It is speculation and rumour, but it was the feeling I gained from other people (that he was still practising in the same way).

“It is only rumour really, but that is how I perceived it. I had no direct evidence of that.”

The inquests will continue from December 2.