The
UHBristol Campus comprises of the Bristol Royal Infirmary,
The Bristol Oncology Centre,
The Bristol Children’s Hospital and
The Bristol Eye and
Dental Hospitals.
In addition it also covers St. Michael’s Hospital which provides Obstetric and Gynaecological services as well as ENT. This Campus is also the main Teaching Hospital for the South West Deanery, it is a traditional City Centre Campus and enjoys close links with both the University of Bristol and the University of the West of England. All aspects of training are undertaken, both undergraduate and postgraduate level. Many Regional services are developed on this Campus and these include Cardio-thoracic, Paediatrics and some Oncological specialties. This complex and diverse nature of Clinical Specialties allows the development of both general and specific opportunities for Sub-specialty Training in the 5th year for Radiological Registrars. In addition, close proximity of such specialties would allow for the possible development of a tailored programme to cover one or more of these specialties whilst developing a common interest. For example the development of both obstetric and paediatric imaging in combination with gynaecological radiology.
All aspects of interventional radiology are performed on this campus apart from those associated with interventional neuroradiological provision. Indeed, although there are interventional procedures only undertaken at UBHT and not available at any other hospital within the rotation, for example; Thoracic Cardiovascular Stenting, TIPPS Procedure and Radiofrequency Ablation, and whilst these are techniques that only a dedicated Sub-specialist Radiologist will require, they do provide the opportunity to tailor subspecialty trainingg to the individuals needs. The recent development of a ‘Fellow in Abdominal Imaging’ at 6th year level and funded by UBHT provided the opportunity for an individual to sub-specialty skills that will only be required within a specialist unit providing extra opportunity for an individual with interest in abdominal radiology.
At present, we have 'State of the Art' equipment with both a 16 and 14 slice CT scanner, 1.51 and.2 Teslar MR Machines and two 'State of the Art' ultrasound machines capable of performing imaging using micro-bubble contrast media.
Suite A
The Bristol Royal Infirmary Radiology department is divided into separate suites. Suite A consultant staff are Mark Callaway, Jim Virjee and Huw Roach. As well as contributing to the general plain film, ultrasound, CT, MRI and radionuclide workload of the department, the Suite A workload covers more specialist gastrointestinal and abdominal radiological examinations and interventional procedures. These include upper GI, small bowel and lower GI barium studies; ultrasound studies including the use of contrast ultrasound; imaging guided biopsy and drainage; percutaneous transhepatic cholangiography and biliary stenting; transjugular liver biopsy; image – guided radiofrequency ablation of hepatic and renal tumours; liver MRI; percutaneous nephrostomy; colonic stenting and CT colonography.
Radiologists based in Suite A maintain a central role at upper GI and hepatobiliary regional multidisciplinary team meetings and local lower GI and Urology multidisciplinary meetings. Non-cancer clinicoradiological meetings in upper GI, lower GI and Urology are also supported.
The extensive and varied case mix lends itself to audit and original research opportunities, which the consultant staff are keen to support.
Oncology
The radiology input into the renowned Bristol Haematology and Oncology Centre is pivotal to the staging and follow-up of oncology patients with a wide variety of cancers and plays a vital role in the many oncology trials taking place. The case mix mainly involves plain radiograph and cross-sectional imaging.
The BHOC is equipped with its own single slice spiral CT scanner (although when higher quality imaging is necessary, the BRI 4 and 16 slice scanners are employed). The BHOC is also equipped with a 0.35T open MRI scanner, which is used not only for oncology patients but also for non-oncology patients from all around the south west when open scanning is necessary egg for claustrophobic patients
Bristol Children's Hospital
The department provides experience of all aspects of paediatric imaging. This includes plain film reporting, ultrasound, fluoroscopy, CT, MR and radionuclide investigations. Bristol Royal Hospital for Children is a tertiary referral centre for the Southwest and beyond, meaning there is a very diverse and interesting caseload.
There are regular clinico-radiological meetings with colleagues in paediatric specialties providing trainees with further training opportunities.
There is an opportunity for further sub-specialty training for specialist registrars in years 4 and 5 who wish to develop an interest in paediatric radiology. There are also opportunities for research with clinical and radiological colleagues.
The College Tutor is Dr H Roach and Consultant Radiologists include:-
Dr M Hamilton, Dr J Hughes, Dr A Jones, Dr E Kutt, Dr D Grier, Dr P Wilde. Dr J Kabala, Dr C Wakeley, Dr P Davison, Dr M Callaway, Dr J Virjee, Dr P Murphy
PACS
The Radiology Department at UBHT will be taking on the new PACS system (Picture Archiving and Communications System) as part of the National Programme for Information Technology (NPfIT) in November 2006. The project comprises two components. The first is a new Radiology Information System (RIS), to be implemented at the end of September 2006 and the second the actual PACS system in November 2006. These electronic systems enable the radiology department to capture images in a digital format and to transfer them electronically both within the department and throughout the Trust. This results in increased efficiencies in workflow such as radiology reporting but also allows images to be delivered efficiently and simultaneously to the point of clinical need.
The systems are supplied by the Governments NPfIT Programme, the biggest civil IT project in the world. Within the south of England (Southern Cluster), the provider for the NPfIT solution is Fujitsu with its sub-contractors, HSS providing the RIS system and GE the PACS system. Trainees starting in the department after PACS go live in November can expect to be using modern state of the art radiology image acquisition and reporting systems including speech recognition. A further advantage of the Programme is the deployment of similar systems in other Trusts on the training scheme with a few exceptions. This will reduce the need for re-training and disturbance to the trainee when rotating through different departments. Further advantages of the move to fully digital imaging systems are enhanced teaching, audit and research facilities and the potential to move to teleradiology.
Year 4/5 Training Rotations Available at UBHT
UBHT houses the Regional Cardio-thoracic Unit supporting both Professorial Units of Cardiology and Cardio-thoracic Surgery. This has produced a busy unit that had fully integrated with the Department of Radiology. There are currently 3 Cardiac and Cardio-vascular Radiologists, Dr Wilde and Dr P Murphy and Professor Rees. Whilst all aspects of intervention radiology are performed within the unit, the introduction of the Multi-slice Scanner with full coronary packaging would allow any individual to undertake research into the expanding fields of coronary artery calcification scoring and non-intervention methods of assessing coronary artery disease. In addition, the unit provides radiological support for the grown up congenital heart disease patients in whom modern MR techniques are proving invaluable. A sub-speciality rotation within this field at UBHT would allow the individual to develop an appreciation of both interventional and non-interventional techniques of cardiovascular radiology. This sub-specialty is one of the most rapidly developing as one of the most important aspects of modern radiology. In addition there are multiple case presentation session and weekly meetings attended by cardiologists and cardiac surgeons from within the region. This rotation allow an individual to develop their skill within the confines of the Regional Centre.
Paediatric
The Bristol Children’s Hospital boasts 3 Consultant Paediatric Radiology posts and there is support from a dedicated Neuroradiologist. Most of the Regional paediatric provision at both medical and surgical level is provided by the Bristol Children’s Hospital and a 5th year placement would allow the individual to gain a great deal of experience in the field of Paediatric Radiology. All aspects of imaging are undertaken, including Paediatric Nueroradiology with fully supported general anaesthetic session within the MR Scanner.
The Paediatric Radiological Department has an extremely active meetings programme with many multi-disciplinary conferences held on a weekly basis. This sub-speciality opportunity would provide a great deal with both basic and specialist experience in all aspects of paediatric radiology.
Gastro-intestinal
UBHT is developing as a ‘Centre’ for the provision of gastro-intestinal oncological services. It has been chosen as both the provider of surgery for upper gastro-intestinal malignancy and pancreatic malignancy and pancreatic malignancy in the Northern aspect of the South West Deanery. There are 5 upper GI surgeons on site supported by both professorial unit of oncology and histopathology.
In addition there are 3 lower GI surgeons providing specialist surgical provision, often only available in this Centre. The recent appointment of 2 hepatologists has emphasised the Trust’s role in managing hepatobiliary disease. This central surgical provision requires extensive support from radiological services and would allow 5th year sub-speciality training in either non-interventional or interventional GI Radiology.
All aspect of abdominal interventional are undertaken, including a large number of interventional biliary procedures, transjugular liver biopsies, TIPPS, radiofrequency ablation, luminal stenting, chemo embolisation of liver tumours and a multitude of biopsy and drainages. In addition the services are supported by a full provision of MR and CT which includes complex MR examination of the liver, MR of the pelvis, development of CT protocols for pancreatic and upper and lower GI malignancies and the development of CT colonography.
Pelvic imaging is also undertaken with defaecating proctography and endoluminal ultrasound, techniques which would allow the 5th Trainee the opportunity to develop their experience in pelvic imaging. If required, sub-speciality training in endoscopic ultrasound could also be provided. The unit has 2 multidisciplinary meetings in addition to several smaller clinical pathological conferences. The largest of these – The Upper GI Multidisciplinary Meeting attracts surgeons and physicians from throughout the Region.
The opportunities for sub-specialty training abdominal radiology in both non invasive and invasive techniques are great and could be tailored to the individual’s interests or requirements.
Urinary Genital radiological provision is provide to support 4 Urologists within UBHT. Each of the individual urologists has a sub-speciality interest. Provide surgical support for complex uro-gential oncological problems. UBHT acts also as a regional oncological centre for certain urogenital tumours
Sub-speciality training within this environment would provide the individual with good experience of a multidisciplinary approach to the management of these malignancies in addition to providing ample opportunity to undertake such interventional procedures as nephrostomy and ureteric stenting. A rotation in this area could also be tailored to include either experience in gynaecological imaging or paediatric imaging to complement adult urological radiological experience.
St. Michael’s Hospital provides obstetric and gynaecological support for the population of South Bristol with many of the gynaecological consultants providing surgical support for complex gynaecological malignancies. Currently radiological provision is provided Dr Andrews, supported by a dedicated team of radiographers. This is a busy unit and would provide opportunity for sub-speciality training in all aspects of obstetrics and gynaecological imaging, with an added opportunity to develop and support imaging of complex gynaecological malignancies. There are close links with the Oncology Centre and weekly multidisciplinary meetings are undertaken to provide experience for any individual undertaking this training.
The close proximity to both the Oncology Centre and the Bristol Children’s Hospital means modules such as gynaecology, uro-genital or paediatric radiology could be combined to experience one or two of these modalities during the year’s placement
The UBHT has an extensive orthopedic workload which covers both an adult and paediatric population. This rotation would provide experience in all aspects of musculoskeletal radiology including musculoskeletal ultrasound. In addition, the department has close links with the city’s busiest emergency department which provides opportunity to gain experience in Trauma and emergency radiology. The musculoskeletal rotation is supervised by Dr Wakeley and Dr Davison
The Regional bone tumour meeting is also held on a weekly basis at UBHT, providing experience in this highly specialized field
The Musculoskeletal rotation could be coupled with either the general oncological or head and neck rotation to provide extensive experience in cross sectional imaging.
The UBHT has an extensive orthopedic workload which covers both an adult and paediatric population. This rotation would provide experience in all aspects of musculoskeletal radiology including musculoskeletal ultrasound. In addition, the department has close links with the city’s busiest emergency department which provides opportunity to gain experience in Trauma and emergency radiology. The musculoskeletal rotation is supervised by Dr Wakeley and Dr Davidson. The Regional bone tumour meeting is also held on a weekly basis at UBHT, providing experience in this highly specialized field. The Musculoskeletal rotation could be coupled with either the general oncological or head and neck rotation to provide extensive experience in cross sectional imaging.
The Bristol Oncology Centre, part of UBHT is the main department for coordinating cancer services in the Northern Deanery. The centralisation of oncology services complemented by the provision of in-patient haematology means that a prospective trainee can gain extensive experience in all aspects of oncological imaging.
This service provision means that there are a multitude of Multi-disciplinary meetings available to the trainee, facilitating the development of a sub-specialty interest. A rotation in general oncology although could be taken as a stand alone option, would provide a useful adjunct to either head and neck or musculoskeletal radiology to provide extensive experience in cross sectional imaging
The UBHT provides the opportunity to develop a sub specialty interest in breast radiology. Dr. Jones, Dr. Kutt and Dr Basten cover all aspects of breast imaging, from the screening programme to the provision of a one-stop clinic to complex staging MR examinations. This is a busy unit and would provide an excellent opportunity to develop a sub-specialty interest.
The unit contributes to the busy Multi-disciplinary meeting at UBHT as well as providing the appropriate oncological imaging via the oncology centre.
This rotation could be taken as a stand alone programme providing a high degree of sub specialty experience or in combination with either the general oncological rotation or the gynaecological rotation providing two sub specialty interests
H Roach (huw.roach@ubht.swest.nhs.uk)