Glasgow Royal Infirmary & Stobhill ACH

GRI

 

Glasgow Royal Infirmary

The Department

Population

The Royal Infirmary serves the East end of Glasgow and as such includes a large area of social deprivation. Pathology is therefore often at a very advanced state on presentation. The department performs over 160,000 patient day attendances per year.
Staff

There are 11 consultant Radiologists at Glasgow Royal Infirmary with a wide variety of interests and skills. The Educational Supervisor is Dr Ross MacDuff.

Equipment

  • A new (2010) dedicated angiography/ intervention suite housed in a surgical theatre environment (Theater K – Siemens Artis Z).
  • Three CT scanners with a Siemens Sensation 4 CT scanner installed in 2002 including CT fluoroscopy, a Toshiba Aquilion 64 installed March 2007 with cardiac gating and CT fluoroscopy and a further Toshiba Aquilion 64 installed in A&E March 2008.
  • GRI now has two 1.5 T MRI scanners in the purpose built MR suite. The first scanner, installed in March 1998, is a 1.5 Tesla Philips Gyroscan NT and this was upgraded in late 2001 with a new RF amplifier allowing improved gradient performance along with moving table angiography and software/ sequence enhancements including SENSE for parallel imaging. The new second scanner is a Siemens Avanto i Class with full range of PA coils, extended table for whole body imaging, parallel imaging for all body regions and echo-sharing sequences for time-resolved MRA.
  • 6 ultrasound scanners : Two Siemens Antares and two Philips/ATL 5000s, all in the main department along with a Sonosite Titan portable US unit for ward examinations. A further Sonosite Titan portable US unit has been installed in theatre K for IR work.

Computers 

The department is equipped with personal computers with CD RW/ ROM, including up to date teaching programs and texts. These may be used for research, audit and learning. Communication with the Internet within the department is available through the hospital server system. You are encouraged to contact IT if you do not already have an email account so that this can be set up.

Modules

The following text outlines the individual modules for higher training we offer for you at Glasgow Royal Infirmary. These modules are intended to represent a base on which you are invited to customise your training. If you are interested in a module and wish to adapt it to your individual training needs, please contact the individual trainer and Dr R. MacDuff (Educational Supervisor) for further discussion.

General Service Work

Apart from your four special interest higher training sessions, you will be rostered for a further four sessions of varied radiological work to enhance your general skills.

Musculoskeletal Imaging

Trainers: Dr C Nicholas; Dr G O’Neill

The radiology department provides for a large orthopaedic and rheumatology service and is a major trauma centre. Musculoskeletal imaging input is also provided for the regional plastic surgery services.

The trainee will gain exposure to acute and elective musculoskeletal imaging in all modalities: ultrasound, plain film, CT and MRI. The trainee will gain experience in arthrography (performed at Stobhill by Dr Nicholas) and will be trained to undertake simple joint aspirations. Dr Nicholas also has an input to the regional soft tissue/bone sarcoma service. Dr Ritchie and Dr Nicholas run the Sarcoma MDT which has recently transferred to GRI on Thursday lunchtimes. The Plastic Surgeons at the ‘Canniesburn Unit’ have a large hand surgery practice overlapping with orthopaedics and the trainee will gain experience, in particular, in hand/ digital ultrasonography.

The trainee can tailor the module to suit him or herself but a typical attachment might involve two MRI sessions, one ultrasound and one CT session of specialist MSK work. While the remainder of the time is focused on ‘service commitments’ given the nature of the workload at GRI/ Stobhill it is envisaged that a significant amount of this work will inevitably also be geared towards musculoskeletal imaging.

Attendance is expected at the MDT meetings in rheumatology, the sarcoma meeting and A&E.


Upper Gastrointestinal

  • Trainer: Dr Al-Adhami, Dr Viswanathan, Dr Digby, DrPlatt

This module mainly covers Pancreaticobiliary Imaging.  The emphasis of the module could be changed to suit individual preference.

The Royal Infirmary Surgical Unit has an international reputation in pancreatic disease.  The unit takes a special interest in all aspect of pancreaticobiliary and upper GI disease acting as the main tertiary referral centre for the West of Scotland and there is a thriving intervention endoscopic service including ERCP backed up by appropriate radiological procedures.  This unit is a major user of ultrasound, CT and MR. Referrals for upper GI contrast exams are also common.

You will be invited to attend the weekly Pancreatic and Gastroenterology MDTs. Experience will be gained in US and CT guided drainage and biopsy.  The trainee can gain experience in various MRI investigations including MRCP , MR Small Bowel , MR Pancreas and MR Liver including a wide range of other general GI tract imaging.  The module could involve sessions in Stobhill ACH.

Additionally there is an opportunity to participate in the general work of the hospital.  You will be invited to participate in audit and research would be encouraged.

Any questions please contact the Department.

 

Nuclear Medicine & PET-CT

Trainer:  Dr. B Neilly; Dr. S Han

The nuclear medicine department at Glasgow Royal Infirmary has been the leading centre in Scotland providing a comprehensive nuclear medicine training. It has a national reputation and is also a recognized centre for higher (5th & 6th years) training in radionuclide radiology and nuclear medicine. As well as Dr F W Poon, the department is run by two nuclear medicine physicians, Dr B Neilly and Dr. S Han. The department is also well supported by a strong team of physicists and technologists. The department runs the thyroid clinic, and has a close link with nuclear cardiology and general nuclear medicine departments in North Glasgow Hospitals.

There are three gamma cameras for whole body imaging and dynamic studies including the first combined gamma camera & CT (SPECT/CT) in Scotland. Hermes reporting workstation as well as PACS is in use.

The West of Scotland PET Centre is based at Beatson Oncology Centre serving half of the population of Scotland. Currently a GE Discovery PET-CT scanner is in place and an onsite cyclotron is to be opened soon.

The GRI nuclear medicine department provides a wide range of diagnostic and therapeutic nuclear medicine. Approximately 7000 clinical studies are performed annually and some of the common studies include:

  • Bone scan 1900
  • Lung V/Q 420
  • White cell scan 260
  • Renogram 290
  • Gastric 160
  • Thyroid 270
  • Brain 120
  • Biliary 130
  • Sentinel node 80
  • Parathyroid 50
  • Neuroendocrine tumour 40
  • Annual workload of PET/CT is approximately 2200

At present, the PET/CT centre is running seven multi-centre trials with at least two other trials due to start in the near future. Funding of £0.25 million has been secured and a grant application has been submitted for a further £1.6 million. There is an ample opportunity for clinical experiences as well as audits and research.

You will be involved in general reporting sessions as well as colorectal and lung MDT and regional thyroid MDT.

Breast Imaging

Trainer: Dr J Litherland

The North East Glasgow Breast Team at the ACH have a considerable breast practice seeing over 200 new cases of breast cancer each year. This module includes a one-stop symptomatic breast clinic on a Wednesday morning, attended by the Consultant Surgeon, Radiologists and breast care nurses. Immediate reporting of mammograms and breast ultrasound are performed in the clinic with fine needle aspiration and core biopsy under ultrasound guidance, as required. There is also a multidisciplinary breast meeting on Wednesday lunchtime attended by all the clinicians involved in the care of patients with breast carcinoma.

Attendance at the NHS Breast Screening Unit at Nelson Mandela Place will be arranged. There will be an opportunity to learn the principles behind breast screening, to view screening mammograms and attend assessment clinics. Fine needle aspiration and core biopsy under ultrasound and stereotactic guidance will be taught. There are weekly clinico-pathological conferences attended by the relevant surgeons, pathologists and radiologists. There would also be an opportunity to be involved in the research interests of the Breast Screening Unit.

MRI is regularly used to assess difficult breast cases and implants & this is incorporated into the trainee’s timetable.

Studies per year (approx.):

  • Mammography 1600+
  • Breast Ultrasound 400+

Colorectal and Hepatic Imaging

  • Trainers: Dr S Viswanathan; Dr M Digby, Dr J Platt

GRI is a tertiary referral centre for hepatology and colorectal surgery.  We are also a major centre looking after patients with inflammatory bowel disease.  Therefore, the radiology department is working closely with colorectal surgeons,hepatic surgeons, medical gastroenterologists and hepatologists,

With this module, you will get experience with CT, ultrasound, MR, Image guided biopsies and drainages, gastrointestinal nuclear medicine, CT colonography, MR/CT enteroclysis and colonic stenting.  The module may involve sessions at Stobhill ACH.

Attendance at the following clinical meetings is encouraged:

  • Colorectal cancer MDT Monday 1130
  • Gastroenterology/IBD Meeting Wed 1330 GRI

Studies per annum (approx)

  • Gastrointestinal CT 1801
  • Gastrointestinal US 8221
  • GI MRI 3 sessions per week (~120 liver MR)
  • GI Nuclear medicine 540

Arrangement can be made to attend regular PET-CT session if interested.  Audit and research will be encouraged

 

Thoracic Radiology

Trainers: Dr G Roditi; Dr C Noble; Dr R MacDuff

This module offers experience in all aspects of thoracic imaging and exposure to thoracic intervention. The Royal Infirmary has a large respiratory unit, a regional cardiological unit with two modern catheterisation laboratories and a major cardiothoracic surgical unit. The Royal Infirmary is the Scottish Cardiac Transplant Centre.

Specifically, you will have two at least CT sessions and be involved in CT guided biopsy of pulmonary nodules/ masses including CT fluoroscopic technique. Recent trainees have indeed had their own dedicated chest CT session. Plain film service commitment sessions can also be tailored to concentrate on chest film reporting for the respiratory service. Participation in pulmonary interventions, including biopsy, aspiration and tracheobronchial stents will be given as appropriate/ available. Experience in all forms of acute and elective thoracic aortic imaging will be offered, including plain film, arteriography, CT, HRCT, CT angiography and MR angiography. The Royal Infirmary has an established record of supraoartic great vessel intervention in occlusive disease for acute and chronic arm ischaemia and hind brain ischaemia. Participation in all these techniques will be offered.

Attendance and participation in the weekly lung cancer/respiratory MDT is expected and there is a new monthly cross-site ILD meeting for North Glasgow.

Head and Neck Imaging

Trainers: Dr G O’Neill; Dr C Noble

The radiology department provides for a large ENT out-patient practice and also services for the regional plastic surgery services. Half of the ENT out-patient service for North Glasgow is based at the Royal Infirmary and there is an extensive practice of CT and MRI involved in the investigations of problems for this service along with a weekly neck lump clinic supported by one-stop ultrasound diagnosis including biopsy, indeed by this means ultrasound has become a major modality for the staging of Head & Neck malignancy at GRI. The Plastic Surgeons at the ‘Canniesburn Unit’ have one of the largest oral cancer practices in Scotland and the imaging for this is carried out on the CT and MRI scanners at the Royal Infirmary. There is an interest in imaging of the salivary glands and patients are referred from the ENT Service, the Plastic Surgery Service and the Dental Hospital.

This module can be tailored to the needs of the individual trainee and indeed the content of sessions could be changed as the three month period progresses. It is anticipated that the four specialist interest sessions would principally be split between CT and MRI with the ultrasound neck lump clinic session.

Cardiac Radiology

Trainers: Dr G H Roditi; Dr C Noble; Cardiology colleagues

Based between Glasgow Royal Infirmary, Western & GJNH. This is a new cross-site module intended for training in all aspects of the expanding field of cardiac radiology with sessions supervised by radiologists with cardiac interest and other sessions under the auspices of cardiology colleagues. The aim is for the trainee to become familiar with a broad range of non-invasive cardiac imaging including echocardiography, nuclear techniques, CT and MRI.

The Royal Infirmary is not only a major cardiothoracic surgical unit but also the Scottish Cardiac Transplant Centre and a regional cardiological unit including supra-regional arrhythmia services. There are two catheterisation laboratories and a dedicated cardiac nuclear medicine department. At GRI the new 64 slice CT scanner is used for cardiac examinations. At the end of the module the trainee should have clear knowledge of the current capabilities and role of CT in the assessment of patients with cardiac disease. MRI exposure will include MRA and cardiac MRI. At GRI Dr Roditi provides a problem solving CMR service with a range of diagnostic strategies including morphological and functional imaging, fast SSFP imaging and viability studies but not perfusion or coronary angiography. The Cardiac MRI unit at the WIG works closely with Dr McMillan on a range of research projects, this scanner has a full set of CMR appropriate pulse sequences and perfusion imaging etc. are performed. At the end of the module the trainee should be able to devise appropriate CMR imaging strategies for common clinical problems and be able to interpret functional MRI imaging data as part of a comprehensive CMR assessment. The trainee will also have been able to review the CMR appearances of many cardiac conditions from the wealth of studies that have been accumulated.

Echocardiography training will be obtained with Dr M D Cowan at Gartnavel and training can also be obtained under the auspices of Dr A Brady, consultant cardiologist at GRI including exposure to transoesophageal echo. Cardiac catheterisation could also be arranged as required as well as a session observing performance and reporting of complimentary cardiac nuclear techniques. Attendance at some cardiac clinics is anticipated e.g. cardiac transplant clinic at GRI. The trainee will be encouraged to attend a national cardiac radiology meeting to further compliment training and also be encouraged to complete a small research or audit project during the attachment which could be for 3 or 6 months.

To discuss this new module please feel free to contact Dr Roditi who is happy to answer any enquiries.

General MR Module

Trainer: Dr G O’Neill

This module is intended to offer the trainee experience of general MRI which may or may not come under one of the system-specific modules. The trainee has great scope to tailor this module to suit his/her particular interest. Exposure to the full gamut of MRI including neuroimaging, MSK, ENT, vascular and GI is available and further, more specialist areas, such as cardiac and breast imaging may be available if discussed with the appropriate trainers.

Please contact Dr G O’Neill for further information. It is envisaged that all trainers will be available depending on whether they have trainees assigned concurrently on parallel modules.

The module may also involve working at Stobhill ACH.

 

Uroradiology Module:

·         Trainers: Dr Heffernan-Ho, Dr R MacDonald, Dr M Digby

The NE sector performs a high volume of both in and outpatient Urological imaging inc: CT KUB, CT IVU , CT Kidneys, CT Staging and follow up of urological malignancies. The module would involve specialist Urology MR sessions which would involve MR Prostate (pre and post biopsy), Kidneys, Bladder, MRU, MR Penis.

Module would involve a session of general /urological Fluroscopy inc cystograms, urethrograms etc.

Block would involve general and urological specific ultrasound with an opportunity to perform both urological and non –urological non-vascular intervention such as biopsy, drainage and aspirations. There may be an option to observe/participate in TRUS of the Prostate.

Attendances at the following MDTs would take place: Uro-oncology (weekly), Stones (weekly) and General Urology (Monthly).

Module would involve some sessions contributing to the general workload of department. Also some sessions could take place in the Stobhill ACH.

Audit and research would be strongly encouraged during block.

 

 

 

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