Hairmyres Hospital

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The Department

Hairmyres Hospital is a new PFI build DGH, opened in March 2001 with 466 beds (331 acute) and built on the site of the old Hairmyres Hospital in East Kilbride.   It is the only hospital in South Lanarkshire (population 300,000) but is also geographically adjacent to South East Glasgow.  With the recent reconfiguration of services, patients from Cambuslang and Rutherglen are now referred to Hairmyres. Transport links are excellent, with an adjacent rail station (services from Glasgow Central).  Road access is also comprehensive with approximately half an hour’s drive to central Glasgow and ample free parking available.

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The hospital provides the following services:

Accident and Emergency, Acute Medicine, Stroke medicine, Geriatric and Rehabilitation Medicine, Psychiatry, General Surgery , Area Vascular Surgery,  Area Interventional Radiology service, Orthopaedics, Gynaecology, ITU Medicine (7 beds), Area Cardiac Catheterisation and Interventional Facility (24 / 7 primary percutaneous coronary intervention service for Lanarkshire and Ayrshire),  Area Inpatient Ophthalmology Unit, Oncology Grade 1 Centre, Outpatient Rheumatology.

A well equipped hospital library, supported by a librarian, with Internet access is available within the education suite.  Within the radiology department there is an up to date reference library in addition to an extensive teaching film collection.

The hospital is filmless with a Scotland wide national PACS (Picture Archiving and Communication System).  This is linked to other acute hospitals in Scotland, allowing radiological images to be readily available.  The Radiological Information System and voice recognition facility is integrated to the PACS for seamless working.

Within the radiology department, there are 14 full and part time consultant radiologists.

There are varied and frequent clinico-radiological meetings including weekly thoracic/oncology, breast, GI, medical, urology, vascular and orthopaedic meetings, colorectal/oncology and monthly gynaecology, urology and geriatric medicine meetings.  A two weekly audit/education meeting is held within the radiology department.  In addition, a weekly hospital postgraduate lecture is held in the Education Centre with external speakers invited frequently.  These meetings attract CME points.  The department is actively engaged in undergraduate education supporting PBL, special study module students and weekly radiology tutorials for rotating surgical and medical students. See Appendix 1 in Radiology trainee induction pack.

A busy ultrasound department, with three sonographers, has a high throughput of varied cases.  In addition to general ultrasound work, many consultants have areas of special interest and expertise e.g. head and neck, musculoskeletal, vascular work, orbits and transvaginal scanning.

All trainees will be given an induction period initially, with training in PACS and the radiology information system.

It is expected that all sessions are led or reviewed by consultant radiologists.  As a result, the trainees are supernumerary and can choose which area(s) they would like more exposure in. This may be a mixture of interventional and / or diagnostic modules. This mix can be modified during the course of the attachment during regular appraisals with the Clinical Supervisors.

Extra film review sessions can be arranged for those trainees sitting FRCR part IIB exams.

Trainees will be expected to contribute to multidisciplinary meetings and to share in the teaching of medical students attached to the department on special study modules or on medical/surgical rotations.

In general, trainees will have two study sessions per week, four special interest sessions and four general sessions.

 

Consultants                              Subspecialist Interests

Dr K Ali                                     Musculoskeletal (Diagnostic and interventional)

Dr J Ballantyne                          Head and neck, Chest

(Educational and Clinical supervisor)

Dr I. Cameron                            Interventional radiology, Chest

Dr C Chew                                Abdominal, Colorectal lead

Dr. Donna Edwards                   Breast, Pelvic including Gyn

Dr. A. Forrester                         Musculoskeletal, head and neck imaging,

Dr. F. Gardner                           Cross sectional imaging, ENT, orbital

(Associate Medical Director)                  ultrasound

Dr. K Gray                                Breast, Pelvic including Gyn

Dr. B. Hamilton                         Breast, gynaecology, chest

Dr G Harold                              SPECT, Abdominal, MR enteroclysis

Dr. F Lau                                  Interventional Radiology, Chest, Abdominal

(College Tutor, Educational and Clinical supervisor)

Dr. N Mathias                            Interventional radiology, Abdominal

Dr S. Millar                                Interventional radiology, Urology, ENT

(Deputy Clinical Director)

Dr. C. Murch                             Interventional, Abdominal

Dr E Teasdale                           Neuroradiology

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Departmental Workload

Patient Exams Per Year

 

Plain Films

General                                     45,607

A&E                                         25,920

General Fluoroscopy                1,905

Computed Tomography

Head/ENT                                 3,279

Body                                        4158

Magnetic Resonance               

Musculoskeletal                        682

Abdomino/pelvic                       747

Neuro                                       385

MRCP                                       33

MRA                                         308

 Vascular/Interventional           

Vascular Diagnostic                  674

Vascular Interventional               692

Non-vascular                             245

Other (Biopsy, drainage etc)      535

Ultrasound

General                                     11,004

Vascular                                   313

Equipment Log

2002 – MRI                   Philips Gyroscan Intera 1.5T with moving table, MR compatible pump, all surface and phased array coils with appropriate software.

                        Including perfusion/diffusion imaging, EPI and advanced MRA.

Independent workstation.

2009 – CT                     Philips Brilliance 64

2012 – CT                     Second 64-Slice CT (Philips Ingenuity 64)

2010 –

Interventional Unit        Philips Integris, with 3D angiography, reduced dose screening

And bolus chasing.  Theatre spec airflow, located in theatre complex, next to Day Surgical Unit.

2001 –                          Siemens 3000 Nova Mammomat with digital stereotactic

Mammography          localisation.

Ultrasound                   5 Philips scanners

All units have colour, power and Doppler capabilities.  Multiple probes include general abdominal, linear phased array for vascular and superficial imaging, paediatric probe, orbital probe and transvaginal probe.

Mobile Sonosite with colour Doppler

Fluoroscopic                Remote control Philips multidiagnost (video fluoroscopy

Rooms                         and digital subtraction angiography capable).

With reduced dose screening and frame grab capability.

General Rooms            5 General radiographic rooms

Separate A&E ceiling mounted unit

Dental Room

Cardiac                            2 separate cardiac catheterisation suites adjacent to coronary

Catheterisation care and theatre complex provide 24 / 7 cardiac catheterisation and                                            interventional service for Lanarkshire and Ayrshire.

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Musculoskeletal Imaging

Clinical Supervisor: Dr K Ali (khalid.ali@lanarkshire.scot.nhs.uk)

The MSK module at Hairmyres offers exposure in acute and elective musculoskeletal imaging in modalities including plain films, ultrasound, CT and MRI including arthrography.  The full spectrum of imaging in joint derangement, bone and soft tissue abnormalities will be covered including trauma and sarcoma cases.  There are busy A&E, Orthopaedic and Rheumatology departments based on-site at Hairmyres covering South Lanarkshire.  The MSK radiology service has a large volume of referrals from Orthopaedics, including acute cases from A&E, as well as from Rheumatology and General practice.

There is a weekly Orthopaedic MDT that trainees are encouraged to attend and present cases at, as well as a Lanarkshire wide Rheumatology meeting.   Trainees will also be encouraged to attend the Thursday AM MSK Radiology conference at GRI with Dr Ali, at which cases from Lanarkshire are presented.

There is a dedicated MSK interventional session on Friday mornings at which the trainee will have direct Consultant training and supervision in procedures including MR and CT shoulder and hip arthrography, nerve root injections and ultrasound guided joint and bursa injections, including shoulder barbotage, Morton’s neuroma and plantar fascia injections.  Ultrasound and CT guided bone and soft tissue biopsies are also performed for patients across Lanarkshire.

The number of dedicated MSK sessions is flexible and tailored to meet the needs of individual trainees.  As sessions are predominantly Consultant delivered and/or supervised, trainees are largely supernumerary and those wishing to mix this module with other sub-specialty diagnostic and interventional work are encouraged to do so.  In particular, there is ample scope to develop experience in CT and ultrasound guided percutaneous biopsy and drainage techniques daily under direct IR Consultant supervision.  Trainees who express an interest have opportunities to participate in audit.

Please feel free to email khalid.ali@lanarkshire.scot.nhs.uk if you have any questions or queries.

 

Cross-sectional Imaging      Co-ordinator Dr. J Ballantyne

The content of this module is flexible and tailored to meet the needs of individual trainees. This will be discussed at the start of the attachment and may be modified at any time during the course of the attachment. Trainees wishing to mix this module with some interventional work with the interventional radiologists are encouraged to do so.

The department provides a busy cross-sectional imaging service in CT, MRI and Ultrasound.

There are well developed musculoskeletal (Dr. K Ali, Dr A Forrester) and head and neck ultrasound services (Dr. A. Forrester, Dr J Ballantyne) which complements the CT and MRI practice. There are busy orthopaedic and rheumatology units on site, which provides a wide range of general skeletal scanning. Trainees will be given supervised instruction in musculoskeletal and head and neck ultrasound.

The module will centre round the use of ultrasound, CT and MRI scanning to solve the clinical problems encountered principally in orthopaedics, rheumatology and A&E. Also on the assessment of head and neck masses.

There are excellent opportunities for clinical feedback as both the outpatient clinics and the A&E department are adjacent to Radiology.

There is an extensive chest imaging service to support Respiratory Medicine service. This is co-ordinated at the weekly MDT.

Dr Edwards, Dr Gray and Dr Hamilton have an interest in Female (Breast and Gynaecology) imaging covering mammo, CT, MRI and Transvaginal and Transabdominal Ultrasound.

Dr Chew and Dr Edwards supervise and double-report CT Colonograms.

There is ample scope to develop skills in biopsy and drainage techniques with our interventional team.

The module will be adjusted to suit the needs of the individual trainees through ongoing appraisal.

Trainees will be encouraged to take advantage of all the clinical opportunities available and to attend the variety of multi-disciplinary meetings available.

Vascular/Interventional        Co-ordinator Dr. F. Lau

The other interventional radiologists are Dr. C. Murch, Dr S Millar, Dr. N Mathias, Dr I Cameron.

The content of this module is flexible and may be adjusted to meet the needs of individual trainees. This will be discussed at the start of the attachment and at any time during the course of the attachment. Trainees wishing to mix this module with some diagnostic work are encouraged to do so.

The radiology department at Hairmyres hospital provides interventional services for the whole of Lanarkshire. This includes referrals from various medical and surgical teams, vascular surgical units and for all other, local hospital specialties, plus interventional radiology for Monklands and Wishaw General Hospital. In addition to the long running local EVAR service, we are also jointly doing EVARs for patients from Ayrshire at Hairmyres to help develop an EVAR service in Ayrshire. Carotid stenting is performed at Hairmyres with patients referred from various health boards in Scotland.

This result in a high throughput of general vascular and non-vascular radiological procedures such as angiography, vascular stenting, EVAR, thrombectomy, venous access, embolisation and uroradiology, biliary and GI procedures.  More specialised procedures such as tracheal and oesophageal stenting, SVC stenting, placement of percutaneous thoracic drains and colorectal stenting are also performed on an ‘ad hoc’ basis.   All percutaneous biopsies and drainages are carried out by the interventional radiologists using either ultrasound or CT.

The interventional team are responsible for the placement and maintenance of PICC lines, Hickman lines, Portacaths for oncology patients.

Sonographers and Dr Lau provide carotid Doppler ultrasound services.

Four days of dedicated angiography lists are scheduled each week, but non-vascular interventional procedures are arranged daily in the main radiology department on a more ad hoc basis.

Dedicated CT time is allocated daily to interventional procedures and biopsies. CT & MR angiography is now an integral part of vascular imaging.

Depending on the level of initial expertise, trainees will receive plenty of ‘hands on’ experience, with consultant supervision and training.

Trainees will be expected to participate in audits, pre and post procedure assessment of patients.

Fong Lau

Consultant radiologist

College tutor, Educational & Clinical supervisor

Jan 2016

 

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