Monklands Hospital

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Monklands Hospital – Senior Training Radiology Modules

Why come to Monklands?

Experience a friendly atmosphere both within the department and the hospital as a whole, where there is genuine interaction with clinicians who will appreciate your input.  Monklands is a busy D.G.H., now with 8 full-time consultants and 1 less than full time. There is ample opportunity for trainees to see a wide range of pathologies and for teaching on a one-to-one basis.  All junior trainee sessions will be supported by a consultant, whilst being given the opportunity to work independently within their capabilities.

More senior trainees will have their own sessions but with consultants available for support when required.  We want to provide trainees with a taste of D.G.H. life (there is life outside a teaching hospital!) and to allow the development of autonomous working within a supportive environment.

Monklands has many regional services, with Infectious Diseases, E.N.T., Maxillo-facial surgery, Renal and Urology all centralised on site.  There are ample opportunities for non-vascular intervention, with nephrostomies, anterograde ureteric stenting, P.I.C.C lines, oesophageal, gastric and colonic stenting and percutaneous gastrostomies performed on site, in addition to a wide range of image guided biopsies, F.N.A.s and drainages.   For those with a more diagnostic inclination we have a 64 slice CT scanner & 1.5T MRI both installed in 2011/early 2012, 5 US machines and a Fibroscanner.  Consultants have their own sub-speciality interests and a trainee’s requirements can be incorporated in to these.

There are many clinico-radiological meetings throughout the week: Respiratory, Breast, Haematology, Urology, Head and Neck Cancer, Stroke, Gastro-intestinal, Chest oncology, Infectious diseases, and Colorectal cancer.

There is a weekly one hour meeting in protected time for all Consultants and Trainees to discuss interesting cases. Approximately every fourth week this is an Education/Discrepancies meeting.

The details of the specialist modules outlined below is a broad overview of what we offer, but a training module can be tailored to meet the individual trainees needs.

Please feel free to discuss any rotation with Dr Leigh Smart

Telephone: 01236 712170

E-mail: Leigh.Smart@lanarkshire.scot.nhs.uk

Consultants                                        Special Interests

Dr S Khan                                                                 Urology, Breast, C.S.I.,

Dr J Guse (Clinical Director)                                 Breast, Intervention, Nuclear medicine.

Dr A McGhee                                                            Thoracic, Intervention, Nuclear medicine

Dr K Nwafor                                                              GI imaging, C.S.I.

Dr Y Husami                                                             Head and neck, Musculoskeletal

Dr A Paddon                                                             Nuclear Medicine, Haematology

Dr E Owens                                                              Breast, G.I imaging.

Dr L Smart (Educational & Clinical Supervisor) Thoracic, C.S.I., Oncology.

Dr. U Nachtrab

  

The Department and our Equipment

The department is furnished with the most updated version of Carestream PACS which is integrated with the Kodak R.I.S. Voice recognition reporting software and digital requesting is also in place through TrakCare.

Each radiology terminal has CD and DVD drives, with e-mail and Internet access. Trainees will have access to their own workspace, furnished with a PACS workstation, a computer set up for full functionality with the RITI website and e-portfolio and air conditioning.

C.T. Scanning

 CT Scanner : Philips Ingenuity 64 slice.

The work is mainly general, but Monklands is now the ENT and Urology regional referral centre and there is a substantial associated specialist workload.  We also see a significant amount of cancer.  C.T. colonoscopy and enterography are also performed.

Ultrasound Scanning

We have a selection of 5 ultrasound machines in the department, 2 x Toshiba, 1 Siemens, 1 GE and 1 Philips.

The work is mainly general, but includes small parts, vascular and transvaginal work. There is a large E.N.T and Breast workload. Again there is ample opportunity to become involved with the increasing interventional workload including guided biopsies, abscess drainages and nephrostomies.

Dr Y Husami provides a dedicated weekly session of Neck Ultrasound/FNA Service as a one-stop neck lump clinic, with direct feed-back on all cases. Dr J Guse and Dr E Owens support a one-stop symptomatic Breast clinic.

Magnetic Resonance Imaging

Equipment: Philips Achieva 1.5T

A general MRI service is provided including brain, musculoskeletal (except MR arthrography), head/neck cancer staging, abdomen and pelvis.  MRA (renal, carotid, peripheral), MRI breast and MR enteroclysis are also performed.

Mammography

Our unit provides a full diagnostic service to the Symptomatic Breast Clinic, including needle localisations. 

Nuclear Medicine

Our department provides the service for Lanarkshire. Mainly general nuclear medicine work, with more specialised E.N.T imaging, and breast sentinel node scintigraphy. We also have V/Q SPECT for investigating pulmonary embolism.

Intervention

Although the centre of vascular intervention for Lanarkshire is centred at Hairmyres, an Interventional radiologist from Hairmyres performs a day of intervention at Monklands hospital every week and arrangements can be made to attach to this list.  We also have a lot of non-vascular intervention performed by the Monklands radiologists on dedicated lists (such as the 3 CT biopsy slots per week) as well as ad hoc cases and the trainee is encouraged to take an active role in these with an appropriate level of supervision.

Training

All sessions are supported by a consultant.

Trainees are encouraged to undertake a Quality improvement/Audit Project or possibly a small Research project.

Active participation in the Discrepancy Meeting is encouraged.

There is a once weekly interesting cases meeting and ad hoc informal one on one teaching on request.

There is a strong emphasis on clinical discussion/ feedback and we have an active clinico-radiological meeting programme which includes urology, breast imaging, chest disease and oncology, haematology, head and neck, stroke, gastro-intestinal, colorectal cancer, infectious diseases.  Trainees are encouraged to be involved in these.

There is an undergraduate radiology teaching program once weekly in the department run by Dr. Smart and Dr. Owens and Trainees are welcome to teach at this to contribute to their e-portfolio for ARCP requirements.

There will be continued appraisal of Trainee with regular feedback.

Modules

  1. Breast (Drs. J. Guse & E. Owens)

This is an expanding specialty, with a high degree of collaboration between the radiologists and the surgeons. There is the opportunity to become proficient in reporting mammography, attend one-stop breast clinics, to perform ultrasound guided biopsies and localisation procedures, and to carry out stereotactic biopsies and localisations. Some breast MRI is also performed. Breast MDTs provide a good opportunity to review the treatment and imaging of breast cancer patients and other interesting breast-related pathology.

A suggested working week might consist of:

1 session one-stop breast clinic

1 session mammography reporting

1 session “interventional” breast work (biopsies etc.)

1 session breast ultrasound (including axillary imaging)

Weekly MDT meeting, with the option to attend the “whole Lanarkshire” meeting.

1 session cross-sectional imaging and nuclear medicine for staging of disease

MRI breast ad hoc

1 or 2 session(s) general and A&E reporting

1 session general ultrasound or CT

2 sessions study

Training is almost to Level 2 competency, with the exception of breast screening and with limited exposure to MRI.

  1. Thoracic (Dr. A. McGhee & Dr. L. Smart)

 

Lanarkshire’s industrial past, and staunch adherence to the humble cigarette provides a fertile ground for the chest physician and the thoracic radiologist. There are close links between the radiology department and a progressive respiratory medicine service. There are, on average approximately 140 interventional procedures per year from the respiratory unit, mainly CT guided lung biopsies, and trainees are encouraged to perform these under Consultant supervision.  For interested trainees, there may be the potential to observe transbronchial biopsy, bronchial stenting, SVC stenting, thoracoscopy and endobronchial ultrasound. There are weekly meetings with the respiratory physicians, and a separate weekly lung cancer MDT.

A suggested working week might consist of:

2 sessions of CT with a high respiratory component, and including 3 CT biopsy slots plus ultrasound guided biopsies, aspirations and drainages as required.

1 session preparing for and attending the lung cancer and respiratory MDTs.

2 sessions of plain film reporting.

1 session of general MRI reporting

2 sessions for trainee study.

1 session of teaching.

1 session of general ultrasound.

Training is almost to level 2 competency (with the exception of PET-CT interpretation.)

  1. General Radiology (All Consultants)

 No matter how specialist you become as a Consultant, you will still require a general skillset to enable you to deal with emergency/inpatient workload and to justify and protocol appropriately.  This requires core general radiology skills.  Often, skills related to small portions of the core curriculum are not fully developed by the end of 3rd year and senior trainees may wish to polish these skills with an additional general block.   Being a DGH, the workload is very general and we are able to tailor a block to the specific training needs of most trainees with the advantage of less competition from other trainees than in a central teaching hospital.  As Consultants, we still take an active role in the proper justification and protocolling of scans which is an essential skill for the consultant radiology workforce in an NHS that is increasingly under financial pressure.  We are willing to teach how to do this safely.

A mix of diagnostic and non-vascular interventional work can be accommodated and we can give good training in a broad mix of modalities as described above, which will furnish the trainee with a skillset suitable to future life as a Consultant.

  1. Non-vascular Intervention (Dr.A.Mcghee, Dr.L.Smart and Dr.I.Cameron)

 For those who do not want to pursue the separate career path of an Interventional radiologist, but want to develop non-vascular interventional skills that would be a useful to the standard skillset of a diagnostic radiologist, why not choose a non-vascular interventional block?

This is a new block for this year which is being developed across two lanarkshire sites.  Split between Hairmyres and Monklands, we would anticipate that the trainee would spend approximately half their time on each site to maximize the non vascular interventional opportunities that each site could provide.

We can provide exposure to a wide range of procedures, including CT and US guided biopsies and drainages, nephrostomies, gastrostomies, cholecystostomies, PTC and lung biopsies.

The exact working week would be by negotiation depending on the key training needs, but we would anticipate 3 sessions of non-vascular intervention a further session of ad-hoc intervention throughout the week to accommodate emergency drainages, etc, 4 sessions of general service provision and 2 study sessions.  We would try to avoid trainee cross site travel on the same day.

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