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 10 full-time and 3 part-time consultants. 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 controlled 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, Hickman 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 there is a 64 slice CT scanner & 1.5T MRI both installed in 2011/early 2012 and 5 US machines.  We also perform nuclear medicine for Lanarkshire.  Consultants have their own sub-speciality interests and a trainee’s requirements can be incorporated into 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. 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 trainee’s needs.

Please feel free to discuss any rotation with Dr Leigh Smart 

Telephone: 01236 748748 Ext 2170

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

 

 Consultant Special Interest
Dr. J Ballantyne (Clinical Lead) Head & Neck
Dr. M Ahmad
Dr. P Garnett Thoracic, Non-Vascular Intervention
Dr. J Guse Breast, Nuclear Medicine, Vascular Access
Dr. S Khan Urology
Dr. A McGhee Urology, Intervention, Head & Neck, Nuclear Medicine
Dr. K Mitchell Head & Neck, Neurology
Dr. U Nachtrab
Dr. K Nwafor Gastrointestinal, Stroke
Dr. E Owens Breast, Gastrointestinal
Dr. A Paddon Nuclear Medicine, Haematology
Dr. L Smart (Clinical Supervisor) Thoracic
Dr. A. Vohra Thoracic

The Department and our Equipment

The department is furnished with Carestream Vue PACS Reporting and digital requesting is also in place through TrakCare.

CT Scanning

CT Scanner: Philips Ingenuity 64 slice.

The work is mainly general, but Monklands is the ENT, Urology and Infectious Diseases regional referral centre and there is a substantial associated specialist workload.  We also see a significant amount of cancer with an associated sizable number of image guided biopsies (3-4 reserved CT biopsy slots per week), and the trainee would be encouraged to participate in these.  CT colonoscopy and enterography are also performed.

Ultrasound Scanning 

We have a selection of 5 ultrasound machines in the department, 3 x GE and 2 x 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 be involved with the interventional workload including guided biopsies and abscess drainages.

Dr J Ballantyne & Dr F Harries from Hairmyres & Wishaw respectively provide a dedicated Wednesday morning Neck Ultrasound/FNA Service as a one-stop neck lump clinic. Dr J Guse and Dr E Owens support a one-stop symptomatic Breast clinic on a Tuesday.

Magnetic Resonance Imaging

Equipment: Philips Achieva 1.5T

A general MRI service is provided including brain, musculoskeletal, head/neck cancer staging, abdomen and pelvis.  MRA (renal and 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 ENT 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 based at Hairmyres, an Interventional Radiologist from Hairmyres performs a day of mainly renovascular 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 (3-4 CT biopsy slots per week) and three other dedicated non vascular interventional sessions provided by Drs McGhee and Garnett as well as ad hoc cases. 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. Active participation in the Discrepancy/Education Meeting is encouraged. There is a once weekly interesting cases meeting (Friday morning) 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, Respirology (including Oncology), Haematology, Head & Neck, Stroke, Gastro-intestinal, Colorectal cancer, and 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 Trainees are welcome to teach at this to contribute to their ARCP requirements. There will be continued appraisal of the Trainee with regular feedback.

Facilities

Trainees will have access to their own workspace with two PACS workstations and a computer set up for full functionality including the RITI website. A recent addition to the department is a Nespresso® Coffee Machine and an iMac desktop computer with full Osirix® software and a currently growing archive of multi-modality teaching files. 

Transport Links to the Hospital

There are good public transport links to the hospital which can be easily reached by train (nearest station being Coatdyke – a 5 minute walk) from Glasgow Queen Street. In addition, there is free car parking and as a department we encourage cycling to work with secure cycle storage within the department.

Modules

  1. Cardiothoracic Module (Golden Jubilee National Hospital & Monklands Hospital)

This new block commencing in August 2020 is split 50:50 between the GJNH and Monklands and offers experience in advanced cardiothoracic imaging and intervention to senior trainees. Both sites offer a friendly atmosphere with ample opportunity for one-to-one teaching, whilst also giving trainees the opportunity to work independently within their abilities.

Cardiac [GJNH] (Dr. J. Dreisbach) [john.dreisbach@nhs.net] 

The GJNH is Scotland’s national tertiary referral centre for Cardiology and Cardiothoracic Surgery with a high-volume cardiac imaging service covering both acquired and adult congenital heart disease. This placement provides a unique opportunity to gain experience with state-of-the-art imaging equipment and a team of specialist radiographers. In addition to an established cardiac MRI service performed on the MAGNETOM Aera 1.5T (Siemens) with an expert team of cardiac radiographers, the GJNH have recently acquired a new 640-slice cardiac CT scanner – the Aquilion ONE/PRISM (Canon) with cutting-edge Deep Learning Reconstruction technology (AiCE). Even humble chest x-ray reporting has recently been dramatically improved with a new image processing software (CARESTREAM Tube, Line and Pneumothorax Visualization Software), providing ‘companion views’ which significantly enhance the image quality of ICU films.

Two days a week at the GJNH will be divided between cardiac CT and MRI in acquired heart disease (and adult congenital heart disease for interested trainees), as well as cardiothoracic ICU plain film reporting. In addition to live clinical cases, less ‘opportunity-dependent’ learning will be encouraged with access to a large library of cardiovascular cases (including, for example, over 100 acute aortic dissections). Available weekly meetings include: TAVI MDT, Coronary MDT, Cardiac Surgical MDT, Valve MDT, Heart Failure/Advanced Device MDT, Congenital MDT, Pulmonary Vascular MDT, Electrophysiology MDT, and ICU meetings. There is ample opportunity and support to undertake audits, case reports and research.

To get the most out of the placement, trainees are strongly encouraged to come post FRCR (there is currently very limited representation of cardiac imaging in the 2B) and attend a level 2 cardiac CT course.

Essential End of Block Objectives:

  • Provide accurate and comprehensive cardiothoracic ICU plain film reports independently, including in patients with mechanical circulatory support devices (e.g. intra-aortic balloon pumps, Impella devices, ECMO and ventricular assist devices).
  • Protocol, supervise and report:
    • Basic cardiac-gated CT angiograms for coronary disease, TAVI planning and thoracic aortic aneurysm assessment under indirect supervision.
    • Cardiac MRI in acquired heart disease and aneurysm assessment under supervision.
  • Familiarity with common congenital cardiac conditions in adults on cross-sectional imaging.

Optional End of Block Objectives:

  • Protocol, supervise and report complex cardiac CT and MRI studies under direct supervision, for example:
    • Common congenital cardiac conditions (e.g. atrial septal defects, bicuspid aortic valves and aortopathy, tetralogy of Fallot).
    • Pre- and post-procedural CT imaging in mechanical circulatory support.
    • Electrophysiology planning scans.

Thoracic [Monklands] (Dr P. Garnett, Dr L. Smart & Dr A. Vohra)

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 staffed by 5 consultants and a staff grade. There are two weekly respiratory radiology meetings:

  • Respiratory Radiology Meeting. This includes urgent suspicion of cancer referrals, interstitial lung disease and other benign pleuropulmonary / mediastinal conditions.
  • Lung Oncology Meeting. Attended by radiology, respiratory physicians, oncologists and thoracic surgeon. 

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. If there is a strong interest from the trainee, then the study sessions could be rearranged to include exposure to non-vascular intervention on a Thursday with combined exposure to over 60 procedures / biopsies in this 4-month module. 

For interested trainees, there is the potential to be educated/observe transbronchial biopsy, bronchial stenting, SVC stenting, thoracoscopy and EBUS. 

End of Block Objectives:

  • Report and accurately stage lung cancer on imaging (including CT and PET-CT) in the context of presenting the patient at the Lung Oncology Meeting. 
  • Be independent / require minimal supervision to perform more straightforward CT guided lung, mediastinal and pleural biopsies with the ability to acutely manage / intervene in associated complications (e.g. decompress tension pneumothorax, chest drain insertion). 
  • Have a systematic approach in HRCT acquisition and reporting and be able to produce an appropriate differential based on imaging findings and the clinical history.

Example Weekly Structure

Monday Tuesday Wednesday Thursday Friday
AM TAVI MDT

Cardiac CT

Respiratory CT List Respiratory Meeting

CT List (Including 2-3 Lung Biopsies)

Study Congenital MDT

Cardiac MRI

PM ICU MDT

Cardiac CT

Lung Oncology MDT Plain Film Reporting Study ICU MDT

Cardiac MRI

  1. Thoracic (Dr. P. Garnett, Dr. L. Smart & Dr. A. Vohra)

Please note that as some of the same sessions / supervising radiologists are involved in both cardiothoracic and thoracic blocks we cannot accommodate trainees doing both blocks simultaneously. 

This is the same as the thoracic component of the Cardiothoracic Module detailed above with the cardiac component being replaced by general imaging sessions at Monklands. 

Example Weekly Structure:

Monday Tuesday Wednesday Thursday Friday
AM Study Respiratory CT List Respiratory Meeting

CT List (Including 2-3 Lung Biopsies)

Non-Vascular Intervention Interesting Cases

Plain Film Reporting

PM MRI Reporting Lung Oncology MDT Plain Film Reporting General US Study

Training is to level 2 competency (except for PET-CT interpretation.)

3. Non-Vascular Intervention (Dr. P. Garnett, Dr. A. McGhee 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 the third year that this block is being offered and it is still 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 (allowing for potential competition from chest trainees – we would aim to try to avoid simultaneous thoracic and non-vascular interventional placements).

The exact working week would be by negotiation depending on the key training needs but would include 3 sessions of dedicated 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.

Example Weekly Structure:

Monday Tuesday Wednesday Thursday Friday
AM HM HM MK MK MK
PM Study HM Study MK MK
  1. Breast Module (Dr. J. Guse & Dr. 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 MDTMs 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 to Level 2 competency, except for breast screening and with limited exposure to MRI.

  1. General Radiology (Everyone)

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 little competition from other trainees. 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.