POST AND PROGRAMME DESCRIPTION
INTERVENTIONAL RADIOLOGY ST4/5/6 POSTS
HULL & EAST YORKSHIRE NHS TRUST
These posts are intended to meet the increasing demand for sub specialist training in
Interventional Radiology. The appointments will be for up to 3 years at ST4, ST5 and ST6
level and offer training in most aspects of vascular and non-vascular intervention.
HOSPITALS
The posts are based in the Radiology Departments at Hull Royal Infirmary and Castle Hill
Hospital, which are the two main acute hospitals in East Yorkshire.
HULL ROYAL INFIRMARY
This hospital is the larger of the two main acute hospitals in East Yorkshire with over 750
beds. It has the Accident and Emergency department and the following specialities:
Dental Surgery
Dermatology
Endocrinology
ENT and Head & Neck Surgery
Gastroenterology
General Medicine
General Surgery
Intensive Care Unit
Maxillo-facial surgery
Nephrology
Neurology
Neurosurgery
Obstetrics and Gynaecology
Ophthalmology
Orthodontics
Orthopaedics
Paediatric Medicine
Paediatric Surgery
Rheumatology
Vascular Surgery
Radiology Facilities
The main Department of Radiology in this hospital contains three general purpose rooms,
one general fluoroscopy room, a multi-detector CT scanner, three vascular rooms (one biplane) and three ultrasound rooms. Adjacent to the Accident and Emergency Department
are three general X-ray rooms with the facilities expected of a major trauma unit. As part of
acute services, there is a separate Radiology facility adjacent to the Acute Admissions Unit
(AAU) which houses a second multi-detector CT scanner, ultrasound room and two
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reporting areas. A major redevelopment of the Emergency Department and adjacent
imaging services is currently in progress.
The three vascular interventional rooms are shared by Neuroradiology and Vascular
radiology. The interventional vascular suite was opened in October 1998. It has theatre
specification and is used for aortic endograft procedures. A bi-plane angiographic room,
used mainly for neuro-interventional work, and a third new single plane angiographic room
for peripheral vascular work were opened in 2003. A state of the art Radiology Day Case
Unit was opened in 2012.
The MRI Unit is housed in a separate purpose built department, closely adjacent to the
main department. It houses a Philips Intera 1.5 Tesla and GE Signa 1.5 Tesla scanners,
with a full range of coils, workstations and imaging software. The Philips machine has
angiographic capabilities. A GE Signa 3T MRI scanner was installed and commissioned in
early 2004.
The Nuclear Medicine Department is located on the floor below the main X-ray
Department and has one dual-headed gamma camera with CT attenuation/image fusion
capability. A mobile PET-CT service was commissioned in 2005 and this hospital is a
designated site for national PET-CT procurement.
There is a single centralised computer system serving the hospitals via a network, and
permitting computerisation of film filing, reporting, appointments as well as other functions.
All reporting is via a centralised digital dictating system with voice recognition.
PACS has been implemented across the Hull Royal Infirmary and Castle Hill Hospital sites
with reorganisation of the internal layout of the department producing a modern and
improved environment for reporting.
CASTLE HILL HOSPITAL
The hospital is located in Cottingham outside the City of Hull and within the East Yorkshire
Borough of Beverley. The hospital is set in a pleasant environment and is being rapidly
developed. It presently has over 500 beds. In excess of £15 million has been spent in
recent years in the construction of a new surgical block, a 10 bed intensive care unit,
satellite biochemistry laboratory, dedicated day care centre surgery unit, endoscopy suite,
pulmonary function laboratory and cardiac catheterisation laboratory.
The following specialties are located on the Castle Hill site:
Cardiology
Cardiothoracic Surgery
Colorectal Surgery
ENT
Gastroenterology
General Medicine
Genitourinary medicine
Gynaecology
Haematology
Infectious Diseases
Medicine for the Elderly
Oncology
Orthopaedic Surgery
Rehabilitation
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Respiratory Medicine
Rheumatology
Plastic Surgery
Upper GI Surgery
Urology
North Humberside Breast Screening Service.
A £65 million Queen’s Oncology and Haematology Hospital development was opened in
2008 with the transfer of Oncology services from the Princess Royal Hospital.
A £50 million cardiothoracic unit development was also completed in 2008.
Radiology Facilities
The current Department of Radiology was opened in spring 2002. There are four general
purpose rooms, two fluoroscopy rooms and four ultrasound rooms.
A cross-sectional imaging department, close to the main department, was opened in June
2005 consisting of 2 CT scanners (16-slice and 40-slice) and a Philips Achieva 1.5 Tesla
MRI scanner. A GE Optima 1.5 Tesla wide bore scanner was added in 2010. CT and MRI
scanners have cardiac capability and non-contrast angiography is available on the GE
MRI.
Nuclear medicine is in a separate department adjacent to the main radiology department
and contains 2 dual headed gamma cameras, 1 of which has CT attenuation/image fusion
capability
The East Yorkshire Breast Unit opened in 2000 and has allowed centralisation of
screening and symptomatic breast imaging on to the Castle Hill site.
THE MEDICAL SCHOOL and THE ACADEMIC DEPARTMENT OF RADIOLOGY
The Postgraduate Medical School in Hull was formally created in 1994, and now has
Clinical Professors in the major disciplines, including Cardiology, Respiratory Medicine,
Oncology, Colorectal surgery, ENT and Reproductive Medicine.
The Hull-York Undergraduate Medical School had its first intake of students in September
2003. A considerable expansion in the number of academic staff has therefore taken
place. The central role of imaging in medicine means that the undergraduate teaching will
increasingly take place in Radiology and there are opportunities for more senior Radiology
trainees to contribute to this teaching.
In December 1997 Professor L W Turnbull was appointed to the Yorkshire Cancer
Research Foundation Chair in Radiology and the Scientific Directorship of the Centre for
Magnetic Resonance Investigations at Hull Royal Infirmary, which was established in
1992. The academic Department of Radiology has continued to pursue oncological
applications of MR imaging and spectroscopy which currently include a major nationally
and internationally respected programme into breast cancer research with close
collaboration with the Departments of Academic Medicine, Surgery and the Centre for
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Metabolic Bone Diseases. Additional projects concentrate on prostate, uterine, brain and
colorectal imaging as well as the development of mathematical models for accurately
quantifying the uptake of MR contrast agents. The Centre for MR Investigations currently
employs a number of Physicists, a Biochemist, several research fellows and PhD students
and is equipped with up-to-date personal computers, SUN, Allegro and Advantage
Windows Workstations.
VASCULAR SERVICES
The Hull and East Yorkshire NHS Trust provides vascular services to a population of
approximately 1.2 million patients. There are in addition, tertiary referrals from
Scarborough, North Yorkshire and the Trent region.
There are currently six vascular interventional radiologists in post. All aspects of diagnostic
and interventional vascular radiology are undertaken by each of the consultants and
complex interventions are shared to increase experience. Training to cover the radiology
curriculum to level 1/2 is provided.
One consultant (GJR) has a special interest in pulmonary arteriovenous malformations
and another (DFE) has a commitment to cardiac CT and MRI. Vascular CT and MRI are
performed on both the HRI and Castle Hill sites while all interventional work is currently
performed on the Hull Royal site.
There are five vascular surgeons including a Professor of Vascular Surgery, senior lecturer
and research fellows. All interventional procedures are discussed at the weekly
MDT meeting. A small number of joint procedures are undertaken in the vascular
operating theatres, while stent-graft cases are performed within the Radiology Department.
The Trust is exceptionally well equipped for vascular intervention with three state of the art
angiographic rooms including one bi-plane suite with rotational angiography and full
analysis packages. All angiographic rooms have full anaesthetic facilities. There are three
1.5T MRI scanners, access to a 3.0T MRI scanner (University) and 4 multislice CT
scanners. New ultrasound equipment has recently been installed for the vascular duplex
service and a further ultrasound scanner is available for use in the interventional rooms.
NON-VASCULAR SERVICES
The Hull and East Yorkshire NHS Trust provides a comprehensive range of non-vascular
interventional services to the population of Hull & East Yorkshire. This includes
percutaneous biopsy and drainage procedures, percutaneous renal intervention including
nephrolithotomy; upper and lower GI stenting and percutaneous biliary intervention. The
trust is the regional centre for pancreatico-biliary cancer services and tertiary referrals for
percutaneous biliary intervention are accepted from Scarborough and Northern
Lincolnshire. The trust has one of the busiest percutaneous biliary interventional services
in the country performing in excess of 150 cases per year.
There are two non-vascular interventional radiologists based mainly on the Castle Hill site.
Some additional input is provided by two of the vascular radiologists. Training to cover the
Radiology Curriculum to level 1/2 is provided.
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One consultant (JEIC) has a special interest in percutaneous radiofrequency ablation of
hepatic and renal tumours. This service has run since 1999. This is therefore one of the
longest established units in the country. There is a particular interest in the treatment of
renal tumours. Currently, 30 – 40 cases are performed per year.
There is a close working relationship with upper and lower GI Surgery, Gastroenterology
and Urology. This is facilitated through thriving cancer MDT meetings and additional
clinicoradiological meetings.
INDUCTION
On taking up appointment the trainee will undergo a period of induction. The components
of this will include introduction to the department, members of staff and work practices. A
formal training of basic and advanced life support will be incorporated in the course of
training.
TIMETABLE
This can be tailored to the interests and training requirements of the appointee.
Vascular
1. Vascular Intervention
2. Duplex Ultrasound
3. Vascular MRI
4. Vascular CT
5. Cardiac CT and MRI
6. Vascular MDT
7. General Reporting
8. Study
3 - 4 sessions
1 session
1 session
1 session
1 sessions
0.5 session
1 session
1 session
Additional opportunities include participation in the weekly joint vascular radiology –
surgery clinic.
3 - 4 sessions in the angiography suite combining diagnostic angiography and
interventional vascular procedures. This includes peripheral angioplasty and stenting;
visceral angioplasty; venous intervention and aortic stent graft procedures.
1 session of vascular duplex ultrasound devoted to assessment of carotid disease and
peripheral vascular disease; venous disease; vascular malformations; follow up of patients
after interventional procedures and surveillance of post-surgical patients.
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1 session of vascular MRI including peripheral and visceral MRA studies for assessment of
potential interventional cases; carotid MRA and pre interventional work up of patients with
fibroid uterus.
1 session of vascular CT and 1 session of cardiac CT including new patients referred for
endovascular repair of thoracic and abdominal aortic aneurysms. Experience of coronary
and cardiac CT as well as non-invasive peripheral angiography is provided. Review of out
of hours CT studies is undertaken with exposure to diagnosis and management of aortic
dissection and rupture.
0.5 session for weekly MDT. The trainee has the opportunity to observe and participate in
the discussion of the preceding week’s interventional cases and the discussion in planning
interventional procedures.
Non-vascular
1. General Interventional procedures
2. Radiofrequency Ablation
3. CT / MRI
4. General reporting/Ultrasound
5. MDT
6. Audit / Study
4 sessions
1 session
1 session
1 session
1 session
2 sessions
4 sessions of non-vascular intervention combining GI and uroradiology intervention. This
includes PTC; GI stenting; percutaneous gastrostomy; nephrostomy and ureteric stenting.
1 session of radiofrequency ablation, with specific emphasis on renal tumour ablation,
imaging assessment and follow up.
2 sessions of acute CT / MRI to provide insight into the planning and management of
acute GI / GU emergencies, planning for interventional procedures and also CT guided
drainage and biopsy.
1 session of MDT will include exposure to upper GI, lower GI and urology cancer and
clinicoradiological meetings.
ON CALL
The trainee will participate in the general on call rota. Progression to participate in the sub
specialist interventional on call is expected.
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AUDIT, RESEARCH AND TEACHING
The trainees will be encouraged to participate in undergraduate and postgraduate
teaching and departmental audit and research projects with a view to attending and
presenting at national/international meetings.
A research meeting is held each month at Hull Royal Infirmary for such discussions,
updates and presentation of projects.
Study leave is available with permission from the Specialty Study Leave Advisor.
APPRAISAL AND ASSESSMENT
There will appraisal by the educational supervisors prior to taking up the post and at 3
monthly intervals during tenure to establish initial and ongoing training objectives and to
assess progress.
Formal assessment of progress at 12 monthly intervals through the ARCP process.
Trainers
Dr James E I Cast
Training Programme Director
Non-vascular IR
Dr Raghuram Lakshminarayan
Study Leave Advisor and Deputy Training Programme Director
Vascular IR
Dr Graham J Robinson
College Tutor and Educational Supervisor
Vascular IR
Dr Oliver R Byass
Educational and Clinical Supervisor
Non-vascular IR
Dr Mohamed Ahmed
Educational Supervisor
Vascular IR
Dr Vivek Shrivastava
Educational Supervisor
Vascular IR
Dr Paul M Scott
Clinical Supervisor
Vascular IR
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Prof Duncan F Ettles
Former Regional Advisor
Vascular IR
FURTHER ENQUIRIES
Prospective candidates are encouraged to visit the department by prior appointment.
Please contact Mrs Alison Vickers, Secretary, on 01482 674608 to organize a visit.
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