THE LOTHIAN UNIVERSITY HOSPITALS NHS TRUST
THE WESTERN GENERAL HOSPITAL
ONCOLOGY DIRECTORATE
JOB DESCRIPTION
1. JOB IDENTIFICATION
Job Title:
Consultant Radiologist and Clinical Lead in South East Scotland Breast Screening
Service
Responsible to:
Clinical Director of Breast Services
Department(s):
Breast Radiology Western General Hospital/ SE Scotland Breast Screening
Directorate:
Clinical and Non Clinical Support Services
Operating Division S/E Scotland Breast Services (Borders General & Western General Hospital)
Job Reference:
No of Job Holders: 1
Last Update:
2. JOB PURPOSE
1. Professional lead for speciality with responsibility to develop and manage speciality breast imaging
services in SESBSP. Contribute to Division and Directorate Clinical Strategy, performance and
practice in specialist area.
2. Professionally accountable to the Clinical Director
3. In partnership with appropriate managers and healthcare professionals, ensure that resources are
effectively managed.
4. Directly deliver care within speciality
5. To be involved in planning the strategic direction for Breast Screening as part of the management team,
regularly reviewing the provisions across SE Scotland.
6. To represent the directorate in leading Breast Screening services across SE Scotland, advising and
acting on professional issues both within the directorate and outwith as appropriate.
7. Advising SCAN on breast imaging.
3. DIMENSIONS
Clinical Areas:
1. The breast services of the South East of Scotland.
2. Symptomatic breast services are provided on five sites in South East Scotland. The mammography
department at the WGH is the largest of these and provides the radiology support for the Edinburgh
Breast Unit as well as specialist services for SES Breast Service. The EBU is referred approximately
6,000 new patients, 700 new breast cancers, 150 cases of recurrent breast cancer and 12,000 review
cases per year.
3. The SESBSP provide a screening imaging service to the eligible population of 167,000 over a three
year cycle of women aged 50-70 years and self referral over 71 years within the areas designated to the
South East Division which are City of Edinburgh, East, West and Midlothian, 2/3 of Fife and East
Forth Valley The Borders
4. The service also provides a film interpretation, imaging review and assessment service to those clients
identified as requiring further investigation – 3000-3500 review examinations per annum – 650 – 750
assessment examinations per annum.
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Educational Activity:
1. Participate in and deliver education programmes for other professionals involved in breast cancer care
including radiologists, breast surgeons, specialist radiographers, assistant practitioners and nurses and
radiographic department assistants.
Staff Responsibility:
1.Work as an independent practitioner at Consultant level practice in both the mammography department
of the Edinburgh Breast Unit and the South East of Scotland Breast Screening department and Borders
General Hospital.
2.Provide professional leadership to radiology colleagues, initiate and mentor for role development in
specialist radiographers and advanced practitioners and specialist radiology registrars.
4. ORGANISATIONAL POSITION
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5. ROLE OF DEPARTMENT
1. To provide high quality, efficient and effective breast imaging and assessment service to the designated
areas.
2. To provide diagnosis using specialised imaging equipment and highly developed clinical skills.
3. To provide education and training for Radiologists, Radiographers and other health professionals to
post graduate level.
4. The departmental clinical governance strategy ensures a high standard of care to the clients/patients and
provides multidisciplinary working.
5. To promote research and audit in breast imaging.
6. KEY RESULT AREAS
This role is of Lead Consultant in the Radiology Team working as an independent practitioner at
Consultant level practice in the South East of Scotland Breast Screening department doing the following:
Expert Clinical Practice
1. To report mammograms independently. Advising and arranging additional views as necessary.
Perform and report breast ultrasound independently and correlate findings with clinical and
mammographic features. Issue comprehensive and timely reports with recommendations for further
imaging and/or biopsy.
2. Effective management of all new patient clinics, to ensure they run smoothly for all Consultant
Radiologists with increase in patient numbers
3. Perform ultrasound-guided FNA and core biopsy and wire localisations independently, safely and
appropriately.
4. Perform stereotactic-guided core biopsies. Place markers under stereotactic guidance after core biopsy
where appropriate.
5. Perform stereotactic-guided wire localisations and communicate effectively with the surgeons to
achieve optimal wire placement. After wire localisations, assess excision completeness and report
specimen x- rays after wire localisations.
6. Place markers under ultrasound guidance where necessary, for example into tumours prior to the
chemotherapy.
7. Perform ultrasound guided skin marking in preoperative cases as requested.
8. Undertake imaging support for one stop new patient clinics as an independent practitioner reporting all
imaging (multiple modalities inclusive of mammogram and ultrasound imaging) and communicating
results to and liasing with clinicians and performing FNA core biopsies as felt appropriate.
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9. Lead and develop new services within the SESBSP.
10. Be an integral part of the multi-disciplinary team in the Edinburgh Breast Unit and SESBSP
communicating effectively with members of the team. Provide effective communication between
screening and symptomatic breast practice.
11. Lead the unit multi-disciplinary meetings and give an informed opinion on cases.
12. Lead the departmental meetings with radiographers and radiologists.
13. High level communication skills enabling effective leadership of the clinical team.
14. Communicate effectively and sensitively with patients.
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Managerial
1.
2.
Clinical Lead in Mammography for the SESBSP
Lead regional Radiology – development of gold standards for breast service over the SCAN region,
which includes Borders General Hospital, St John’s Hospital, Queen Margaret Hospital Fife and
Dumfries and Galloway.
3. SESBSP Radiology Lead on NHS Lothian Cancer Services Reprovision Project – Breast Services
Group.
4. Quality Improvement Scotland- SCAN Radiology Lead for deciding on Breast Quality Standards to
be adopted.
5. Responsible for leading development of Specialist Registrar Training in SESBSP
6. Provide clinical leadership, motivation and support for all radiology staff, members of service and
other agencies as appropriate within areas of responsibility.
7. Delegate appropriate tasks and supervise junior grades to achieve the desired standard of patient care.
8. Advise on safe use of equipment.
9. Based on clinical assessment procedures, make appropriate and informed referrals within the
multidisclipinary team.
10. Lead development and review policies and procedures within highly specialized areas of
responsibility
11. Lead development of long term strategic planning of breast services
12. In consultation with the Clinical Director and Superintendent 1 and service administrator lead in the
monitoring and review of service provision and implement change as required in breast screening.
13. Lead planning, development and implementation of new ways of working to deliver clinical services,
recognizing and supporting policy.
14. Contribute to the effectiveness of clinical services in breast imaging, by ensuring practice is evidence
based and delivered through care protocols and pathways whose effectiveness is demonstrated by
audit and benchmarked against best practice.
15. Support the Clinical Director, Head of Service and Associate Medical Director in implementing the
strategy for reconfigured clinical services and the objectives of the Directorate.
16. Provide regular communication to all the staff within the specialty on developments in clinical
governance.
17. Support Clinical Director to implement arrangements for clinical risk management, within the
Division’s overall policy towards risk management.
Professional Leadership and Consultancy
1. To provide professional leadership to radiology colleagues to initiate and mentor for role development
in radiographers and advanced practitioners.
2. To provide inspirational leadership to motivate and inspire staff across the SCAN region and
nationally to progress their practice in line with the strategic direction for the delivery of cancer
services.
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3. To lead service change across the SCAN area to promote best practice particularly in relation to skill
mix.
4. To be an acknowledged national lead in the field of radiographic breast screening with clear
partnership working with colleagues from other AHP professions, Medicine and Nursing.
5. To lead development of breast radiology services across the region.
6. Responsible for recruitment and selection of Consultant Radiologists. Responsible for management
of Consultant Radiologist annual leave, Time in lieu, sickness and maternity leave. Responsible for
Consultant Radiology rotas, assignment of work
7. Line manager/clinical lead in SESBSP
8. Responsible for dealing with disciplinary and grievance procedures
9. Responsibility with appropriate professionals to ensure continuing medical education standards in
training and development of all training grade doctors within the specialty.
Educational and Professional Development
1. Undertake CPD to maintain registration requirements of the Health Professions Council
2. Maintain professional standards for film reading as recommended by the RCR Breast Group and QA
Radiology Manual at BSP.
3. Read a minimum 500 symptomatic and 5,000 screening mammograms per year.
4. Undertake PERFORMS or similar activity
5. Demonstrate a commitment to life-long learning.
6. Undertake regular CPD equivalent to consultant radiologists with a special interest in breast disease.
7. Audit own work and participate in departmental audit projects.
8. Lead breast imaging discrepancy meetings.
Service Development and Research
1.Lead, develop and participate in collaborative research projects within the Edinburgh Breast Unit and
initiate research and audit within the /SESBSP.
2.Lead and develop collaborative approaches to research between radiographers working in breast
screening services, others working in universities and within existing groups to establish projects that
develop and evaluate imaging interventions in randomised trials and systematic reviews.
3.Disseminate appropriate evidence/research findings and, wherever possible, ensure integration of
research evidence into practice.
4.Act as a role model and encourage research awareness among AHP staff.
5.Monitor and evaluate the effect of any new areas of work and changes in practice.
6. Encourage research activities within the appropriate clinical fields, ensuring these activities reflect the
Research and Development strategy and take into account of the capabilities of staff within the clinical
speciality, ensuring findings inform clinical practice within the division and is disseminated as
appropriate.
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7a. EQUIPMENT AND MACHINERY
X-ray systems: Instrumentarium Diamond & Delta 32 small field digital unit, Lorad Mark 4 + DSM
small field digital unit, Faxitron analogue and digital specimen imaging unit.
Ultrasound equipment: Philips ATL HDI 5000, Philips ATL HDI 3000
Film Multi-viewers: Rollux M , Philips Auto-alternator , Planilux, Rad-, Picture Archiving and
Communication Systems (PACS) workstations.
7b. SYSTEMS
1. SBSP QA programme + e-mail link to Scottish Healthcare Supplies.
2. Small field digital systems DSM and Delta 32 including image manipulation and data management
3. Access the internet and ‘trust’ intranet via the training computer for relevant information for personal
and professional development and research.
4. Use software programmes such a s Microsoft Word and Excel to create documents and tables for
audit, research etc. Powerpoint for managerial and educational presentations
8. ASSIGNMENT AND REVIEW OF WORK
1. Self directing, working at a senior level within broad guidance and principles to manage the
responsibilities of the post. The Clinical Lead and Consultant Radiographer will be expected to have
successfully completed accredited courses in film reading and interpretation, stereotactic core biopsy
and breast ultrasound.
2. As Clinical Lead, mentor and performance review of all elements of training of advanced practitioner
radiographers and Consultant Radiologists in department. Lead for audit of work by Consultant
Radiologists.
3. The post holder will be lead in MDMs, research and audit review and other internal CPD activities of
the associated departments. Access to study leave monies equivalent to a Consultant Radiologist.
4. Performance and CPD activity will be included and reviewed at appraisal by the Clinical Director.
5. Formal mechanisms exist to measure waiting times to diagnosis and treatment and are reported to the
Scottish Executive.
9. DECISIONS AND JUDGEMENTS
1. Make judgements that involve highly complex facts requiring analysis, interpretation and comparison
of a range of systems. Based on prior knowledge and experience, decide whether films/ultrasound
scans represent normal appearances or require further investigation.
2. Decide whether the area visualised on assessment films/ultrasound scan is the correct area for
investigation. Decide if sufficient specimens have been taken to obtain a diagnosis.
3. Assess whether there is a need to insert a marker in the biopsy site and ensure correct
positioning for possible surgical excision
4. Instigate research leading to changes in service delivery, protocols and procedures.
5. Development of departmental protocols at each site in South East Scotland anticipating any changes to
practice and incorporating into department protocols.
6. Managing rotas and staffing, deploying and redeploying staff were required throughout the service.
MOST CHALLENGING/DIFFICULT PARTS OF THE JOB
1. Ability to manage the competing demands of the core functions of the post i.e. clinical, strategic
development, leadership, education, research.
2. Lead radiology SCAN with involvement of key strategic staff in order to achieve an improvement in
services to people who undergo breast imaging.
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3.
4.
5.
6.
Leading and influencing change that will deliver improved breast-imaging services.
Develop equity of service and continuity of standards across the whole SCAN region.
Make judgements that involve highly complex factors requiring analysis and interpretation.
Interpret mammograms and breast ultrasound – using knowledge and experience to determine whether
normal or abnormal. Determine level of suspicion and organise appropriate further investigation.
7. Gain advanced knowledge and experience necessary for safe, efficient and accurate tissue sampling
with stereo-guided biopsy to enable diagnosis of relevant area under examination.
8. Gain advanced experience and knowledge for concise and accurate placement of wires using both
stereotactic and ultrasound placement. Discuss placement with the surgeon and confirm exact
location.
9. Lead discussions on patient management at MDT.
10. Communicate effectively on highly sensitive issues pertaining to management with patients who are
often in the highest state of anxiety.
11. Managing complex relationships and delivering clinical leadership across breast imaging, whilst
maintaining clinical practice and creditability.
12. Making an effective contribution to the Directorate’s success.
13. Contribute to the clinical leadership of the speciality by assisting in the delivery of the benefits of
reconfiguration and integration.
14. Maintaining staff morale and developing a cohesive team approach during times of organisational
change.
11. COMMUNICATIONS AND RELATIONSHIPS
The postholder will work closely with: Patients and their carers/families.
Leaders of breast services across SCAN, involving all disciplines including Medicine and Nursing
Radiological and Radiographic.
Members of the MDT
Senior AHP staff working in breast radiological and radiographic services.
Higher Educational Institutes.
Radiography staff delivering breast imaging services
Senior clinical staff and non clinical staff
Professional orginisations
Scottish Executive Health Department
Other NHS Boards
Local and national governmental personnel.
12. PHYSICAL, MENTAL, EMOTIONAL AND ENVIRONMENTAL DEMANDS OF THE JOB
Physical Skills:
1. Highest level of precision and speed are necessary in the accurate sampling of breast core biopsies.
2. Expert in handling and operating technically highly specialised and expensive equipment (£50,000 £100,000).
3. Dexterity – need to handle biopsy samples very carefully to avoid damage.
4. Precisely and accurately position all clients whilst minimising the discomfort/distress of the procedure
irrespective of the client’s physical/mental condition.
5. Coordination required to control a and manipulate biopsy device/wire with US transducer
Physical Demands:
1. Film interpretation – requires prolonged periods of up to 4 hours sitting in a fixed position at a
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computer VDU in a low lit environment.
2. Work for extended periods of time (4-5 hours) with no breaks to maintain optimum workflow and
patient care in core biopsy assessment situation.
3. Stand for extended periods up to 1 hour whilst performing biopsy examinations.
4. Risk of repetitive strain injury from ultrasound scanning and carrying out interventional techniques.
Mental Demands:
1. At national level bring together multiple sources of information on own speciality to develop opinions
and standards (Quality Improvement Scotland, SCAN).
2. Lead MDM meetings where opinions and discussions on complex cases are required, bringing together
multiple pieces of information within a stressful environment.
3. High level of concentration and commitment needed to lead breast services at WGH and BGH, coordinating and instigating change as required. Whilst advising clinical leads at St Johns and Dumfries
to develop their breast services, to bring them in line with others across the region.
4. Managing complex rotas to ensure that all aspects of breast radiology are covered, arranging cover for
sickness and other leave and managing staffing levels and distribution.
5. High levels of concentration for up to 4 hours for film reading and biopsy sessions, often whilst being
interrupted and asked advice.
6. Achieving and maintaining recall rates and pre-operative diagnoses rates as demanded by the NHSBSP
strict quality assurance guidelines.
7. Making decisions in complex and unpredictable circumstances (number of cores necessary for
diagnosis, whether to insert a biopsy market, repeat cores at time of examination).
8. Correct and accurate information and data collection on pathology requests and patients’ notes.
9. Prioritise and manage clinical and managerial tasks to ensure that actions are undertaken appropriately
and in a timely manner.
Emotional Demands:
1. On a regular basis provide emotional support to screening clients and patients, who fear they may be
diagnosed with breast cancer, whilst at the same time performing highly demanding biopsy techniques.
2. Working as lead in a multidisciplinary team environment, maintaining and boosting morale of other
members of the team.
3. Dealing with colleagues who are unhappy with their position and find it difficult to be team members
Working Conditions:
1. Film reading must be carried out in a darkened room, preferably in isolation.
2. Lack of ventilation/air conditioning when carrying out core biopsies and during multidisciplinary
meetings.
3. Carrying out highly skilled biopsy techniques and being exposed to body fluids and blood products
4. Potential for needle stick injury
5. Frequent exposure to poor patient personal hygiene, skin conditions etc.
6. A risk of physical/verbal abuse from clients, who may be highly stressed, confused and/or
disorientated.
13. KNOWLEDGE, TRAINING AND EXPERIENCE REQUIRED TO DO THE JOB
Qualifications:
1. MBCHB,
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2. FRCR
3. Advanced training in Breast Imaging with a Special interest in Breast Screening
4. At least 5 years experience working as clinical specialist and at management level.
5. At least 2 years experience working at Consultant Radiologist level, with proven leadership and
management ability before individual can work as Clinical Lead.
Experience:
6. Evidence of regular appraisal learning and continuous professional development.
7. Evidence of ability to take full responsibility for the independent management of patients.
8. Able to co-ordinate imaging investigations and tailor them to patient’s needs.
9. Ability to redesign clinical service or process
10. Evidence of commitment to research, publications and presentations.
11. Evidence of commitment to formal and informal teaching and training of Radiographers, Advanced
Practitioners SpRs, Junior Doctors and Medical Students.
12. Evidence of participation in audit projects and commitment to clinical governance
13. An understanding of the anatomy, physiology, pathology and treatment of benign and malignant
diseases of the breast.
14. Depth and breadth of experience and knowledge of the radiographic interpretation of mammograms
and ultrasound examination of the breast in addition to stereotactic and ultrasound core biopsies with
evidence of achieving results to the current QA targets.
15. Acknowledged and demonstrable contribution to high quality patient care within the multidisciplinary team.
16. Evidence of effective and efficient management of their own workload with autonomous working.
Personal Qualities:
17. Demonstrate inter-professional and team working with excellent interpersonal skills and an
understanding of the roles and functions of other team members. With evidence of teamwork with
colleagues in own and other disciplines
18. Intimate knowledge of Ionising Radiation (Medical Exposures) Regulations 2000 (IRMER).
19. Have a flexible and positive approach to work with proven ability to organise time efficiently and
effectively
20. Enthusiastic and self reliant and able to cope with stress whilst also able to motivate departmental
colleagues, both radiographers and radiologists.
21. Established evidence of clinical leadership in radiography, demonstrating motivational skills to
promote optimal quality of patient care.
22. Have demonstrated continuing professional development with previous experience in mentoring and
research supervision at Masters level.
23. Have a solid knowledge of professional and clinical governance and of any relevant QA guidelines
with evidence of involvement in QA activity.
24. Previous managerial training and experience.
This job description is not intended to be a definitive or exhaustive list of the responsibilities but identifies
the key tasks and duties of the postholder. This job description is subject to review in light of
developments within SCAN and in consultation with the post holder.
14. JOB DESCRIPTION AGREEMENT
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A separate job description will need to be signed off by each jobholder to whom
the job description applies.
Job Holder’s Signature:
Head of Department Signature:
Clinical Supervisor:
Signature:
Date:
Date:
Date
Date:
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