Wessex Branch autumn meeting 2014

Wessex Branch autumn meeting Meeting organised by the Wessex Branch of The British Institute of Radiology Wednesday 10 December 2014 Wessex Heartbeat Centre, Southampton 12:15

Registration and lunch

13:50

New directions in interventional oncology Dr David Breen, Consultant Radiologist, University Hospital Southampton

14:15

The one-stop prostate MR/TRUS biopsy service in Lymington Dr Nirav Patel, Specialist Registrar in Radiology, University Hospital Southampton

14:30

The revised adenocarcinoma classification – an imaging guide Dr Natasha Gardiner, Radiology SpR, Portsmouth Hospitals NHS Trust

14:45

Paediatric bowel imaging Dr Mark Griffiths, Consultant Radiologist, University Hospital Southampton

15:05

An introduction to simulation in ultrasound skills training Aisha Tariq, Medaphor Ltd

15:15

Refreshments

15:45

Current and future applications of PET CT Dr Ayshea Hameeduddin, Consultant Radiologist, St Bartholomew’s Hospital

16:05

To what extent has the demand for out of hours cross-sectional imaging increased in the past decade?

Dr Gemma Dawe, Radiology SpR, University Hospital Southampton

16:25

Can reducing the z axis for CTPAs limit dose without impacting on patient safety?

Dr Rute Martins, Radiology Registrar, Portsmouth Hospitals NHS Trust

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President Dr David Wilson MBBS BSc MFSEM FRCP FRCR Chief Executive Ms Jacqueline Fowler BA, MInstF(Cert)

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16:40

Prostate artery embolisation for BPH: the Southampton experience Dr David Flowers, Radiology Registrar, University Hospital Southampton

17:00

Close of meeting

Welcome and thank you for coming our event ‘Wessex Branch autumn meeting’ organised by the Wessex Branch of The British Institute of Radiology.

This booklet contains the abstracts and biographies for each speaker.

This meeting has been awarded 3 RCR category I CPD credits.

Please complete the meeting evaluation survey online at: https://www.surveymonkey.com/s/wessexautumnmeeting We will email your CPD certificate within the next two weeks once the survey has been completed.

We are most grateful to

For supporting this event

Speaker profiles Dr Gemma Dawe, Radiology Registrar Basingstoke Hospital Dr Gemma Dawe is a final year radiology registrar in the Wessex deanery, with a subspecialist interest in neuroradiology.

Dr Natasha Gardiner, Radiology Registrar Queen Alexandra Hospital, Portsmouth Dr Natasha Gardiner is a radiology registrar at Queen Alexandra Hospital, Cosham, Portsmouth. She is currently in the third year of her training.

Dr Mark Griffiths, Consultant Paediatric Radiologist University Hospital Southampton Dr Mark Griffiths has been a Consultant Paediatric Radiologist University Hospital Southampton since 2001 and Chairs the UK Imaging Informatics Group.

Dr Ayshea Hameeduddin, Consultant Radiologist, St Bartholomew’s Hospital NHS England Dr Ayshea Hameeduddin a radiology consultant working at Barts Health NHS Trust, London.

Her subspecialty areas are urological and gynaecological cancer imaging and PET CT. She trained at the Royal Free Hospital and subspecialised in radionuclide imaging. Following this she completed an Oncology Imaging Fellowship at the Royal Marsden Hospital and completed an MSc in Nuclear medicine.

Dr Nirav Patel, Clinical Radiology trainee (ST3) University Hospital Southampton Dr Nirav Patel graduated from Barts and the London Medical School in 2010 and is currently a Wessex deanery Clinical Radiology trainee (ST3) based in Southampton. He currently has an interest in abdominal and oncological imaging and education.

Abstracts (where supplied) The one-stop prostate MR/TRUS biopsy service in Lymington Dr Nirav Patel Prostate cancer is the most common male cancer, predominantly affecting older males.

Patients are screened by PSA testing, digital rectal examination and TRUS guided biopsy.

This leads to the stratification of patients into risk groups and determines the treatment pathway: active surveillance versus radical therapy. The role of imaging is to provide biopsy guidance and staging.

MRI has traditionally been used in selected patients for pre-radical therapy to assess for localised or extra-prostatic disease. This is usually performed several weeks after biopsy to reduce post-biopsy haemorrhage artefact. Recently, multi-parametric MRI (MP-MRI) has improved the diagnostic yield in detecting and characterising prostate cancer. The Prostate MRI Imaging Study (PROMIS) is a UK trial awaiting completion in 2015 and is investigating the detection rate of clinically significant cancer using MP-MRI, whether prostate biopsy can be avoided in low-risk patients and cost-effectiveness. However, whilst the results of this trial are awaited, NICE recommends the use of MP-MRI in patients who have a negative TRUS biopsy, those in active surveillance and those for consideration of radical therapy.

At Lymington New Forest Hospital, we provide a one-stop service of MP-MRI prior to TRUS biopsy for pre-selected patients. During this presentation, we will review cases where a prebiopsy MRI has been beneficial for patient management and experience.

The revised adenocarcinoma classification – an imaging guide Dr Natasha Gardiner Advances in our understanding of the pathology, radiology and clinical behaviour of peripheral lung adenocarcinomas facilitated a more robust terminology and classification of these lesions. The International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society (IASLC/ATS/ERS) classification introduced new terminology to better reflect this heterogeneous group of adenocarcinomas formerly known as Bronchoalveolar Cell Carcinoma (BAC). There is now a clear distinction between preinvasive, minimally invasive and frankly invasive lesions. The radiographic appearance of these ranges from pure ground glass nodules to solid mass lesions. Radiologists must be aware of the new classification in order to work alongside multidisciplinary colleagues to allow accurate staging and treatment. This presentation reviews the new classification of lung adenocarcinomas. Management options of these lesions with particular focus on radiological implications of the new classification will be reviewed.

Paediatric bowel imaging Dr Mark Griffiths Use of imaging in the diagnosis of bowel pathologies in children. The role of different imaging modalities and implications for service provision in the management of inflammatory bowel disease will be discussed.

Current and future applications of PET CT Dy Ayshea Hameeduddin The advent of PET CT in the late 1990s has revolutionised oncology imaging due to the ability to detect subcentimetre cancerous cells combined with accurately localising disease.

The main PET tracer used is 18F-FDG, a glucose analogue that is taken up by metabolically active cells. This is now widely used in the detection and staging of many cancers, in response assessment, identification of recurrent disease and as a ‘problem solver’. This talk aims to discuss some of the current applications of PET CT and its impact on cancer using lung cancer and lymphoma as examples. The role of 18F-Choline PET CT in prostate cancer is discussed with examples demonstrating its clinical utility in practice. The future directions of PET CT are addressed including the development of non-FDG tracers, the recent introduction of PET MRI and the associated challenges of such rapid technological advances.

To what extent has the demand for out of hours cross-sectional imaging increased in the past decade?

Dr Gemma Dawe As the NHS moves towards 7-day working, radiology plays a key role in the provision of a timely reporting service for acutely unwell patients. At my institution (UHS), in the past decade we have moved from a non-resident ‘on-call’ senior registrar reporting service to a two-tier resident ‘full-shift’ registrar service. Additionally, consultants on call over the weekend are expected to be in the hospital for a minimum specified number of hours each day to report and verify registrars’ reports. Hospitals such as Hampshire Hospitals Foundation Trust, who continue to run a consultant-led on call service during the day at weekends have also noticed a marked increase in activity over the past few years. Scans are increasingly complex and there is a feeling that the threshold for scanning patients has lowered. Guidelines stipulate who should be scanned and when, and reports are required quickly.

The number of CT and MR scans performed on-call at UHS and HHFT over a 24 hour period on the first Saturday of each month over 6 consecutive months from the years 2006-2014 were counted. Scans performed out of hours but for other reasons, such as waiting-list initiative lists, were excluded. The results showed a significant increase in the volume of scans performed on-call at the weekend at both hospitals. Possible reasons for this are discussed and include an aging population, a more litigious society and less experienced registrars accepting referrals.

Can reducing the z axis for CTPAs, limit dose without impacting on patient safety?

Dr Rute Martins The number of CTPAs being performed is increasing year on year and the positivity rate is decreasing. In some studies this has decreased from 20 to 5%. More patients are being exposed to greater medical radiation and measures are being undertaken to reduce CT radiation dose. For example, reducing the CTPA kvp from 120 to 100 reduces dose by 33%, but can reducing the z axis further safely reduce dose?

We will present a retrospective study of our current CTPA practice of reducing the z axis by not including the apices. We will present the average dose reduction achieved through this change in practice and assess whether this change is safe. We will also highlight our recall rate for repeat CT chest including the lung apices. We will also highlight positive pick up rates for pulmonary embolism.

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FORTHCOMING EVENTS THE SPINE IN HEALTH AND DISEASE 21 JANUARY 2015 LONDON CONTRAST STUDY DAY AND ESSENTIAL PHYSICS FOR FRCR 29 - 30 JANUARY 2015 SHEFFIELD RADIOLOGY ERRORS 6 FEBRUARY 2015 LONDON EMERGENCY INTERVENTIONAL RADIOLOGY 13 FEBRUARY 2015 LONDON 4TH ANNUAL SPECT/CT SYMPOSIUM: CURRENT STATUS AND FUTURE DIRECTIONS OF SPECT/CT IMAGING 23 FEBRUARY 2015 LONDON THE TECHNOLOGY AND USES OF ON-TREATMENT IMAGING IN RADIOTHERAPY 24 MARCH 2015 LONDON IMAGING IN DEMENTIA 23 APRIL 2015 LONDON EMERGENCY OUT OF HOURS RADIOLOGY APRIL 2015 GLASGOW MANAGEMENT AND RADIOLOGY - A GUIDE TO CURRENT AND FUTURE MANAGEMENT ISSUES IN RADIOLOGY 1 MAY 2015 LONDON THORACIC IMAGING 15 MAY 2015 CAMBRIDGE VISIT: WWW.BIR.ORG.UK FOR MORE INFORMATION AND TO REGISTER

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