Diagnostic and Interventional Neuro-Radiology

Subspecialty Training Post in Diagnostic and Interventional Neuroradiology (2 years)

This is a RCR accredited 5th/6th year post, for two years, and provides the opportunity for comprehensive training in all aspects of Diagnostic and Interventional Neuroradiology.

The post has Royal College of Radiologists’ approval and conforms to the curriculum outlined in the college document ‘Sub-specialist training in Clinical Radiology’. Training may be varied depending on the interests of the appointee.

MRI/CT

The StR in Diagnostic and Interventional Neuroradiology will be expected to develop their skills in reporting of MR/CT in neuroradiological practice to a sub-specialist level. Teaching is in the form of pre-reporting of routine departmental workload with checking by a consultant. The acquisition of knowledge concerning the use of advanced MR techniques in the diagnosis and monitoring of neurological disease is expected.

Angiography

The StR will participate in routine check and diagnostic angiography in order to develop core competence in cerebral catheter techniques.

Intervention

When a sufficient level of skill is obtained in cerebral angiography, an interested StR would progress to training in neurointerventional techniques, principally endovascular treatment of intracranial aneurysms.

Paediatrics

Opportunity exists for training in paediatric neuroradiology. If an StR has a specialist interest then sessions may be arranged at the Bristol Childrens Hospital.

Radionuclide Neuroimaging

There is an opportunity to gain experience of cerebral SPECT principally for cerebrovascular disease and dementia and also DAT scanning.

Head and Neck

Optional experience in head and neck imaging can be arranged for any trainee wishing to develop an interest.

 Specimen Timetable

Teaching

The StR would be expected to participate in teaching of general radiology StRs and, occasionally, medical students.

Supervision of MR/CT

Whenever in the department, the StR should be prepared to partcipate in the supervision of radiographers in the MRI and CT suites.

Research/Audit

Participation in these activities is an essential component of training.

Meetings

The StR would be expected to attend clinicoradiological meetings and from time to time present at the weekly joint neurosciences meeting. Attendance at national/international meetings relating to the neurosciences is also encouraged.

Daily -  08:00 Neurosurgical Business Meeting
Monday
08:30 -  Neurovascular
09:30 - Skull Base MDT (monthly)
Tuesday
12:30 - Vascular Surgery
Wednesday
08:30 - Paediatric Neurology
08:30 - Neuropathology
09:30 - Neuro-oncology MDT
09:30 - Paediatric Epilepsy (First week of month)
09:30 - Adult Epilepsy (Second week of month)
10:30 - Pituitary and Meningioma (monthly)
11:00 - Joint Neurosciences
13:00 - Stroke
Thursday
14:00 - Neuroinflammation
Friday
09:30 - Neurology

On Call

There is a 1:6 on call rota for neuroradiology. The StR would be supervised by one of the consultant neuroradiologists in rotation. There may be a requirement to cover some general radiology on-call in year 5.

Annual Leave

Six weeks per annum.

Study Leave

Thirty days per annum.

Frenchay Hospital

The neuroscience unit for Bristol and surrounding region is at Frenchay Hospital. It is one of the busiest neurosurgical units in the UK and has an international reputation in the treatment of neurovascular disease.

Department of Neuroradiology

The department of neuroradiology has six full time consultant neuroradiologists, all of whom participate in routine brain and spine reporting. The neuroradiology department provides a full range of imaging services to the Neurosciences at Frenchay and associated hospitals. The neuroradiology department also provides an imaging service to cover Frenchay’s role as a busy District General Hospital. The subregional departments of plastic surgery and Burns are also based on the Frenchay site.

Consultant Areas of Specialist Interest

Dr Shelley Renowden - Neurovascular Intervention
Dr Marcus Bradley - Intervention and Neuro-oncology
Dr Tim Lewis - Dementia, Nuclear Medicine
Dr Verka Beric - Spinal Intervention
Dr Neil Stoodley - Paediatrics
Dr Marcus Likeman - Paediatrics, Epilepsy

List of Major Equipment

• A new Phillips Achieva TX, 3T scanner with improved fMRI, MRS, MRA and DWI capability and adding DTI/tractography, installed 2010.
• Phillips Intera 1.5T with angiographic facilities and a stand alone workstation. Full general anaesthetic provision installed 1994.
• A second Phillips Intera 1.5T system with Explorer gradients and facility for DWI, perfusion imaging, MRS, CEMRA and fMRI installed 2004.
• GE Biplane angiography suite with rotational angiography.
• Siemens Somatom Plus 4 slice CT installed 2000
• Siemens Somatom Sensation 64 slice CT installed 2007
• GE/SMV DST Xi dual head gamma camera – installation 2001
• Siemens Artis Zee biplane flat-panel angiography suite with 56" large screen display, DynaCT and Perfusion capability installed 2011

Diagnostic Examination Workload April - September 2009

Interventional Procedure Workload

Procedure - No. of procedures performed per annum

• Endovascular treatment of intracranial aneurysms - 200
• Intracranial stent insertion (aneurysms) 3 - 20
• Acute stroke cases - 20
• Temporary/permanent balloon occlusion 5 - 10
• Embolisation of arteriovenous malformations - 15-25
• Venous thrombolysis - 3
• Vertebroplasty - 30
• Nerve Root Blocks - 600+
• Paediatric interventional and diagnostic cases - 20-25

Library and Educational Facilities

There is a library within the Postgraduate centre on the Frenchay Site. Neurosurgical journals are located here or through the use of online passwords. A full range of Neurology and other neuroscience journals are available at the Burden Neurosciences Unit on the Frenchay Site.

Neuroscience Unit

The neurosurgical unit consists of twelve consultant neurosurgens including four paediatric neurosurgeons and provides a comprehensive neurosurgical service to a core population of 2.2 million. It receives further specialist referrals for complex spinal neurosurgery, and paediatric neurosurgery over a wider catchment area and receives further specialist referrals from elsewhere in the UK and abroad. Paediatric, Spinal, Stereotactic, Image guided, Cerebrovascular, Epilepsy, Skull base sub specialist neurosurgical services are provided.

There are nine consultant neurologists including a chair in clinical neurosciences in the University of Bristol. There are six consultant paediatric neurologists who hold joint appointments between Frenchay Hospital and the Bristol Childrens Hospital.

There are two Consultant Neuropathologists including a chair in Neuropathology.

Person Specification

Subspecialty Training Post in Diagnostic and Interventional Neuroradiology (2 years)