GIRSIG 2004 - Conference Organiser's Report

Conference Organiser's report
The Role of Barium Enema in the Diagnosis of Colo-Rectal Cancer
Borders Colon Service - Triage of Referrals
Collaborative Practice - working together to feed the growth of the future
Radiographer Managed Paediatric Micturating Cystography

Poster Abstracts

• To show that an increase in radiographer involvement in the barium service reduced waiting times at Sunderland NHS Trust
• Use of a tin filter for lateral decubitus projections in double contrast barium enema: image Quality and potential dose reduction Compared to use of secondary radiation grids
• Citramag bowel preparation for double contrast barium enema: A 5 year audit cycle
• Towards a Radiographer led Gastro-Intestinal Radiology Service in York
• Development of a Low Dose Fluoroscopy Technique to Image the Paediatric Pelvis

Presenters Profiles

• Dr Kay East. Chief Health Professions Officer, Department of Health
• Ingrid Walker, Radiology Divisional Manager, South Tees NHS Trust
• Nick Clarke / Gill Gibbard / Tia Hollis
• Andrea Owen
• Rob Law
• GI / Fluoroscopy Consultant Radiographer - Frenchay Hospital, Bristol
• Dr Maxine Power
• Professor Peter Hogg
• Professor M G Bramble MD FRCP
• Dr Geoff Naisby

Conference Organiser's Report

This year the conference was held at the Blackwell Grange Hotel, Darlington on 11 - 12 September. Hosting the conference does rely on willing volunteers to organise the event in their own time, and I certainly had a lot of help from colleagues in my own department and from other radiographers within the Northern Region, with particular thanks to Liz Judson, Pat Conlon and Faye Bibbings. Thanks also to the following companies who sponsored the conference E-Z-EM, Guerbet, Sanochemia, Agfa, Siemens and Philips.

On the weekend of the conference I was so grateful for all of those people who pitched in sorting out programmes, all the freebies and any of the problems that arose. My particular thanks goes to Gary Culpan, who came to the rescue with the audio-visual equipment. To cap it all on that Saturday, I just could not believe when the fire bell went off just as we sat down to dinner! I was sure that someone was just playing a joke. The food and hotel staff came in for very high praise, and I must say the food throughout the whole weekend was excellent both in quality and quantity.

The committee had decided that the conference themes should reflect, the 4- tier structure in Fluoroscopy and GI radiology, GI radiographer role development, and the influence of the Government's modernising agenda. Major conferences are the ideal opportunity to debate the wider picture, as we are only able to get together in such large numbers at these events. It was felt that with Agenda for Change looming it was important to debate a number of issues that may influence the progression of radiographers with GI / Fluoroscopy. For example, how will we compare with other radiographers involved in role development and advance practice? Will radiographers who perform enemas be recognised for their skills? What will the future hold for GI radiographers in the face of developments such as CT Colonography? Will the barium enema become redundant? Are there new fields of role development which GI / Fluoroscopy radiographers move into? Will the position of radiographers within Fluoroscopy be threatened with the introduction of Assistant Practitioners?

Agenda For Change can be downloaded here as a Powerpoint file.

However, we have taken note from the delegates that perhaps there is a need to provide more clinically based study days. This may be because some GI radiographers are not able to access clinical training and education as easily as others.

We were delighted to have as our keynote speaker Kay East, the Chief Health Professions Officer. Her presentation was centred on the national agenda and modernisation of the NHS, and Allied Health Professionals role development.

We certainly now have a champion in Kay, as she has demonstrated by including two short articles on GIRSIG in the October and November issues of the Allied Health Professions Bulletin. You can access the bulletin via the Department of Health Website.

The programme contained a good level of clinical content with four GI / Fluoroscopy radiographers presenting their work to a national audience, either in presentation or poster format. On the Saturday, the successful candidates presented their case studies on audit of practice and service developments within their respective Trusts. The case studies were not just barium enemas, and this emphasizes the diversity of roles that GI radiographers are involved in. GI radiographer role development has evolved rapidly over the last ten years, and the opportunities that the four presenters have grasped may have seemed to have had little in common with the some of the delegates who were at the early stages of GI role development. But it will probably be the future for some of those delegates, especially if the numbers of enemas performed falls due the use of CT Colonography.

There was a good entry for the poster section. Dr East and Gary Culpan judged the poster submissions, with prizes being awarded for 1st and 2nd places to Liz Judson and Sue Rimes. Well done

The four workshops, with delegates being able to attend two, were very successful. The people who kindly ran the workshops had, in some cases, stipulated maximum numbers in order for delegates to get the best out of the sessions. So, unfortunately the numbers had to be restricted.

The swallowing workshop by Maxine Power dealt with normal and abnormal swallowing, and was extremely interesting and informative not only for those GI radiographers already involved in videofluoroscopy swallows, but also those contemplating moving into this area of role development.

Research and publishing is something that most of are not as involved as we should be. Peter Hogg provided the delegates with an insight into the importance of publishing our work in that it adds value to our work and that we have a responsibility to share our practice. Those of us who attended his workshop felt it was extremely valuable and helped allay some of the fears that we have towards publishing.

The feedback overall from the delegates was that they thought the conference was a success. Once again, all my thanks to everyone involved in organising the conference, to those who presented and to all the delegates who attended for making it such a successful event.

Rosalind Waugh
GIRSIG Conference 2004 Organisor.

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The Role of Barium Enema in the Diagnosis of Colo-Rectal Cancer
Saminah Yunis - Clinical Specialist GI Radiographer
DCR.R, PgC GI Image Interpretation

Introduction: As Barium Practitioners are becoming more competent and experienced in performing the procedure there appeared to be a decline in the number of barium enema examinations performed.

Methods: A retrospective audit was performed looking at the investigations used in the diagnosis of patients with colo-rectal cancer over a twelve-month period. The findings will be based primarily on statistics provided by the Mid Yorkshire NHS Trust Hospitals

Results: There was no clear patient pathway designed to investigate patients with symptoms of colo-rectal cancer. The type of investigation depends solely on the clinician's preference or the availability of the examination as opposed to the most appropriate investigation Patients who have been diagnosed with colo-rectal cancer have often never had a barium enema examination as part of their initial investigations.

Conclusion: The audit demonstrated the decline of barium enema as a primary investigation. However it does still have a role to play in the confirmation of disease and examination of synchronous pathology. But rather than the role shrinking opportunities are arising for radiographers to develop their role into Endoscopy and CT Colonography and achieve specialist status in the area of colo-rectal disease.

Author Profile: Saminah trained as a radiographer in Manchester and gained experience in both Barium Enemas and plain film reporting before taking the post of Clinical Specialist GI Radiographer at the Mid Yorkshire NHS Trust in 2002. Whilst in post she has completed the PgCert in GI image reporting and is performing flexible sigmoidoscopies.
Email saminah.yunis@panp-tr.northy.nhs.uk

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Borders Colon Service - Triage of Referrals
Fiona Hawke - GI Specialist radiographer

Aim: Provision of a seamless investigative process to facilitate diagnosis and rapid treatment of colo-rectal cancer

Purpose: Clinicians are often unsure of which colonic investigation is most appropriate and timely for their patient. The patients' fitness, their symptoms and the perceived urgency of the referral need to be considered in selecting the appropriate investigation.

Method: A co-ordinator triages referrals for colonic investigations using an agreed matrix based on SIGN guidelines for Colo-rectal cancer. The referrals are triaged to colonoscopy, radiology or surgical consultation with appropriate urgency. The reports of these initial investigations are confirmed and any further referral for treatment or investigation is planned by the co-ordinator. The co-ordinator is a GI Specialist Radiographer with MSc in Health Science and an additional Post Graduate Certificate in GI Image Interpretation.

Conclusion: The audit trail of the patients' journeys from referral to treatment has been audited and demonstrates that the triage system is appropriate.

Author profile: Fiona is a radiographer with specialist interest in GI studies and Clinical audit. As part of her studies for BSc in Health Studies she worked with the radiologists in setting up a Radiographer performed barium enema service (1998). While studying for MSc (1999-2001), she researched presenting symptomatology for colonic disease and set up a clinical audit programme for enema competency, false negative reports and false positive reports and bowel preparation. On completion of MSc she was appointed as Clinical Co-ordinator for the Borders Colon Service. From within this post, clinical activity in the investigative process of colonic disease has been streamlined. In 2003 she obtained a Post Grad Certificate in GI Image reporting and now first reports all enema examinations. She also informally reports all CT Colonography to gain experience in this branch of GI imaging. Her next venture is to train to perform flexible sigmoidoscopy examinations, and plans to undertake the Lower GI Endoscopy course in Caledonia University in Glasgow in Spring 2005.

Fiona A Hawke, Clinical Co-ordinator, Borders Colon Service, Borders General Hospital, Melrose, Roxburghshire, TD69BS, fiona.hawke@borders.scot.nhs.uk

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Collaborative Practice - working together to feed the growth of the future.
Sue Rimes - Specialist GI Senior 1 Radiographer (DC.R.R)
Nicky Forsyth - Colorectal Cancer Nurse Specialist BSc (Hons), RGN, EN (m)

This presentation aims to depict the ways in which collaborative practice has improved the service offered to patients following a colorectal care pathway in Musgrove Park Hospital, Taunton.

Avon, Somerset and Wiltshire Cancer Services (A.S.W.C.S) have been part of the Cancer Services Collaborative (C.S.C) since Nov. 1999. The purpose of this group is "to improve the experience and outcome of care for people suspected or diagnosed with colorectal cancer by improving the way in which care is delivered" (C.S.C Website). Musgrove Park Hospital is part of the ASWCS that was a pilot site for the first wave of the Cancer Collaborative back in 1999. Since then the ethos of the Collaborative has been shared across a number of specialities with the bowel cancer team embracing it wholeheartedly.

The CSC has demonstrated that "it is possible to reduce waiting times for diagnosis and for treatment by weeks and in some cases even months". (The NHS Cancer Plan, 2002).

The NHS Cancer Plan has an ultimate goal that "no one should wait longer than one month from an urgent referral for suspected cancer to the beginning of treatment except for a good clinical reason or through patient choice" (The NHS Cancer Plan, 2002).

Using the goals and targets defined by the NHS Cancer Plan and using the programme established by the CSC, Taunton and Somerset NHS Trust have established a multi- disciplinary team which works together aiming "To optimise service delivery from the patient perspective and to support clinically effective care". (CSC Website)

Appendix 1 shows some of the positive outcomes of this collaborative effort.

The presentation will demonstrate the basis on which changes in practice were made. It will establish which staff groups took ownership of the ideas and look at the initiatives they took to drive the service forward.

It will depict the advances made in the service, expressing how unity within the multi-disciplinary team and a shift towards patient focused care has improved the experience and clinical outcome of care.

AIMS AND OBJECTIVES

• To show examples of collaborative practice
• To demonstrate the positive outcomes of collaborative practice in terms of improved patient experience.
• To support the objectives of the Cancer Services Collaborative
• To highlight the opportunities for role development of nurses and AHP's resulting from the service changes.

Appendix 1

Examples of new and collaborative practice and their outcomes.

	1	2	3	4	5	6
Rapid referral for patients with suspected CRC	x		x			x
Pre-booked appointments	x	x	x		x	x
Pre-planned care	x	x	x	x	x	x
Radiographer led lower GI service		x	x			x
Nurse led clinics		x	x	x	x	x
Nurse endoscopy service		x	x		x	x
Patient care by clinical nurse specialists	x	x	x	x	x	x
CRC team meetings	x	x	x		x	x
Patient assessment prior to x ray	x	x	x		x	x

Key for CSC objectives. (NHS Modernisation Agency website)

1. Certainty and choice across the process of care
2. Predict patient requirements - Pre-planning and pre-booking
3. Reduce unnecessary delays and restrictions on access
4. Provide a personalised, consistent service
5. Improve patient and carer satisfaction
6. Provide the best care, in the best place, by the best team.

Reference list:

Cancer Services Collaborative website: www.acws.nhs.uk
NHS Modernisation agency website: www.modern.nhs.uk/cancer
Department of Health (2002)
The NHS Cancer Plan HMSO, London.

Recommended reading list:

Cancer Services Collaborative website, www.acws.nhs.uk
NHS Modernisation Agency website, www.modern.nhs.uk/cancer
The NHS Cancer Plan, Sept.2002, Department of Health.
Radiography Skill Mix; A report on the four-tier delivery model, June 2002, Department of Health.
Improving Outcomes in Colorectal Cancer, The Manual; Nov.1997, Department of Health.

Author Profiles:

Sue Rimes - Radiographer for 20+years, all of them spent at Taunton following training at Plymouth School of Radiography. Started doing barium enemas in 1996, went on the Cranfield course in 1997/8. Upgraded to Senior 1 in 2000 to look after the barium enema service in Taunton. Now responsible for the rapid referral service and running of unsupervised lists. Responsible for a team of 5 GI radiographers, their training and supervision of their work. Susan.Rimes@tst.nhs.uk, Tel. 01823 343038. Taunton & Somerset NHS Trust, Musgrove Park Hospital, Taunton & Somerset NHS Trust, Somerset TA1 5DA.

Nicky Forsyth - Nursing for 20+ years, obtained degree in nursing in 2003. Has been a Colorectal Cancer Nurse for 5 years. Her role is to support patients with colorectal cancer by creating a "seamless pathway of care". Nicola.Forsyth@tst.nhs.uk

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Radiographer Managed Paediatric Micturating Cystography
Rosalind Waugh - Clinical Lead - Fluoroscopy (PgC; DCR.R)

This paper will report on the development of a radiographer managed paediatric micturating cystography (MCUG) service at James Cook University Hospital, South Tees NHS Trust Middlesbrough. It will discuss how this area of radiographer role development led to other urological procedures being undertaken by GI radiographers, and has led to continuity of the service and streamlining of patient care.

Background: The paediatric radiologist who performed paediatric MCUG examinations resigned her post in June 2002, with a leaving date mid September 2002. As there were no external applicants for the post, and none of the radiologists in post were able to provide this service due to already heavy commitments, the Clinical Lead Radiography in Fluoroscopy, a Gastrointestinal Advanced Practitioner, was asked to consider training to take over this particular role.

Development of the Role: The Radiographer Practitioner, after discussion with her manager and the Paediatric and Urology Radiologists, became responsible for developing her own training plan. This was due, in part, to the fact that there were no formal, accredited courses available for the performance of paediatric MCUG's.

Outcome: Following a period of training, supervision and evaluation of practice, the Radiographer Practitioner was deemed competent to both perform and report the examinations. This change in practice has been supported by training, policy and protocol, resulting in the paediatric MCUG service being maintained at South Tees without affecting patient care or safety.

Further Advances in Radiographer Role Development: Since successfully demonstrating her ability to manage the paediatric MCUG examinations, the Advanced Practitioner has further developed her role by independently performing and reporting adult cystograms. Other examinations also now performed and reported include nephrostograms and tubograms,

Further opportunities have now arisen for other GI radiographers to perform adult post radical prostatectomy cystograms, under the supervision of the GI Advanced Practitioner.

Author Profile: Rosalind's experience in GI Radiographer role development began in 1992, being the 1st radiographer to perform and report barium enema examinations in South Tees NHS Trust. She attended the 1st St James's Barium Enema Course, and she has gained a Pg C in GI Image Interpretation at Salford University. She is also undertaking an MSc in Fluoroscopic Imaging at the University of Wales, where she has had input into the postgraduate course as an Honorary Lecturer. She has presented both internationally and nationally on her role in Fluoroscopy, and has had 2 publications in a peer reviewed international paediatric journal.

Her clinical role also includes performing and independently reporting upper GI examinations and some urological examinations. She also participates in the training / education of specialist radiology registrars in fluoroscopy.

Passionate about radiographer role development in Fluoroscopy, she leads a successful team of GI Radiographer Practitioners who independently report their studies. The team is recognised in the Trust for delivering a high quality, accurate barium enema service that is associated with a high level of patient satisfaction.
Rosalind is now developing the role of an Assistant Practitioner in Fluoroscopy, a new role that is already bringing benefits to the Fluoroscopy service at South Tees.

Rosalind Waugh, Clinical Lead - Fluoroscopy, James Cook University Hospital, Marton Road, Middlesbrough, Cleveland, TS43BW, rosalind.waugh@stees.nhs.uk
01642 850850 ext 3612 /3619

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Poster Abstracts

To show that an increase in radiographer involvement in the barium service reduced waiting times at Sunderland NHS Trust

In 2003, one radiographer performed barium enemas and was studying for a postgraduate reporting qualification.

May 2003 a radiographer with a Postgraduate Certificate in Fluoroscopy, and who performed barium enema, meal and swallow examinations, was employed by the Trust. This Lead radiographer had also previously been part of a Radiographer/Speech and Language Therapy (SALT) led video fluoroscopy service.

September 2003 - pilot for radiographers to use all fallow sessions and provide a report for comparison with the radiologists report.

November 2003 - Lead radiographer set up Radiographer/SALT led video fluoroscopy service.
Radiographers provide a report as part of a double read service and continue to use fallow sessions.
Radiographer performing barium swallows and meals.

June 2004 - pilot for radiographers to supervise barium follow throughs following a protocol-providing comments and the radiologists issuing the final report.
August 2004 - a third radiographer employed able to perform barium enemas and studying for a postgraduate reporting certificate.

Results

The graphs show the percentage rise in radiographer performed studies and waiting time reductions.
With radiographers continued involvement and full room usage these waiting times are sustainable.
The barium follow through waiting times should reduce in a similar way.
The radiographers are audited for reporting accuracy.

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Use of a tin filter for lateral decubitus projections in double contrast barium enema: image Quality and potential dose reduction Compared to use of secondary radiation grids

Matthew Palfreman, Radiographer, York Hospital

The lateral decubitus projections could be considered the most important images in any DCBE examination. However, they have been shown to contribute almost 30% of the total examination dose, so any way of reducing the radiation dose to the patient, without compromising image quality should be explored.

Lateral decubitus films are conventionally produced with stationary secondary radiation grids, but radiographers at York hospital routinely use tin filtered cassettes for lateral decubitus projections. This study compared the image quality and patient radiation dose using tin filters and stationary secondary radiation grids.

The results showed that although there seemed to be a marginal loss in resolution with the use of tin filters, the image quality was adequate enough to make a diagnosis. The dose results showed that a substantial reduction in patient dose could be achieved with the use of tin filters.

Although this was a small study, the results justify further investigation to verify the findings and promote this radiation dose reduction technique more widely.

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Citramag bowel preparation for double contrast barium enema: A 5 year audit cycle

Alison Booth, Philip Copley, Sam Daley, GI Radiographers.

A clean colon from adequate bowel preparation is an essential prerequisite for a successful double contrast barium enema (DCBE) examination. In order to effect continuing improvements in the quality of bowel preparation in a district general hospital performing over 600 DCBE per year, a five year audit was carried out.

Data for the audits were collected from the record files of four experienced GI
radiographers. Part of their routine practice was to apply the scoring system to all examinations to assist with audits. Audit cycles were performed over a five year period. Changes to the regime were made and a re-audit carried out at each stage to measure the effect of the changes.

The improvement seen between (a) the original single sachet of Citramag and the results for (c) the double sachet of Citramag were found to be statistically significant (p<0.0001, Chi 2 test).

The ideal bowel preparation should leave no residual faecal material or fluid. It should be tolerable for the patient with minimum side effects and be easily administered on an out patient basis. Doubling the amount of Citramag taken by patients prior to their barium enema examination met these criteria to our satisfaction.

Acknowledgements:
This poster was peer reviewed and accepted for the European Congress for Radiology 2003 in Vienna on EPOS(TM) - the Electronic Poster Online System.

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Towards a Radiographer led Gastro-Intestinal Radiology Service in York

Philip Copley, Jane Savage, Louisa Crowe, Alison Booth, GI Radiographers, York Hospital

Radiographer performed gastro-intestinal (GI) examinations have become accepted practice both locally and nationally. York Hospital has been at the forefront of service redesign and staff development in the GI field since 1992. Four specially trained radiographers currently perform 75% of the 1800+ barium enemas undertaken annually in York.

More recently, following the development of appropriate postgraduate training schemes, radiographers in York are now issuing radiographic reports on barium enemas. In addition, the range of examinations being undertaken is expanding, with the clinical lead radiographer undertaking barium swallows and being a member of the multidisciplinary team undertaking videofluroscopy for speech and language therapy. GI tract barium studies account for over 90% of the routine activity in the two screening rooms at York Hospital.

The poster outlines the training, local implementation, reporting developments and maintainance of competence as well as the service achievements locally and plans for the future.

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Development of a Low Dose Fluoroscopy Technique to Image the Paediatric Pelvis

Rosalind Waugh, Moira McCarty, Hazel McCallum, Richard Montgomery.

Background: An audit of pelvic radiographs identified deficiencies in gonad shield placement and radiographic technique.

Objective: A technique using grid - controlled fluoroscopy (GCF), with hardcopy images in frame grab and digital spot images (DSI) format, was evaluated to optimise gonad shield placement and reduce the dose given to children with Perthes disease and developmental hip dysplasia (DDH) attending for pelvic radiographs.

Materials and Methods: Phantom and patient dose surveys of conventional and fluoroscopic techniques were carried out. Image quality and radiation dose were compared for the frame grab and DSI techniques. Retrospective evaluation was undertaken to compare their clinical acceptability.

Results: Both fluoroscopic techniques gave considerably less radiation than conventional non - grid radiography (67-83%, P < 0.05). The frame grab technique gave less radiation than the DSI (P < 0.05). There was no significant difference in the clinical acceptability score of the DSI and frame grab images (P < 0.05).

Outcomes: Fluoroscopy acquired images are now used as they give much less dose than conventional radiography, and provide images of sufficient quality for clinical assessment. Paediatric patients attending for follow up pelvic radiographs are now appointed onto dedicated fluoroscopy sessions, prior to their outpatient appointments. There is also flexibility of appointments for parents and carers who can only attend at particular times. This has led to a higher patient throughput and a reduction inpatient waiting times in clinic.

The main author designed a set of gonad shields for this project. They have proved easier to use than other commercially designed products, with audits demonstrating that there was an improvement in gonad protection for paediatric pelvic examinations in all areas of the department.

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Presenters Profiles

Dr Kay East

Chief Health Professions Officer, Department of Health

Kay East has an extensive background in practice, policy and service management in both health and social services. She spent five years as a University lecturer and has been a board member of a charity and a Community Health Council member.

As Chief Health Professions Officer, Kay works closely with colleagues in the Department of Health, and other Government Departments, to ensure professional advice on the practice and delivery of AHP services is available to policy colleagues. As part of the Professional Leadership Team, working in the Directorate of Patient and Public Involvement, she is passionate about patient choice and ensuring that patients are partners in the decisions made about their care. Kay is committed to improving health and social care, developing new roles and ways of working and promoting the unique contribution that allied health professionals offer to patients.

Ingrid Walker

Radiology Divisional Manager, South Tees NHS Trust

Ingrid qualified in the Netherlands as a radiographer in 1980, and moved to England in 1983. She has been involved in managing radiology departments for the last 10 years, and holds an MBA from the Open University. Through establishing an energetic, creative and supportive environment she aims to develop both the individual and the radiology departments.

Nick Clarke / Gill Gibbard / Tia Hollis

Nick is Supt.Radiographer at Glenfield Hospital in Leicester, responsible for plain film and fluoroscopy. He has been a GI Practitioner for 7 years and has just completed a Pg C in GI Image Interpretation.
Gill Gibbard has been in the NHS for 25 years, first as a Health Care Assistant, then for 7 years as an RDA before commencing on the APU Assistant Practitioner Course 2 years ago.

Tia Hollis started as a Care Assistant within a Care Home, then was appointed as an RDA 7 years ago, and has for the last 2 years been undertaking the APU course.

Gill and Tia have now completed the course and work in all areas of the department, including Fluoroscopy. They have since enrolled with APU for another 2 years to do their BSC and become HPC registered.

Andrea Owen

Andrea graduated from Salford University in 1995, as one of the first intake of degree students. Leaving her training hospital, Burnley General, she took up her first post at South Manchester University Hospital, first based at Wythenshawe then Withington. By 1998 Andrea had developed an interest in GI radiography and encouraged by the GI Lead radiologist, Professor D.F. Martin she completed the Leeds Barium Enema course. In 1999 the entire diagnostic barium service moved to the Wythenshawe site, and Andrea took the lead in this area, first as Senior 2 and the Senior 1. Having undertaken several short courses she enrolled on the new GI Reporting course at Salford University in 2001. Upon completion regarded to Advanced Practitioner, Andrea went back to Salford but this time as Honorary Lecturer, working closely with Julie Nightingale on the GI courses. 2004 and Andrea was approached by the University of Central Lancashire to assist with development of an Assistant Practitioner course, leading to another Honorary Lecturing post. This year also Julie Nightingale and Andrea present to the American Radiographers National Conference in Dallas.

Rob Law

GI / Fluoroscopy Consultant Radiographer - Frenchay Hospital, Bristol
1970 Qualified in Bristol
1974 Radiographer Frenchay Hospital
1980 Supt Radiographer General X-Ray
1992 Supt Clinical Radiographer in GI
1996 GI Fluoroscopy became a radiographer led service
1999 Appointed Clinical Specialist at District 1 Grade
2003 Appointed Consultant Radiographer in GI Fluoroscopy

Written and talked widely on aspects of GI Fluoroscopy, particular interest is GI intubation and enteroclysis, and of course GIRSIG. Outside interests: I'm a Magistrate and I enjoy golf, writing pantomime and "acting" in i., wining and dining.

Dr Maxine Power

Maxine is a senior research fellow who works between The University of Salford and Salford Royal Hospitals NHS Trust. She is a Speech and Language therapist with an academic background in the physiology of swallowing in health and the patterns of swallowing abnormality after cortical stroke.

She has specific expertise in videofluoroscopy, and for the last ten years has been studying stroke patients within the first two weeks of stroke assessing their level of impairment with videofluoroscopy and correlating this with long-term outcome. In her current role, she also provides a clinical governance lead for the integration of evidence into practice in stroke and dysphagia.

She has responsibility for post-graduate dysphagia teaching, which includes the training of nurses and allied health professionals. She has worked with Julie Nightingale and Andrea Owen at the University of Salford to set up advanced training in the videofluoroscopic assessment of swallowing. This is the first UK programme to allow advanced non-medical practice in videofluoroscopy and upper GI examinations and was run for the first time in September 2003 and completed June 2004.

Professor Peter Hogg

Peter is a qualified diagnostic radiographer whose clinical interest remains nuclear medicine.
In 1985, whilst working at the Institute of Nuclear Medicine (University of London), he took a particular interest in research and publishing and conference presentations.

His publication track record began in 1986 and since then he has made contributions to the professional knowledge base in diverse fields, including child protection, applied computing and of course nuclear medicine. He regularly lectures in the States and in June 2004, together with UK GI specialists, he managed a day workshop on the role of the GI radiographer in Dallas, Texas. He is also an honorary lecturer at Gdansk Medical School in Poland and he is external examiner for "PhD's" at two universities and for "MSc's another two universities.

At the University of Salford he holds a professorship. He is also the course leader of the MSc Nuclear Medicine and the Clinical Reporting Course in Nuclear Medicine. In his spare time he is Editor in Chief of the international journal of Radiography.

Professor M G Bramble MD FRCP

Professor Mike Bramble is a Consultant Gastroenterologist at the James Cook University Hospital in Middlesbrough. Appointed in 1982 after training in Newcastle upon Tyne, he became Clinical Director for Gastroenterology in 1991 and Head of Medicine (budget £52m) in 1998. He is widely known for encouraging open access endoscopy to Primary Care and was chairman of the Endoscopy Committee and Vice-President of the British Society of Gastroenterology 2000-2002. He has been involved as an independent reviewer for both the SIGN and NICE dyspepsia guidelines. His research interests include the value of endoscopy in the early detection of upper gastrointestinal malignancy and the effect of acid suppression on diagnosis. He is also a member of the training faculty for the Basic Skills in Therapeutic Upper Endoscopy Course and member of the North East of England Endoscopy Training Centre based at the James Cook University Hospital.

Dr Geoff Naisby

Consultant Radiologist (1989) James Cook University Hospital, Middlesbrough. Honorary Lecturer and Internal Examiner - Medical Ultrasound, School of Health, Teesside University.

Special interests - Uroradiology, Breast Imaging, Ultrasound and staff development through skill mix.

Dr Naisby believes that

" Staff involved in the care of patients should own the patient's clinical problem - proper role development through skill mix should have this at it's heart- if not, it will fail"

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