Guys and St Thomas Radiology - London Deanery

Introduction
Guy’s and St Thomas’ Hospital Trust
Job Description 2009
Specialty Registrar in Diagnostic Radiology
This post is currently a rotation between the Guy’s and St Thomas’ Hospital Trust and
Frimley Park Hospital, Lewisham Hospital, Kent and Canterbury Hospital and
Hastings and Eastbourne Hospitals. This training programme will comprise three
month rotations within the Trust with three month rotations to Frimley Park Hospital,
Lewisham, Eastbourne and Hastings Hospital in the first two years. The training
programme in year three will include a six month rotation with the Kent and
Canterbury Hospital or Hastings and Eastbourne Hospitals. Years four and five
comprise six month rotations which are generally held within the Trust allowing the
candidate a choice for sub-specialty training in the fifth year.
The large Trust was established in April 1993 with the combination of Radiology
Programmes in 1994. The Radiology Departments will remain on both sites and are
managed by a single Clinical Lead and clinical director. The trust has an excellent
financial backing and there have been and continue to be significant investment in
new technology and new staff in the radiology department making it an exciting and
youthful department.
Training
Training is based on clinical radiological experience at the six participating Hospitals
and the Royal College of Radiologists, London Lecture programme and structured
training in clinical radiology. Study sessions are provided as per terms of contract.
Research opportunities are available at all stages
Guy’s and St Thomas’ Hospital Trust
In addition to district specialties of medicine, surgery, obstetrics, orthopaedics etc,
there are specialist units in the Trust for adult and paediatric cardiology, adult and
paediatric nephrology, including transplantation. There is a large oncological
department at both sites with facilities for radiotherapy and a large breast unit on
Guys site. Neurosciences are represented both for adult and paediatric neurology in
association with the King’s Neurosciences Centre and there are rotations to Kings in
years 2 and years 4
There has been a movement of acute services from the Guy’s site to the St Thomas’
site and the establishment of a single A+E Centre at St Thomas’. The PACS and
radiology information system is cross Trust. The hospital has a fully operational;
PACS system

Guy’s Hospital
The main radiographic facilities are on the 2nd and 3rd floors of Guy’s Tower, which
was built in 1977. There are 13 examination rooms including 3 ultrasound rooms, an
angiocardiographic room and a non-vascular interventional room. There is a 1.5
Philips Gyroscan MRI Unit predominantly for research purposes and a 16 slice
Philips multislice Spiral CT Scanner installed. There is an additional new CT scanner
being installed this year (2009). New digital rooms have being installed.. There are 3
US machines in general US. There is a newly developed Breast Unit with 3 digital
mammography units and 2 dedicated US machines. Obstetric ultrasound and
ultrasonic angiology are separate departments. There is a separate, large very active
nuclear medicine department.
Facilities and Activities
There are StR offices and research facilities. The Department has a well-equipped
Lecture Theatre and a separate demonstration room. There are Registrar offices.
There is a department library containing a selection of books and journals, and there is
a departmental film library. Internet access is available across the department. A
computerised reference retrieval system is also available. Departmental teaching
conferences are held daily. There are regular clinico-radiological conferences in
urology/nephrology, chest medicine, surgery and neurology. Multidisciplinary
meetings for gynae and uro -oncology, lung cancer, breast cancer and ENT oncology
are held weekly.
Department of Radiological Sciences
This Department is now firmly established and headed by Prof Razavi. There are a
number of other members of staff with scientific backgrounds. Members of the
Department of Radiology and Nuclear Medicine are automatically members of the
Department of Radiological Sciences.
Academic Chair of Interventional Radiology
This post was established in 1992 and is held by Professor A Adam. Professor Adam
is Chairman of the Minimally Invasive Therapy Group at Guy’s in the Department of
Radiological Sciences.
There are extensive facilities for intervention in the trust with a very broad range of
vascular and non vascular intervention. New techniques available include oesophageal
stent insertion, oesophageal dilatation, vertebroplasty, RF ablation of liver, renal and
lung tumours, carotid angiography/angioplasty.
St Thomas’ Hospital
The Radiology Department at St Thomas’ Hospital consists of 26 examination rooms.
Three of these are situated in the A&E Department but the rest are altogether in the
main department. There are good links with the Department of Nuclear Medicine

which is in close proximity. There are 2 CT/PET units at the St Thomas with regular
PET /CT sessions in the oncology blocks. Three of the departmental radiologists
have regular PET reporting sessions
There is a self contained ‘vascular suite’ within the main department with digital
subtraction angiography and full theatre suite for endovascular stents installed in
2006. There is a new Philips multislice 46 slice CT installed in 2006, and 2 back to
back Siemens 1.5 T MRI scanners also installed in the same year. There is a
Multislice CT in A and E
There is a newly developed 3 room general US department and a separate
gynaecological ultrasound department.
Facilities and Activities
The Department has good conference and library facilities within the Department.
There are Registrar reporting areas. There are regular clinico-radiological
conferences in urology, gastro-intestinal radiology, chest radiology, oncology,
neurology, endocrinology and paediatrics. A daily teaching meeting is held. Regular
audit is undertaken within the Directorate involving junior medical staff and there is a
monthly audit meeting.
Study leave is allowed at 30 days per annum.
Research facilities are available in all aspects of rotational training.
Staff Summary
Between the two sites there are 18 consultant radiologists including 5 full time
interventional radiologist, two fellows (Interventional), and approximately 25-30
specialty training grade registrars.
Summary of Training
Specialty Registrars joining this rotation will gain experience in basic radiology as
well as exposure to specialist techniques. Emphasis will be placed on the accurate
interpretation of radiological signs essential for the interpretation of all x-rays and
other clinical radiology modalities. The first part of FRCR is held in March and is
requires knowledge of the physics related to Radiology and radiation protection. The
remainder of the year will be spent learning basic radiology skills.
The second and third years will be based on modular teaching to allow completion of
FRCR part 11A and 11B. The Specialty Registrars will be expected to analyse films
and carry out procedures and develop skills in angiography and other interventional
procedures. Ultrasound, CT and MR will be taught in the appropriate modules.
Assessment and appraisals will be undertaken and the Royal College of Radiologists
personal portfolio will be completed. The post is subject to yearly review.
The forth and fifth years will allow for a subspecialty interest to be developed while
continuing general radiology training.

Inteventional training will be undertaken at all stages, but there are facilities for
fellowships and lecturer position in pure intervention in years 5 / 6.
On Call
The candidate will participate in the on call rota that covers both sites from the second
year providing they have demonstrated competency in assessments and satisfactory
progress in their training. There are always consultants on call for assistance. The
banding and intensity of on call are in the process of reorganisation due to EWTD
changes, and it is anticipated that a partial shift will operate at some time.
Terms and Conditions of Services
Please refer to the medical staffing department of the trust.
Arrangements to inspect the Department
Due to the probable number of prospective applicants it is not anticipated that
applicants will be shown around until after shortlisting.
Shortlisted candidates wishing to view the Departments should contact Dr Rottenberg
via e mail on giles.rottenberg@gstt.nhs.uk. the imaging secretary on 0207 1885461 (
Denise) to provide information on the open days that will be arranged.

Outline of post FRCR/ year 4 and year 5 training options
Breast Specialisation
1 Several registrars have undergone specialisation in breast radiology and 3
new breast radiologists have been appointed over the past 24 months
2 Established links have been made with the breast units at Kings college
hospital and the breast screening centre at St Georges hospitals. STRs have
rotated to the centres for periods of between 1 and 3 months to obtain
experience in screening
3 There are 3 one stop breast clinics at Guys and St Thomas and these provide
extensive experience of symptomatic breast disease.
4 The department has recently acquired digital mammography at Guys and a
new dedicated breast US machine has been obtained for Guys hospital
5 There is an active breast MRI service
ROTATION
Monday Tuesda Wednesday Thursday Friday
AM Breast MDT One stop
Localisation/
Biopsies
PM Mammography
Biopsy
Guys one
stop clinic
clinic
Breast
MDT
Mammograph

Gastrointestinal Imaging
1 Most of the GI services are centralised at the St T site. Due to its wide
breadth of modalities subspeciality training can be offered in 2 blocks with
the emphasis of one block on interventional BI radiology and the other
block emphasising non interventional GI radiology.
X- sectional GI
General Screening
(AJ)
GI CT
Colon cancer
MDT(GR)
Interventional
GI CT
C
OPTIONS
Upper GI
MDT (SR)
Endoanal US
(GR)
GI Ultrasound Body CT
(AJ)
Research Proctography
(GR)
Liver Biopsy Biliary
intervention
(AA)
Oesophageal
Stent (TS)
Pelvic MRI
(GR)
There is an active endoscopic ultrasound unit with the opportunity to participate in
watching or training in EUS.
Interventional
Biliary intervention, Oesophageal stent insertion, Biopsy,

Musculoskeletal Imaging
1 Several registrars are currently undergoing subspeciality training in
musculoskeletal radiology. Links have been established with The Royal
National Orthopaedic Hospital and recent trainees have attended Stanmore 3
full days a week for subspecialty training
3 A new vertebroplasty service has been established
Guys / St T MSK Rotation (6 months)
M T W T F
MRI (WJ) MSK
MRI/CT
MSK US (VJ) Generalradiolgy General
General Plain XR MSKMRI Study Mri msk

Paediatric Radiology
Guys / St T
1 Several STR’s have recently completed subspeciality training in oadiatric
radiology. Guys and St T offers excellent tertiary referral experience in
paediatric cardiology, neurology and urology including transplantation.
There is a large padiatric ICU with an active retrieval service. There is a
large neonatal unit at St T. Acute general paediatric experience is lacking
at the trust and peripheral attachments have been establishes at Lewisham
to provide experience/
2 Tertiary referral paediatric experience has been made available to STRs
with a full time rotation to Great Ormond street Hospital which offers
paediatric onclology, respiratory and general surgery which is not
available at the trust. Research projects are also undertaken at GOS.
3 New paediatric radiological developments at Guys include a new
paediatric cardiac MR service with non interventional imaging of cardiac
congenital cardiac abnormalities in a unique unit with MR/ catheter unit .
4 Since the last college visit Dr Jan has been appointed who leads the
paediatric neuro radiology service. A new full time paediatric radiology
appointment is in process and is due to be in place by the end of march
2004
5 A new paediatric hospital is nearing completion on the St T site and will
unite paediatric services across the trust. The new hospital will offer full
paediatric imaging including US, screening, MRI, and a full PACS system.
Mon Tues Weds Thurs Fri
Plain Xray
General X
Ray
GOS (typical week)
Paediatric
neuroradiolgy
meeting (WJ)
Guys
Paediatric
Urodynamics/
screening(AJS)
Guys
Paediatric
US(LLM) St T
PICU
meeting
Paediatric
neuro MRI
(WJ) Guys
Paediatric
US
(AJS) Guys
General
radiology
Study
Mon Tues Weds Thurs Fri
Research Ultrasound PICU/NICU
meeting
Plain Xray
Screening MRI CT Study

Chest Radiology
Guys
1 Guys hospital offers a large chest oncology service with an active thoracic
surgery department. There are 2 excellent MDTs with all specialties
represented. There is excellent experience in PET for lung cancer.
2 There is an established link with the Royal Brompton hospital which offers
additional experience in benign chest disease and research opportunities.
Mon Tues Weds Thurs Fri
PET/CT Chest Biopsy
Thoracic
Brompton Chest
surgery
oncology
meeting
meeting
Chest CT
(SR)
General X
Ray
CT chest
General Xray

Oncology Imaging
There is extensive opportunity to specialise in oncological imaging in the training
scheme. Most of the cancer services are centralised on the Guy's site although surgical
oncology is predominantly on the St Thomas site.
There are many multidisciplinary meetings that STR's are encouraged to attend.
There is extensive exposure to PET imaging during training and several recent STRs
have undergone additional training in PET as part of their sub speciality training. 2
new CT/PET cameras are due to be installed in 2004 and will no doubt lead to even
more exposure to PET and research potential.
There is a new 1.5 T Phillips MR at Guys with dedicated oncological slots for staging
of cancers. There is a new 16 slice CT scanner on the Guys site which is used
predominantly for oncological imaging.
Mon Tues Weds Thurs Fri
Uro
oncolo
gy
MDT
(SR/G
R)
Nuc med/PET CT(SR) US Biopsy
(GR)
MRI (SR) CT(SR)
Oncology
meeting
Example of St Thomas cross sectional oncology rotation
Chest
oncology MDT
Interventional
(CS)
STRs wishing to specialise in oncological imaging are encouraged to undertake a 6
month block on the Guys oncology rotation. They would also be encoraged to
perform a cross sectional 6 month block at St Thomas to gain further exposure in
surgical oncological staging and interventional techniques for oncology
There are informal limks with the Royal Marsden Hospital and STRs with an interest
in oncology would be encouraged to visit on a weekly basis to enrich their exposure
to oncological imaging. Several STRs have previously undertaken this training over
the past few years (Dr E Elson/ Dr Scott- Mackie, Dr E Sanderson)

Urology
Urology is based exclusively at Guys site. There is very active enthusiastic team of 9
consultant urologists who have all subspecialised. The stone unit is one of the largest
in the country. The stone unit produces significant renal access work. The surgical
oncology urologists are very active and perform large numbers of radical
cystectomies, nephrectomies and prostatectomies each year. Prostate Brachytherapy
is being performed. Laparoscopic surgery is performed as is robotic laparoscopic
surgery. The renal unit is very large and busy with approximately 150 renal
transplants performed annualy. There is a large renovascular workload.
Mon Tues Weds Thurs Fri
Urol MDM
Uro
US Prostate
Bx (GR)
intervention
UrologyMRI
(SR)
Uroradiology
meeting
Urology US
Renal meeting
Uro-
intervention
(CS) or Uro
MRI
Additional experience in lithotripsy and brachtherapy can be arranged via the stone
unit.
Additional interventional sessions can be arranged and STR’s who wish to specialise
exclusively in uroradiology would be encouraged to undertake a 6 month
interventional attachment during which time they would become independently
proficient in renal access, ureteric stent insertion and renal vascular intervention.

Gyaecological/Obstetric Radiology
St Thomas is the regional centre for gynae oncology services. There is an active
weekly MDT.
M T W Th Fr
Gynae US Gynae MRI Gynae MDM/
Intervention
LLM (stT)
HSG
(guys) (CS)
Obstetric US Gynae US
CT (Guys) MRI
Transvaginal
(Guys)(GR)
*Additional Gynae MRI experience may be available at Barts via Prof R Reznek.
Informal links are in place
*Optional sessions in breast imaging could be made available

Dental /ENT
Most of the ENT services are centralised on the Guys site with a large maxillofacial
surgery unit.
Guys has a large dental hospital with its own dental radiology department and
trainees. There is a link in place with interventional procedures taking place in the
radiology department
Additional experience can be made available at the Royal national ENT Hospital
where there is an informal arrangement for year 5 StR to visit.,
M T W Th Fr
Screening
CT Guys/ MR
Guys ENT
Dr S Conner
MR Dr Conner
ENT
Sialography/
Stone
extraction
(StT)
US FNA
(VJ) (StT)
CT Guys
ENT meeting
Teaching Dr S
Conner
MDM ENT