Health Education Yorkshire and the Humber

Breast Imaging Fellowship ST4/5

Job Description

Breast Imaging Fellowship ST4/5

Job Description

Introduction This post based at the Royal Hallamshire Hospital in offers a unique opportunity to obtain comprehensive training in breast imaging. This fellowship is part of the Yorkshire & Humber School of Radiology and will be coordinated by the specialty Lead for Breast Imaging in Sheffield – Dr Olga Hatsiopoulou. The duration of the post if entering at ST4 is 2 years, and if entering at ST5 is 1 year. RCR core curriculum breast imaging experience is required for entry at the ST4 level, and 6 months of breast imaging experience is desirable, but not essential, for ST5 entry, together with a clear demonstration of a career focus towards breast imaging. The program will cover all aspects of both diagnostic imaging and breast intervention, leading to level 2 competency in breast radiology and Certificate of Completion of Training. Sheffield has an excellent track record in training breast radiologists, having trained 11 registrars to consultant level breast imaging posts in the past 8 years. Training in breast imaging will comply with the standards specified in the breast sub section of the Royal College of Radiologists 2015 curriculum in clinical radiology.

Sheffield Sheffield is England's fourth-largest city, with a population of over half a million, with the wealth of facilities you would expect to find in a major city, yet it is compact, welcoming and accessible. It is a friendly city with a prosperous economy and relatively low cost of living, all of which makes for an excellent quality of life. It has good rail and road links, with a typical train journey to London St Pancras taking 2 hours. Manchester Airport is also just over an hour away with an ever expanding repertoire of routes to national and international destinations. The city of Sheffield contains an abundance of entertainment and cultural activities including award-winning theatres, (the Crucible and Lyceum are world-class theatres and major regional attractions), museums and galleries, a variety of clubs and live music venues, and a range of spectator and participation sports. With a thriving cultural industries quarter and a range of city-wide events throughout the year, there is something on offer to suit everyone’s taste and interests. Sheffield also boasts two of Britain's most popular and successful Universities, which between them attract more than 38,000 students a year Located on rolling hills and dissected by river valleys, Sheffield is one of the greenest and most wooded cities in Europe. More than a third of the city lies inside the beautiful Peak District National Park, and it is virtually surrounded by open countryside – over half the city’s population live within 15 minutes of open countryside. It is also the greenest city in England, with 175 woodlands and 75 public parks. Sheffield offers a unique proposition of city culture alongside access to some of the most stunning countryside in the UK. This environment, together with the unparalleled strength of the city’s climbing, running, walking and biking communities, sets Sheffield apart from anywhere else in the UK. There is also a wide range of affordable housing and excellent schools on offer.

Organisation Profile Sheffield Teaching Hospitals NHS Foundation Trust is one of the UK’s busiest and most successful NHS foundation trusts. We provide a full range of local hospital and community services for people in Sheffield, as well as specialist care for patients from further afield, including cancer, spinal cord injuries, renal and cardiothoracic services. In addition to community health services, the Trust comprises five of Yorkshire’s best known teaching hospitals. • The Royal Hallamshire Hospital • The Northern General Hospital • Charles Clifford Dental Hospital

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• Weston Park Cancer Hospital • Jessop Wing Maternity Hospital The Trust has a history of high quality care, clinical excellence and innovation in medical research. We are proud to be in the top 20% of NHS Trusts for patient satisfaction and, following its inspection in 2015, the Care Quality Commission has given the Trust an overall rating of ‘Good’ with many areas and services highlighted as ‘Outstanding.’ This means that the Trust is one of only 18 (out of 174 Trusts) to have achieved green in every one of the five domains which the Care Quality Commission use to rate a NHS organisation. We are also the only adult healthcare Trust in the Yorkshire and Humber region to have achieved a Good rating overall. We strive to promote a culture of continuous quality improvement and encourage our staff to innovate and adopt ‘best practice’ in order to deliver the highest standard of care to our patients. The Northern General Hospital is the home of the City’s Accident and Emergency department which is also now one of three adult Major Trauma Centres for the Yorkshire and Humber region. A number of specialist medical and surgical services are also located at the Northern General Hospital including cardiac, orthopaedics, burns, plastic surgery, spinal injuries and renal to name a few. A state-of-the-art laboratories complex provides leading edge diagnostic services. The hospital also provides a wide range of specialist surgery such as orthopaedic, spinal cord, hand and kidney transplantation. The Royal Hallamshire Hospital has a dedicated neurosciences department including an intensive care unit for patients with head injuries, neurological conditions such as stroke and for patients that have undergone neurosurgery. It also has a gastroenterology department, a large tropical medicine and infectious diseases unit as well as a specialist haematology centre and other medical and surgical services. Sheffield Teaching Hospitals is home to the largest dental school in the region, a maternity hospital with a specialist neonatal intensive care unit and a world renowned cancer hospital. The Trust is also integrated with the City’s adult NHS community services to support our work to provide care closer to home for patients and preventing admissions to hospital wherever possible. We have a long tradition of clinical and scientific achievement, including the development of one of the UK’s first Academic Health Sciences Networks. Through our partnerships with the , Sheffield Hallam University, other health and social care providers and industry we remain at the forefront of advancements in clinical services, teaching and research. We have around 15,000 employees, making us the second biggest employer in the city. We aim to reflect the diversity of local communities and are proud of our new and existing partnerships with local people, patients, neighbouring NHS organisations, local authority and charitable bodies. We strive to recruit and retain the best staff: the dedication and skill of our employees are what make our services successful and we continue to keep the health and wellbeing of our staff as a priority. Our vision is to be recognised as the best provider of healthcare, clinical research and education in the UK and a strong contributor to the aspiration of Sheffield to be a vibrant and healthy city. We have begun this journey with our staff, partners and patients and we will continue to explore every aspect of our business to ensure we are doing our very best to achieve our vision.

Proud Values These are the values that all staff at Sheffield Teaching Hospitals NHS Foundation Trust are expected to demonstrate in all that they do. Patients First – Ensure that the people we serve are at the heart of what we do Respectful – Be kind, respectful, fair and value diversity Ownership – Celebrate our successes, learn continuously and ensure we improve Unity – Work in partnership with others Deliver – Be efficient, effective and accountable for our actions

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For further details of our services and organisational structure, including our Board of Directors, and our future plans please visit www.sth.nhs.uk/about-us

Breast Radiology in Sheffield Breast Imaging is currently provided within the Trust by a team of 4 Consultant Breast Radiologists In addition to the team of 4 consultant radiologists, the service makes extensive use of 2 Advanced Practitioners who undertake stereo biopsies, symptomatic ultrasound, cyst aspirations and stereo localisations as well as screening film reading. 2 of the 3 advanced practitioners are being upgraded in order to advance their US interventional skills, managements and training skills to meet the demands and vision of the unit. The unit has its own call-recall database for management of family history and cancer follow-up women. Such mammograms account for approximately 1000 mammograms per year. MRI scanning is increasing, and encompasses high risk family history screening, neoadjuvant chemotherapy scans (pre and post treatment), Hodgkins surveillance scans and clinical scans. All MRIs are double reported and audited. Scans are done at Weston Park Hospital on the Siemens Avanto 1.5T scanner. Surgical services are provided by 3 breast surgeons, Mr Stan Kohlhardt, Mr Loaie Maraqa and Miss Lisa Caldon (Locum) with a recent appointment of a breast specialty middle grade surgeon and immediate plans for further expansion with further surgical appointments. There is strong oncoplastic commitment and ongoing oncoplastic fellowships. At present, 3 breast clinicians provide clinic support, in addition to the surgical SpRs. There is a team of 5-6 breast care nurses, who support both screening and symptomatic women. Two psychologists (both part time for breast) are employed by breast services. There is a weekly MDT meeting, discussing both screening and symptomatic women, with diagnostic cases discussed at the beginning of the meeting. In addition to the surgeons, radiologists, pathologists and breast care nurses, there is representation from clinical and medical oncology plus a research nurse. Radiographer and breast screening clerical staff attend on a rota. The staff of the screening unit and the directorate managers meet regularly with the Commissioners to discuss funding issues and compliance with standards. The unit holds a meeting twice a year to discuss operational issues and peer review compliance. The unit works within QA standards on almost all criteria & has a commendably high non-operative diagnosis rate. Breast Services Management Structure: Mr Stan Kohlhardt: Breast Services Lead Dr Olga Hatsiopoulou: Breast Service Pathways Lead & Breast Imaging Lead Breast Imaging Activity The Breast Screening service covers an eligible population of 80,000 women in the city The assessment rate for the screening service is 3.25% In addition to the above - Symptomatic Breast Imaging approximate annual workload: 4,000 Mammograms 5,000 Diagnostic Breast Ultrasound 1,500 Aspirations, Biopsies & Drainages including 50 Vacuum Assisted Biopsies 200 Stereotactic & Ultrasound Guided Localisations 200 Breast

Research and Audit Research The Fellow will have the opportunity to participate in original research & the Academic Section of Radiology has an extremely active programme of research.

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The breast imaging unit contributes to research by both the surgical oncology professorial unit and by the Cancer Research Centre. There is scope for further research, and ample support. There are active links with the Clinical Research Centre at Weston Park Hospital, and the unit has a good record of recruitment of patients to clinical trials. Audit All trainees are expected to undertake audit as part of their clinical practice and provide evidence of this for appraisal and ultimately, revalidation. The successful candidate will be expected to participate in audit, discrepancy and report review and interesting case review.

Appraisal and Assessment The framework for appraisal and assessment will be based on the 4 domains of Good Medical Practice; 1. Knowledge, skills, performance, 2. Safety and Quality, 3. Communication, partnership and teamwork & 4. Maintaining Trust. For the duration of their post the trainee will be supervised by an overarching Educational Supervisor. During each placement there will be induction, midterm and end of post appraisal with a clinical supervisor. In-training assessment, based on regular Rad-DOPS (12 per year), mini- IPX, MSF and Teaching observation, audit assessment and MDT assessment tools, are utilised to ensure that the trainee attains level 1 in diagnostic breast imaging by the end of year 4 and level 2 at the end of year 5. At all times the trainee will: Practice within their competence level; practice in accordance with the standards expected of them in the unit they are placed; refer to more experienced colleagues/teachers/mentors when they are uncertain as to the best management of a particular patient; practice according to prevailing professional standards and requirements. Formal assessment of progress at 12 monthly intervals will be through the ARCP process. The scheme actively seeks feedback from trainees to monitor and improve the training provided.

Radiology in Sheffield Teaching Hospitals NHSFT The Sheffield Breast Imaging service, including Breast Screening is also located within the Royal Hallamshire Hospital. There are 3 Hologic Dimensions digital mammography machines which were installed in 2011 & are used predominantly for screening. There are 2 Hologic Selenia mammography machines, a prone table biopsy mammography machine, 1 Siemens Acuson 2000 & 2 Philips iU22 Ultrasound scanners, a Bard Encor Vacuum Assisted Biopsy machine which is used for Assessment /Symptomatic cases. One of the Dimensions Mammography machines will be upgraded to be capable of Tomosynthesis imaging & biopsy during the spring of 2016 The Department of Radiology at the Royal Hallamshire Hospital houses 2 multislice CT scanners both of which will be replaced in 2016 with high specification Toshiba machines. A Philips Ingenia 3T MR scanner was installed in 2012 & a Siemens Avanto 1.5T scanner was installed in 2009. A further 1.5T MR scanner will be installed in 2016. The adjacent Academic Radiology Department houses a further 3T Philips Ingenia MRI scanner & a GE 1.5T MR Scanner. There are 6 ultrasound rooms, which are equipped with Philips iU22 and Siemens Acuson 2000 scanners, 2 modern fluoroscopy rooms & 2 angiography units. The Department of Medical Physics at the Royal Hallamshire Hospital has two dual headed GE gamma cameras both of which are capable of SPECT and one of which also has CT functionality. The Department of Radiology at the Weston Park Hospital has access to 2 Philips multislice CT scanners, commissioned in 2016. They are used extensively for radiotherapy planning as well as diagnostic scans for the In-Patients in the hospital. There is also a 1.5T Siemens Avanto MR scanner (which will be upgraded in 2016) & a Philips iU22 ultrasound scanner. The Department of Radiology at the Northern General Hospital has 2 GE 64 multislice CT scanners (which will be replaced in 2016 & 2018) & a 1.5T Siemens Avanto MR scanner. A further 1.5T Mr scanner will be installed in 2016. There are 9 ultrasound rooms which are equipped with Philips iU22 & Siemens Acuson 2000 scanners & 2 modern fluoroscopy units. There are 2 Gamma Cameras in the Medical Physics department & an independent sector PET CT scanner is installed on the site which is available for the trust’s use. Page 4

There are 2 modern vascular angiography rooms & an angiography day ward adjacent to the Radiology Department which are managed as part of the Vascular Surgery directorate There is a suite of 5 cardiac catheter labs on the site which are managed as part of the Cardiology directorate. The Jessop Wing Ultrasound department is managed by Radiology & houses 7 ultrasound rooms. Three of which are equipped with Philips iU22 scanners & 4 Toshiba Aplio MX scanners Clinical Activity and Workload Over 500,000 imaging examinations are undertaken annually within Sheffield Teaching Hospitals’ Imaging Departments across all modalities including CT, MR, US, NM Angiography & Fluoroscopy. Work-load statistics 2015 Breast – Symptomatic Mammo 6,000 Breast – Screening 21,000 MRI scans 50,500 CT scans 65,000 Ultrasound scans 90,000 Fluoroscopy & Angiography 13,000 Radionuclide studies 10,000 Plain radiography 254,000

Duties of the Post The appointee will, together with consultant colleagues, contribute to the provision of a comprehensive Breast Imaging services to the Trust. This will be predominantly at the Royal Hallamshire Hospital site but the successful candidate will be expected to provide support to all other hospitals with the Trust (Weston Park, Jessop Wing & Northern General Hospitals). The successful candidate will work flexibly and co-operatively with other members of the team in order to provide a high quality, comprehensive service within this teaching hospital environment. The successful candidate will work according to the terms and conditions of the national specialty registrar contract. The trainee will be expected to participate in the cross-site, senior registrar on call rota with colleagues in ST3 – ST6, together with second on call support from ST2 trainees and supervision by consultant colleagues. An appropriate on call banding will be paid according to the terms and conditions of the national specialty registrar contract. The allocation of time between the various duties of the post will be open to some adjustment in consultation with your clinical and educational supervisors, but initially the timetable is anticipated to be as follows:- Monday Tuesday Wednesday Thursday Friday am Breast MDT Prep MDT & Research Breast Breast Localisations & Localisations & Localisations & Fast Track Clinic Breast MRI Fast Track Clinic Fast Track Clinic reporting MRI review LCT meeting Family History Mammograms Reporting pm General duty Breast Breast Breast Screening session Assessments Localisations & Assessments reporting Fast Track Clinic

The appointee will be expected to take an active part in undergraduate and postgraduate teaching and training. Active participation is encouraged in the training of more junior radiology specialty registrars.

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Junior specialty registrars are attached to Breast Unit as part of their core and subspecialty training. Advice and teaching is provided to registrars throughout their training. Sheffield fellows take an active role in the Sheffield FRCR part IIb course (which is heavily oversubscribed) and are expected to take part in ‘in-house’ anatomy teaching and film viewing Viva practice as part of the Sheffield Radiology training programme. Sheffield fellows regularly participate in the teaching of other clinical groups, e.g. breast imaging nurses, radiographers and surgeons. Salary Scale The current nationally agreed payscale for this grade is payable.

Points of Contact and Visiting Arrangements Interested candidates are encouraged to make direct arrangements with:-

Dr O Hatsiopoulou Dr R Batty Breast Imaging Lead Radiology Training Programme Director Consultant Radiologist Consultant Radiologist Royal Hallamshire Hospital Royal Hallamshire Hospital Royal Hallamshire Hospital Royal Hallamshire Hospital Sheffield S10 2JF Sheffield S10 2JF Tel: 0114 271 2341 Tel: 0114 271 2940 [email protected] [email protected]

These arrangements are fully supported by the BMA.

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