ADVANCED PRACTICE IN GASTROINTESTINAL IMAGING
A JOINT CONFERENCE HOSTED BY GIRSIG AND THE COLLEGE OF RADIOGRAPHERS
Report of the 2008 G.I.R.S.I.G. Conference.
The 2008 GIRSIG conference which included presentations / workshops on all aspects of GI advanced practice was again voted a great success by the delegates.
The fifth national G.I.R.S.I.G. conference was held at the Thistle Hotel in Bristol on the 25th and 26th October. The conference was very popular with G.I. Radiographers with a range of expertise and practice in the field of G.I. imaging, attracting around 110 delegates. The theme of the conference was G.I. Tract Imaging: Present Practice, Future Possibilities and this was reflected in the many and varied presentations and workshops that took place during this stimulating weekend.
The conference was opened and delegates welcomed by Julie Nightingale the G.I.R.S.I.G. Chairperson and Director of Radiography at the University of Salford. Jane and Clare from the SOR were thanked for organising the registration and venue for the event. The G.I.R.S.I.G. committee were thanked for their hard work putting the conference together and special thanks went to the exhibitors Bracco, Sanochemia and Guerbet for their continuing support.
Julie also welcomed a special delegate, Liza Ricote a Radiographer from South Australia, who was visiting England on a sponsorship programme with the Australian Winston Churchill Memorial Trust in order to learn about Advanced Practice for Radiographers.
The Saturday morning session was Chaired by Robert Law, Consultant Radiographer, Frenchay Hospital, Bristol.
Sean Kelly, Professional Officer at the College of Radiographers, began the conference by giving the College of Radiographers address. Acknowledging the theme of the conference “Present Practice: Future Possibilities”, he discussed the challenge of leadership and guidance that is common to both the COR and the delegates as senior members of our profession. Looking towards the future he emphasised that although professional bodies can put together guidelines and standards it is the senior members of the profession, when pushing the boundaries of role extension, who need to have the moral conviction and courage to interpret the guidelines and then work within them.The rest of the morning session focused on the lower GI tract.
The first speaker was Mr. Alan Roe, Consultant Surgeon North Bristol NHS Trust. He gave an overview of the National Bowel Cancer Screening Programme, beginning with some facts and figures about colon and rectal cancer leading onto the rationale for developing a screening programme. He described a patient journey through the screening process and the implications for the imaging services.
The subject of the last two presentations of the morning was CT Colonography which is an area that many experienced Advanced Practice Radiographers see as an area to extend their role. The first speaker of this session was Dr. Paul McCoubrie, Consultant Radiologist North Bristol NHS Trust. This informative presentation by an enthusiastic advocate of CTC gave the Radiologists perspective on CTC beginning with an overview of the rationale and evidence behind the emergence of CTC as a mainstream imaging technique for the colon and rectum. He continued by describing bowel preparation, technique for carrying out the examination and interpretation of the images.
The final speaker was Christine Bloor, Consultant Radiographer Royal Cornwall Hospital who gave an informed overview of the key considerations when setting up a CTC service. Using current literature and her own experience she discussed the logistics of the patient pathway within the department, bowel preparation, patient information, patient care, protocols and procedures and training.
The session concluded with the delegates splitting into different groups to attend workshops on:
- Barium Swallow pathology – a pictorial review (Elizabeth Judson, Sunderland).
- How to: CPD Now (Sean Kelly, College of Radiographers)
- CT Colonography: Viatronix views the colon (Keith Lakin, Vertec Scientific)
- Gastric Banding: rising to the challenge of bariatric patients (Stephen Jones, Hinchingbrooke Hospital)
The Saturday afternoon session was Chaired by Jon Pearson, Advanced Practitioner, Norfolk and Norwich University Hospital.
The first speaker to be introduced was Alison Booth, Research Fellow, Centre for Reviews and Dissemination, University of York and a co-founder of G.I.R.S.I.G. Alison gave an informative and broad outline of the latest published research that is relevant to GI practice including a guide to good sources of evidence. She critically appraised the identified research and then gave an overview of its possible influence on clinical practice and policy in the future.
The second speaker was Gary Culpan, Lecturer in Radiography, University of Bradford. The title of Gary’s highly entertaining and graphic presentation was ‘You only see what you know: Image perception explored’. He began by introducing the concept of ‘pattern recognition’ and continuing with a description of the method by which the eye and the brain process information in order to create the recognised image. Before looking at examples of double contrast barium enemas that demonstrated patterns that the delegates would be familiar with he challenged the audience with some examples of ‘change blindness’ illustrating the point that the brain does not always immediately register that a moving image may be changing.
The day concluded with a second workshop session and the G.I.R.S.I.G. Annual General Meeting.
The final session was Chaired by Alison Booth.
This session was entitled Small Bowel Imaging and split into three modalities. The relative merits and indications for use of Barium studies, CT Enteroclysis and MR Enteroclysis were explored.The first presenter was Robert Law, Consultant Radiographer whose topic was Small Bowel Imaging: Fluoroscopic Investigations. Rob, an enthusiastic advocate of small bowel enteroclysis described the technique for this examination and then presented a summary of results from various papers that indicated that it has a high negative predictive value. He concluded that it is an effective procedure both cost and time efficient and well within the capabilities of a GI radiographer to carry out.
Victoria Louise Clark, Radiographer Bristol Royal Infirmary gave a detailed presentation of CT Enteroclysis, a technique for imaging the small bowel. She also presented a summary of results on sensitivity and specificity from various published papers concluding that CT Enteroclysis is a viable imaging tool to diagnose Crohns disease it is not as sensitive as small bowel enteroclysis in the early stages of the disease.
The final speaker in this section was Dr Helen Bungay, Consultant Gastrointestinal Radiologist Oxford Radcliffe Hospitals NHS Trust who presented the case for MR Enteroclysis summarising the technique and illustrating her points with images of various examinations. She concluded that it was an expanding technique which gave excellent soft tissue contrast of the entire small bowel, had the potential to assess disease activity in Crohns disease and of course did not use ionising radiation.
The delegates were left to conclude that all three modalities had their merits but the jury was still out as to the imaging modality of choice.
The last speaker before coffee was Dr. Ian Shaw, Consultant Gastroenterologist, Gloucester Royal Hospital. Dr. Shaw presented an interesting case study of a young man from his diagnosis with Crohns disease to the present day, reviewing the impact of the diagnosis on the patient and the effect that it has had on his life.
Following coffee the delegates attended the final session of workshops on:
- Barium Swallow pathology.
- CT Colonography: Viatronix.
- Waiting list targets (Judith Richards and Christine Bloor, Royal Cornwall Hospital)
- Creating effective poster presentations (Julie Nightingale, University of Salford)
The presentation of Poster prizes then took place, with the first prize award going to Nicola Gibbons.
The concluding session was a duel presentation by Alison Booth and Julie Nightingale ‘A Brief History of Radiology Time’. Alison began her talk back in 1800 BC when even then people would undergo colonic irrigation as a cure for all ills running through the various imaging techniques and contrast media that have been used in the past until the present day and the formation of GIRSIG and the GI practitioners extended role. Julie looked forward to what was next for the GI Radiographer and concluded that there was a bright future for GI radiographers.
The conference closed with a farewell to Alison Booth who was one of the co-founders of GIRSIG and has been an enthusiastic advocate of the GI radiographer. Alison has done much to ensure that protocols and procedures were correctly established to ensure that GI radiographers work safely and build their profile as a group and we all owe here a sincere debt of gratitude.
Julie then closed the conference. All the delegates felt it had been an excellent event and look forward to the next in 2010.