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Have you recently received a letter from the NHS breast screening programme inviting you to come for your first screening mammogram?

The NHS provides a breast screening service because early detection of breast cancer saves lives.

The NHS screening programme has been using mammograms to detect cancer since 1988… But still, 30 women die of breast cancer every day in the UK.

The FAST MRI DYAMOND study is looking to see if a new form of MRI scan, called FAST MRI, can pick up aggressive cancers even earlier than mammograms can. 

The NHS already uses breast MRI to detect cancers, but only for women who have a very high likelihood of having breast cancer. For these women, MRI detects breast cancers earlier than mammograms and saves more lives.

The FAST MRI DYAMOND study will be the first UK study to offer a FAST MRI scan to women at normal or average risk, aged 50-52. People invited for their first screening mammogram can take part at 4 NHS breast screening services in England. (Bristol, Cheltenham, Swindon, Truro, London (St George’s & King’s College).

Everyone’s breasts are different, and in addition to how breasts look and feel in real life, they also look different on mammograms.

At age 50-52, breasts can look completely white on mammograms. They can also look completely dark. Both appearances are normal, as are all the different combinations of white and dark in between. These differences are called mammographic density or breast density.

The problem is that breast density can make a small cancer difficult to spot on a mammogram. Breast cancers tend to show as white on mammograms, so you can see how much easier a cancer would be to spot on the dark mammogram on the left than on the white mammogram on the right.

Fortunately, however, FAST MRI works well at detecting small cancers for women of all breast densities. The pink arrow highlights what a cancer, that was completely invisible on the mammogram, looks like on FAST MRI.

Breast screening with mammograms already saves around 1,300 lives each year in the UK by finding cancers that are too small to feel or see. 

FAST MRI could find cancers even earlier for women and our research is designed to find out which women would benefit from breast screening with FAST MRI through finding breast cancer even earlier than mammograms.

We want to find breast cancers earlier because:

• finding cancer early makes it more likely that treatment will be successful
• finding cancer early makes it less likely that a mastectomy will be needed
• finding cancer early makes it more likely that the cancer will be cured.

The only way to discover your breast density is to have a mammogram.

The FAST MRI DYAMOND study wishes to offer a FAST MRI scan to 1000 people who all have average breast density. At age 50-52, four out of every 10 women will have average breast density and could join the FAST MRI DYAMOND Study to have a FAST MRI scan. 

We can only find out whether you can join the study if you give us your contact details and let us know you are happy for us to use your mammogram to measure your breast density.

Research is fundamental to improving treatment and care for patients and the public but it is your choice whether you join the study or not.

If you are having your first screening mammogram and would like to learn more about the FAST MRI DYAMOND study, please fill in a FAST MRI DYAMOND consent to be contacted form, either online or at your mammogram appointment. 

This is the web address of the online form. 

If you would like to ask any questions at all, you will find the telephone number for the nurse from your local research team below this video along with the link to the online form.

Thank you for taking the time to watch this film. Thank you for helping us with this research.

Funding to cover the time of those either “Early” in their research “Career” and/or those with a research idea that is at the “Early Concept” stage and needs development.

• Short term funding
• Applicant salary costs covered
• PPIE costs covered

Funding for the applicant’s time to develop a NIHR application. You will know your NIHR funding stream and the deadline you are aiming to submit by (you can be at Stage 1 / EoI or Stage 2).

• Grant deadline identified
• Short term and long-term funding
• Applicant salary costs covered
• Other salary costs covered
• PPIE costs covered

For those holding Research Grant Development Funding but with a delay in the initial timeline.

• Grant deadline identified
• Short term funding
• Applicant salary costs covered
• Other salary costs covered
• PPIE costs covered

For those holding Research Grant Development Funding who have been shortlisted for an NIHR grant and need further “Follow-on” funding to protect their time to develop their Stage 2 application.

• Grant deadline identified
• Short term funding
• Applicant salary costs covered
• Other salary costs covered
• PPIE costs covered

Funding to cover Public/Patient Involvement & Engagement (PPIE) activities prior to formal grant funding being received for a research project (“Pre-award”). This will cover Working with People & Communities to allow diverse engagement at the project/grant development stage.

• Suitable for developing a research project or a program/portfolio
• Short term funding
• PPIE costs covered

A personal training and/or project award for Nurses, Midwives and AHPs with an interest in evidence-based care and who want to get a “taste” of clinical research.

• Suitable for Nurses Midwives and AHP’s
• Short term funding
• Applicant salary costs covered
• Non-pay costs covered
• PPIE costs covered

This fund supports NBT staff to undertake research projects (max. £25k per project) which could be directly implemented in the NHS, or feed into larger funding bids with the potential for future impact on the NHS. Applications are invited from NBT staff, including clinicians, nurses, midwives, and allied health professionals (AHPs) from any clinical area. 

Springboard supports staff with a range of experience, from staff with no prior research experience applying for their first research grant, through to an experienced researcher looking to undertake pilot, feasibility, or proof of concept work. 

R&D understand that applying for research funding can be daunting, but there is plenty of support available to help develop an application. Please contact researchgrants@nbt.nhs.uk as soon as possible to benefit from support

Personal awards to give applicants a “stepping-stone” to the next stage of their research career – e.g. funding of salary costs to free up time to develop and submit an external fellowship application, such as a NIHR Doctoral Award.

• Suitable for Medics, Nurses Midwives and AHP’s
• Grant deadline identified
• Short term funding
• Applicant salary costs covered
• Non-pay costs covered
• PPIE costs covered

Funding to cover research staff salary costs (Personnel) to develop a programme / portfolio of research in a specified clinical area (Division / Team / Speciality).

• Suitable for Medics, Nurses Midwives and AHP’s
• Suitable for developing a research program/portfolio
• Long term funding
• Applicant salary costs covered
• Other salary costs covered
• PPIE costs covered

Photo 1 is what the polysling looks like when not fitted. 

1. The polysling is made of lightweight foam. Most people find it comfortable to wear when fitted correctly. It is made up of a trough that your forearm sits in, supported by straps. It works by supporting your arm in a position to immobilise your operated shoulder (stop it moving). 

2. If someone is fitting the sling for you, support your operated arm with your elbow bent to 90 degrees (a right angle) using your unoperated arm. Slide the “trough” part of the sling in from behind so that your elbow fits snugly into the corner. See photo 2.

3. If you are fitting the sling without help, sit down, with your elbow bent to 90 degrees (a right angle). You will find it more comfortable if your arm is supported on a pillow. Then slide the “trough” part of the sling in from the side and ensure that your elbow fits snugly into the corner. See photo 3.

4. Fasten the strap nearest to your elbow across your forearm, it should be approximately one inch below your elbow crease. It attaches with Velcro. See photo 4.

5. Attach the wrist strap approximately one inch from your wrist (towards your elbow). It attaches with Velcro. The lower ‘D’ ring should rest against your body and the upper ‘D’ ring should face upwards. See photo 5.

6. The shoulder strap is the long strap that is sewn to the “trough” part of the sling at the elbow end. Take this strap across your back and over your unoperated shoulder. See photo 6.

7. Feed the shoulder strap through the upper ‘D’ ring on the wrist strap. See photo 7.

8. Attach the shoulder strap back onto itself with the Velcro. See photo 8.

9. If you are told to wear the waist strap, feed the other long strap through the lower ‘D’ ring and attach it onto itself with the Velcro tab. See photo 9.

10. Take the waist strap around your back and attach it over the front of the elbow section of the sling. Adjust as necessary so that your arm is held snugly against your body. See photo 10.

11. The final position should have your arm held close to the front of your body with your knuckles facing forwards. Your wrist should be slightly higher than your elbow to prevent any swelling in your hand. See photo 11.

You will need to be able to take your sling on and off for physio exercises and, if you are allowed, for washing and dressing.

Getting dressed if you are allowed to move your shoulder (within restrictions)

If you are told you can move your shoulder within restrictions, you can carefully dress and then put the polysling over the top of your clothes using the following method: 

1. Remove the polysling and let your operated arm hang down to your side. You may find this easier if you sit down. See photo 12.

2. Using your unoperated arm feed the sleeve of the garment onto your operated arm all the way up to your armpit. See photo 13.

3. Do not use your operated arm to help. Your unoperated arm should do all the work. See photo 14.

4. Next use your unoperated arm to bring the garment across your back. See photo 15.

5. Put your unoperated arm into the other sleeve of the garment. See photo 16.

6. Use your unoperated arm to fasten the front of the garment. See photo 17.  Do not use your operated arm to help as you may move your shoulder too much and cause damage to the surgery on your shoulder.

7. If the garment does not open at the front, use the method in steps 1 and 2 to feed the sleeve of the garment onto your operated arm. Then use your unoperated arm to put the garment over your head. See photo 18.

8. Put your unoperated arm into the other sleeve of the garment. See photo 19.

10. Use your unoperated arm to pull the garment down over your body. See photo 20.

Once you are dressed you should put the polysling back on straight away unless you have been told that the polysling is for comfort only.

To get undressed you must use the reverse of the above method: take your unoperated arm out first then slide the garment off your operated arm as it hangs to your side.

Do not move your operated shoulder or arm to help take the garment off. Your unoperated arm should do all the work.

Getting dressed if you are not allowed to move your shoulder

If you are told that you must not move your shoulder for a period after your surgery you must dress over the top of the sling. See photo 21.

This means you will need loose fitting clothes so that your arm will fit inside the body of the garment. If you wear a bra, you will not be able to wear one with straps as you will not be able to move your shoulder to put your arm into the straps. You may be able to feed a strapless bra under your operated arm and fasten it with help.

Try to have loose/baggy clothing available for after your surgery as dressing will be more difficult due to your shoulder restrictions. As a general rule - the looser the clothing, the easier it will be to get dressed and undressed.

Some people find that front fastening tops are easier than tops that go over the head. Choose upper and lower garments with easy fastenings. Shirts and blouses with large buttons will be easier to do up one-handed than small buttons.

Zip up cardigans or coats are very difficult to do up one handed so avoid them. Trousers or skirts with elasticated waists will be easier to manage than buttons, zips, and belts.

Wear slip-on or Velcro fastening shoes as you will not be able to fasten lace-up shoes one-handed.

Washing if you are allowed to move your shoulder (within restrictions)

You can carefully remove the polysling to wash. You should keep your operated arm by your side and you can have a shower or a bath if you feel safe to do so. Your surgical wound should be covered with a shower-proof dressing but do not run the shower directly over the dressing, or soak it in the bath. Do not use your operated arm to help wash yourself as this may cause damage to the surgery on your shoulder.

You can then wash your armpit with a flannel or sponge. You can also lean forward to access your armpit to apply deodorant. See photo 22.

You may wash your hair in the shower or by leaning over a sink or bath. Do not use your operated arm to help wash your hair. Some people need assistance to wash their hair.

Washing if you are not allowed to move your shoulder at all

In some cases you may be told to keep the sling on at all times. This means washing around the polysling with a flannel or sponge. To wash your armpit of your operated side you can slide a thin flannel or a wet wipe under your armpit. Do not attempt to move your arm away from your body to get access to your armpit as this may cause damage to the surgery on your shoulder. You will not be able to apply deodorant to your armpit, but can apply it around the area (taking care to avoid your surgical wound).

To wash your hair you can lean over a sink or bath/shower whilst keeping your arm within the polysling. Take care to keep the polysling dry. Do not use your operated arm to help wash your hair. You may find that dry shampoo is a useful alternative for a short period. Some people need assistance to wash their hair.

One handed washing advice

• Use liquid soap from a dispenser if you find it difficult to handle a tablet/bar of soap.
• Use a flannel mitt with soap inside.
• A sponge lathers easier than a flannel and is easier to squeeze out after use.

You will need to wear your polysling to sleep in unless you are advised otherwise. The most comfortable positions for sleeping or on your back or un-operated side. Use pillows or cushions to support your operated arm and shoulder in a comfortable position. 

• Wipe yourself with your un-operated arm.
• Adjust your clothing with your un-operated arm.

Putting toothpaste on a brush one-handed can be difficult. The following technique can be easier:

• Position the toothbrush on its back on the sink with bristles facing up. If it will not stay in position you can secure it with a piece of “blutack” or grip the toothbrush between your knees.
• Use your unoperated hand to squeeze toothpaste onto the brush.
• A pump type dispenser may be easier to use than squeezing a standard tube of toothpaste.

If you have no-one at home to help you in the kitchen try to opt for meals that will be easy to prepare one-handed.

Here are some tips:

• Ready meals can be easily put into the oven on a baking tray or into a microwave on a plate.
• Pre-prepared fresh or frozen vegetables are available in many shops to prevent the need to wash, chop, or peel vegetables.
• When cooking vegetables avoid carrying a whole pan of boiling water one-handed. Instead put the vegetables in a frying basket within a saucepan. They can then be lifted out and drained in one movement. Alternatively take the vegetables out with a slotted spoon. Once the saucepan of water has cooled it can be tipped away.
• Remember most tin openers require two hands to operate. You may need to get someone else to open tins for you or look into buying an electric one-handed tin opener.
• Scissors can be useful for opening awkward packets.
• To open jars, grip the jar between your knees and twist the lid off with your unoperated hand. If you have help from other people ask them to loosen very tight lids and transfer the contents of the jar into an easy open plastic storage container.

If you are concerned about managing kitchen activities and have no-one to help you, please ask to see the Occupational Therapist about gadgets to make life easier

You will need to eat one handed. Here are some tips: 

• Eating out of a bowl may be easier than a flat plate to prevent food being pushed off the edge of the plate.
• Choose foods which are easy to cut up one-handed.
• Using a spoon may be easier than a fork.
• Put a slightly damp folded cloth under a bowl or plate to stop it sliding around the table top.

If you are concerned about eating and have no-one to help you, please ask to see the Occupational Therapist for advice.

If you are concerned that you will not be able to manage your everyday activities and have no-one to help you, you may need a referral to Community Services for help at home.

If you are assessed as needing it, Community Services can provide assistance with washing and dressing, shopping, laundry and meals (usually from the Community Meals service). They cannot provide help with general cleaning/housework.

If you feel you need a referral for Community Services please alert the nurses or Occupational Therapist in hospital. 

If you are a carer for someone else and you will not be able to meet their needs after your shoulder surgery, you will need to make arrangements for their care yourself. The hospital cannot arrange help for anyone who is not a hospital inpatient.

LEEP Lung Exercise and Education Programme (LEEP) 
Physiotherapy Department 
Cossham Hospital 
Lodge Road 
Bristol 
BS15 1LF 
LEEP@nbt.nhs.uk 
0117 414 2010

Sirona Pulmonary Rehabilitation Community Respiratory Specialist Team 
Sirona Care & Health CIC 
New Friends Hall 
Heath House Lane 
Bristol 
0300 124 5909 
Respiratory – Sirona care & health NHS services

The pleura is a thin membrane that lines the inside of your chest cavity. Some patients have thickening of this lining and require a small sample (a biopsy) be taken to help identify the cause. Before the biopsy is taken, the area will be cleaned and local anaesthetic will be injected to numb the surface of the chest wall. A needle can then be targeted, with the help of an ultrasound machine, to take a biopsy from the pleura. Your doctor may take several biopsies to give you the best chance of a diagnosis. We then analyse these samples in the laboratory to try and get a diagnosis.

Your doctor has recommended a pleural biopsy as the best way of finding out what is causing your illness. Your doctor will have considered this carefully and made their decision with your best interests in mind. However, it is ultimately your decision as to whether or not you wish to have the procedure done.

If you have any concerns or questions, please let your doctor know and they will be happy to discuss things with you in more detail.

Please make sure we have your correct phone number(s) as we may need to call you a few days before your procedure to confirm arrangements and that you are still able to come to hospital. If we are unable to contact you, we may offer your appointment to another patient who is waiting for this procedure.

Please let us know in advance if you are:

• Pregnant.
• Taking medication to thin your blood

If any of these apply to you, we will need to make special arrangements for your procedure. These may include instructions as to what you should do with your medication.

Please bring the following items with you on the day of your procedure:

• All your medications (we need to know what you are taking, including prescription and “over the counter” treatment).
• Reading glasses, if you need them.

It is important to let us know in advance if you are taking medication to thin the blood. These will need to be stopped temporarily before your procedure can go ahead. Your procedure may need to be cancelled if you do not follow these instructions.

Please take your other medication as normal.

The table below explains what you should do with your medication in more detail. Please contact your doctor if you are not sure what to do. If your blood thinning medication cannot be stopped then your doctor may change it to an alternative medication temporarily, to enable the procedure to take place.

You will be greeted by a member of the team who will check your observations (e.g. heart rate, blood pressure, temperature) and go through a checklist with you. This will include questions about your medical history, medications, and allergies.

A member of the team may take some blood for tests if these have not been checked in advance. The procedure itself takes place in a procedure room or theatre. The procedure will be explained to you in more detail, and you will be asked to sign a consent form to confirm you are happy to go ahead.

A doctor will do an ultrasound scan of your chest to help decide where to sample the pleura. This involves placing gel and a hand-held probe over your skin to create a picture on a screen. The ultrasound scan should not be painful and does not involve any radiation. The doctor will then inject local anaesthetic into your chest wall – this may sting at first, but will soon numb the area so you should not feel any pain during the procedure.

Once the area is numb, the doctor will make a small incision and then insert a needle into the pleura to take a sample. Your doctor may take multiple samples from this site to improve the chances of getting an answer. With each biopsy, you will hear a loud ‘click.’ After the samples are taken, a plaster will be placed over the site. There is rarely a need for a stitch.

The whole procedure usually lasts between 30 and 60 minutes in total.

A pleural biopsy is generally a very safe procedure, and serious complications are rare.

• Pain: most people (1 in 2 patients) will experience some pain in association with the procedure, but this is rarely severe. There is likely to be discomfort associated with the local anaesthetic and after the procedure the site may feel bruised. It is normal for your chest to be sore for a week or so after your procedure; this can be managed with simple painkiller (such as paracetamol).
• Infection: there is a low but important risk of infection following a pleural biopsy (less than 1 in 100). This can usually be treated with antibiotics, although it may sometimes need a chest drain to be inserted (a small tube) to empty the chest cavity of any infected fluid and therefore, can result in a hospital stay. Very rarely (1<1000 patients), infections can be more serious and need surgical treatment (an operation). Your doctor will take precautions during the procedure to ensure that this risk is minimised.
• Bleeding: a small amount of bleeding at the site of the procedure is normal. However, a small number of people have significant bleeding during their procedure (1 in 500). This can usually be managed at the time of the procedure, but very rarely another procedure might be required to stop the bleeding (including surgery).
• Pneumothorax (collapsed lung): while your doctor uses the ultrasound scanner to locate the pleura for the procedure, they will also be checking to see where the lung is. However, there is a slight risk that the needle used to take a sample of the pleura punctures the lung, causing it to collapse down. If there is no fluid the risk is around 4 in 100, however this is likely to be much lower in the presence of fluid as in your case. This is called a pneumothorax. This usually doesn’t need any extra treatment but, around 5% of the time a chest drainage tube, pleural vent, or needle will need to be inserted to allow the lung to re-expand. This may require a hospital stay. Even more rarely, if the tube doesn’t fix the pneumothorax, the collapsed lung needs to be treated with a surgical operation.
• Damage to surrounding structures and organs: there is a very small risk that other nearby structures or organs (such as the diaphragm or liver) could be damaged during the biopsy procedure. However, the use of ultrasound to find a suitable and safe site makes this extremely unlikely.
• Failure to get a diagnosis: there is no guarantee that the biopsy will give an overall diagnosis. If the biopsy does not provide an answer as to the cause, your doctor will discuss what further investigations might be needed with you
• Death: the risk of death from an ultrasound guided pleural biopsy is very, very rare indeed (less than 1 in 1000).

After the procedure a member of the team will take you back to the observation area, where you will have your observations (blood pressure, oxygen levels, heart rate and temperature) checked again. The team will also arrange for you to have a chest X-ray. If you are in any discomfort, we will give you painkillers to manage this. You must let your nurse and/or doctor know if your chest becomes increasingly painful or you feel increasingly short of breath. If you feel well and your chest X-ray is ok you will be allowed to go home. We would expect everything to be completed in around half a day.

It will take 1-2 weeks for the results of your pleural biopsy to be ready. This is because it takes time for the specimens to be analysed. You will be given an appointment with the team who organised the biopsy to discuss the results with a doctor about 2 weeks after your procedure. Please contact your lead consultant’s secretary one week after your procedure if you have not received an appointment. 

If you have any questions or concerns, please contact 0117 414 6322 or the team who organised your biopsy.

In the event of an emergency, please contact your on-call GP or NHS 111 for further advice.