This page provides information and toolkits to support clinicians who are requesting germline genetic tests for inherited cancer syndromes. The toolkits provide a step by step guide for selecting and arranging these tests, including key forms for consent and arranging samples.
The following drop-down boxes contain information for some of the inherited cancer testing services we support. For a full list of genetic tests available via our service, please visit the National Test Directory.
Eligibility for these tests is determined according to the National NHS England » National genomic test directory - see rare and inherited disease eligibility criteria. If, after accessing the directory and the toolkit, you are unclear about eligibility or sample arrangements, please contact SWGLHcancer@nbt.nhs.uk and we will be glad to support you.
(Note: these toolkits are for germline tests. For somatic tests see SWGLH Requesting a Genomic Test for Solid Tumours)
Germline genetic tests have implications for future and family health. Patients should be informed of the implications and appropriately consented, using a tool such as the Mainstreaming Consent Form to document in the patient record. The below Patient information leaflet can be used with or without local trust logo to support patient information provision.
Patient Information Leaflet – R207 Patient Information Leaflet V1 GLH LOGO:
Patient Information leaflet with the option to add your Trust Logo:
Blood samples in EDTA tubes (2 x 4ml for adults, 2-5ml for children and 1-2ml for neonates) are required for these tests. Samples should be kept at room temperature or at 4oC and not be frozen before dispatch.
Please ensure all sample tubes are labelled and accompanied by the test request form
Complete the SWGLH Genomic Test Request form, including:
Send the completed form with samples:
Samples should be transported to the SWGLH through your local pathology systems, unless advised otherwise. These samples should be kept at room temperature or at 4oC and should not be frozen before dispatch. They should ideally arrive within 3 days of sample collection.
Please refer to the SWGLH Sample Requirements and Transport page for further information.
Results will be returned to the email account or clinician listed on the form
Devon and Cornwall region: rduh.pcgreferrals@nhs.net (or via the Epic system if you are based at the Royal Devon University Healthcare NHS Foundation Trust)
Bristol region: UHBWClinicalGenetics@uhbw.nhs.uk
Eligible tumours and the available tests are shown in the National Genomic Test Directory for Cancer (NGTD).
Germline genetic tests have implications for future and family health. Patients should be informed of the implications and be appropriately consented, using a tool such as the Mainstreaming Consent Form to document in the patient record. The below patient information leaflet can be used with or without local trust logo to support patient information giving.
‘BReast CAncer Genes and Me’ is a digital patient empowerment project that’s set to transform the experience of people with a diagnosis of breast cancer that might have implications on other family members.
The project introduces the concept of genetic testing for breast cancer in an accessible format, presented as a six-part series of colourful animations. Each video features digestible information accompanied by gentle music and a clear voiceover that takes the participant through the process and implications of genetic testing.
This project has been developed as part of a Collaborative Working initiative between the South West Genomic Medicine Service Alliance and AstraZeneca UK, and has been co-designed by clinicians and patients alike, providing an overview of the genetic testing pathway from start to finish. We have been working with Magentus Global Health Tech for our digital solution.
BReast CAncer Genes and Me aims to streamline the consent process for breast cancer genetic testing through a digital consent pathway, supporting patients and their families through every stage and guiding them to become confident decision-makers.
View the videos on our YouTube channel.
Blood samples in EDTA tubes (2 x 4ml for adults, 2-5ml for children and 1-2ml for neonates) are required for these tests. Samples should be kept at room temperature or at 4oC and not be frozen before dispatch.
Please ensure all sample tubes are labelled and accompanied by the test request form
Complete the SWGLH Genomic Test Request form, including:
Send the completed form with samples:
Samples should be transported to the SWGLH through your local pathology systems, unless advised otherwise. These samples should be kept at room temperature or at 4oC and should not be frozen before dispatch. They should ideally arrive within 3 days of sample collection.
Please refer to the SWGLH Sample Requirements and Transport page for further information.
Results will be returned to the email account or clinician listed on the form
The national turnaround time for these tests is 42 working days, from sample receipt. Current turnaround times for some tests are considerably shorter than this.
When special circumstances require a more urgent result, please flag this on the form and contact the Bristol Genetics laboratory to discuss the best approach.
Once results are received, please see your local mainstreaming guidance for information on management and Clinical Genetics involvement. If you need advice, contact your local Clinical Genetics service:
rduh.pcgreferrals@nhs.net (or via the Epic system if you are based at the Royal Devon University Healthcare NHS Foundation Trust)
UHBWClinicalGenetics@uhbw.nhs.uk
Competency frameworks for cancer genomics are available on the Genomics Education programme website.
Eligible tumours and the available tests are shown in the National Genomic Test Directory for Cancer (NGTD).
Germline genetic tests have implications for future and family health. Patients should be informed of the implications and be appropriately consented, using a tool such as the Mainstreaming Consent Form to document in the patient record. The below patient information leaflet can be used with or without local trust logo to support patient information giving.
Please use the mainstreaming R208 Consent Form:
Blood samples in EDTA tubes (2 x 4ml for adults, 2-5ml for children and 1-2ml for neonates) are required for these tests. Samples should be kept at room temperature or at 4oC and not be frozen before dispatch.
Please ensure all sample tubes are labelled and accompanied by the test request form
Complete the SWGLH Genomic Test Request form, including:
Send the completed form with samples:
Samples should be transported to the SWGLH through your local pathology systems, unless advised otherwise. These samples should be kept at room temperature or at 4oC and should not be frozen before dispatch. They should ideally arrive within 3 days of sample collection.
Please refer to the SWGLH Sample Requirements and Transport page for further information.
Results will be returned to the email account or clinician listed on the form
rduh.pcgreferrals@nhs.net (or via the Epic system if you are based at the Royal Devon University Healthcare NHS Foundation Trust)
UHBWClinicalGenetics@uhbw.nhs.uk
Competency frameworks for cancer genomics are available on the Genomics Education programme website.
There are three different test codes depending on the reason for testing prostate patients. Please see the NGTD for eligibility criteria and select the appropriate test.
• R430 - direct germline testing for patients who are eligible for panel testing based on personal or family history.
• R444 - for patients being assessed for PARP inhibitor eligibility, where somatic testing has failed.
• R240 - for patients whose somatic test showed a gene variant. This test confirms whether the variant is present in the germline.”
Eligible tumours and the available tests are shown in the National Genomic Test Directory for Cancer (NGTD).
Germline genetic tests have implications for future and family health. Patients should be informed of the implications and be appropriately consented, using a tool such as the Mainstreaming Consent Form to document in the patient record. The below patient information leaflet can be used with or without local trust logo to support patient information giving.
Please use the generic consent form:
Patient Information Leaflet – Patient Information Leaflet – R444.2 NICE approved PARP Inhibitor treatment (Prostate) PIS with SWGLH logo:
Blood samples in EDTA tubes (2 x 4ml for adults, 2-5ml for children and 1-2ml for neonates) are required for these tests. Samples should be kept at room temperature or at 4oC and not be frozen before dispatch.
Please ensure all sample tubes are labelled and accompanied by the test request form
Complete the SWGLH Genomic Test Request form, including:
Send the completed form with samples:
Samples should be transported to the SWGLH through your local pathology systems, unless advised otherwise. These samples should be kept at room temperature or at 4oC and should not be frozen before dispatch. They should ideally arrive within 3 days of sample collection.
Please refer to the SWGLH Sample Requirements and Transport page for further information.
Results will be returned to the email account or clinician listed on the form
rduh.pcgreferrals@nhs.net (or via the Epic system if you are based at the Royal Devon University Healthcare NHS Foundation Trust)
Eligible tumours and the available tests are shown in the National Genomic Test Directory for Cancer (NGTD).
Germline genetic tests have implications for future and family health. Patients should be informed of the implications and be appropriately consented, using a tool such as the Mainstreaming Consent Form to document in the patient record. The below patient information leaflet can be used with or without local trust logo to support patient information giving.
Blood samples in EDTA tubes (2 x 4ml for adults, 2-5ml for children and 1-2ml for neonates) are required for these tests. Samples should be kept at room temperature or at 4oC and not be frozen before dispatch.
Please ensure all sample tubes are labelled and accompanied by the test request form
Complete the SWGLH Genomic Test Request form, including:
Send the completed form with samples:
Samples should be transported to the SWGLH through your local pathology systems, unless advised otherwise. These samples should be kept at room temperature or at 4oC and should not be frozen before dispatch. They should ideally arrive within 3 days of sample collection.
Please refer to the SWGLH Sample Requirements and Transport page for further information.
Results will be returned to the email account or clinician listed on the form
rduh.pcgreferrals@nhs.net (or via the Epic system if you are based at the Royal Devon University Healthcare NHS Foundation Trust)
UHBWClinicalGenetics@uhbw.nhs.uk
Competency frameworks for cancer genomics are also available on the Genomics Education programme website.
The patient information on the South West Genomic Laboratory Hub webpages are provided by the Genomics Medicine Service. For further information please visit www.england.nhs.uk/genomics/.
Page updated: 25/02/2025
The staff at North Bristol NHS Trust (NBT) offers their condolences to you at this time.
We understand that you may have important personal and cultural requests about the care of your loved one; please let a member of staff know and we will do our best to help in any way that we are able.
We know that giving all the information in this booklet can look daunting but please do not worry. Take time to share this information with a trusted family member or friend. This booklet will help you when you have the quiet time and space to read through it.
The Patient Affairs team will correspond with the person recorded in the hospital records as next of kin concerning
the administration of your loved one’s death. This can be any person designated by the deceased prior to their death and may or may not be a relative of the deceased.
If there is no designated next of kin, then this will usually be the closest relative or other person who will take responsibility for registering the death.
It can be important at this sad and difficult time that the next of kin keeps family members, or those close to the deceased, informed of what is happening.
It is important to read ‘Who can register a death?’ below.
Following the death of your loved one, you should receive a telephone call from the patient affairs team between 9am and 4pm on the next working day.
The Patient Affairs team will take some details from you, tell you what to do next and answer any questions you may have.
You are advised not to make a Register Office appointment until you have spoken to the Patient Affairs team.
If you have a query, you can contact the Patient Affairs Office at Southmead Hospital on 0117 414 0184, Monday to Friday, 8am – 4pm.
The Patient Affairs Office is located in the Sanctuary, Level 1, Gate 30 of the Brunel Building, Southmead Hospital.
The Medical Certificate of Cause of Death (MCCD) is an important legal document, showing the cause of death. This must be signed by a doctor who was responsible for the medical care of your loved one while they were in hospital.
Doctors are not always able to complete the paperwork immediately, so it may be several days before the certificate is ready. In some cases, they may need to contact the Coroner’s Office which will delay the paperwork further.
North Bristol Trust uses a medical examiner system. This is a role which has been implemented into all NHS hospitals within England. The role of medical examiners (MEs) is to provide support for bereaved families and to improve patient safety.
The Medical Examiner’s Office will be able to share any feedback to the clinical team or request they review the notes to reflect on the care provided and consider if there is any learning to improve the care of patients in the future.
There are two types of medical examiner:
Medical Examiners are independent senior medical doctors who are appointed to review all deaths that occur in hospital. They are specially trained in the legal and clinical elements of death certification processes.
They are here to check the information written on the Medical Certificate of Cause of Death (MCCD) is correct, and that any referrals that need to go to the coroner are made in a timely fashion to avoid any delays.
They scrutinise clinical notes and meet with the treating doctor to discuss the deceased’s care and the cause of death.
Medical Examiner Officers are a mix of clinical and nonclinical staff who have received special training in the role.
They assist the ME.
You will receive a call from a Medical Examiner or Medical Examiner Officers in the coming days. They will help you understand the wording used on the MCCD. You will have a chance to ask any questions you may have regarding the care of the deceased or their last illness. The Medical Examiner Officers will advise you how you can obtain the Death Certificate and other forms from the Registry Office.
The Medical Examiners Office will make reasonable attempts to contact the deceased’s Next of Kin. If you have any questions and have not been able to speak with the medical examiner, please contact the Patient Affairs team.
Once completed the death certificate will be delivered to the Bristol Registrars from the hospital by email (you do not need to collect the death certificate).
You will need to make a telephone appointment to register the death with the Bristol Registrars (telephone number 0117 922 2800) or complete an online form through the Bristol City Council Website: www.bristol.gov.uk/residents/births-deathsmarriages/deaths/register-a-death
The Medical Certificate of cause of Death will not be issued until the cause of death has been reviewed by the Medical Examiners Office or the Coroner’s Office.
In some instances, the hospital doctor is legally required to discuss the death with the coroner. The coroner is
an independent judicial officer and are responsible for investigating deaths in circumstances such as:
Once information is obtained by the Coroner’s Office from the medical staff, a decision will be made as to whether or not a post mortem is necessary.
In many cases, permission will be given to issue a Medical Certificate of Cause of Death.
However, you should note that the post mortem procedure with the Coroner takes at least 3 working days to complete before the certification can be released and in these circumstances an appointment with the Register Office cannot be made until all documentation has been completed and issued.
The post mortem examination will usually take place within a week of the death at the Coroner’s Mortuary in Flax Bourton.
The Coroner’s Office will take over responsibility from the Patient Affairs Office and will be responsible for keeping you informed of what is happening and guiding you in the next steps that you should take.
The coroner does not require the consent of any other person for this to take place. Funeral directors should be advised about the post mortem and are usually happy to proceed with funeral arrangements.
You will be informed by the Coroner’s Office when they have sent paperwork to the Register Office so that you can make an appointment to register the death.
The Coroner’s Office can be contacted on 01275 461 920. Opening hours: 7.30am - 3.30pm, Monday to Friday.
In some circumstances the coroner will proceed to open an inquest.
The purpose of an inquest is to find out four facts.
They will also record the medical cause of death.
You may be contacted by one of the coroner’s officers if an inquest has been opened. You may be asked to provide a statement about your loved one. The Trust will also provide the coroner with statements from those who cared for the deceased.
Once the coroner has considered this evidence, there may be a hearing. This is a fact-finding hearing, not to apportion blame, but to answer the above four questions. You will have the opportunity to ask questions.
The coroner will then record a conclusion, such as natural causes or suicide.
Whilst the aim is for this process to conclude within 6 months of the death, it can sometimes take longer. You will be kept up to date by the coroner’s office.
If the deceased has property or clothing in the care of the Patient Affairs team which is not taken by relatives at the time of death, the Patient Affairs team will contact you to discuss arrangements for returning the property to you or the disposal of any unwanted property.
Jewellery (for example wedding rings, earrings) is usually left on the deceased unless family request otherwise and will go to the funeral director where it is removed if requested.
It is important that you agree the arrangements for the return or disposal of property with the Patient Affairs Office.
Any property not collected after 3 months will be disposed of without recourse to the Trust.
You may wish to come to the hospital’s viewing room to see your loved one. The viewing room is a separate room within the hospital Mortuary.
If this is something you wish to do, you can make an appointment with the Mortuary Team by telephoning 0117 414 0184 between 8am - 4pm, Monday to Friday, to arrange this. We do not currently offer viewings on evenings or weekends.
Alternatively, you may prefer to wait until the deceased is transferred to the care of the chosen funeral director.
On the rare occasions when the cause of death may be a criminal matter there will be restricted viewing. In these
circumstances, the police will advise.
After someone has died it may be possible for their tissues to be donated to help others. Your loved one may have carried a donor card, be on the Organ Donor Register or may have discussed donation with you during their lifetime. Even if they did not, you may want to consider tissue donation at this time.
To ensure tissue transplants are as successful as possible, tissues can only be donated in certain circumstances.
If you choose this for your loved one, they will be cared for with dignity and respect and their appearance will be restored. Tissue donation will not delay funeral plans.
You may be contacted by a specialist tissue donation nurse after someone dies to offer information about tissue donation. The nurse will explain the options available for tissue donation and answer any questions.
Please remember, tissue donation is entirely voluntary. If you would like further information, please contact NHS Blood and Transplant National Referral Centre on 0800 432 0559. Please leave your name and contact number and a tissue donation nurse will call you back promptly.
Alternatively, you may ask a doctor, or nurse involved in the care of your loved one to contact the appropriate person on your behalf.
You can register the death if you are:
Once the Medical Certificate of death has been issued by the doctor and emailed to the registrar, you will need an
appointment to register the death with the Bristol City Council Registrars.
The whole process will be completed in person at the Registrar’s office at Southmead Hospital or at a local Registrar’s office close to you.
When you register the death, you will receive the following:
Once you have registered the death you can inform your chosen funeral director that the death is registered so that arrangements can now proceed.
If the death has been referred to the coroner, you will not be able to register the death until the registrar has received a notification from the coroner’s office.
You will need to report the death to various organisations and government departments. Bristol City Council runs a service called Tell Us Once, which will help you to contact these. In doing so you will not have to pay for extra death certificates for each organisation they contact. There is a cost in providing the certificate to organisations who are not contacted by the council.
If you wish to use this service, inform the registrar when you attend the Register Office, and the options will be explained to you. The registrar will show you what to do and this is a service many people find invaluable. You will be able to access this service by telephone or online once you have registered the death.
If you choose not to use the Tell Us Once service, you will need to report the death to various organisations and
government departments.
The following are organisations which may be appropriate to notify.
Please ask a member of staff for a printed copy of this patient leaflet if you would like a checklist to complete.
Before going ahead with any arrangements, it is advisable to check whether the deceased person left a Will and any instructions for the funeral.
If you are not the next of kin (nearest relative) or executor, you should check with the next of kin or executor that you have the authority to proceed.
Most funeral directors are members of one of 2 trade associations:
Member firms must provide you with a price list on request and cannot exceed any written estimate they give you without your permission.
Most people would probably require the funeral director to provide the following services as a minimum:
Embalming, viewing of the deceased, or providing a limousine for mourners are optional extras. Discuss these fully with your funeral director and make sure you receive an itemised written quotation.
Funeral costs for the same services may vary considerably from one funeral director to another.
It is advisable to get more than one quote to compare costs and services. Funeral directors should provide detailed price lists for you to take away. Disbursements are fees paid to others, for example doctors (for cremation forms), a minister, newspaper announcements, flowers, and crematorium. Ask the funeral director for a written quotation detailing all these fees.
In addition, it should be remembered:
If you receive certain benefits from the Department of Work and Pensions you may be entitled to some assistance towards the funeral expenses of your relative. For further information please contact the nearest Jobcentre Plus Centre.
A bereavement payment or bereavement allowance may be made in certain circumstances if you are the partner or spouse of someone who died whilst employed. These are dependent upon National Insurance contributions and other conditions. Please contact Jobcentre Plus to find out more.
The time ahead may be a very difficult one for you. If you have any further questions, a member of the chaplaincy team (0117 414 3700) or your GP would be happy to help.
If you would like to discuss any aspect of your loved one’s care, please contact the ward to arrange an appointment with a member of the medical/nursing team.
www.gov.uk/after-a-death/overview
www.bristol.gov.uk/births-deaths-marriages/bereavement-support
Patient Affairs Office
If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.
If you’re an overseas visitor, you may need to pay for your treatment or you could face fraud or bribery
charges, so please contact the overseas office: Tel: 0117 414 3764 Email: overseas.patients@nbt.nhs.uk
© North Bristol NHS Trust. This edition published April 2023. Review due April 2026. NBT002506
Clinical Guidelines
For guidance on hyperlipidaemia treatment guidelines and monitoring patients on lipid lowering therapy please see advice on Remedy
BNSSG Adult Vitamin D Prescribing Guidance
Blood Tests
Urine and Other Tests
NBT002316 Instructions for urine collection for Cystinuria
NBT002424 Instructions for 24 hour urine collection
Now that Infection Prevention & Control guidelines have been relaxed in line with the Government’s “Living with Covid-19” guidance, members of the public and staff are able to attend our Trust Board meetings in public. If you would like to attend, please let us know by emailing trust.secretary@nbt.nhs.uk and we can provide details of the location, and print papers if required. If you wish to ask a question of Trust Board, please submit it in writing follow the process set out here.
The Trust Board meets in public at 10am.
We will continue to record each Trust Board meeting that is held in public, and the recording will be available for viewing for two months following the meeting until the next meeting’s recording is uploaded.
Download Integrated Performance Reports (IPR):
Download Meeting Papers:
With over 15 years of commercial and non-commercial research, the Respiratory Research team led by Professor Maskell is one of the largest and most successful clinical and academic pleural research teams in the UK.
For nearly a decade they have been designing and delivering practice-changing clinic trials, improving the lives of patients with mesothelioma, pleural infection, and pneumothorax.
They have tested new devices designed to manage recurrent pleural effusions and pneumothorax, including a first in human trial which led to an international multi-centre randomised controlled trial (SEAL-MPE trial).
The multidisciplinary team includes highly skilled and motivated research nurses, managers, clinical research fellows and clinical academics. The team has also successfully been awarded research grants of more than £5million.
Please speak to the person treating you to find out if there is a research study that may be able to help you.
There is a high prevalence of anxiety, depression and neurocognitive dysfunction which impacts on the wellbeing of patients with severe asthma. These factors may be the result of poorly controlled asthma, the effects of asthma treatments, but also themselves impact on asthma severity. The relationship between these factors is not well understood.
Magnetic resonance imaging (MRI) of the brain demonstrates structural and functional differences between the brains of people with asthma and those without. Though not extensively studied, a small number group of trials have shown a 'normalisation' of brain activity after cognitive behavioural therapy in patients with asthma and depression. The effect of asthma treatments on brain structure and activity requires further investigation.
Mepolizumab is amongst a group of injectable treatments that have revolutionised the treatment of poorly controlled severe eosinophilic asthma. Randomised controlled trial and real-world data shows reduced exacerbations and oral corticosteroid use in patients taking mepolizumab. Trials also show improved asthma-specific quality of life, though there have not been studies that have assessed anxiety, depression, well-being and cognition in detail.
In this observational study we propose to examine the MRI structure and function of the brains of people with severe eosinophilic asthma before and six months after starting mepolizumab as part of routine clinical practice. We will collect detailed health and neurocognitive information to evaluate changes in psychological health and cognition with mepolizumab. We will compare these data, to results in patients with well-controlled asthma. We will assess whether changes seen on MRI brain imaging relate to the direct effect of the mepolizumab on the brain, or of the secondary effects of improved asthma control that is known to be achieved by mepolizumab.
To become participate in this study, find out more information here.
Project Details
Principal Investigator: James Dodd
Planned End Date: TBC
Local Ref: 5409
Many people with chronic obstructive pulmonary disease (COPD) remain very breathless and limited. In some patients, with the appropriate pattern of emphysema, an operation called lung volume reduction surgery is effective at removing the worst affected area of lung. New techniques have been developed where emphysema can be treated using a fibre-optic camera called a bronchoscope. Trials have shown that using a bronchoscope to place endobronchial valves into the airways can be very effective in carefully selected patients and the technique is now being adopted in hospitals across the UK.
This study will collect data from people undergoing these procedures at hospitals across the UK to evaluate how well they work in practice and what factors at baseline influence response. Baseline, three month and 12 month follow up data will be collected. This will include lung function data, measures of exercise capacity, questionnaires about health status and CT scan results. Questions addressed will include:
The study is supported by The British Lung Foundation and sponsored by Imperial College, London. By building collaboration, the establishment of the network will also produce a structure that will make evaluation of future bronchoscopic techniques easier bringing innovative treatments into play more quickly.
Project Details
Principal Investigator: Dr James Dodd
Planned End Date: 30/06/2026
Local Ref: 4076
When people get chest infections, fluid can sometimes build up around the lung. This is called a parapneumonic pleural effusion. In about 1 in 10 cases, the fluid itself becomes infected, this is called pleural infection. Pleural infection is usually treated by removing the infected fluid and using antibiotics to mop up the left-over infection.
Patients with pleural infection often receive long courses of intravenous antibiotics because doctors are uncertain of how well antibiotics reach the infected pleural fluid and whether bacteria are becoming resistant to them.
The Pleural Antibiotic Concentrations informing Treatment (PACT) study is observational and aims to see how well antibiotics are reaching the infected fluid, and how quickly the bacteria are being killed. To answer this, we will collect samples of pleural fluid from participants who are being treated for pleural infection with pleural drainage. This fluid will be tested to measure how much antibiotic has managed to get into it. We can then tell if the antibiotics are reaching high enough concentrations to kill bacteria. We will also be testing this fluid to see if the bacteria are being killed by the antibiotic or not. In the future, this information may shorten the time patients are treated with intravenous antibiotics and therefore how long they need to stay in hospital.
Project Details
Local Ref: 4581
Background and study aims
Pleural mesothelioma is a cancer that affects the lung lining, caused by asbestos. Despite recent treatment advances, the prognosis is often poor. Prompt diagnosis is vital. A biopsy can diagnose mesothelioma, guide treatment and support compensation claims. However, some people need multiple biopsies, increasing the risk of biopsy-related complications and prolonging the time to diagnosis. Doing additional tests on initial biopsies may increase the chance of diagnosing mesothelioma and avoid repeat biopsies. This would allow anti-cancer treatment to be started sooner and improve survival. The extra tests are not genetic but look for genetic changes in the cancer that allow it to grow and spread. The genetic markers in mesothelioma are called BAP1, p16 and MTAP. If they have disappeared on biopsy mesothelioma is diagnosed. Another study was previously conducted on people with suspected mesothelioma who required further biopsies as their first biopsy did not give a diagnosis It took place in eight UK centres and recruited 59 patients. This study aims to perform these additional tests on their biopsy samples to see whether this would have made the diagnosis sooner and removed the need for further biopsies. It will investigate how many biopsies could have been avoided, how much time would have been saved, how this may have impacted survival and what cost-savings this would have offered the NHS.
Who can participate?
This study includes the 59 participants in the original TARGET study who were recruited between September 2015 and September 2018. No additional participants will be recruited. Should any participants of the original TARGET trial wish to opt-out, they can contact the main contact below.
What does the study involve?
Biopsy samples taken as part of the participants’ routine clinical care will be tested for the markers of genetic change in mesothelioma (BAP1, MTAP and p16). The ability to make a diagnosis using these tests will be compared with the original diagnostic pathway, which was before the use of these tests.
What are the possible benefits and risks of participating?
The benefits of enrolling are to future patients, whose diagnostic process could be improved, with no additional requirements of TARGET participants. As there are no additional interventions required of participants and this will not impact management, there are no risks identified.
Project Details
Principal Investigator: Prof Nick A Maskell
Duration: October 2022 - July 2025
Funded by the Southmead Hospital Charity
Main contact : Geraldine.lynch@nbt.nhs.uk
IPF is a progressive scarring lung condition causing coughing and breathlessness. IPF patients often have reflux disease meaning stomach acid may be breathed into the lungs, potentially damaging them. Medicines which stop stomach acid production, proton pump inhibitors (PPIs), can be used to reduce reflux symptoms including heartburn. Some researchers suggest PPIs also reduce IPF progression.
This research aims to see if IPF progresses slower if treated with PPIs. Based on the results, we will be able to recommend whether or not IPF patients should take PPIs.
This trial will involve 298 IPF patients from approximately 37 UK hospitals. At the beginning of the study, we will ask patients to perform breathing tests, and ask those with a cough to use a device to count the number of times they cough in 24hours. We will ask them to answer two questions rating their coughing and breathlessness, and complete questionnaires on their coughing, IPF, sleep habits and general condition. People will be given a PPI, called lansoprazole, or dummy tablets, twice per day for 12 months. They will be given a leaflet telling them what to do about reflux symptoms. At the end of the study, we will repeat these tests and analyse the results. We will record any side effects people may get. If people suffer side effects, they can reduce the dose.
People taking medicines that interact with PPIs or have other serious medical conditions won’t be able to participate. People receiving PPIs will only be able to participate if they can stop taking their medication without their heartburn returning.
The study will be undertaken by doctors and researchers with experience of IPF, reflux disease, PPIs and coughing. We will publicise our results by writing reports for medical publications, media articles and social media.
Project Details
Local Ref: 4672
Become one of the thousands of people taking part in research every day within the NHS.
Find out more about our research and how we're working to improve patient care.
Research & Development
North Bristol NHS Trust
Level 3, Learning & Research building
Southmead Hospital
Westbury-on-Trym
Bristol, BS10 5NB
Telephone: 0117 4149330
Email: research@nbt.nhs.uk
This page is a guide to help you understand some of the current treatments used to treat early inflammatory arthritis.
On diagnosis with inflammatory arthritis, it is common practice to be started on some of the medications in this leaflet, either individually or in combination, to reduce pain, swelling and stiffness in your joints.
It may take 3 - 4 months before you start to feel the benefit of these medications (6 or more weeks for Leflunomide). Steroids should provide more immediate (but short term) relief.
Your doses may be increased or decreased gradually at clinic appointments or new drugs may be added or taken away from your regime.
You will be given the first prescription (for 1 month duration) from the hospital. Further supplies of your medicine should be obtained from your GP. It is important you do not run out of your medication.
Keep all medicine out of the reach of children.
If you buy medicines from your local pharmacy, tell the Pharmacist you are on this medication.
| 500mg tablets | Morning | Evening |
|---|---|---|
| Week 1 | One tablet | |
| Week 2 | One tablet | One tablet |
| Week 3 | Two tablets | One tablet |
| Week 4 (onwards) | Two tablets | Two tablets |
DMARD therapy should not routinely be stopped for surgery although individualised decisions may be made depending on the type of surgery.
During a serious infection (if you require hospital admission and / or antibiotics given via a drip infusion), your methotrexate, leflunomide or sulfasalazine should be temporarily discontinued until you have recovered from the infection.
More information about the drugs is available via www.versusarthritis.org/ and National Rheumatoid Arthritis Society (nras) leaflet Medicines in Rheumatoid Arthritis (including information about side effects).
These drugs will need regular blood monitoring as stated in your clinic letter. Your GP can also check the monitoring requirements on the BNSSG website.
Routine blood monitoring includes full blood count (FBC), renal function (SeCr / eGFR), and liver function tests (LFTs).
Routine blood tests every 2 weeks until on stable dose for 6 weeks, then every month for 3 months, then every 12 weeks.
Routine blood tests every 2 weeks until on stable dose for 6 weeks, then revert to previous schedule.
Sulfasalazine – standard monitoring schedule for 12 months then no routine blood tests required (unless combined with other treatment).
Hydroxychloroquine – no blood tests required (unless combined with other treatment).
Methotrexate in combination with leflunomide – continue on monthly monitoring longer term.
We want you to be active in your healthcare. By telling us what is important to you and asking questions you can help with this. The three questions below may be useful:
Ledingham, J., Gullick, N., Irving, K. et al., on behalf of the BSR and BHPR Standards Guidelines and Audit Working Group, 2017. ‘BSR and BHPR guideline for the prescription and monitoring of non-biologic disease-modifying anti-rheumatic drugs’, Rheumatology, 56 (6) p865–868. Available at: doi.org/10.1093/rheumatology/kew479.
National Rheumatoid Arthritis Society (NRAS) (2017). Medicines in Rheumatoid Arthritis. Available at: nras.org.uk/product/medicines-in-rheumatoid-arthritis/
Versus Arthritis. Treatments: Drugs. Available at: www.versusarthritis.org/about-arthritis/treatments/
A Rheumatology DMARD medication record form (compliance chart) is available on the printed copy of this patient information leaflet (NBT003100). Please ask your clinician if you would like a paper copy to complete.
It is important that you update your medication record form regularly and after any medication changes (and specify the date it has been updated).
We want you to be active in your healthcare. By telling us what is important to you and asking questions you can help with this. The three questions below may be useful:
If your arthritis is not well controlled on conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs), your treatment may be escalated to either a biologic disease modifying anti-rheumatic drug (bDMARD or biologic) or targeted synthetic disease modifying anti-rheumatic drug (tsDMARD) by your rheumatology clinician.
One of the Rheumatology Specialist Nurses or the Specialist Pharmacists will already have discussed with you which medicine you will be taking.
This page has been created to help you remember the important key information in relation to your medicine.
bDMARDs are a group of medications that are used to treat arthritis (such as rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis).
These medicines can decrease the amount of inflammation you have and reduce the damaging effects of your arthritis on your joints.
There are now quite a few bDMARDs available to treat different types of arthritis; which medicine you have been prescribed may depend on the type of arthritis that you have or another medical condition at the same time as your arthritis that might make one treatment more appropriate than another.
At the time of writing, bDMARDs used for different conditions include:
However more are becoming available very often.
bDMARDs can be given either as an injection into the layer of fat just underneath the surface of your skin (a subcutaneous injection) or by a drip into your vein (intravenous infusion).
If you have a subcutaneous injectable medication you can be taught how to do this yourself at home or someone can be taught to give you the injections, such as a family member.
If you are having an intravenous infusion you will need to come to the Medical Day Care Unit in Southmead Hospital which is located on Level 1 in Gate 5 of the Brunel building.
Some of the bDMARD medicines listed above are now available in the UK as similar versions made by different companies, because the patent (allowing one company to make the product exclusively) has expired.
These different versions of existing bDMARDs are known as ‘biosimilars’ because they are deemed to be sufficiently similar (in terms of safety and effectiveness) to the original product.
Switching between biosimilar brands should not affect the safety or the effectiveness of your medicine.
Switching patients to the most cost-effective version of bDMARD allows the NHS to treat more patients with these expensive therapies.
NHS England may ask us to change the brand of bDMARD medication you are prescribed from time to time and we will discuss this with you.
tsDMARDs are targeted synthetic therapies.
Like biologic medicines, they target specific parts of the immune system, however they are not made from living cells. They are smaller chemical drugs and can usually be taken by mouth.
There are now quite a few tsDMARD medicines available to treat different types of arthritis; which medicine you have been prescribed may depend on the type of arthritis that you have or your other relevant medical conditions.
At the time of writing, this group of medicines include:
But others are going through approval steps so may be available soon.
When your consultant or clinician decides it would be appropriate to start a b/tsDMARD therapy, we will usually invite you to a clinic appointment with the Rheumatology Specialist nurse or Rheumatology Specialist Pharmacist to carry out your baseline assessments (this usually includes a joint examination and blood tests) and talk to you about your new treatment options.
The Nurse or Pharmacist will complete some paperwork with you and discuss the main symptoms associated with your condition, your other medical problems, previously tried therapies and any patient preferences you might have.
Once we have discussed your condition and preferences, we will look at the most cost-effective treatment to suit your needs.
We will support you to make a shared, informed decision about the most appropriate treatment for you.
This depends on whether you take another medication, such as methotrexate, with the b/tsDMARD medicine.
If you are taking another medication with the b/tsDMARD medicine
You should be having regular blood tests via your GP to monitor this, and you will not need any different or additional blood tests (unless we tell you). You need to phone your GP surgery to arrange these blood tests.
Once you have started treatment, we will usually give you a call after a couple of months to see how you are getting on with your new medication. We will then invite you to attend a face-to-face appointment to check your joints and see if you are responding to your new treatment. This appointment will be either 3, 4, 5 or 6 months after starting treatment, depending on which treatment you are on.
You will then be followed up routinely every 6 months.
Your review appointments may be face to face or in our Remote Therapy Clinic (RTC). This can be via telephone, video, or occasionally we may be able to complete a virtual review which means we have checked your hospital records and blood tests and have deemed it safe to prescribe further medication without speaking to you, but we will always write to you to let you know if this is the case.
If you feel you need to be seen sooner than your scheduled appointment or if you feel you need to be seen face-to-face rather than remotely, please contact us via the rheumatology advice line; you do not have to wait until your scheduled appointment.
It is very important that you do attend regularly for reviews with your Rheumatology Team as the prescriptions of the b/tsDMARD medicines are based on your hospital appointments – if we do not review you in clinic (face-to-face or remotely), we will not be able to prescribe more b/tsDMARD medicine until we have seen you.
It is really helpful for us to understand how you are responding to your b/tsDMARD medication.
Some patients are able to track their symptoms, disease activity and overall wellbeing on a disease activity tracking smartphone application. If you are not already using this but are keen to do so, please contact our rheumatology team so we can register you for this service (free of charge).
If you are expecting to be seen by the hospital but do not receive an appointment letter, please get in touch with us to check you have been booked into an appointment.
It usually takes about 3-6 months for your b/tsDMARD to be fully effective, although some patients feel the benefit much sooner. We might prescribe you some other medication to help with symptoms whilst waiting for your b/tsDMARD to have an effect.
If your new medication doesn’t help improve your symptoms, we may need to stop your medication, allow for it to come out of your system and decide on an alternative treatment.
Sometimes, your medication will work very well at the beginning but might lose effect over time. If this happens, we may need to stop your medication, allow time for it to come out of your system and chose an alternative treatment.
It is important that you attend your follow up appointments so we can check how well your medication is working. Please always be honest with how your symptoms are feeling.
You should not have your b/tsDMARD medicine if you are unwell in any way, if you are currently taking antibiotics or if you have just had or are having any surgery in the next few weeks.
You can use the checklist below to help you to decide if it is safe for you to give the injection or to help you decide if you should contact us for further advice before your infusion.
If you say ‘yes’ to any of the above you should contact us on the rheumatology advice line for further advice before giving your injection or before attending your next appointment for an infusion.
It is usually safe to restart your b/tsDMARD medication when you are feeling well and you do not have any signs of symptoms of an infection.
We recommend not starting treatment until at least 48hrs after completing the course of antibiotics as long as you are well.
If you restart your b/tsDMARD therapy on a different day to your usual injection day, this will become your new injection day and you need to count the dosing interval from this day. Never shorten the gap between doses.
If you develop chicken pox, shingles or come into contact with someone who has chicken pox or shingles (and you have not had it before), stop your b/tsDMARD and seek medical attention.
Although we have more information to suggest some bDMARD therapies are safe to use in specific trimesters of pregnancy, it is generally advisable that you do not become pregnant whilst on a b/tsDMARD medicine unless you have discussed this with your rheumatology consultant first and been told it is safe to continue taking your medicine.
Although it is thought that a number of therapies can be considered safe in men who wish to father children, it is advisable that you discuss this with your rheumatology consultant first and check it is safe to continue taking your medicine.
This decision is made on your personal needs and your thoughts and beliefs are taken into consideration before making the decision; this is to make sure that any decision made is the best one for you and your family.
You should make sure that you use reliable contraception whilst taking a b/tsDMARD medicine.
You will need to come off your treatment for a certain amount of time beforehand to lower your infection risk with your surgery. Please contact us on the rheumatology advice line well in advance if your surgery so we can advise on the appropriate time to stop your b/tsDMARD.
It is important you let the surgical team know when you last had your dose of b/tsDMARD in case you need some preventative antibiotics.
You should also carry your b/tsDMARD alert card around with you.
You can usually restart your b/tsDMARD when your wound shows evidence of healing, any sutures/staples are out, there is no significant swelling, redness or drainage and there is no ongoing nonsurgical site infection, which is typically around 14 days.
The information leaflet provided with your medication will list the potential side effects with your specific b/tsDMARD and some information on the likeliness of them occurring.
How long will I be on my b/tsDMARD medication?
The rest of this page focuses on the important parts to remember if you are taking an injectable form of bDMARD or oral tsDMARD medicine that is supplied via a home delivery provider.
Your b/tsDMARD medicine can only be prescribed by your Rheumatology team through the hospital. This means that you won’t be able to collect it with your usual medicines from your pharmacy, chemist or GP.
We use a Home Delivery Service who will deliver your medication to you at home. If you wish, you may arrange with them to deliver your medication to an alternative address (e.g. work address) if this would be more suitable (but this cannot be a local GP or community pharmacy).
Your Rheumatology Specialist Nurse or Specialist Pharmacist can give you details about which home delivery service will be delivering your medication.
If this happens then you will need to contact the homecare delivery company who deliver your medicine and let them know so that they can arrange for the affected medication to be replaced.
You will also need to let the Rheumatology department know by calling the rheumatology advice line in case we need to provide the homecare delivery company with another prescription.
In some circumstances, we may advise that one or two injections can still be used, but we will provide personal instructions to you depending on your situation.
tsDMARD medicines do not need to be stored in the fridge.
If you forget to give an injection then you should give a dose as soon as you remember and then make sure that you take the next dose at the correct interval to make sure that you do not give the next dose too early.
For further advice on the specific medicine you are taking please contact the Rheumatology Advice Line.
If you forget to take a tablet (tsDMARD), do not take a double dose to make up for the forgotten dose. Take your next tablet at the usual time and continue as before.
If the pen or syringe slips when you are giving your injection or if the device does not work properly for any reason please contact us on the Rheumatology Advice Line for more help on the particular problem you have experienced.
Do not try and inject another dose in case some of the first dose was given.
If you think that your pen or syringe is faulty for any reason please make a note of the batch number and expiry date (this information can be found on the box containing your medicine).
Please report any faulty pens or syringes to your home care delivery company.
You will be supplied with a sharps bin for disposing of your injections. When your sharps bin is full with used pens/syringes, contact your homecare company to arrange a collection for disposal.
It is possible to travel (either abroad or within the UK) with your b/tsDMARD medicine, but you will need to plan ahead.
If you:
If you:
To arrange your blood tests and let them know once you’ve had your first dose of b/tsDMARD.
If you have an allergic reaction to your medication or severe side effect.
An injection using either a syringe or a pen injection device. The injection is given into the small layer of fat just underneath the surface of the skin.
Medication which is given slowly through a needle in your vein.
These are different versions of existing biological medicines, thought to have similar effectiveness and safety, brought out because the patent (allowing one company to make the product exclusively) has expired.
This is a term which is commonly used when patients have just one medicine to control their arthritis.
Removal of a tooth, which would leave a hole in the gum and may become infected.
Filling material is placed in the canals and the tooth is sealed with a temporary filling to protect it from infection. Then a crown is usually placed over the tooth to seal and protect it from recontamination and future damage.
www.versusarthritis.org/about-arthritis/
Telephone: 0117 414 0600
111 (Monday to Friday, 6.30pm - 8am, all day weekends and Bank Holidays)
rheumatologyadviceline@nbt.nhs.uk
Contact the rheumatology advice line to sign up.
Early breast cancer detection and diagnosis saves lives. The NHS Breast Screening Programme offers women aged 50-70 years a mammogram every 3 years. By detecting breast cancers before they can be seen or felt, breast screening already saves about 1,300 lives each year in the UK. MRI scans can detect some aggressive breast cancers even earlier than mammograms.
Unfortunately, MRI scans are expensive, and so the NHS uses them only to screen women at a high risk of developing breast cancer. New evidence suggests that MRI scans can be abbreviated to reduce their cost to the NHS, without affecting their ability to accurately display breast cancers.
FAST MRI is an abbreviated form of MRI which takes less time to acquire (3 vs 20 mins on the scanner) and to interpret (1 vs 10 mins). Unlike mammograms, FAST MRI scans can identify aggressive cancers irrespective of breast density – a trait found more commonly in younger women. Therefore, we are developing FAST MRI for women who are having their first screening by the NHS Breast Screening Programme. We wish to find out if FAST MRI could find aggressive cancers even earlier and smaller for these women because early detection of breast cancer saves lives.
Interested in taking part? To read the patient Information about FAST MRI Dyamond please go to the FASTMRI Dyamond webpage.
(Diagnostic Yield study for Average MammOgraphic screeNing Density): A multicentre study offering women a FAST MRI scan in addition to their screening mammogram, to see if FAST MRI can find cancers missed by mammography
Aim:
To see if FAST MRI, a new imaging test, can detect cancers that have been missed by mammograms for women with average breast density at their first screening mammogram (age 50-52).
Background:
Finding breast cancers early saves lives. The NHS breast screening programme uses mammograms tofind breast cancers early but sometimes a mammogram misses a cancer which keeps growing until the woman finds it herself. MRI (Magnetic Resonance Imaging) detects aggressive cancers better than mammograms but is expensive and the NHS uses it to screen only women at very high risk. FAST MRI is a shorter MRI test which might benefit more women by finding more breast cancers earlier and saving more lives.
Every woman’s breasts are different. Breast composition affects how they look on mammograms. Women with denser breasts are more likely to have their cancers missed on mammograms because dense breast tissue can hide a cancer. Of four density categories (A,B,C and D), A is the least dense and D is the densest. At age 50-52, about 8 of 10 women will be in one of the middle categories, B or C, about half in each. We already know from previous research that FAST MRI can find cancers missed by mammograms in women with denser breasts (C and D). But women with average breast density (B) also have cancers missed, because mammograms are better at finding some types of cancer than others. We want to find out if FAST MRI can detect additional cancers for this group of women (category B). Women in category A are least likely to benefit as their mammograms show any cancers present more clearly and easily.
Design and methods used:
We will invite women aged 50-52, the age when women at average risk of breast cancer are first invited for an NHS screening mammogram. We will use computer software to measure women’s breast density from their mammogram and invite women with breast density in category B and a normal mammogram result to have a FAST MRI scan. 1,000 women will be scanned at 4 NHS sites, chosen for the ethnic diversity of the screened population and the experience the site has in working with FAST MRI. This choice of NHS sites will ensure our sample is representative of the UK. NHS professionals who have completed FAST MRI reader training will interpret the FAST MRI scans. We will count the total number of cancers detected by FAST MRI and record the types, aggressiveness and size of cancer found. We will count how many women need further tests but turn out not have cancer. We will ask women to share with us their experience of having a FAST MRI. The results will help us decide which women should be included in a future FAST MRI trial to measure if FAST MRI is clinically and cost effective for the NHS by finding breast cancers earlier and saving lives.
Patient and public involvement (PPI):
Patients and the public are integral in our work and we have ongoing support from:
Our two lay research team members with personal experience of breast cancer and of breast screening will work with the wider PPI group to write public-facing documents so that participants and the public understand the research. They will also work to increase diversity, equality and inclusion in the PPI group.
Dissemination:
We will publish the results in academic journals and present at international meetings. Our PPI network will help us to share the results with charities and support groups locally and nationally.
Funded by the NIHR and MRC via the EME funding stream (NIHR 150502).
Chief Investigator: Dr Lyn Jones
Co-Lead: Dr Rebecca Geach
Planned End Date: 01/11/2026
Local Ref: 5273
(OPtimisation of the FAST MRI protocol: an Evaluation of what makes a good breast MRI through detailed Analysis of scans from multiple NHS sites)
Background:
Finding breast cancer early saves lives. The NHS Breast Screening Programme (NHSBSP) uses mammograms to detect early breast cancers. However, not all cancers show on a mammogram so a cancer can be missed and continue to grow until the woman finds it herself. Magnetic Resonance Imaging (MRI) scans are better at detecting cancers than mammograms. However, MRI is expensive, and the NHS only uses it to screen women classed as high risk of developing breast cancer.
Recent studies have shown that using only part of the full breast MRI scan detects cancer equally well as the full scan, but is a much quicker scan with lower costs. This technique is called FAST MRI and has the potential to save more women’s lives by finding breast cancers earlier than a mammogram and providing value for money for the NHS. A group of research studies led by North Bristol NHS Trust aim to develop a better breast screening programme using FAST MRI for women who currently have mammograms, to screen for breast cancer.
How easy it is to see a breast cancer on an MRI scan depends on the scan quality and the technical details of the scan, known as the protocol. Quality control is therefore crucial for breast screening to optimise the detection of cancers.
This pilot study will develop a standardised and optimised protocol to be used in a separate multicentre trial of FAST MRI for women having their first screening mammogram (DYAMOND).
Aims:
Design and Methods:
Our study will analyse breast MRI scans from different scanners across NHS sites within the FAST MRI Research Programme. Anonymised scans will be sent electronically to a panel of Breast Radiologists who will each score the scans for multiple aspects of scan quality. A team of Medical Physicists will also extract the numerically measurable aspects within each of the sites’ scan protocol and images. These two information sets, radiologists’ visual assessments and objectively measured values, will then be analysed to discover which settings make the optimal FAST MRI scan for each type of MRI scanner used. Site specific recommendations will be made to improve scan quality.
Results:
Study in progress.
Funded by Southmead Hospital Charity Research Fund.
Principal Investigator: Dr Katherine Klimczak
Planned End Date: 31/12/2024
Local Ref: 5268
(EvaluatioN of an Artificial Intelligence (AI) Tool developed within and owned by the NHS to accurately measure mammographic breast Density): Selection for personalised screening with FAST MRI.
Background:
Finding breast cancer early saves lives. The NHS uses mammograms to try and detect early breast cancers. However, as mammograms do not show some cancers very well, a cancer can be missed and continue to grow until the woman finds it for herself. MRI (Magnetic Resonance Imaging) is a test that can find cancers better than mammograms, but it is expensive and so the NHS only uses it to screen women at very high risk of breast cancer. A quicker, shorter MRI test is now available called FAST MRI. Not only might this test benefit more women, it may also provide better value for money for the NHS to find breast cancers early and save lives.
Every woman’s breasts are different. One way they differ is in a characteristic known as mammographic or breast density, which affects how they look on mammograms. Women with denser breasts can have their cancers missed on mammograms, as the dense normal tissue can hide the cancer. FAST MRI is better at finding these cancers.
To find out which women have dense breasts and could benefit from a FAST MRI, the mammograms need to be studied and measured. Currently, breast density is looked at and estimated by the radiologist but as each radiologist might view images slightly differently, results for breast density might not always be correct. There are now better systems to do this using (expensive) technology.
Aims:
To evaluate the accuracy and reliability of a breast density measurement tool. This will provide the National Breast Screening Programme (NHSBSP) with the ability to describe a woman’s breast density. If this tool is successful, it will further enable the North Bristol NHS Trust led FAST MRI research programme to develop a better breast screening programme.
Methods:
Our study uses an NHS developed and owned artificial intelligence (AI) software tool to automatically categorise the breast density. The cost to other NHS organisations will therefore be much lower when compared to commercial software. In this study we have tested our tool on anonymised mammograms, held in a research database called OPTIMAM, and compared the results to measurements made by commercial technology.
Our study looked at women aged 50-55, the age when women at average risk of breast cancer in the population are first invited to attend for an NHS screening mammogram.
Results:
The results of this study will be presented at the Symposium Mammographicum Conference, June 2023
Funded by Southmead Hospital Charity Research Fund.
Project Details
Principal Investigator: Dr Katherine Klimczak
Planned End Date: 01/04/2023
Local Ref: 5086
A study to improve FAST MRI interpretation training and to enhance Breast Clinician and Advanced Practitioner Radiographer understanding of breast MRI at multidisciplinary team (MDT) discussions.
Background:
FAST MRI (a shortened form of breast MRI) has been developed to address limitations of full protocol breast MRI (fpMRI), by shortening the time needed to acquire and to report the scan. FAST MRI diagnostic accuracy is similar to fpMRI and therefore has potential for wider use in screening but to roll it out on a larger scale more readers skilled at interpreting FAST MRI would be needed. Initial evaluation showed NHSBSP mammogram readers could be trained to interpret FAST MRI with a single day of structured training, but novice MRI readers were still learning at the end of the final assessment task and therefore it is likely that further training could further improve their performance. The current study aims to see if further training can enable novice MRI readers to match the performance of experienced breast MRI readers at FAST MRI interpretation. The improvement in novice reader performance during the training will be monitored to enable evaluation of their "learning curve” so that we can find out how much training mammogram readers need to enable them to interpret FAST MRI scans in clinical practice.
Methods:
Mammogram readers from seven NHS sites in England will undertake the developed North Bristol FAST MRI interpretation training programme. The final assessment task of the training programme has been updated for this study (since its use in the previous Multi Centre Reader Training Study) so that feedback (the true results of each FAST MRI scan) is given to the readers immediately after they have recorded their opinion about the scan. This modification to the assessment task is known as "formative assessment” in educational theory and has been shown in education research to be an effective teaching tool. Because the FAST MRI scans of the final assessment task are presented to each reader in a different random order, we will be able to map the learning curve of each reader as they complete the final (formative) assessment task.
Results:
The results of this study will be presented at the Symposium Mammographicum Conference, June 2023
Funded through the National Breast Imaging Academy by Health Education England.
Project Details
Principal Investigator: Dr Liz O’Flynn
Planned End Date: 30/12/2022
Local Ref: 5041
Background:
To be able to get high quality FAST MRI images it is important that the correct protocol (information/sequences programmed into the scanner) is optimised. To do this test (phantom) breast need to be developed to trial the protocols to put into the MRI machine.
Aims:
To develop breast test objects to ensure an optimum FAST MRI protocol (the information put into the MRI scanner to run the scan) and develop a quality assurance (QA) programme that can be used across different sites and MR scanner vendors.
Methods:
This phantom development work includes the design and construction of 2 magnetic resonance imaging (MRI) test objects that will be used for quality assurance (QA) tests of MR scanners at centres participating in the FAST MRI project.
One of these test objects will be used to assess the dynamic range of the dynamic contrast enhanced (DCE) sequence and the other the resolution in 3 dimensions. The MRI test objects will be trialled at NBT initially in order to finalise the design.
Results:
The results of this study will be presented at the Symposium Mammographicum Conference, June 2023
Funded by the National Institute of Health Research (NIHR) Research for Patient Benefit funding stream.
Project Details
Principal Investigator: Dr Lyn Jones
Planned End Date: 30/10/2022
Local Ref: 4543
Background:
After the promising results of the single centre study, the FAST MRI training programme was awarded an NIHR grant to expand and develop the FAST MRI training further.
Aims:
The aim of this study was to refine and pilot a training programme for FAST MRI interpretation within the NHS Breast Screening Programme (NHSBSP) workforce, to support the delivery of a future multicentre study of FAST MRI versus mammogram for breast cancer screening.
Methods:
The aim was achieved in two work streams:
Results:
Conclusions:
Funded by the National Institute of Health Research (NIHR) Research for Patient Benefit funding stream.
Project Details
Principal Investigator: Dr Lyn Jones
Study Completion: 07/09/2020
Local Ref: 4543
Background:
Mammographic screening programmes result in both over diagnosis and under diagnosis of breast cancer. Under diagnosis leads to cancers presenting symptomatically between screening visits (interval cancers), and to cancers being detected by screening only once they have already reached more complex and life-threatening stages.Although MRI is the most sensitive method to detect breast cancer, currently only women classified as high risk (>30% lifetime risk) are offered screening MRI in the UK. However, in the future, personalised screening could enable larger numbers of women to be offered different screening regimes, each incorporating different imaging modalities, according to their level of risk.
Finding breast cancer early saves lives, and there is therefore a need to develop cost-effective imaging tests that will benefit women at risk of breast cancer by finding significant disease early. First post-contrast Acquisition SubtracTed (FAST) MRI is a type of abbreviated (shortened) breast MRI. FAST MRI is essentially as accurate at breast cancer detection as full protocol breast MRI, but is much faster to acquire and report. This technique might benefit more women than are currently offered screening with full protocol breast MRI. FAST MRI may be especially useful for women with dense breasts, since cancers obscured by dense tissue on mammograms are often visible on MRI
Aims:
The aim of this study was to explore whether NHS breast screening programme (NHSBSP) mammogram readers can learn to effectively interpret FAST MRI with less than one day’s additional training and to match the capabilities of expert breast MRI readers at this task in terms of accuracy and speed of interpretation.
Methods:
FAST MRI images were created by using previously acquired full protocol breast MRI scans. The anonymised images were reformatted and simplified into a form equivalent in its display to a FAST MRI. Using these FAST MRI images, training was offered to colleagues at Bristol Breast Care Centre.
Four consultant radiologists who were qualified to report full protocol breast MRI and four screening mammogram film readers who had not previously been trained to report MRI were trained to read FAST MRI. They were shown a set of training images with answers in a one to one session with the Chief Investigator, and the length of time taken to train each person was recorded.
Results:
The findings showed that the brief structured training carried out in the study enabled multi-professional mammogram readers to achieve similar accuracy at FAST MRI interpretation to that of the consultant radiologists experienced at breast MRI interpretation.
For more information about this study, published results can be found on the British Institute of Radiology website (main results), European Journal of Radiology website (training methodology) and the Pub Med website (review of published literature).
Funded by North Bristol NHS Trusts’ Research Capability Fund.
Project Details
Principal Investigator: Dr Lyn Jones
Study Completion: 26/02/2019
Local Ref: 4002
If you would like more information about the FAST MRI research programme, or would like to find out how you can get involved, please contact FASTMRI@nbt.nhs.uk.
You can also get to know the researchers and support staff delivering this study by visiting the FAST MRI Research Team page.
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Research & Development
North Bristol NHS Trust
Level 3, Learning & Research building
Southmead Hospital
Westbury-on-Trym
Bristol, BS10 5NB
Telephone: 0117 4149330
Email: research@nbt.nhs.uk