British Society of Neuroradiologists

www.bsnr.co.uk

To: Honorary Secretary BSNR Members Neuroradiology Department

Clarendon Wing, Leeds General Infirmary

Great George Street, Leeds LS1 3EX

Tel: 0113 392 6813

E-mail: bsnr.sec@gmail.com

President: John Straiton (JS) President-elect: Chris Rowland Hill (CRH) Treasurer: Prof Jonathan Gillard (JG) Hon Secretary: Tony Goddard (TG) Training and Education SC Chair: Rob Lenthall (RL) Academic SC Chair: Stavros Stivaros (SS) Standards SC Chair: Prof Phil White (PW) European Representative: Kyri Lobotesis (KL) Member-at-Large: Tim Hodgson (TH) Trainees Representative: David Minks (DM)

Main Conference Arena Belfast Hilton Hotel 11th October 2014

4.30 - 5.30 p.m.

Meeting Agenda: 1. Apologies:

Received from David Minks.

2. Minutes of previous meeting: Two amendments were proposed by JS. One was a spelling mistake - Don Colley, correct spelling is Collie. JS was misquoted insofaras he has never said there was never a proposed annual fee. The initial fee was proposed at £2 annually. Previous ABM minutes otherwise accepted as a true record.

3. Matters arising:

These will be discussed within the body of the meeting. 4. President’s Report:

JS stated that it had been a privilege and an enjoyable time during the last two years as BSNR President. JS thanked all the Committee members for their support during this time. He also specifically thanked Jonathan Gillard and James Byrne who have significantly improved the finances over the last few years and also Tony Goddard, the current Honorary Secretary as this role seems to be increasing in size and complexity. He also stated that the overall Society’s duties are increasing in their complexity and the constitution needs to change to reflect such changes. There will be further details on this in the Treasurer’s report. Complex changes are going to be required which have legal implications for us, and also changes in the conduct and constitution of the sub-committees. JS welcomed Geradine Quaghebeur (JQ) as the Standards Sub-committee Chair. One immediate ongoing concern is iREFER and JS encouraged colleagues to assist GQ in this endeavour. He also mentioned that NICE requires the BSNR to be an active participant in areas where there is a mutual interest and encouraged members directly or collectively as part of the BSNR to contribute. JS also offers thanks to Phil White who is now stepping down as the Standards Sub-committee Chair, particularly for his role there but also his role in promoting stroke intervention and standards for patient treatment, and also with regard to the NCEPOD report into management of aneurysmal subarachnoid haemorrhage. JS also pointed out that next year there will be two elections - 1. Election of a President to serve from 2016 - 2018 2. Election for a new Secretary starting from the BSNR Annual Meeting in 2015 Volunteers are of course encouraged to come forward.

5. Treasurer’s Report: Reviewing the accounts, overall £39,000 was returned for the meeting in 2012. There have been issues with the flow-diverter registry insofaras funds have been provided by industry in support of this, but these have been paid through the BSNR accounts. This has created a slight legal difficulty, as a mutual society is meant to be funded by its members and not by any third party. Bad debts were going to be included in this year’s financial records. Approximately £3,200 is as yet unpaid. There is a slight discrepancy between the databases held by the Treasurer and Secretary and TG to check (again) who has and who has not paid. £5,000 loss was written against the Oxford meeting as this was the subsidy for trainees who attended at a reduced rate. Overall profit was only around £500 for the meeting as a whole.

No Isherwood prize has been awarded this year and this will be rolled over to next year and anyone is encouraged to apply for this (provided the supportive consultant is a member of the BSNR and in good standing). The website also ate up £2,400 over two years of payment to Edinburgh and then further support was then swiftly withdrawn. The BSNR Secretary has now taken over management of the website with support from eDot3. JG pointed out that tax liability would increase substantially if the constitution is not changed. Total funds are approximately £142,444. This actually sounds better than it is as the net increase each year i.e. the contribution from industry and membership subscriptions is not very high. Formal advice received from the accountants is to do with how the funds are handled as a mutual society. The BSNR has been advised that It should not be in the business of accumulating funds or necessarily investing funds. Funds should be for the benefit of its members. Several complex recommendations have been made which is beyond the scope of these minutes but summarised as: a The constitution needs updating b BSNR members are all equal beneficiaries c Ideally needs to run at zero turnover or even at a deficit

d The BSNR needs to be protected from unauthorised use of its funds and protect their own liability.

e At this point in time we have been advised against becoming a charity due to the complexities of this, provided the finances are handled correctly The BSNR committee plan to go through the constitution in detail and will discuss it at the next Committee meeting and with the membership at large for, hopefully approval. For the annual meetings we need more financial rigour and the BSNR will open a meeting account alongside the main account for the purposes of securing money for the annual meeting. John Millar questioned whether there was any personal liability for members due to financially failed meetings and for the Society as a whole going into debt. JG responded that there was potentially a personal liability but this will have to be limited as part of an amendment to the constitution. Overall JG pointed out that we are not utilising money for the members’ benefits quickly enough. Funds will become available for the: Du Boulay professorships; the Isherwood prize; reduced membership registration for the annual meeting; and a reduced fee (possibly abolished fee) for trainees for the annual meeting. David Hughes suggested that the meeting could be free as we have so much money available. JG pointed out the finances again were not quite as robust as they appear, they could barely cover free meetings without significant ongoing members’ payments. Steve McKinstry pointed out the cost of the annual meeting in Belfast of £48,000 and small profit is likely to be made.

Phil White asked why we were not a charity. JG replied that this is very difficult logistically and there are no clear advantages over our current status as essentially a trade association. JS stated that there was plenty of discussion and alterations to the constitution still to occur and there would be further notifications from the BSNR Committee in due course. We still need to keep on chasing non-payers but not to “name and shame”. There is an impetus to institute constitutional changes before the end of the BSNR financial year next July. We anticipate that an amended constitution will be available for circulation in January 2015. There was a discussion on how members would vote on the constitutional changes as the constitution itself states that two-thirds majority is required. An online vote could quite easily be set up for this purpose and also utilised for the upcoming elections for President and Honorary Secretary. GQ mentioned that £10,000 from the BSNR was given to the Oxford organising committee for use for the meeting and this is purely a matter of trust, the money could easily have been used for something else and we need to tighten up our financial probity. Both JG and CRH discussed further how an amended constitution was going to be approved. CRH suggested that those present at the Annual Business Meeting could give the Committee a mandate to go ahead and approve it in advance. In practice, the amended constitution will be circulated to members who will be asked to provide approval by return email.

6. Secretary’s Report:

Website This is taking shape quite nicely with the help of Ian Shield at eDot3 at minimal cost and a fraction of what was previously provided. There was a discussion on the members area where password protected items are held. At the moment there is one generic password for all members, which could be passed on to those who have not paid, at the moment this is currently simple and effective. Anyone can contact the Secretary via the email on the website. It is not yet available for mobile devices. TG encouraged communication on website content, what should or should not be on the website and overall comments on the style, content and usability. There are potential links that could be developed between the BSNR site and the stent registry having a potential UKNG section, SITS thrombectomy, and a password-protected juniors forum. All these could be developed in the future. It was discussed that a webmaster may be able to assist the secretary in this task. David Minks has subsequently come forward to offer his help. New Members There were eight applications for associate membership and four applications for full membership (see appendix 1).

Current membership status as of 28.11.14 as follows: Full members in good standing 137 Full members not in good standing 40 Associate members in good standing 72 Associate members not in good standing 36 Honorary members 3 Permanent or temporary international members 26 (who we have agreed are exempt from subscriptions) Senior members 33 New Secretary This was discussed and TG gave strong encouragement for a replacement so that he can stand down after four years. Currently no-one has yet volunteered though this is likely to be considerably later next year before somebody does offer. The current secretary received thanks from both JS and JG for his ongoing efforts.

7. Training and Education Sub-committee Report: Presented by RKL.

The annual review was prepared by Ian Craven (see appendix 2). Overall, as usual, there is a general balance between current vacancies and provision of trainees, particularly outside London. A complex review of trainee issues was described (also included in appendix 2). RKL met with Caroline Ruben at the Royal College to discuss review of ongoing training issues. This was felt to have major implications for radiology particularly diagnostic neuroradiology. The College has not been given any structure on training programmes. UKNG are also involved in discussions about potentially allowing access to non-radiologists for interventional training although this is an ongoing issue. An example of some difficulties with cohesion amongst interventionalists and engaging of specific topics - David Minks sent out a questionnaire regarding antiplatelet therapy but only received two responses. We ought to be better at collating and sharing our important data. In September RKL and CRH attended a meeting of the Royal College of Radiologists on interventional training. Several issues were discussed, but one main area of concern was the limited opportunity to undertake INR training for those individuals who happen to be training in centres that do not provide interventional neuroradiology, training as local advertising is favoured by Deaneries. The Shape of Training documents were also discussed and training may be able to extend beyond CCT, although funding may well be an issue for final year training. For INR, work based assessment tools have not yet been approved by the GMC and therefore until we see what happens here we are not going to progress with any INR work-based assessment tools (DOPS).

8. Standards Sub-Committee Report:

The Standards Sub-Committee Report is attached (appendix 3). Ongoing projects are iREFER and eBrain and also assessment and application of the recent NCEPOD guidelines for management of aneurysmal subarachnoid haemorrhage. The latter is divided into three phases: emergency and primary care; secondary and tertiary care; and rehabilitation. This document does have significant implications for developing standard operating procedures within neurosciences centres and affects the relationship with their surrounding referring hospitals.

Stroke and thrombectomy guidelines have also been provided with hard work led by Phil White. These guidelines are soon to be uploaded to the BSNR website and available for review. PW was thanked by JS and JQ was welcomed at the new Lead for the Standards Sub-committee. Flow diverter registry is being built very slowly by a company called ‘Dendrite’ with support from industry. PW discussed potential Peer Review stroke centre visits which will need some neuroradiology input. The details of this are yet to be finalised.

9. Academic Sub-Committee Report:

Stavros Stivaros was unable to be present for the presentation of Academic Sub-committee Report. A document previously prepared is appended (appendix 4).

The du Boulay professorship has been very successful but SS has felt it taxing to combine the roles of Standards Sub-committee lead and visiting du Boulay professor. eBrain is ongoing with many projects having been signed off to the project website (see appendix 4). The current Isherwood prize would be advertised and closing date is planned for 1st December 2014 with interviews January 2015. The last recipient of the Isherwood prize is due to present her findings at the current BSNR meeting. The Isherwood applicant must be supervised by a member in good standing in the British Society of Neuroradiologists. SS is the face and voice of neuroradiology of the current International Day of Neuroradiology which is stated to be the “year of the brain”. SS is involved in a public engagement lecture and a ‘Youtube’ film and there are also other public engagement interviews which have been signed off by the RCR.

The next du Boulay professors have subsequently been interviewed and appointed: Rob Dineen (Nottingham) and Adam Waldman (Imperial) will serve concurrently starting early 2015. Members are encouraged to make arrangements for a visit at the earliest opportunity. It was discussed how the application process ought to be made for subsequent du Boulay professors. It was felt it was not just for young members and that the interview process might put off older, more established potential applicants. Overall it was felt that perhaps it would be acceptable to approach a potentially good candidate directly.

SS also led a discussion about what a member of good standing actually meant, and what we could do to encourage other members to pay. He suggested having a list of members who have paid on the website. JS reiterated the need that for the Isherwood application to be valid, the supervising consultant ought to be a member in good standing and that the application form ought to contain a statement to this effect. CRH noted that all members of good standing should be able to access the eBrain website. TG to contact Kenny Hardy Smith who is still at the helm of this to enable this to occur.

10. European Representative Report:

The European situation is still confusing with apparently little communication between the UEMS and the ESNR. The BSNR European representative liaises with both organisations. There is perhaps a feeling that we ought to confirm what benefit we achieve by remaining with the European Society. As regards to WFNRS there appears to be no activity apart from requests for money although it was unfortunately noted that non-membership may have adversely impacted on the bid for London to host the Symposium Neuroradiologicum. Prof Yousry received good support from Egyptian and pan-Arabic countries although they apparently provided their support too late. Also there was strong financial support for the meeting from the winning US bid.

11. Trainees Representative Report:

Unfortunately David Minks could not attend but submitted a written report, which is detailed below.

The majority of trainees understand it is wise to make provisions for non-radiologists to undertake neurointervention. They see it is sensible so that we can decide on the process rather than it being decided for us by external bodies such as the Royal College of Surgeons etc.

However the concerns they have mainly relate to the provision of high quality training: 1. If non-radiologists are to enter training, this must not impinge on quality and volume of training for radiologists requiring training. 2. Currently there appears to be just about the right workload / caseload for the number of trainees in the system and those looking to start training in the near future. By introducing new pools of trainees, it is likely that this workload will be diluted which will inevitably impact on the quality and volume of the training that everyone receives. This would not be desirable. 3. Is it appropriate and safe for potential interventionalists to interpret and act on radiological imaging with radiation based procedures when they do not have any formal diagnostic radiology experience or qualification (such as FRCR). 4. All trainees (radiologists and non-radiologists) should be accountable to the same high quality of competency in order to operate independently. This has been raised as apparently there is a discrepancy between the number and complexity of EVARs a radiology SpR has to do compared with the vascular surgery SpRs. The vascular surgery SpRs apparently are not required to do as many before they are 'signed off'. 5. The number of candidates admitted into the training scheme should match requirement of the service/work force. Currently the number of trainees probably matches the number of retirements and new positions. By introducing a new pool of trainees we may have lots of people in training with no consultant jobs to apply to.

I'm not sure if these issues will be relevant to raise at the meeting or if they have/will been covered at the Royal College meetings. However they are issues that have been voiced by trainees so I thought it may be relevant to raise them. These discussions are ongoing and will feature in committee meetings in the future.

12. Any Other Business:

JS said it was a privilege to be President of the Society and thanked the Committee and Subcommittee members who have helped him in the last two years and also congratulated Chris Rowland-Hill, his successor. CRH then thanked John for his last two years of excellent work as BSNR President.

13. Date and Location of Next Meeting: Next meeting is in Sheffield - with Registrars Day the day before 2016 Leeds/York 2017 Cambridge 2018 Dublin have offered 2019 Cardiff 2020 Plymouth Dublin have been offered first refusal to decide which date they want.

London have also offered to host the meeting in 2020, which will be the 50th anniversary of the birth of the BSNR.

Tony Goddard Honorary BSNR Secretary

Appendix 1 Associate Members Mohammed Wazim Kaleel IZZATH (Glasgow) Proposer: Dr. Dan Connolly Seconder: Dr. Stavros Stivaros Rachel SMITH (Swansea) Proposer: Dr. Andrew Hill Seconder: Dr. Shaun Halpin SAIPRIYA (Manchester) Proposer: Dr. R. Siripurapu Seconder: Dr. A. Helwadkar Brynmor JONES (Imperial College) Proposer: Dr. Kyri Lobotesis Seconder: Dr. Adam Waldman Dr. Lakshmi M. Kanagarajah (Queen’s Hospital) Proposer: Dr. Sanjiv J. Chawda Seconder: Dr. Shevantha Rosa Dr. Oliver CONWAY (Queen Square) Proposer: Dr. Katherine Miszkiel Seconder: Dr. William Mukonoweshuro Dr. Leesien YAP (Royal Victoria Infirmary) Proposer: Dr. Daniel Birchall Seconder: Dr. Priya Bhatnagar Dr. Conal CORBALLY (Glasgow) Proposer: Dr. Robin Joseph Seconder: Dr. Ahmed Iqbal Dr Johnathan CROOKDALE (Nottingham) Proposer: Dr Tim Jaspan Seconder: Dr Rob Dineen

Full Members Dr. Shivaramavula (Alder Hey) Proposer: Dr. Tim Jaspan Seconder: Dr. Stavros Stivaros Dr. Sachit SHAH (National Hospital) Proposer: Dr. Katherine Miszkiel Seconder: Dr. Matthew Adams Dr. Tilak DAS (Cambridge) Proposer: Dr. Jonathan Gillard Seconder: Dr. Nagui Antoun Dr. Avinash Kumar KANODIA (Dundee) Proposer: Professor Alison Murray Seconder: Dr. Kirsten Forbes

Appendix 2

Appendix 2 (cont’d)

TESC Report for BSNR meeting Belfast 2014 Membership Rob Lenthall (Chairman) Ian Craven Rob Dineen James Byrne Kyrikos Lobotesis Tufail Patankar Rajeev Padmanabhan William Mukonoweshuro David Minks (Trainee representative) Co-opted Adam Thomas (RITI) Feb 2014 Group edited changes to the DNR and INR sections of the Clinical Radiology and Interventional Radiology curricula in liaison with the RCR curriculum committee. 2/5/14 TESC meeting in London (RL, IC, RD, JB, TP, WM, DM) Discussed current training issues in DNR and INR and agreed to split into two working groups as follows, DNR: RL, IC, RAD, KL, DM INR: JB, WM, RP, TP, DM The main objectives of each group were to produce training manuals and refine WBA tools to complement delivery of training. 5/6/14 Following the BSNR committee meeting at the RCR, RL met Caroline Ruben (RCR Warden) to discuss training. The RCR is reviewing the Shape of Training and will be introducing credentialing. This will require: entry criteria for subspecialty training and definition of specific competencies in training In the absence of a proposed structure for sub-specialties to implement, RL put committee work on-hold pending further clarification of RCR requirements. 13/6/14 RL discussed potential opportunities associated with ‘Shape of Training’ and the provision of training for clinicians with different specialty backgrounds at the UKNG with mixed feedback.

August 2014 David Minks arranged a Trainee survey to assess use of antiplatelet medication in INR departments with very low feedback (only 2 responses, one from David and one from Australia). 4/9/14 Notes from BSNR/UKNG/BSIR/RCR Liaison Meeting at RCR Attendance: Caroline Ruben (Warden), Duncan Ettles (BSIR), Richard Fitzgerald (RCR), Giles MAskell (President), RL and CRH (BSNR) Proposed changes to INR training Agreement that run-through training reduced competition Acknowledgement the Deaneries preferred run-through training CR discussing Shape of Training/Credentialing at AoRMC Credentialing will not be related to specific competencies, but will cover ‘whole areas of practice’. Year-6 credentialing may occur post CCT Any curricular change (such as incorporating trainees from different specialty backgrounds) will require AoRMC agreement and GMC approval (unlikely to be before 2017). Procedural Based Assessment tools (PBA) prepared for IR training have not been approved by the GMC. Exit exams: the group recognised that trainees are attending European courses and sitting related examinations. CR reported that the RCR was looking to develop an on-line, specialty-based collective resource with scripted lectures and SBA-type questions. This could evolve into an RCR-badged process (along with RITI and possibly e-Brain). Taking the above information into account… Proposed committee work that can proceed

1. Training guidelines / improved WBA (to be developed and evaluated without changes in the RCR Curriculum)

2. UK Courses in DNR/INR 3. Improving RITI 4. Measures to improve networking between trainees, trainers and the BSNR

Longer-term projects National advertising Entry criteria to INR training Definition of specific training competencies Exit-exam-equivalent process Credentialing Incorporating trainees from different specialty backgrounds Rob L 8/10/14

Appendix 3 BSNR Standards Subcommittee Report 2014

The BSNR Standards Subcommittee deals with professional standards in Neuroradiology, particularly how these interface with closely linked specialities and NHS/Regulatory developments.

Current membership (from 10/10/14) Chair- Dr Gerardine Queghabeur, Oxford Members Dr Tina Good, Hurstwood Park Dr Shawn Halpin, Cardiff Dr Tim Hodgson, Sheffield Dr Norman McConachie, Nottingham BSNR Sec – currently Dr Tony Goddard, Leeds UKNG Sec – currently Prof Phil White, Newcastle Co-opted: Dr Kling Chong - GOSH , London Dr Andy Clifton – St Georges, London as BSNR rep on ICSWP

Activities in recent years include:

• Support for multiple editions of the RCR iREFER guidelines

o Latest edition is getting underway with PW on RCR Oversight Group and GQ/DC leading Neuroradiology panel

o Volunteers for Delphi groups will be sought from StSC and more widely

o It may offer a good route to recruitment of younger members onto StSC

• Support for Intercollegiate Stroke Working Party (this body produces National Clinical Guideline for Stroke- 5th ed in preparation and oversees the Sentinel Stroke Audit for UK)

o Great national & international impact

o SSNAP >95% coverage already of stroke patients outwith Scotland

• Development and publication of SAFE NEURORADIOLOGY

o Roger (Laitt) editorial lead

• Production of Diagnostic & Interventional Neuroradiology specific Guidance for Revalidation

o Tina & Tim led

• Led multisociety consensus statement on IA Therapy in stroke- due for publication shortly

o BSNR Led Multisociety Consensus Statement

• With UKNG, made a substantial contribution to 2013 NCEPOD report on SAH “Managing the Flow” and follow on working parties

o For further discussion but input into secondary & tertiary care phases working parties

• UK Flow Diverter Registry with UKNG

o Progressing slowly but Dendrite now building database and invoice to Stryker sent & payment awaited – then full cost of project will have been received (£30K)

o Once running under Dendrite model, BSNR/UKNG should no longer be involved in financial side at all and academic oversight can continue under UKNG Committee/BSNR StSC auspices

In addition:

• We support the ongoing Peer Review programme for stroke managed by the RCP(L)

• Feed into NCAS via Dr Halpin

Appendix 4 BSNR Academic Subcommittee Report 8th October 2014

Current membership Chair - Stavros Stivaros, Manchester Secretary – Nigel Hoggard, Sheffield Members Tufail Patankar - Leeds Jonathan Gillard - Cambridge Tarek Yousry - London Joanna Wardlaw - Edinburgh Dorothee Auer - Nottingham Adam Waldman - London Paul Griffiths – Sheffield Dan Connolly - Sheffield Activity

• Du Boulay Visiting Professorship - Current

o Current tenure ends this year.

o Final visit is scheduled for the 22nd

October 2014

o Number of visits over the last two years – Eleven half day equivalents

o Presentation at BSNR 2014 but in summary:

� Engagement of Medical Students – lectures on entering academic and non-academic radiology training streams

� Engagement of Radiology trainees

• Teaching (case based)

• Lectures on developing a neuroradiology career and developing an academic neuroradiology career

� Engagement of consultants

• Advanced MRI in research and practice lectures

• Development of an academic interest in an NHS job plan.

• Du Boulay Visiting Professorship – Future

o No applicants for the 2015 post.

o Direct approach to Rob Dineen – Nottingham. Awaiting result of his application for another visiting chair. If this is not successful he will be interviewed for the 2015 position. If this is not possible, then Adam Waldman (London) has kindly agreed to take over the position.

o Discussions have been held regarding direct appointments in the future.

o It needs to be stressed that this is not a pre-professorial post and would suit all members of the BSNR in good standing as long as they have an interest in academic neuroradiology and are good teachers.

• eBrain

o BSNR provided the following modules for the eBrain project

� Principles of neurological investigation

• X-ray development, physics, uses, risks and regulation

• CT based imaging techniques

• MR based imaging techniques

• Nuclear medicine based imaging techniques

• Ultrasound and doppler imaging

• Digital subtraction angiography

• Spinal myelography

� Intraoperative Imaging Techniques

• Normal cranial radiological neuroanatomy

• Normal spinal radiological neuroanatomy

• Normal vascular radiological neuroanatomy

� Imaging in head Injury

� Imaging features of intramedullary spinal cord tumours

� Imaging features of bacterial brain infections

� Imaging features of encephalitis

o These have now all been completed and signed off onto the project website.

• Isherwood pump priming grant

o Closing date for applications is the 1st December 2014.

o Interviews January 2015

o Verbal advertisement at BSNR 2014

o Uptake of awards by May 2014

o Interim Presentation at BSNR 2015 by successful candidates with final presentation expected at BSNR 2016.

o Candidates must be supervised by BSNR member in good standing

• International Day/Year of Radiology

o 2015 is the ‘Year of the Brain’ – BSNR was approached by the RCR to provide assistance regarding public engagement relating to the development and impact of neuroradiology in modern medical practice and specifically the UK’s role in this.

� BSNR will provide a public engagement lecture – Stivaros based on work already completed for the du Boulay engagement lectures

� You Tube film of 5 minutes or so duration illustrating the role that neuroradiology plays in modern medical practice

� International day of radiology public engagement interviews – completed for the RCR and signed off by them.

�

• Next committee meeting will be held on the week of the 3rd November 2014 in London.