‘Something a bit different’: Q&A with Rachel Eddershaw
The senior radiographer tells Synergy about her experience helping to run the capsule endoscopy service at the Runnymede Circle Hospital in Chertsey
What is capsule endoscopy?
Capsule endoscopy is a way of viewing the small bowel. Often, patients have had colonoscopies and gastroscopies, and they might have had an MRI of their small bowel too. It’s a way of looking at the mucosal lining to help doctors diagnose inflammatory bowel disease and look for other pathologies in the stomach and small bowel.
The clinicians we work with, the gastroenterologists, often refer patients to us for these procedures. It involves the patient going through some bowel prep beforehand, and they swallow a capsule that contains a camera that takes images at two frames per second, producing a video over an eight to 10-hour period.
They wear a detector belt around their waist, attached to a data recorder. The patient walks around for 30 minutes and then we check on the data recorder to see if it has passed through the stomach and it’s moving through the duodenum on its way to the small bowel.
The patient then goes home with the equipment on, and they’re on a clear fluid diet for that day, returning the kit later that evening. We then download the study on to the PillCam software, where the images can be viewed as a video study.
Patients sometimes need a patency capsule beforehand to check it will pass through the small bowel without obstruction, particularly if they have had abdominal surgery or radiotherapy or have been on non-steroidal anti-inflammatory drugs for a while. This just involves swallowing a capsule that contains some barium and then they are X-rayed the following day to check it has passed through the small bowel.
I completed an online course at the end of last year to read the capsule studies, so I do a pre-read to flag any abnormalities that I see and then the gastroenterologists look at them and write a formal report.
What is capsule endoscopy?
Capsule endoscopy is a way of viewing the small bowel. Often, patients have had colonoscopies and gastroscopies, and they might have had an MRI of their small bowel too. It’s a way of looking at the mucosal lining to help doctors diagnose inflammatory bowel disease and look for other pathologies in the stomach and small bowel.
The clinicians we work with, the gastroenterologists, often refer patients to us for these procedures. It involves the patient going through some bowel prep beforehand, and they swallow a capsule that contains a camera that takes images at two frames per second, producing a video over an eight to 10-hour period.
They wear a detector belt around their waist, attached to a data recorder. The patient walks around for 30 minutes and then we check on the data recorder if it has passed through the stomach and it’s moving through the duodenum on its way to the small bowel.
The patient then goes home with the equipment on, and they’re on a clear fluid diet for that day, returning the kit later that evening. We then download the study on to the PillCam software, where the images can be viewed as a video study.
Patients sometimes need a patency capsule beforehand to check it will pass through the small bowel without obstruction, particularly if they have had abdominal surgery or radiotherapy or have been on non-steroidal anti-inflammatory drugs for a while. This just involves swallowing a capsule that contains some barium and then they are X-rayed the following day to check it has passed through the small bowel.
I completed an online course at the end of last year to read the capsule studies, so I do a pre-read to flag any abnormalities that I see and then the gastroenterologists look at them and write a formal report.
What are the differences between capsule endoscopy and other kinds of imaging?
It’s unique – most patients think it’s quite clever technology, which it is, because they’ve often been through lots of other tests. It’s relatively non-invasive; even if they have to go through a bit of bowel prep beforehand, it’s not a difficult procedure.
Most patients find it OK, as it’s just swallowing a large capsule. The worst part for them is following the clear fluid diet for a couple of days, so they are normally hungry!
Our previous imaging manager set up the service about seven years ago with the help of Medtronic; my colleague and I went on an introductory course at the Royal Hallamshire Hospital in Sheffield and we’ve been offering the service ever since.
The course was run by Medtronic, the company that provides the PillCams. On the course we learned about the anatomy of the gastrointestinal tract and small bowel. They had simulators so we could view the studies and pick out things you’d observed.
We’re a small private hospital on a shared site with an NHS hospital. Capsule endoscopies are usually run through the endoscopy department in the NHS. As we don’t have a dedicated endoscopy unit here, it made sense to run it through the imaging department.
We complete between 50 and 60 capsule studies a year – we average a couple a week. It’s a unique service, because regular X-ray, CT and other modalities often have ionising radiation, where capsule endoscopy doesn’t. It’s a relatively easy procedure, especially for patients who don’t like going into scanners because they’re claustrophobic. It’s done as an outpatient, so the patient doesn’t need to have any sedation or stay in the hospital.
What are some of the challenges of capsule endoscopy?
We have had a few patients who are unable to swallow a capsule, but we have an alternative – if they really aren’t able to swallow the PillCam they can have the capsule put down through an endoscope, but they have to come in as a day case and go to theatre for that with some mild sedation.
My colleague and I work part time on opposite shifts, so we have to arrange the studies around our shift pattern each week. Depending on how many referrals we get, there can be some difficulties with fitting them in, as we only have one belt and data recorder, so that limits us to one patient per day.
I’m really enjoying doing the reporting side of things now, which has given me a different skillset, but finding time in a busy day to report can be challenging as they’re quite time consuming. Each study consists of a video between six and 10 hours long, which I look at sped up.
'It’s a relatively easy procedure, especially for patients who don’t like going into scanners because they’re claustrophobic'
How could other radiographers get involved with capsule endoscopy?
Within smaller hospital settings, particularly in the independent sector, it is something that imaging departments could consider doing – it’s another skill for radiographers. The course we initially went on up in Sheffield was attended by mainly endoscopy nurses; we were the only radiographers.
Particularly in the private sector – there’s not many hospitals in our locality that offer this service, so we do get patients travelling from quite a distance to come here and have the procedure.
The number of cases has risen over the years. Often, it’s the delay in reporting because of time pressures that limits the service, but with AI starting to be used in the software there is the potential for an increase in service delivery.
I enjoyed the challenge of the reporting course I completed last year. We learned in detail about the anatomy of the GI tract and had webinars where they went through cases and showed you specific abnormalities and things to look out for. We then had access to the simulator, and we had to read 20 cases – five easy, five moderate, five difficult and five summative, completing a report for each one with our findings.
If you are interested in setting up a service, contact Medtronic. The reps helped us to set up the service, providing the kit and advising us on the protocols they use in the NHS for consultants. They provide us with ongoing support if needed on the technical side.
We had to get our processes in place initially with safe operating procedures with the back up of the gastro consultants, considering any issues that may arise – if we can’t answer the patient’s questions, or we need advice, we contact our consultants.
How could other radiographers get involved with capsule endoscopy?
Within smaller hospital settings, particularly in the independent sector, it is something that imaging departments could consider doing – it’s another skill for radiographers. The course we initially went on up in Sheffield was attended by mainly endoscopy nurses; we were the only radiographers.
Particularly in the private sector – there’s not many hospitals in our locality that offer this service, so we do get patients travelling from quite a distance to come here and have the procedure.
The number of cases has risen over the years. Often, it’s the delay in reporting because of time pressures that limits the service, but with AI starting to be used in the software there is the potential for an increase in service delivery.
I enjoyed the challenge of the reporting course I completed last year. We learned in detail about the anatomy of the GI tract and had webinars where they went through cases and showed you specific abnormalities and things to look out for. We then had access to the simulator, and we had to read 20 cases – five easy, five moderate, five difficult and five summative, completing a report for each one with our findings.
If you are interested in setting up a service, contact Medtronic. The reps helped us to set up the service, providing the kit and advising us on the protocols they use in the NHS for consultants. They provide us with ongoing support if needed on the technical side.
We had to get our processes in place initially with safe operating procedures with the back up of the gastro consultants, considering any issues that may arise – if we can’t answer the patient’s questions, or we need advice, we contact our consultants.
What drew you to radiography in the first place?
I was interested in human biology at school and I liked the idea of doing something hospital related. I didn’t want to be a nurse, and I didn’t think I had the qualifications to be a doctor, but I had a cousin who was a radiographer – which pointed me in that direction.
I volunteered at my local hospital in the X-ray department while I was in school, and decided I liked the idea of doing radiography. I completed the diploma of the College of Radiographers more than 30 years ago now.
Once qualified, I worked in the Queen Elizabeth Hospital in Welwyn Garden City as a newly qualified radiographer, where we got a chance to rotate through all the different modalities in the department. Then I moved down to Surrey and got a job at St Peter’s Hospital, where I worked up from junior to senior radiographer and latterly was in charge of CT.
I took a career break to have my children and, when I returned, I needed to get my HCPC registration back, so I started working at Runnymede Hospital and then worked as a bank radiographer, eventually taking on a part-time contract.
I’ve been there ever since. Initially, it was lots of orthopaedic radiography, general fluoro, theatre and dentals, as well as helping the radiologists with ultrasound lists and interventional procedures. Our department has grown over the years, and we now offer CT and MRI and cardiology services as well as capsule endoscopy. I’ve recently taken on a more senior role and have just been appointed deputy imaging manager.
What drew you to radiography in the first place?
I was interested in human biology at school and I liked the idea of doing something hospital related. I didn’t want to be a nurse, and I didn’t think I had the qualifications to be a doctor, but I had a cousin who was a radiographer – which pointed me in that direction.
I volunteered at my local hospital in the X-ray department while I was in school, and decided I liked the idea of doing radiography. I completed the diploma of the College of Radiographers more than 30 years ago now.
Once qualified, I worked in the Queen Elizabeth Hospital in Welwyn Garden City as a newly qualified radiographer, where we got a chance to rotate through all the different modalities in the department. Then I moved down to Surrey and got a job at St Peter’s Hospital, where I worked up from junior to senior radiographer and latterly was in charge of CT.
I took a career break to have my children and, when I returned, I needed to get my HCPC registration back, so I started working at Runnymede Hospital and then worked as a bank radiographer, eventually taking on a part-time contract.
I’ve been there ever since. Initially, it was lots of orthopaedic radiography, general fluoro, theatre and dentals, as well as helping the radiologists with ultrasound lists and interventional procedures. Our department has grown over the years, and we now offer CT and MRI and cardiology services as well as capsule endoscopy. I’ve recently taken on a more senior role and have just been appointed deputy imaging manager.
'I didn’t want to be a nurse, and I didn’t think I had the qualifications to be a doctor, but I had a cousin who was a radiographer'
What are some of the differences you’ve found between working in the NHS and the private sector?
The department works quite differently to one in the NHS, as it’s on a much smaller scale. We get involved in some of the admin duties, doing IEP transfers for consultants and patients; because we don’t have dedicated X-ray nurses, we help our HCAs with trolley set-ups and interventional procedures a bit more.
Our job scope is quite varied compared to what it probably would be in the NHS. I’ve done some bank work in the NHS over the years, but I haven’t worked in a dedicated NHS unit for a long time now.
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More about capsule endoscopy
Capsule endoscopy is a procedure in which patients swallow small pill-sized cameras that take pictures of the inside of the small or large bowel.
Radiographers can get involved with capsule endoscopy via learning modules such as those mentioned above, which include the IMIGe Online Upper GI/Small Bowel Reading Course (https://imige.co.uk/) and the capsule endoscopy introduction reading for gastroscopy nurses at the Royal Hallamshire Hospital run by Medtronic.
Image and video credit: Getty Images