West Herts has a strong team of respiratory consultants who provide services in many different areas including:

  • Cancer and the investigation of nodules
  • Airways disease including asthma and COPD
  • Infection
  • Pleural disease
  • Interstitial lung disease
  • Thromboembolic disease and vasculitis
  • in cancer and pleural disease

They are one of the most experienced teams in the country and leaders in their field, offering intervention and complex diagnostics.

Dr Andrew Barlow was the first consultant in the network area (need to define) to deliver when he developed it at Harefield. So, it’s not surprising that he is now the most experienced practitioner in the network.

He is joined by Dr Rahul Mogal who brings extensive experience. He trained as a respiratory specialist at the Royal London and London Chest Hospitals before undertaking a prestigious Clinical Fellowship in Interventional Bronchoscopy at Thoraxklinik in Heidelberg, Germany.

The team is actively involved in ongoing research to further improve performance. They are looking at the use of artificial intelligence in real time ultrasound, to achieve biopsies that are even more targeted. Both have published widely.

Procedures

  • Endobronchial Ultrasound - EBUS
  • EUS
  • Standard Bronchoscopy

West Herts is the only service in the network able to offer Rapid On-Site Evaluation (ROSE).

An Endobronchial Ultrasound (EBUS) supported by ROSE is a highly effective procedure that checks for lung cancer and other cancers suspected of spreading to the lymph nodes, lymphoma and non-cancerous conditions such as sarcoidosis or tuberculosis.

The accuracy and speed of the procedure means we can have a cytologist in the operating room who will process and examine biopsy samples as they are obtained and, if needed, request additional samples which can be taken immediately.

This provides assurance at the time of the procedure that the best possible material has been obtained for the investigations that the patient requires. For patients it means a shorter procedure and a greatly reduced need for any repeat biopsies.

ROSE accurately predicts final benign/malignant assessment (after examining all material harvested) with a sensitivity of 95%, a specificity of 98% and a positive predictive value of 99%.

The material used for ROSE is a very small proportion of all material harvested (Mean 1.9% in malignant nodes, 3.6% in benign nodes), leaving the major part for DNA and other analyses, thus our success rate for next generation sequencing (NGS, which looks at 20+ genes in parallel, including EGFR) is 92.7%, which compares favourably with other European centres.

The use of ROSE enables a reduction in the number of sites targeted, with 84% having no more than two sites sampled. This contrasts favourably with guidelines that suggest in the absence of ROSE at least three sites should be sampled.

Thoracic Ultrasound

West Herts offers a full diagnostic pleural service in ultrasound, ultrasound-guided aspiration of pleural infusions, and where necessary chest drain insertions, pleurodesis and indwelling catheters.

Interstitial Lung Disease, thrombotic and vasculitic disorders

Dr Rama Vancheeswaran and Dr Julius Cairn provide a comprehensive diagnostic and treatment service for these complex disorders with MDT input at a tertiary specialist level with immune suppression. A research unit into the Epigenetics of these disorders, AI use for follow up and clinical trials are all provided within this specialist service with network collaborations with Cambridge and the Royal Brompton and Harefield.

Cardio pulmonary CPEX testing

West Herts offers a service to aid diagnostic of unexplained breathlessness, and pre-op stratification of risk.

Standard respiratory diagnostics

West Herts offers a full range of lung function testing with state-of-the-art new kit and results that are interpreted by leading consultants.

  • Allergy testing
  • Fitness to fly tests
  • Oxygen assessments
  • Sleep diagnostics
  • Cough monitoring and work up