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
  • Endoscopic Ultrasound - EUS
  • Standard Bronchoscopy

West Herts is the only service in the network to offer Rapid On-Site Evaluation (ROSE) alongside EBUS and EUS.

ROSE significantly enhances the diagnostic value of procedures by enabling a cytologist to review biopsy samples in real time during the procedure. This ensures that the most appropriate samples are taken while the patient is still in theatre, greatly reducing the need for repeat biopsies and shortening procedure time.

Key outcomes of ROSE-supported procedures:

  • Sensitivity: 95%
  • Specificity: 98%
  • Positive Predictive Value: 99%

Only a small proportion of biopsy material is used for ROSE (mean of 1.9% in malignant nodes, 3.6% in benign nodes), allowing the remaining sample to be used for advanced DNA testing, including Next Generation Sequencing (NGS). The Trust’s success rate for NGS (which examines 20+ genes, including EGFR) is 92.7%, placing it among the best in Europe.

Additionally, ROSE reduces the number of biopsy sites needed — 84% of cases require two or fewer, compared with standard guidelines recommending three or more when ROSE is not available.

Thoracic ultrasound and pleural services

West Herts offers a full diagnostic and therapeutic pleural service, including:

  • Thoracic ultrasound
  • Ultrasound-guided aspiration of pleural effusions
  • Chest drain insertion
  • Pleurodesis
  • Indwelling pleural catheter placement

Interstitial lung disease, thrombotic and vasculitic disorders

A specialist service led by Dr Rama Vancheeswaran and Dr Julius Cairn, providing advanced diagnosis and treatment for:

  • Interstitial lung disease (ILD)
  • Thromboembolic conditions

  • Vasculitis and autoimmune lung conditions

Cardio pulmonary CPEX testing

This is used to investigate unexplained breathlessness and to support pre-operative risk assessment, CPEX testing helps guide appropriate care planning and referral.

Standard respiratory diagnostics

Comprehensive Respiratory Diagnostics

The Trust offers a wide range of respiratory tests using state-of-the-art equipment, with all results interpreted by leading consultant respiratory physicians:

  • Full lung function testing
  • Allergy testing
  • Fitness-to-fly assessments
  • Oxygen therapy assessments
  • Sleep studies and diagnostics