Regular | North Bristol NHS Trust

Exclusive Enteral Nutrition (EEN)

Read more about Exclusive Enteral Nutrition (EEN)

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Introduction

This page will tell you about Exclusive Enteral Nutrition (EEN). It will answer some questions you may have about it.

What is Crohn’s disease?

Crohn’s disease can affect any part of your gut. It causes inflammation, ulcers, swelling and soreness on the lining of your gut.

When symptoms are under control, it is known as remission. When symptoms are more active, it’s called a flare-up.

Crohn's disease is a lifelong illness. It currently has no known cure. However, medications, surgery, or a mix of the two can help you stay well.

Symptoms of Crohn’s disease can include:

Feeling tired.
Diarrhoea.
Blood in your poo.
Constipation.
Bloating and wind.
Tummy pain.
Joint problems and/or weaker bones.

What is EEN?

It is a liquid only diet. The aim is to put your Crohn’s into remission or to reduce your symptoms. The diet is followed for a short time of 6-8 weeks.

It replaces all food and most drinks with prescribed drinks. These drinks will provide all you need to stay healthy. These drinks come in a range of flavours. Your dietitian will tell you how many drinks you need.

We don’t fully know how it works. One idea is that it helps the gut ‘rest’. Some studies have shown it works for 45-75% of patients.

Sometimes you will need to follow it if you have a narrowing in your gut called a stricture. Your doctor will tell you if you have this.

How long will I need to follow EEN?

It should usually be followed strictly for 6-8 weeks. This depends on your response.
Once you start to eat food again, you may need to continue some of the drinks. Your dietitian will advise on this.

My target for EEN

Name of Nutrition drink(s)	Number of drinks per day
E.g. Fortisip	6

Extra fluid you need:
Provides:
- kcal:
- g of protein:
- ml fluid:

Following this diet can be hard! Here are some tips to make it easier:

Freeze your drinks into ice lollies.
Try lots of flavours. Your dietitian can discuss this with you.
Spread your drinks throughout the day.
Sip on the drinks slowly to make them last longer.

Contact your dietitian if you can’t finish all your drinks.

How do I know if EEN is working?

The treatment goal includes:

Remission.
Normal bloods.
Healing of your gut.
Better quality of life.

We can use The Harvey-Bradshaw Index to see if the diet is working.

This table is at the back of the sheet for you to fill out. Please fill it out before, during, and after your diet.

If you have an appointment with a dietitian, please take this completed with you.

What happens after your EEN diet?

After following EEN for a minimum of 6 weeks, you can slowly reintroduce food over 5 days. This is an example based on a total based on total 2400kcal.

Day 1 - breakfast, 7 nutritional drinks.
Day 2 - breakfast, lunch, 5 nutritional drinks.
Day 3 - breakfast, lunch, dinner, 3 nutritional drinks.
Day 4 - breakfast, mid-morning snack, lunch, afternoon snack, dinner, 1 nutritional drink.
Day 5 after EEN - follow your normal diet. You may need to continue the nutritional drinks for weight gain or support. You can discuss this with your dietitian.

Going forward

There is no specific diet you need to follow when your Crohn’s is in remission. No diet has been proven to help keep you in remission. Also, no foods can cause flare-ups. Some foods may trigger symptoms, but they can’t cause a flare-up. If that happens, use the food and symptom diary at the back of this booklet. It may help you spot trigger foods when you are in remission.

Key points for diet in remission

Aim for a healthy, balanced diet that gives you all the nutrients you need to stay healthy.
Avoid cutting out foods or food groups, as you would miss out on important nutrients.
Try to eat a variety of fruits, vegetables, nuts, seeds, proteins, and whole grains.
Limit high-fat, high-sugar, and high-salt foods, especially animal fats and processed meats.
You don't need to cut back on fibre unless you have a narrowing in your gut (called a stricture).

Always talk to your GP, IBD team, or dietitian before making major changes to your diet.

Harvey-Bradshaw Index for Crohn’s

Please fill out this form on day 1 of starting the EEN diet. It is useful to bring this completed if you are due to see a Dietitian. If you are unsure what each section means, please speak to your clinician.

Week	1	2	3	4	5	6	7	8
Your general wellbeing (for previous day) 0 = very well 1 = slightly below par 2 = poor 3 = very poor 4 = terrible
Abdominal pain (for previous day) 0 = none 1 = mild 2 = moderate 3 = severe
Number of liquid stools per day (for previous day) Score 1 per movement
Abdominal mass 0 = none 1 = dubious 2 = definite 3 = definite and tender
Complications (score 1 per item) Joint pain. Inflammation of the middle layer of the eye (uveitis). Red nodules on shins. Mouth ulcers. Necrotic tissue. Tear in the the anus (anal fissure) A new fistula. Abscess.
Total: Remission: less than 5 Mild disease: 5-7 Moderate disease: 8-16 Severe disease: more than 16

Food and symptom diary

Use this template for any day of the week.

Day:	Food	Symptoms	Time of day and how long symptoms lasted
Breakfast
Mid-morning snack
Lunch
Mid-afternoon snack
Dinner
Notes

Privately funded devices

Read more about Privately funded devices

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AAC WEST process for working with people who have a privately funded AAC device

If an individual has an AAC device funded through private, medicolegal, or charity routes, they may still be referred to AAC WEST by a health, education or social care SLT if they meet NHS specialist services criteria. (See How AAC WEST work with independent professionals, suppliers and charities)

Please note the following important points:

AAC WEST will carry out an impartial assessment of the individual’s AAC needs before making decisions about next steps. As part of this assessment we will review all privately purchased elements and make a decision about whether this best meets the person’s needs. This would include reviewing the device, software, access method, accessories, and mounting solutions.
Decisions are made at the conclusion of the assessment process. This may be a single assessment appointment, but will usually (though not always) include a trial/review period.
AAC WEST’s assessment may include consideration of other assistive technology needs, but the primary focus will be on the individual’s communication needs.
Our recommendations may differ from previous advice.
We do not reimburse any costs associated with purchasing or hiring devices privately.

Potential outcomes following AAC WEST assessment

Where the AAC user/family accept the above points, we would proceed with an AAC WEST assessment. The following outlines the typical potential outcomes of an AAC WEST assessment for people who have a privately funded AAC device.

A. Current AAC setup is appropriate and NHS criteria is met.

If the AAC WEST assessment indicates that the current AAC setup (device, access method, vocabulary, mounting) is appropriate and NHS Specialised Services criteria has been met, AAC WEST will:

Offer to take on responsibility for the device.
See section below: What does it mean for AAC WEST to take on responsibility for a device?
Recommend and provide mounting solutions.
See section below: What if the AAC user/family does not wish for AAC WEST to take on responsibility?

B. Current AAC device is appropriate, but setup needs adjusting.

If the AAC WEST assessment indicates the device is suitable, but changes are needed to optimise the set up, AAC WEST may recommend a trial period to explore some of the following: different access method, vocabulary package, or software settings.

If the trial is successful and NHS criteria is met:

AAC WEST will offer to take on responsibility for the device.
Provide mounting solutions.
See section below: What if the AAC user/family does not wish for AAC WEST to take on responsibility?

C. A different AAC solution is recommended and NHS criteria is met.

If the AAC WEST assessment indicates a different AAC solution is needed, AAC WEST may recommend a trial of an alternative AAC solution. This trial will follow our standard pathway.

See section below: What if the AAC user/family does not wish to follow AAC WEST's recommendation.

D. NHS criteria is not met

AAC WEST assessment indicates the individual does not meet NHS Specialised Services criteria, and therefore their AAC needs should be met locally.

AAC WEST will provide recommendations in a written report.
Responsibility for the AAC device and support remains with the family and/or local team.
Mounting solutions will not be provided.

Important notes

AAC WEST will only be responsible for one AAC device per person. If a device has previously been provided by AAC WEST, it must be returned before we take on a new privately funded device.

What does it mean for AAC WEST to take on responsibility for a device?

If AAC WEST agrees to take on responsibility for a privately funded device, this includes:

Maintenance, repairs, and replacement when required.
Labelling the device and charger with a inventory code (STC number) for linking to our patient records.
Annual safety checks of the device and charger.

Benefits include:

Coverage of repair costs.
Device replacement where appropriate.
Regular assurance that the device is safe and fit for purpose.
The device being accepted in all settings. Some local authorities have policies to not permit privately funded devices in their settings.

These benefits will continue as long as the patient remains on the NHS pathway.

What if the AAC user/family does not wish for AAC WEST to take on responsibility of the device?

If AAC WEST does not take on responsibility:

Recommendations will be provided in a written report.
Responsibility for the device remains with the family and/or local team.

What if the AAC user/family does not wish to follow AAC WEST’s recommendations?

If AAC WEST’s recommendations are not accepted:

Recommendations will be provided in a written report.
Responsibility for the device and support remains with the local or independent SLT.
Mounting solutions will not be provided.
If circumstances change and the AAC user/family wish to take on AAC WEST’s recommendations in the future, they can be referred for another assessment. Please include information about the current situation and an update about what has changed.

How AAC WEST work with independent professionals, suppliers and charities

Read more about How AAC WEST work with independent professionals, suppliers and charities

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Independent Professionals

Definitions:

A statutory professional is employed or commissioned by health, education or social care.
An independent professional (also referred to as ‘private’) is not directly employed or commissioned by these services. They may be funded by individuals, families, charities or by medicolegal settlement. We will use ‘independent professional’ to include Speech Therapists, Occupational Therapists, Physiotherapists, AAC Consultants, AAC Teachers, and home school tutors.

At AAC WEST, we value collaborative working to achieve the best possible outcomes for our AAC users. We encourage input from independent professionals, however only statutory Speech Therapists can refer to AAC WEST due to the way that NHS AAC Specialised Services are funded.

Working with independent professionals can work well when:

The statutory SLT and the independent professionals work together. They can both contribute to the AAC assessment and the AAC WEST referral form.
Everyone knows their role from the start and respects each other’s work. You can use tools such as ‘Choosing Roles in AAC Decision Making’ to help (can be found on the I-ASC Resources website).
The team shares the same goals, with the AAC user at the centre.
There is clear and open communication. Everyone is kept up to date.
Everyone supporting the AAC user follows the plan made by AAC WEST.
The AAC user, family, and professionals understand:
- The AAC WEST assessment process
- The criteria for NHS AAC specialised services
- How funding works
- That AAC WEST will:
  - Carry out impartial assessments.
  - Aim to find the best AAC option for the user, whether it’s low tech (paper based) or high tech (powered).
  - Make recommendations that may differ from previous advice, even if devices were already tried or bought. (See also Privately funded devices).

If the AAC user or team want to try something different to AAC WEST’s recommendations, they can choose a private AAC pathway instead of the NHS one.

AAC Suppliers and Assistive Technology Charities

(visits, trials, loans for people not seen by AAC WEST)

Some families or clinicians arrange visits from AAC suppliers. This can help the team to explore potential AAC options, but it may also make things more confusing, as the AAC user and their family will receive advice from multiple people.

We recommend:

The clinician (statutory and/or independent) maintains responsibility on these visits, and makes the clinical decisions.
Everyone knows their role:
- AAC suppliers bring technical knowledge of their company’s devices.
- Clinicians bring knowledge about the AAC user.
The clinician considers arranging visits from multiple suppliers to explore different options.

If the AAC user is referred to AAC WEST, we will:

Carry out an impartial assessment
Aim to find the best AAC option for the user, whether it’s low-tech (paper-based) or high-tech (powered).
Make recommendations that may differ from previous advice, even if devices were already tried or bought. We do not refund money spent on privately bought or hired devices. (See also Privately funded devices).

Information about your referral, assessment, and what we offer

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This page has information for people who have been referred by your GP or specialist to the Bristol M.E. Service for an assessment.

What happens now?

Your first appointment normally takes about an hour. We can offer face to face, video, and telephone assessments. We hope to offer a time that works for you. If you need to take a break part way through your assessment, please let us know.

The assessment appointment will give us more information about your health problem and the effect this has on your everyday life. It does not involve any kind of physical tests.

We will also send you a link to some questionnaires which include the questions we ask in the assessment so you have time to think about your answers. This is so that we can build up a clearer picture of your difficulties, and answer any questions you may have. We can then work out with you the best way to take things forward.

We offer a variety of approaches depending on your needs. Our main focus is to help you develop a range of coping strategies to improve your quality of life. You may be offered one or more of the following:

Individual contact based on your needs.
Group self-management programme using video conferencing/calls.
Us giving advice to existing services or organisations involved in your care. Face to face, video, or telephone appointments.
Face to face, video, or telephone appointments.

Who is involved in running the service?

This service includes:

Occupational therapists
Physiotherapists
Psychologists
Specialist dietitians

All these professionals are specialists in helping people to manage ME/CFS and post viral fatigue syndromes such as long COVID. We are all committed to understanding your individual difficulties. Fatigue and other symptoms can affect your life in many ways and this varies between people. Because of this we tailor our approach to meet your needs.

Where can you find out more about ME/CFS, post viral fatigue syndrome and long COVID?

You might find these web pages from our website to be helpful:

Please note that not everyone that we assess will have (or be given) a diagnosis of ME/CFS, post viral fatigue syndrome, or long COVID. So, please be aware that this information might not be appropriate to everyone referred to the Service.

Editing vocabulary - dos and don'ts

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Don’t

Do not move around existing vocabulary cells – there is a lot of research behind where cells are placed. Moving cells also impacts on the motor patterns the AAC user has learnt.

Do not give out the guided access code (if the device has one) to a young AAC user or others who may not understand these guidelines around editing.

Do not delete words or phrases – your AAC user or someone who models on the device may still need access to these.

Do not duplicate words or phrases to another part of the vocabulary without a good reason – check this with your local SLT.

Do not have lots of different people editing the device – this can quickly make the vocabulary disorganised and confusing.

Do

AAC icon of open book with AAC icon examples

Get your AAC user involved in suggestions of what words and phrases they would like on their device.

Ask for vocabulary suggestions from other places your AAC user spends time – family members, friends, day centres, clubs etc.

Have a system in place for reviewing your AAC user’s vocabulary and do this regularly – at least every term.

Ask for support from AAC WEST (if the AAC user is still being seen by them) or your local SLT.

Agree on a main device editor – others can still be involved in contributing, via email, a shared notebook, whatever works for you.

Understand the colour coding system for different word types on your vocabulary. Ask AAC WEST or your local SLT for more information. It’s important to stick with this system for new words you are adding to help your AAC user learn them.

Attend AAC WEST Software Training to help you learn/refresh your editing skills.

Attend AAC WEST Keeping Vocabulary Updated training for further resources and information about how to ensure your AAC user has access to words they need.

Hypersensitivity pneumonitis

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What is hypersensitivity pneumonitis?

Hypersensitivity pneumonitis is a condition in which your lungs develop an immune response (hypersensitivity) to something you breathe in and results in inflammation of the lung tissue (pneumonitis).

What are the causes of hypersensitivity pneumonitis?

One example is farmer’s lung. This is caused by breathing in mould that grows on hay, straw and grain. Another is bird fancier’s lung, caused by breathing in particles from feathers or bird droppings. The disease can also develop from inhaling fungus in humidifiers, heating systems, and air-conditioners found in homes and offices, especially if they are not well maintained.

Sometimes patients develop hypersensitivity pneumonitis and no obvious cause can be found.

What are the symptoms of hypersensitivity pneumonitis?

Symptoms of cough, shortness of breath and sometimes fever or flu-like symptoms can occur suddenly after you’ve been exposed. This is the acute form of the condition and can go away without causing permanent damage to the lungs, if the substance that caused the attack can be permanently avoided.

In other cases, symptoms of cough and breathlessness can come on more gradually, perhaps over months or years; following repeated exposure to a particular substance, and can result in permanent scarring or fibrosis of the lungs. This is called fibrotic hypersensitivity pneumonitis and often a specific cause cannot be found.

What tests will I have?

Your specialists will take a detailed medical history and perform a thorough physical examination. You may be asked to have the following investigations:

Lung function tests – breathing tests which see how well your lungs are working. These can be used to monitor your lung disease and also to see whether it is responding to treatment. You may be asked to have a walk test to measure how far you can walk and to make sure you are getting enough oxygen into your blood when you are walking. As part of this test you will be asked to rate how breathless you are on a scale.
A CT scan of your chest which shows a detailed picture of your lungs. There are characteristic patterns on these pictures that can help your specialist to identify either scarring or inflammation of lung tissue.
Blood tests are performed to detect the presence of antibodies against the specific agents (allergens), for example bird proteins in bird fancier’s lung or moulds in farmer’s lung. Antibodies are developed by your immune system to try to protect you when an unknown or unwanted substance enters your body. It is possible to have antibodies and not become ill.
Some people may also have a bronchoscopy, where a small flexible tube is passed down into your lungs, allowing collection of cells which may help with diagnosis.
Finally, if the diagnosis remains unclear, the specialist might wish to remove a small piece of lung through a surgical procedure (surgical lung biopsy) to confirm the diagnosis.

What happens to patients with hypersensitivity pneumonitis?

If the cause can be identified and removed, individuals with early hypersensitivity pneumonitis should make a full recovery. However, they will remain sensitised and should they be exposed to the allergen in the future, their symptoms will often return.

For individuals with more chronic (long-term) disease, removal of the allergen hopefully stops the disease getting worse, although unfortunately this is not always the case. Your specialist may advise some treatments to try to slow or stop the disease getting worse (see below).

How is hypersensitivity pneumonitis treated?

If we can identify a specific cause, the most important aspect of treatment is to try to avoid it. This may require rehoming household pets, a change in employment or the use of a specialist mask when exposed to the allergen. Not being able to stop exposure increases the chance that hypersensitivity pneumonitis will progress to irreversible lung damage.

Your specialist may advise a trial of specific medications as detailed below.

Medications

Steroids are produced naturally in the body by the adrenal gland. Additional steroid in the form of prednisolone can be given to attempt to reduce inflammation in some patients. They are usually given in tablet form but may be given by injection into a vein. If you are prescribed steroid tablets on a long-term basis, you should not stop them abruptly. You will be given a ‘steroid emergency card’ which you should always carry with you. The specialist may also assess the need for bone protection medication and anti-reflux treatment to protect against some side effects whilst on steroids.

Immunosuppressive medication is commonly used to dampen down the hypersensitive immune response in the lungs. Some examples of these medications are cyclophosphamide, mycophenolate mofetil and azathioprine. One of these medications will usually be prescribed alongside a steroid such as prednisolone. It can allow the dose of the steroid to be reduced and in some cases, may allow the steroids to be stopped altogether. As a result, they are sometimes also called ‘steroid sparing agents’. Whilst you are taking immunosuppressant medication you will require regular blood tests to monitor your response to treatment.

If your condition worsens despite taking a steroid and/or immunosuppressive medication, your specialist may suggest an antifibrotic medication that aims to slow further progression. Other medications and therapies are used to relieve symptoms, such as cough and breathlessness. Your specialist will discuss options with you on an individual basis.

Other treatments

Pulmonary rehabilitation is an exercise and education programme that can help you to learn to manage your breathlessness and remain active. The programmes are multidisciplinary, meaning that the team includes respiratory physiotherapists, nurses, dieticians, doctors and others, and can help improve energy, strength, and your quality of life.

Supplemental oxygen: As lung scarring can reduce the amount of oxygen getting from your lungs into the bloodstream, some individuals may require oxygen therapy. Where the levels of oxygen are low, oxygen therapy may help with breathlessness and enable individuals to be more active. Correct levels of oxygen in the blood are necessary for normal body functions and reducing additional health problems.

Clinical trials: You should also discuss with your team if there are any clinical trials in which you can participate. Clinical trials are voluntary research studies, which are designed to answer specific questions about your care or the safety and/or effectiveness of medications.

Lung transplantation: A small minority of patients may require assessment for and be suitable for lung transplantation.

How can I help myself?

Have your annual respiratory vaccinations (COVID-19 and Flu) and the pneumonia vaccination (you only have this once).

You may be eligible for a variety of benefits such as Attendance Allowance or Personal Independence Payment if you need help with personal care or getting about.

Our specialist nurses run a regular Pulmonary Fibrosis Support Group which is a space for discussion with other patients with similar lung problems. Here we also aim to provide several presentations from a variety of guest speakers and charities.

Keep active and do what you enjoy!

Resources

Action for Pulmonary Fibrosis

Asthma and Lung UK

Training for AAC professionals

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We run regular training days and facilitate peer supervision sessions. These are open to statutory professionals in the South West of England (independent and out of area professionals may express interest via the forms below). Click the links below for more information, dates and to book a place.

Paeds/ALD

Adult Neuro

AAC Link Therapists

Each Local SLT team has an AAC Link Therapist. We run biannual Link Therapy Days. Link therapists should join the RCSLT AAC WEST (South West Link Therapists) Professionals Network to find out about upcoming Link Therapy Days and resources. (Please turn on notifications so you don’t miss posts). We also encourage Link Therapists to use the forum for peer discussion and resource sharing.

My Medical Record FAQs

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Please see these frequently asked questions below to find out more about using North Bristol My Medical Record (MMR).

Logging in

I have trouble accessing the login page, is there an easy way to access it?

The best way to access MMR is through the link provided on email registration. You can also access My Medical Record by clicking on this link My medical record or by scanning the QR code below:

How do I reset my password?

You can reset your password on MMR by clicking on the ‘Forgot Password?’ link on the sign in page.

Can my family or carers log in? How do I do this?

We can create an account for your family member or carer to use on your behalf.

Please give the cancer team the best contact email for this family member or carer.

The account details will then be sent to their email account.

Results

Will I receive notifications when my results are available?

MMR website cannot send notifications.

Please check the MMR website to understand your monitoring plan and find your test results.

If your test results are abnormal, a member of the cancer team will contact you directly to discuss in further detail.

Will I be able to view historical results on My Medical Record?

No, previous test results will not be visible on MMR.

You will only be able to view test results that happen after your MMR account is set up.

The dates of my blood results and scans are wrong, what should I do?

Scans or procedure results will be available to view after they have been reviewed by a member of the cancer support team.

Blood test results will show as soon as they have been processed.

This may mean the dates shown on MMR, may be slightly different to the date of the test.

Please do not worry if they do not line up exactly and continue following your monitoring plan.

If there are significant differences, or you think your monitoring plan is wrong, please get in touch.

How do I book my follow up blood tests or scans?

Please contact your GP or other community healthcare service to arrange your blood tests.

Any other imaging tests or hospital procedures will be arranged by the cancer nurse team.

You will receive an appointment letter from the relevant department.

If you have not received an appointment, please contact your cancer team.

Other

I have used the message feature, when will I get a reply?

The messaging tool is for non-urgent queries.

The cancer support team aims to respond to messages within 2 working days.

If you have any urgent queries relating to your cancer, please contact your cancer support team directly.

I have changed my mind, am I able to delete my account?

If you would no longer like to access MMR, please tell a member of the cancer support team. This can either be through the ‘Message’ function, or by contacting your cancer support team directly by phone or email. You will then receive results by paper letter or telephone call for the remaining period of follow-up.

What happens when I reach the end of the MMR protocol?

If your tests have stayed within expected levels for the surveillance period, and you have had no concerning symptoms, you will be discharged back to the care of your GP.

Your GP will guide you on any further follow up tests.

Trust Board Meetings 2026/2027

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Members of the public and staff can 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, you can ask a question to the Trust Board.

Papers are available around one week before the meetings. These papers carry a general and press embargo until after the Board of Directors meeting has been held and no discussion concerning them will be entered into until that time.

2026/2027 meeting dates (meetings in common with the Board of Directors for University Hospitals Bristol and Weston NHS Foundation Trust):

Tuesday 12 May 2026. This meeting will be held at The Park, Daventry Road, Knowle West, Bristol, BS4 1DQ
Tuesday 14 July 2026. This meeting will be held at Lockleaze Sports Centre, Off Bonnington Walk, Lockleaze, Bristol, BS7 9XF
Tuesday 8 September 2026. This meeting will be held at the Trinity Centre, Trinity Road, Bristol, BS2 0NW
Tuesday 10 November 2026. This meeting will be held at Thornbury Active Lifestyle Centre, Alveston Hill, Thornbury, South Gloucestershire, BS35 3JB
Tuesday 12 January 2027. This meeting will be held in Seminar Rooms 4 and 5 of the Learning and Research Centre, Southmead Hospital, Southmead Road, Westbury-on-Trym, Bristol, BS10 5NB
Tuesday 9 March 2027. This meeting will be held in the Garden Room at Ham Green House, Chapel Pill Lane, Bristol, BS20 0HH.

Download Integrated Quality and Performance Reports (IQPR):

Board Report (Integrated Quality Performance Report) April 20252.93 MB

Contrast-enhanced mammogram (CEM)

Read more about Contrast-enhanced mammogram (CEM)

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This page contains information about having a contrast-enhanced mammogram (CEM). The information will also be explained by your medical team so if you have any questions or concerns, please let us know.

What is CEM?

A mammogram is an X-ray of the breast. CEM is a technique where a contrast medium (dye) is injected into a vein in your arm before the mammogram is taken. The dye highlights any areas of your breast that we might need to investigate further.

Why do I need a CEM?

CEM is part of your breast assessment. It gives us more detailed information than just using standard mammography as seen below. The image shows the lesions in the breast brighter on the CEM image than a standard 2D mammogram.

Mammography scan images, on the left 2D imaging, on the right contrast enhanced imaging

What happens during a CEM?

When you arrive at the clinic you will complete a short questionnaire. This is to check you can have the test. The mammographer will then call you into the X-ray room and explain the procedure to you.
When you are ready, a small needle attached to a flexible plastic tube (cannula) will be placed into a vein in your arm. The cannula will be used to inject the contrast. This may cause a warm sensation for a short while.
You will then be asked to undress from the waist up.
- Deodorant, antiperspirant, and talcum powder may affect the quality of the X-ray, so please do not use them on the day of your appointment. Or you can wash them off before the mammogram is taken.
The mammographer will position your breasts, one at a time, in the mammogram machine. They will apply some compression and take the X-rays. The compression may be slightly uncomfortable but should not be painful, and is needed to get the best images.
Mammograms will be taken of each breast from different angles.
When the X-rays have been taken, can get dressed and return to the waiting room. You will be asked to stay in the department for around 30 minutes to make sure you are safe to go home. We will then remove the cannula from your arm.

How long will the test take?

The test itself should take no longer than 30 minutes. You will be in the department for about an hour.

Will I be able to resume my normal activities right away?

You can eat and drink normally and return to your usual activities straight away. You can continue with your normal medication as usual.

You are advised to drink plenty of fluids after a CEM test.

When can I expect my results?

The image will be reviewed by the radiology team, who may make further recommendations. You might need further tests, for example an ultrasound scan and/or a biopsy. Your consultant will tell you when you will receive the results of any tests you have, and if we need you to attend for any further investigations.

What are the risks of having a CEM?

Radiation - All X-rays involve radiation. A mammogram uses very small doses of radiation but the benefit of detecting breast cancer at an early stage outweighs the risk of harm from the radiation exposure. The radiation dose from a CEM is slightly higher than a standard mammogram but is still well within the accepted safety guidelines.
Allergic reaction - the contrast is safe and usually has no after-effects. A small number of people can have an allergic (anaphylactic) reaction or other side-effects. This can happen as soon as the contrast is injected or up to a day later.
- Reaction to the contrast dye may include, nausea (feeling sick), vomiting, headache, a rash, and itchy skin. You may also feel lightheaded or faint, breathing difficulties, wheezing, a fast heartbeat (tachycardia), clammy skin, swelling, abdominal pain.
- The mammographers are trained to recognise these reactions. We will check whether you have had any allergic reactions in the past before we give you the injection. If you are concerned you are having a reaction after leaving the department, please seek urgent medical advice or attend A&E.
The dye we use for the test can affect the kidneys. This is uncommon, affecting less than 1 in every 100 people. To reduce the chances of this happening, we will not offer you the test if you have any of the risk factors listed below:
- You are pregnant.
- You are allergic to iodine.
- You have renal (kidney) failure.
- You have diabetes and/or take metformin.

After CEM

Please drink plenty of fluids.
Be aware of signs of allergic reactions detailed above. If you are worried you are having a reaction after leaving the department please seek urgent medical advice or go to the Emergency Department.