There are 5 five professions of Clinical Measurement Physiology;

• Cardiac Physiology
• Gastrointestinal (GI) Physiology
• Neurophysiology
• Respiratory Physiology
• Vascular Physiology 

Clinical Measurement Physiologist –  Professional Description

• Cardiac Physiology

Cardiac Physiologists measure various aspects of cardiac activity and cardiac function using a variety of highly specialised medical equipment to perform invasive and non-invasive cardiac assessments, analysis, and monitoring, to produce high quality data for interpretation, reporting and initiating therapy.

The purpose of these tests is to assist diagnosis, inform treatment or therapy options and provide information to schedule appropriate surveillance.

Cardiac Physiologists can perform non-invasive physiologist-led cardiac tests and services,  and assist with invasive cardiac tests.

Within a Cardiology Department, the Cardiac Physiologist performs the following cardiac tests:

Non-Invasive Cardiology

• 12-Lead-Electrocardiogram (ECG)
• Echocardiogram (Echo)
• Dobutamine Stress Echo (DSE)
• Assist with Transoesophageal Echocardiogram (TOE)
• Exercise Stress Testing, – Diagnostic, Post Angioplasty, Pre-Cardiac Rehabilitation      –
  • Bruce Protocol
  • Naughton Procotol
• 24 hour and 48 hour Ambulatory Holter Monitoring and Analysis
• 24 Blood Pressure Monitoring and Analysis
• Cardiac Rhythm Management (CRM) includes performing Cardiac Physiologist-Led Cardiac Device Clinics for the following Cardiac Therapy Devices:
  • Pacemakers 
  • Loop Recorders
  • Implantable cardioverter-defibrillator (ICD)
  • Cardio Resynchronisation Therapy (CRT) Biventricular Pacemakers

Invasive Cardiology

Haemodynamic monitoring and assistance with the following procedures;

• Coronary Angiography
• Coronary Angioplasty
• Right and Left Heart Study
• Fractional Flow Reserve Assessment (FFR)
• Intravascular Ultrasound (IVUS) 
• Intravascular Ultrasound (IVUS) guided Rotablation
• Intra-Aortic Balloon Pump (IABP)
• Implantable Cardiac Devices;
  • Temporary Pacemaker
  • Permanent Pacemaker (Single and Dual chamber devices)
  • Cardio-Resynchronisation Therapy (CRT) – Biventricular Pacemaker
  • Implantable Cardiovertor Defibrillators (ICD)
  • Implantable Loop Recorders (ILR)
• Electrophysiology (EP) and
• Radiofrequency Ablation (RFA)

Cardiac Physiologists are Advanced Cardiac Life Support (ACLS) qualified, prepared to administer lifesaving assistance in the event of a patient experiencing Cardiac Arrest.

Cardiac Physiologists are encouraged to continually  augment, optimise  and advance their highly specialised knowledge, skills, and abilities. This is achieved through various forms of CPD, including professional accredited competency exams offered by specialised bodies.  The International Board of Heart Rhythm Examiners  (IBHRE) provides cardiac device accredited certification for IBHRE-C3, CDRMS, CCDS and CEPS, this certification validates specialised knowledge and continuing competence in heart rhythm management.  Similarly, the British Hearth Rhythm Society (BHRS) awards accreditation for EP and Devices and is focused on supporting and improving all aspects of arrhythmia care and device based therapies. The British Society for Echocardiography (BSE) provides accredited certifications for a number of specialised types of Cardiac Echo. 

Commitment to ongoing professional development ensures that Cardiac Physiologists remain at the forefront of clinical practice, ultimately leading to improved patient outcomes and advancements in cardiac care.

• Gastrointestinal (GI) Physiology

Gastrointestinal (GI) function investigations have become an important tool in the diagnosis of digestive diseases.  GI Physiology reported findings play a role in assisting surgeons and physicians in the diagnosis and management of patients with GI disorders.

Upper GI investigations for Oesophageal disorders are extremely common with most patients presenting with symptoms of gastro-oesophageal reflux such as heartburn, epigastric and retrosternal discomfort, bloating and nausea. 

Lower GI investigations help colorectal surgeons and physicians in the diagnosis of Ano-Rectal disorders. 

In a Gastrointestinal Department, the GI Physiologist performs the following tests;

• High Resolution Oesophageal Manometry
• High resolution Impedance Oesophageal Manometry-/+ Pressure flow pharyngeal analysis
• High resolution Impedance Rumination Manometry
• 24h pH studies
• 24h impedance pH study
• 24h LPR impedance pH study
• Bravo 24h  pH capsule Testing
• Electrogastrography of the Stomach
• H pylori Testing/ 13C Urea Breath Testing
• Small Intestinal Bacterial Overgrowth Breath Test  +/- Methane production
• Carbohydrate Malabsorption / Intolerance Breath Testing ( Fructose. Lactose/ Sucrose)
• Small Bowel Capsule Endoscopy
• Patency Capsule Endoscopy
• PillCam  Colonoscopy
• High Resolution Anorectal Manometry  +/-  Rectal Sensory Testing
• High Resolution Anorectal Manometry with Biofeedback therapy

GI Physiologists are encouraged to continually advance their highly specialised, knowledge, skills, and abilities by engaging in various forms of CPD, including professional accredited competency exams offered by the Association of GI Physiologists (AGIP), which is the professional body of  British Society of Gastroenterology which awards accreditation supporting advanced practice.

• Neurophysiology

Clinical Neurophysiology focuses on measuring the function of the central and peripheral nervous systems, including the autonomic nervous system and muscles. Neurophysiologists perform tests that identify and characterise diseases of these areas, produce data for analysis, interpretation and generate reports for future patient care plans.

This field relies on these measurements of the ongoing function whether it is spontaneous or in response to a defined stimulus (EEG, EP). 

Each of these tests measure function by recording alterations in physiology as manifested by changes in electrical waveforms, force or electromagnetic fields. These measurements are then obtained by measuring a waveform that changes over time. 

In a Neurophysiology Department, the Neurophysiologist performs the following tests:

• Electroencephalography (EEG)
• Sleep Deprivation Studies, using EEG
• Electromyography (EMG)
• Nerve Conduction Studies (NCS)
• Visual Evoked Responses (VERs)

Neurophysiologists are encouraged to complete CPD to advance their knowledge, skills, and abilities. This can be achieved by completing professional accredited competency exams offered by specialised bodies.  ABRET Neurodiagnostics Credentialing and Accreditation, offer professional certificated accreditation on the following neurophysiology examinations;

• EEG – Electroencephalogram 
• EP – Evoked Potentials 
• IOM – Intra Operative Monitoring
• LTM – Long Term Monitoring
• NCS – Nerve Conduction Studies

Committing to ongoing professional development, Neurophysiologists offer excellence in neurological diagnostics at advanced practice level, supporting patient outcomes and advancements in neurological care.

• Respiratory Physiology

The Respiratory Physiologist is qualified to perform measurements, analyse, interpret and report the various aspects of Respiratory activity.  We also carry out evaluations on sleep disorders using specialised equipment to support accurate diagnosis and effective treatment planning.

In a Respiratory Department, the Respiratory Physiologist will  perform a full set of specialised Lung Function tests includes the following:

• Spirometry
• Lung volumes by gas measurement and body plethysmography
• Diffusing capacity
• Bronchodilator response
• Baseline oxygen saturation
• Cardiorespiratory limited sleep study set up 
• FeNo Testing (exhaled nitric oxide test)
• Muscle strength testing (MIP, MEP & SNIP)
• Point of care testing e.g. haemoglobin
• Forced Oscillation Technique (Impulse Oscillometry)
• Skin Allergy Testing
• Bronchial Provocation Testing: Indirect and Direct challenge methods 
• Hypoxic Challenge (fitness to fly)
• Exercise Physiology Tests including:
  • 6 minute walk tests
  • Cardiopulmonary exercise test
• Polysomnography,  limited  &  screening  sleep  diagnostic  tests,  as  well  as  sleep  and respiratory manual analysing according to international guidelines
• Positive  airway  pressure  initiation  &  compliance  monitoring  &  patient  education on PAP treatments
• Multiple Sleep Latency Test 

Respiratory Physiologists are encouraged to advance and deepen their knowledge, skills and abilities with on-going CPD, including completing professional certified accredited competency. The Sleep Medicine Exam offered by the European Sleep Research Society (ESRS) supports the advanced practice of Respiratory Physiologists.

Committing to ongoing professional development, Respiratory Physiologists remain prepared to lead improved patient outcomes and advancements in Respiratory Physiology care. 

• Vascular Physiology 

Vascular physiologists are involved in the diagnosis of diseases of the veins and arteries, working within a Vascular Department, as part of a multidisciplinary surgical team.

Vascular Physiologists perform, analyse, interpret and report on a wide variety of ultrasound examinations and functional studies which provide essential information for vascular surgeons or other referring doctors to inform patient surgical treatment plans, medical treatment plans and monitoring surveillance protocols.
Vascular conditions commonly diagnosed and followed up by vascular physiologists include; cerebrovascular disease that can lead to stroke, aneurysmal disease of the arteries that can lead to rupture if undetected, peripheral arterial disease (PAD) which can cause difficulty walking and eventually lead to limb amputation if untreated, or venous disease which causes varicose veins and can lead to ulceration if untreated.

 In a Vascular Department, the Vascular Physiologist performs the following tests:

• Ankle Brachial Index (ABI)
• Toe Brachial Index (TBI)
• Exercise ABI
• Finger Pressures
• Upper Limb Segmental Pressures
• Arterial Waveform Analysis
• Duplex Carotid and Vertebral Arteries
• Duplex of Temporal Artery
• Duplex Abdominal Aorta and Common Iliac Arteries
• Duplex Ultrasound of Endovascular Repair (EVAR) and open repair of Abdominal Aortic Aneurysm
• Duplex Ultrasound of Visceral Arteries 
• Duplex Ultrasound mapping and marking lower limb veins for Bypass Re-vascularisation
• Duplex Ultrasound surveillance of lower limb Bypass grafts
• Duplex Ultrasound of Lower Limb Arteries
• Duplex Ultrasound of Upper Limb Arteries
• Duplex  Ultrasound Lower Limb Veins (Deep Vein Thrombosis (DVT) and Venous Incompetency)
• Duplex Ultrasound Upper Limb Veins (upper limb DVT and AVF formation)
• Duplex Ultrasound of Arterio-Venous Formation (AVF) for surveillance
• Transcranial Doppler (TCD)

By committing to ongoing professional development, Vascular Physiologists remain informed, to provide improved patient outcomes and advancements in vascular care. Vascular Physiologists are encouraged to engage in CPD to advance their knowledge, skills, and abilities. This can be achieved by completing professional accredited competency exams offered by specialised bodies – for example, the title of Accredited Vascular Scientist (AVS) offered by the College and Society for Clinical Vascular Science (CSVS) formally known as Society for Vascular Technology of Great Britain and Ireland (SVTGBI).