RADIOTHERAPY

’Radiotherapy is estimated to contribute to 40% of cases where a cancer is cured’

(Prof Mike Richards, UK National Cancer Director, 2007)


Radiation Physics supports radiotherapy provided by Hull University Teaching Hospitals to a population of around 1.2 million living in East Yorkshire, northern Lincolnshire and parts of North Yorkshire.

For patient information please refer to the Hull University Teaching Hospitals NHS Trust Website.

WHO ARE WE?

The Radiotherapy Physics group within Radiation Physics are scientific and technical staff who apply the principles of physics to optimise and develop radiotherapy treatments, usually to treat cancer.

We are a team of Physicists (registered with the Health and Care Professions Council (HCPC)), Dosimetrists and Technicians; all of whom undergo extensive training. Dosimetrists are primarily involved in generating bespoke and optimal patient treatment plans and immobilisation devices. Technicians ensure our highly sophisticated equipment is functional and operating safely. Physicists are involved in routine checks as well as service development. We also have a group of Oncology Information System specialists who write software and look after our extensive databases.

With this team of scientific and dedicated support staff we are able to ensure that radiotherapy is one of the safest and most tightly controlled areas of medicine.

More information on the Roles of the Scientist and Technologist in Radiotherapy Physics is available from the Institure of Physics & Engineering in Medicine (IPEM).

RADIOTHERAPY EQUIPMENT

  • Six Varian Linacs, four Truebeam systems and two state of the art Halcyon systems, all with portal MV imaging and kV CBCT imaging. Truebeams are all equipped with Varian Respiratory Gating System.
  • Flexitron
  • Xstrahl 200 Superficial Therapy X-Ray (SXR) Unit
  • Ariane Papillon 50 Contact Therapy X-Ray Unit
  • 2 Siemens Somatom Go.Open Pro CT Scanners
  • Varian Eclipse treatment planning system for external beam therapy and Oncentra Masterplan for brachytherapy
  • IBA Compass, Varians Portal Dosimetry and Mobius3D for pre treatment verification system.

STATE-OF-THE-ART TREATMENTS

  • SABR Oligomet treatments (2021)
  • Multichannel Vaginal Applicators for Brachytherapy (2021)
  • Auto Contouring of Organs using Siemens Direct Organ software (2021) which improves standardisation and efficiency
  • Automatic Simple Structure creation using ESAPI which improves standardisation and efficiency (2020).
  • First interstitial brachytherapy patient treated, improving target coverage whilst reducing toxicity in difficult gynaecological cancers (November 2017)
  • Introduced Flattening Filter Free treatments for lung SABR patients to reduce treatment times (June 2017)
  • Deep Inspiration Breath Hold for breast patients to reduce heart irradiation (March 2016)
  • Stereotactic ablative radiotherapy (SABR) for lung tumours (July 2014)
  • Implementation of an EPID based In vivo and pre-treatment dosimetry system (2014)
  • On-site PET/CT - Siemens Biograph mCT Flow (April 2014)
  • 4DCT treatment planning (February 2014)
  • Inverse planned IMRT Breast treatments
  • RapidArc volumetric modulated arc therapy (VMAT) prostate treatments (February 2013)
  • RapidArc VMAT Head and Neck treatments (August 2013)
  • Contact radiotherapy treatments (we were one of only five centres in the world who could offer this treatment) (August 2011)
  • On-site wider-bore GE Optima MR450W MRI scanner (April 2011)
  • 3D Image Guided Brachytherapy (IGBT) using MRI & CT (June 2009)
  • Intensity modulated radiotherapy treatment (IMRT) treatments (January 2002)

WHAT WE DO

Radiotherapy is a fast moving, technologically advanced area. Our job is to ensure that all radiation exposures are optimal, safe and legal, and that we use the most up to date techniques. With our help radiotherapy is delivered with complete confidence so that the dose intended is the dose delivered to the patient. Healthcare Professionals provide a range of services from checking equipment, preparing radiotherapy plans and treatments to high level research and development.

TREATMENT PLANNING

The Eclipse™ Treatment Planning System is used by dosimetrists and physicists to create individualised radiotherapy treatments. Patients are CT scanned in the position they will be in for daily treatment and we use the scan to create an optimal plan specifically for them. This involves ensuring that the Planning Target Volume (the area that needs treating which is drawn by the Clinician) receives the required prescription radiation dose without overdosing surrounding organs at risk, aiming to reduce short and long term side effects.

We plan using different treatment techniques including 3D Conformal, VMAT, Sliding Window IMRT and SABR.

QUALITY ASSURANCE

We share a quality management system with the radiotherapy service meaning an integrated, seamless radiotherapy pathway with all procedures independently assessed against ISO9001 by the British Standards Institute.

To add further assurance, we are the first Radiotherapy Physics service in the country to become fully accredited. This means we have the quality and competence of our service independently assessed and verified by UKAS. Our accreditation scope can be found here [UKAS schedule]

We are an Accredited Training Centre for the National School of Healthcare Science for Medical Physics trainees at undergraduate and post graduate level (PTP, STP, HSST). We also provide professional training for many other clinical science programs (e.g. RCT).

We are active in supporting local and national radiotherapy trials, scientific studies and pre-clinical research conducted in conjunction with University of Hull researchers.

QUALITY CONTROL

It is essential that all equipment used in radiotherapy is functioning at the highest level of accuracy and safety. Physicists ensure that our equipment is compared regularly with National Physics Laboratory reference doses. We frequently test our systems and even design new methods to detect potential problems long before they have any clinical impact.
Code has been written locally in Python 3 to aid local QA measurements, and some examples can be accessed from the links below

RESEARCH AND CLINICAL IMPLEMENTATION

As a team of scientists, we frequently engage in research and implement technologies and techniques from the literature into our own practice.

Flattening Filter Free (FFF) beam

We are in the process of implementing FFF beam for treating stereotactic ablative radiotherapy (SABR) lung cancer patients. This will allow to deliver treatments at a faster rate (approximately 2.5 to 4 times faster) compared to the current flattened beam treatments, reducing the time patients are required to stay in the treatment position making the treatments more tolerable.

4DCT and VMAT for Oesophagus Cancer Patients

Thoracic tumours move with breathing leading to a number of issues. 4D CT scanning plays an important role to generate personalised target volumes. The VMAT technique provides highly conformal plans helping to minimise organs at risk doses (OAR) and hence reduce side effects and toxicities. This was implemented for lower third and gastro-oesophageal junction (GOJ) patients recently in 2016.

Deep Inspiration Breath-Hold Technique for Left Breast Patients

Deep inspiration breath-hold (DIBH) is an effective method of limiting radiation exposure to the heart and lungs. In addition, it eliminates movement caused by breathing. It was implemented locally for treating patients with left-sided breast cancer in 2016.

Clinical Trials

Radiotherapy Clinical Trials are complex because data is recorded from multiple centres and has to be correctly interpreted to give high quality results. As a team, we adopt new planning methods and provide large portfolios of evidence and audits in order for our patients to have the opportunity to participate in radiotherapy clinical trials. This also includes performing test plans and measuring radiation doses on our equipment. We aim to have 15% of our patients on clinical trials at any one time.

Currently there are 20 trials involving radiotherapy active in our department, focusing on different treatment sites: brain (BRITER, FUTURE GB and ZGBM), head & neck (ADEPT-DDR, EORTC 1420, COMPARE, MK3475-689 and PATHOS), lung (CA209-73L and HALT), breast (ATNEC), oesophagus (SCOPE2), endometrium (MK3475-B21), prostate (EORTC 1414, RADICALS and STAMPEDE), bone metastases (FITNESS), colorectal (IMPART, PLATO and TRACC). We are currently top recruiters for SCOPE2 in the UK! .

Other current projects include;

  • Install of a new Truebeam Linac to modernise our service.
  • Increasing the use of the Eclipse Scripting Application Program Interface within the department, adding additional functionality and data mining utilities to aid clinical decision making and improve efficiency. .
  • Implementation of an advanced high accuracy treatment planning algorithm (Acuros XB) using dose to medium. .
  • Expansion of the use of RapidArc to additional anatomical sites. .
  • Implementation of Flattening Filter Free (FFF) linac beams for routine clinical treatment. .
  • Machine Performance Check (MPC) for daily QA on all machines. .
  • eDocs Implementation to increase efficiency when creating electronic records. .
  • ProKNOW for planning and contour national peer review.

MEDICAL PHYSICS EXPERTS

The MPE’s under regulation 14 of the Ionising Radiation (Medical Exposure) Regulations 2017 for radiotherapeutic practices other than standardised therapeutic nuclear medicine practices for Hull University Teaching Hospitals are:

  • Professor Andy Beavis (Head of Department)
  • Mr Peter Colley (Consultant Physicist)
  • Mr Nick Harding (Principal Physicist)
  • Miss Katherine Hilton (Principal Physicist)
  • Mr Carl Horsfield (Principal Physicist)
  • Ms Jenny Marsden (Principal Physicist)
  • Mr Thomas Murray-Butler (Principal Physicist)


VISIT THE HULL UNIVERSITY TEACHING HOSPITALS NHS TRUST WEBSITE

For patient information please refer to the Hull and East Yorkshire NHS Trust Website.

TIMELINE

ADDRESS
Radiation Physics Department
Queen's Centre
Castle Hill Hospital
Cottingham
East Yorkshire
HU16 5JQ
U.K.

CONTACTS

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