No sleep ‘till Hammersmith. From Fast Neutrons to Fast Eddie Clark, Hammersmith was the centre of my Universe in 1980! 1

A look at the formative days of neutron and proton radiotherapy and many other fast things in my sphere including Fast-Forwarding to new radiotherapy techniques due to Covid-19.

My hair was long and my shoes turquoise when I had my eventually successful interview to become a radiotherapy radiography student at the Middlesex Hospital in 1980 and was offered a place not only on the DCR course but also digs in Warwickshire House on Gower Street that was part nurses home and part home for parallel courses such as Physiotherapy and Radiography. I had to agree to a hair-cut and so a “Mullet” became the compromise, short and tidy on top but longer at the back (think Spandau Ballet) while black polish made my trendy shoes a kind of acceptable dark blue!

Living in the west end of London was far more fun than suburban Ruislip where I had lived since birth bar a few months in South London when born and I did get around, combining for the first time a few beers and nights out with careful studying for my DCR. I have said all along that being a student therapy radiographer meant I wanted to be a therapy radiographer and so the vocational training and education really suited me for the first time in my life and I was committed.

Shellys Shoes on Oxford Street

The store in was founded in London the 1940s and had been at the pinnacle of footwear fashion ever since. It claimed to have been the first to introduce crepe soles in the 1950s, Winkle pickers in the 1960s, Doctor Martens and platform soles in the 1970s and Chelsea boots in the 1980s. The iconic Shellys flagship shop on Oxford Street closed in 2003 having become the victim of the big shoe chains while customers such as Robbie Williams, Kylie Minogue, Geri Halliwell become Shellys shoe wearers latterly, in 1980 it was punks and bands such as Motorhead that frequented it and therefore so did I!

Buying some white leather boots with a Cuban heel, think more pointy Chelsea boot but with zip was a huge error, my feet are different sizes and so after a crippling walk back from Oxford Street to Gower Street, I decided to take them back, slightly worn but not noticeably so! They were exchanged for white moon boots, think baseball boot but white faux leather and extremely comfortable in comparison.

The initial white boots were a homage to Motorhead, my teenage obsession that I was not letting go of lightly even though I had bigger fish to fry now and a professional career in radiotherapy beckoning and some potential letters after my name. I’ll come back to Motorhead later in the blog.

Quark, Strangeness and Charm

According to Wikipedia and as some of us might know, a quark is a type of elementary particle and a fundamental constituent of matter. Quarks combine to form composite particles called hadrons, the most stable of which are protons and neutrons, the components of atomic nuclei or alternatively named Baryons.

Objects in the Universe composed of baryonic matter include clouds of cold gas, planets, comets and asteroids, stars, neutron stars and black holes.

Pic: Neutron star with gravitational lensing

This baryonic matter only makes around 4% of the constituent parts of the Universe, the rest is made of dark matter (around 27%) and dark energy (around 68%) which fuels its current rapidly accelerating expansion.

If you want to know more, I read a good book recently by Richard Panek, called the “4% Universe” that is well worth a read if you are into Physics, Cosomology and Astronomy and charts the research into dark matter and dark energy from Galileo, Newton and Einstein to the present day including Saul Perlmutter et al and puts this research into some form of Human perspective. I became interested in this field of Physics due mainly to the inspiring Radiation Physics lectures at the Middlesex Hospital as a student given by people like Professor Robert Speller, Dr Les Loverock and Dr Beate Planskoy that intrigued me far more than those Physics lessons at school.

Pic: A good book, well worth a read and available on Amazon!

Six Quarks are out there, Hawkwind used just two

There are 6 variations of quarks with ethereal names, up, down, strangeness, charm, bottom and top and in 1977 the band Hawkwind released their 7th studio album with the quirky but relevant title Quark, Strangeness and Charm. This album did not feature Lemmy as he had left by then (or was sacked depending on who you speak to) and created his what would one day become the world-renowned band Motorhead. This blog will now explore the use of Baryons in radiotherapy from neutrons in the past to present day protons and we will end with some musical anecdotes of my own.

Hammersmith Hospital Radiotherapy Centre

Hammersmith was a place that I went to on numerous occasions in 1980 and 1981 as the hospital had a MRC funded cyclotron that was used for fast neutron radiotherapy, led by Radiotherapist Mary Catterall and so we visited the site as interested students to learn about these somewhat innovative but eventually slightly contentious treatments. A few things were immediately different to our MEL Linac bunker, one was that the treatment room was huge and had only a fixed beam with patients treated in a chair more often than not and the treatment applicators were made of wood! They ranged from about 5 x 5 cm to around 20 x 20 cm, some square and some cylindrical if I recall.

Wood, I know now is a good absorber of fast neutrons as is water and most modern high energy photon Linac installations all over the world have neutron shielding in the maze entrance that is likely made partly of wood. I will come to this in more detail later on but many Physicists out there will know that when your new high energy radiotherapy bunker concrete dries out over time, the neutron shielding performance sometimes alarmingly drops or using magnetite concrete exacerbates the neutron problem and so it’s best to use a concrete with a high lime concentrate instead, however with the current move away from high energy photons to 6MV and VMAT this is less of an issue these days aside from the new Proton Beam Therapy sites.

Pic: A fixed gantry cyclotron for neutron treatment with curtains, a bit similar to a crematorium!
Pic: A rotating isocentric beam set up but using the same cyclotron in Edinburgh

Neutron treatment time-line

Neutron therapy was first introduced in 1938 and 10 years earlier than electron beam treatments and only 6 years after the actual discovery of neutrons themselves! Despite using a beam suitable for radiotherapy, it was discovered largely by trial and error that some late treatment effects were much greater with neutrons than with x-rays which lead to the initial research being terminated and probably a sign of things to come.

Neutron therapy was introduced at the Hammersmith Hospital essentially in 1970 and encouraging results were initially reported where local tumour control was obtained largely at the expense of more frequent and more severe complications. A centre also opened in Edinburgh in 1997 following what looked like promising initial results at the Hammersmith.

These first generation cyclotrons operated at what was considered a low energy neutron production mode of either 7.5 or 15 MeV which was subsequently shown to have a higher RBE than anticipated and one that was conversely higher than high energy neutrons of 60 MeV produced by the second generation cyclotrons with a slightly lower RBE that we will come to later but it is of great importance in this story.

A reminder, what is the definition of RBE and LET, courtesy of Wikidot? You can skip this bit and go to the next section if you wish!

“Relative Biological Effectiveness (RBE) allows comparison of a test radiation with a standard radiation. It is the ratio of dose between the radiations to give a certain biological effect, for instance a grade of skin reaction or death of mice. Standard radiation is either 250 keV x-rays or 1.17/1.33 MeV 60Co gamma rays”

“Linear energy transfer (LET) is the average amount of energy a particular radiation imparts to the local medium per unit length; ie: Energy per Length. For radiotherapy, we are normally concerned about small amounts of energy over small distances, so the units we use are keV/μm”

There is a relationship between LET and RBE. As LET increases towards 100 keV/μm, RBE also increases, up to 4 – 5 when compared with low LET radiations. This increase is also dependent on the other factors which influence RBE (such as dose rate, fractionation and the chosen biological effect). Over 100 keV/μm, the RBE falls as LET increases. This is due to cell overkill – too much dose is deposited in individual cells, wasting radiation which could be used elsewhere.

Photons have a low LET as do electrons. Neutrons show variability based on the way LET is measured. As we know Protons have a low LET when they enter, but give up a lot of energy at the end of their track called the Bragg Peak (see diagram below). Caution must be taken when using LET to describe radiation, as it may be misleading in some circumstances such as with neutrons.

Pic: Bragg Peak

The RBE of neutrons is said to be circa 3 times that of conventional Photons however the general clinical use of an RBE of 3 for neutrons was not only seemingly incorrect but also potentially dangerous. RBE as we know is dependent on the dose/fractionation of either photons or neutrons and differs for various tissues. It is particularly high for the CNS at the doses/fractions used in radiotherapy.

Neutron tolerance can be determined directly from the total dose in an acceptable photon plan by using the RBE at the photon dose/fraction but as mentioned above the neutron energy also changes RBE.

This is relevant to the historical issues of late damage due to fast neutron therapy as the RBE of neutrons was discovered to be higher for lower energies, something that was not taken into account initially.

Hammersmith initial results of neutron therapy

Initially 40 patients suffering from advanced malignant tumours of the breast, head, neck and skin were treated with 7 MeV fast neutrons with an output of 40 cGy/min.

The responses of the skin in the treated areas were noted compared to photon treatments and the reactions quantified in order to obtain the RBE of fast neutrons for effects on skin which they observed as 2.9 with some skin sparing effect shown. It seems that tumours treated with neutrons showed a favourable response similar that seen standard Photons.

As reported by Dr Mary Catterall at the time, all of the patients in the first three years of fast neutron therapy at Hammersmith Hospital had advanced or radioresistant tumours. Of 238 patients who completed their treatment by January, 1973, 180 died less than 1 year after treatment of metastases or other causes, but in 135 of these, the tumours were either regressing or had completely regressed at the time of death. Eleven of the 97 patients who survived more than 6 months after treatment developed necrosis, but it was reported that precipitating factor was present in every case.

Early results of a randomized clinical trial of the treatment of advanced tumours of the head and neck showed that a greater number of tumours completely regressed with neutrons than with conventional supervoltage treatments.

It was stated at the time that the techniques of fast neutron therapy were much more demanding than those photons as the margin was narrow between the dose leading to recurrence and that resulting in necrosis while the results were quoted as being statistically significant.

Edinburgh and the Western General Hospital

A clinical trial in Edinburgh also started in 1977 based on a 15 MeV neutron beam delivered from a similar cyclotron. It had an isocentric treatment head providing 240° of rotation as opposed to the fixed beam at the Hammersmith.

After treating 500 cases the most important stated limitation of the beam was its poor penetrating quality. They compared neutron therapy alone given in 20 daily fractions over four weeks with photon therapy given in the same fractionation schedule. Regression rates were similar after neutrons and photons but the late reactions were greater after neutrons than photons however overall survival was better after photon therapy.

Levels of induced radioactivity in the cyclotron and radiotherapy equipment were also reported and problems of radioactive contamination were taken into account to ensure that this was fully understood and did not affect morbidity or mortality rates.

Pic: Cyclotron basic operation schematic courtesy of Wikipedia.

As tumours tend to be hypoxic they can be resistant to low LET radiation. This gave an advantage to neutrons in certain situations with shorter fractionation and lower doses. Another advantage was the ability of neutrons to, it has been said favourably treat some rarer cancers, such as surgically inoperable salivary gland, adenoid cystic carcinomas and certain types of brain tumours, especially high-grade gliomas.

Radiotherapy’s second set back – The promotion of a potentially dangerous treatment by a backdoor decision”

An article published in the BMJ with the above heading and written by the assistant editor Richard Smith in December 1988 was the beginning of the end for fast neutron therapy in the UK. The UK government had just announced that they were to spend £6m on a brand-new cyclotron facility at St Thomas Hospital to further explore neutron (and proton) therapy. This largely went down like a lead balloon within the radiotherapy community where all of the morbidity and mortality issues associated with this treatment started to make headline news, some argued there was a place for neutrons, many others that it was some form of unsafe and unregulated disaster.

It was pointed out by the editorial that “The overtreatment with radiation of patients with cancer in Exeter has attracted wide attention. Less has been heard about a second episode in radiotherapy that may do as much harm and have wider implications. The story concerns the government’s decision to spend £6m on a cyclotron that will be sited at St Thomas’s Hospital in London. The machine will produce high energy neutrons and will be used to treat patients with cancer. This decision has been taken against the advice of cancer experts, many of whom think the treatment dangerous, and it raises serious questions not only of patient safety but also of how the decision was made”

You can read much more here and some of the communications undertaken by interested parties either looking to validate or to kill off neutron radiotherapy and make up your own mind. Some describe complications post neutron treatment as “horrendous” while others suggested that the author of the BMI article’s editorial was “emotional, one sided and destructive” and so neutron radiotherapy would eventually be phased out in an extremely divisive way.

This is a PDF of the BMJ editorial by Richard Smith here:

These are just some of the replies and communications, there are many more if you care to look:

The “Douglas” cyclotron at Clatterbridge Hospital

As the results of the randomised trials from Hammersmith and Edinburgh were largely conflicted, a 62.5 MeV, far higher energy and 2nd generation cyclotron named “Douglas” was installed at Clatterbridge Hospital and operational in 1986 in order to carry out further studies with fast neutrons.

Several features were incorporated into the new studies to achieve as unbiased comparison between 62.5 MeV neutrons and conventional 8 MV x-ray radiotherapy. Interim analysis of 151 patients in a pelvic study in the autumn of 1989 revealed a trend towards a worse survival in the neutron therapy group which soon became significant, leading to study termination in February 1990 and the beginning of the end.

It was stated at the time that the units in Hammersmith and Edinburgh had poor depth dose profiles due to the low beam energy and so the higher energy might elucidate better outcomes. The Liverpool trials looked at fractionation, time and dose response. Photons and neutrons were compared in cases of head and neck cancer and also pelvic patients with 3 or 4 field plans and plans created for both beam types with cases only randomised if the plans were comparable. The trials were weighted 3 to 1 in favour of neutrons with rectal and bladder doses of 14.4 Gy in 9# over 21 days for neutrons and 44Gy in 22# over 30 days for 8MV. A reduced volume plan of 4.8Gy in 3# or 20Gy in 10# served as a boost.

As the survival rates become a huge concern in the neutron arm and the pelvic cases the trial ended in 1990. It was later surmised that the fractionation regimen may have been the main factor in mortality alongside an obvious lack of knowledge or impact of the true RBE.

Other concerns with neutron radiotherapy were the effectiveness of the target shielding and the neutron-induced radioactivity in the treatment head and so the Clatterbridge equipment had to fully satisfy criticisms of earlier neutron therapy equipment and meet stringent RPA checks and to ensure this did not impact on morbidity or mortality.

The end of neutron radiotherapy in the UK

The work at Clatterbridge showed that along with a significant increase in mortality, considerable late effect damage was only noted several years after treatment had ended. Late effects reported by the Hammersmith at the time were often life-threatening. It was reported that patients treated for advanced head and neck cancer showed signs of dysphagia and other airway issues that also affected speech and swallowing. Other problems lead to the surgical excision of irradiated fields due to poor wound healing along with the need for permanent tracheostomy, laryngectomy and pharyngectomy on occasions. Some put the high mortality rate down to metastasis due to the advanced cancers treated, others fractionation and low beam energy/RBE while more concentrated on the very late and damaging effects.

When the Clatterbridge cyclotron stopped neutron therapy research it aimed its beam at Proton Therapy instead and 20 years of neutron radiotherapy in the UK formally ended.

Eye Proton Therapy at the Clatterbridge Hospital

Proton therapy has been provided on the Wirral for over 25 years for the treatment of ocular melanomas and superseded neutron therapy as discussed when the cyclotron switched to deliver a proton beam.

In 1992, the Douglas cyclotron became a part of The Clatterbridge Cancer Centre and since 2013, the proton service has been known as The National Eye Proton Therapy Centre.

Pic: A vertical ‘slice’ of a patient plan with EyePlan 3.07. This shows a typical posterior tumour near the Optic Disc from the CCC website.

Uveal melanomas are quite rare, occurring at a rate of 7 per million per year in a European population. About 450 new cases of ocular melanoma are diagnosed in the UK each year, and in recent years 40% of these patients have been referred for proton-beam radiotherapy. The average age of eye melanoma patients is approximately 65, but the youngest patient treated was 9 years old and the oldest was 92.

You can read more about this treatment on their website here:

Uniquely this cyclotron is shielded using grass covered earth and appears as a wartime bunker buried underground where 10m of mud provide sufficient shielding to capture thermal neutrons once fast neutrons have been slowed down. We will come to thermal neutrons and neutron shielding later as when captured they give out quite penetrating gamma radiation.

New Proton Beam Therapy services in the UK

Pic: Proton therapy advert at Bristol Airport

The NHS has built one proton centre at the Christie in Manchester now clinical and a further one awaits completion in London at UCL next year. Rutherford Cancer Centres have built 3 Proton Therapy centres in Newport, Reading and in Northumberland, now all clinical, a further site is being opened in Liverpool in the near future and so while the proton and neutron facility at St Thomas’ planned in 1998 was never built as was feared it would be a “white elephant”, progress has now been made and the UK has now embraced Protons or “PBT” for the wider population. I am sure more will come eventually, how many I don’t know but at least expensive visits for patients to the US and Eastern Europe for PBT and the associated media headlines have now essentially ended.

Motorhead – No sleep to Hammersmith ended my “Golden Years”

In June 1977 and aged just 17 my mate Andy Coleman turned up at my house with what he said was the best new single he had ever heard. As someone who was a regular Ramones and Sensational Alex Harvey Band fan, you had to sit up and listen to Andy. This was the original and just released eponymous “Motorhead” 45 on the Chiswick label that needed to be played as loud as possible. He leant it to me and I took it in to school and most people were gobsmacked. Soon after I bought the single myself and the then first Motorhead album was released some months later and I was hooked.

Pic: Famous Motorhead logo by Joe Petagno

My hair grew longer and after leaving school in 1978 with the “wrong” A-Level results my life was continually touched by the band while I worked as a lab technician in the “Path labs” at Mount Vernon Hospital, my local hospital that I would return to as a Radiographer in the future and The Radiochemical Centre in Amersham that when privatised simply became Amersham PLC, essentially a good grounding for a career in radiotherapy.

Hammersmith Odeon become a regular headline haunt for seeing my favourite bands while other less salubrious settings such as the Clarendon Hotel on Hammersmith Broadway (not a hotel, more a dance hall), The Bridge Hotel in Greenford ( not a hotel, more a big pub) and slightly better places such as The Marquee in Wardour Street, The Music Machine in Camden and The Roundhouse by Kings Cross were also frequently visited.

When living in my Radiotherapy student digs in the early 80’s even some of my Middlesex radiography student colleagues ventured out with me to Hammersmith to see some good concerts as living and training in London meant we were well placed for good musical nights out!

Pic: Hammersmith Odeon in early eighties

The “Overkill” album entered the top 40 in early 1979 and later in the year the new album “Bomber” was released with the band playing both singles on Top of the Pops, an unlikely but ultimately successful PR and marketing strategy even with Lemmy giving the TV audience the famous finger on one episode if I recall.

The Bomber tour was announced that now involved Europe as well as the UK but as a trial run Motorhead played the Music Machine under a pseudonym “Iron Fist and the Hordes from Hell” supporting Saxon, who themselves had been announced as the support band on the full tour. We knew this was Motorhead and in fact Saxon played first and much to the surprise to some, Motorhead completed the night and the new Bomber lighting rig passed its first test if I recall.

Pic: The moving Bomber lighting rig was state of the art when it worked!

After the concert we managed to talk our way into the VIP lounge where the band were “coming down” and got chatting. We were told by Lemmy and the then band and tour manager Doug Smith that if we were true fans we would get over to see some of the European tour gigs. If we did so we would be looked after as long as we helped out a bit. They didn’t imagine for one minute we would actually show up but we did, going to in Lille in France! In pre-easyJet days this involved a drive in my old Mk 2 Cortina from London to Dover, a feat in itself, a cross channel ferry to Calais as foot passengers and then catching the train to Lille, arriving just a few hours before the start, finding the venue only due to the warm up/sound test music being very loud!

We were given back stage passes, access to the dressing rooms and Lemmy even introduced us to the French fans during the concert, my fried Mick was “Mick La Bouche” as he was loud and a pain in the butt, especially when treading on Fast Eddie Clarke’s valuable Fender Stratocaster guitar in the dressing room, pre-gig and breaking a string. Eddie’s guitar hand was not impressed. While there we did help clear up afterwards, got some food and drinks and while not a formal member of the road crew it did seem like it for a day and I got home three days after leaving much to the angst of my parents as there were no mobile phones!

We even made it to Belgium a week or two later by walking from the French/Belgian border by Dunkirk to Poperinge near Ypres (about 5 miles) as that was a far as the taxi from the ferry port would take us. We got back to Dunkirk a day or so later by car driven by some members of “Hells Angels MC Ghent” a renegade club who we had got to know and in very old left-hand drive Austin Cambridge (yes, not on Harley D’s). They were not hugely popular with the locals or other clubs but they seemed OK to us. The rest of this tale is available if you buy me a beer or two post lockdown!

Ace of Spades was released in Autumn 1980 with more shows in Hammersmith to take in and Motorhead had really made it, something people did not think possible in 1976 and this single became their career defining anthem in time.

No sleep till Hammersmith released in 1981 and based on live take outs from two Bomber tour UK gigs reached number one in the album charts and was really where my Motorhead days came to an end as I settled down to life in a white coat with cancer patients.

Pic: Motorhead classic line up, Fast Eddie Clark, Lemmy and Phil Taylor in characteristic pose in around 1978.

I did see Lemmy from time to time in the early eighties as he frequented Acton snooker club, where my friend was a member, largely sitting on a bar stool in front of their fruit machine for hours on end with his JD and Coke and would have a chat from time to time but when he was concentrating on his gambling, you didn’t disturb him!

So from Motorhead “Roadie” (not really and very much lost in translation!) to Radiographer in just a few years was possible! I did still follow the band’s progress and even managed some gigs in the new millennium, my last one at the Oxford Apollo in circa 2005 with the post classic line up of Micky Dee and Phil Campbell involved for well over 25 years but while good, it wasn’t the same. Phil (Philthy Animal) Taylor the classic line up drummer died only aged 61 in 2015 shortly before Lemmy and Fast Eddie Clark in 2018 aged 68 and so the classic line-up were no-more and the band were formally retired by Dee and Campbell on Lemmy’s death aged 70.

Back to neutrons and other “Fast” things in RT!

I’ll end this blog on neutron shielding and some latest developments in radiotherapy. If you are walking in and out of a bunker with a Linac that can treat at 15 MV or over you will have issues with neutrons that you may not be aware of, in fact just over 12 MV can also cause some activation while neutrons tend to act a bit like ping-pong or super-balls in the bunker and so calculating the shielding is a fairly time and computer consuming, Monte-Carlo based conundrum.

Most high energy maze entrances without shielding doors or ones with doors and a small lobby style mini-maze entrance will have linings made out of plywood fixed to wood batons backfilled with some polyethylene granules that can be made to fill a predefined and RPA calculated gap thickness between the concrete wall and the ply to moderate the fast neutrons to thermal neutrons. Sometimes the plywood is only required as wood as we have seen earlier is a good neutron shielding material.

The wood is then lined with a boronated wall paper that looks a bit like sand paper and this captures the thermal neutrons, releasing some gamma-radiation. Sometimes, boronated polyethylene sheets can also be used instead of the above but as they are fixed in thickness you can get expensive shielding overkill. Part of my product portfolio at DHA was a neutron shielding service when bunkers were being built and so you may be working in a bunker shielded by one of my projects but it’s all hidden behind the nicely painted plasterboard!

The new UK Proton Beam therapy centres will also have issues with neutrons and involve similar shielding solutions, we hoped to supply our heavy doors and neutron shielding solutions to the 2 NHS sites but these went to US based companies I believe and not little DHA unfortunately.

Pic: Plywood lined maze ready for infill behind and then boronated wallpaper.
Pic: Boronated wallpaper lining fitted ready and for plasterboard finish.

Radiotherapy gets faster

In the 80’s radiotherapy delivery was slow but patient throughput seemed much faster, in fact to get through 50 patients in a day meant running in and out of the Linac bunker around 150 times and so the faster the better and it kept you fit.

Breast cancer radiotherapy is one field of novel research whereby certainly for low grade tumours fractionation is reducing all the time and so from 25 in my early days to 15 and now to 5 with the FAST-Forward trial.

This is a phase III, multicentre, randomised controlled trial sponsored by the Institute of Cancer Research that aims to test a 1 week, 5 fraction schedule of radical radiotherapy that is at least as effective and safe as the current UK standard and NICE guided 15 fraction regimen used after wide local excision for early stage breast cancer.

Control group: 40.05 Gy in 15 Fr of 2.67 Gy/Test group 1: 27.0 Gy in 5 Fr of 5.4 Gy/Test group 2: 26.0 Gy in 5 Fr of 5.2 Gy

Further recruitment to the trial was made in 2016 and a 10 year follow up after radiotherapy is still ongoing.

Covid-19 is making things even faster

However, in the current health crisis the FAST forward regimen is being fast-tracked into some centres clinical routine so that patients avoid the risk of coronavirus infection by limiting their trips to hospital and also freeing up treatment slots to avoid delays to the provision of radiotherapy for other patients whereby some radiotherapy courses are being essentially triaged presently.

The government announced recently that radiotherapy would be prioritised for certain patients and levels of disease, something unheard of until today. You can read more about this in my April blog here.

You could also argue that Intra-Operative Radiotherapy or IORT for early stage breast cancer given at the time of surgery is an even faster form of radiotherapy that is Covid-19 proof too. For carefully selected women with low grade tumours meeting strict patient selection guidelines, to wake up after surgery and to have completed your radiotherapy too is of great interest to many with busy lives to lead. I believe that this will become a further standard of care option for these patients in the future.

You can read more here:

Lastly SABR is also a novel fast treatment but used in more limited settings as we know but should not be left out of this discussion as hypofractionation assists in an era of a coronavirus pandemic and so I am sure we will hear and see more about the adoption of SABR into the clinical routine as time passes. There have been some press releases regarding this in the past few weeks if you care to look.

And so to end, we need to put the impact of Covid-19 into some perspective as innovations in radiotherapy move on.

Fast neutron treatments and Fast Eddie Clark are no more and while Hammersmith was the centre of my Universe for a while, things change sometimes for the better with advances and innovations in radiotherapy treatment delivery racing ahead at some speed, not as fast as the Universe is expanding but in Human terms, just as important.

It is critical in these strange times of Covid-19 that we continue to have a sense of proportion, especially regarding the ongoing annual death rate from cancer when compared to deaths of people with Covid-19 presently. The impact on cancer diagnosis and treatment by Covid-19 is a serious problem and it is so important that people involved in our profession shout from the rooftops, on social media and via our peers that have media coverage that people must not be afraid to leave home and refer themselves to their GP if they have any cancer symptoms and that the restarting of national screening programs for breast, bowel and cervical cancer among others must be a national priority for all our politicians in the UK. The media are doing their job but it will take more than that if we are not to walk headlong into another, if not worse, medical emergency.

Duncan Hynd – June 2020

A Radiographers Life, A 40-year career in Radiotherapy

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