IHEEM REGIONAL CONFERENCE 2018
Billions of medical images On a related front, Huw Shurmer, Programme manager at Fujifim UK, described how the company is working under a Managed Service Framework Agreement to manage the acquisition, storage, and diagnostic viewing, as well as a number of third-party applications (such as orthopaedic templating), of ‘billions’ of medical images for NHS Wales. Under the agreement, managed to tight KPIs (for instance images must be accessible on desktops in under two seconds), Fujifilm UK is managing the acquisition, storage, and viewing of images from devices ranging from MRI machines to hospital PACS systems, as well as business continuity and data recovery, for seven Health Boards, one national cancer centre, one public health screening service, and one teaching academy. Currently, the service covers 694 image acquisition devices, with some 2.1 bn images stored. In summary, Martin Webley said that in running the service, Fujifilm UK’s overriding goal was ‘to keep NHS Wales’s hospital doors open’, and to ‘keep all its data safe’.
UCLH PBT centre The next presentation, by Nigel Church, head of Radiotherapy Engineering at University College London Hospitals NHS Foundation Trust, and Stuart Keen, the Trust’s head of Specialist Capital Projects and Information, focused on the design, engineering, and ongoing construction, of one of the NHS’s first two high energy proton beam therapy units, at London’s University College Hospital. The two-part address began with Nigel Church explaining the key physical characteristics and treatment benefits of proton beam therapy, compared with those of ‘more conventional’ photon-based radiotherapy. Due to the way that the proton beam is delivered, he explained, a very precise radiation dose can be delivered to the tumour site, with less damage to surrounding tissue. He added: “At standard doses, the key clinical benefits are a sparing of sensitive organs at risk, with a consequent reduction in acute and late effects.” To date, with no high energy proton beam therapy available in the UK, patients requiring such treatment have been treated overseas, supported by the National Specialised Commissioning Team. Although the service is well developed, Nigel Church said it was expensive, took time, could be disruptive to patients and their families, and some prospective patients were unable to travel.
A new PBT service
Against this backdrop, the Department of Health had in 2010 launched a national competition to establish an NHS England PBT service, for up to 1,500 adult and
Nigel Church (left), of University College London Hospitals NHS Foundation Trust, explained the key physical characteristics and treatment benefits of proton beam therapy, while his colleague, Stuart Keen, discussed the practical challenges of constructing the new high energy PBT centre at University College Hospital, London
paediatric patients annually who might benefit, with plans for two high-energy Proton Beam Therapy Centres. The new PBT Centre at University College London is currently being built by Bouygues UK, and is expected to begin offering treatment in 2020, while the other such NHS-funded facility, at Manchester’s The Christie, is nearing completion, and should admit patients from later this year. Both feature Varian Medical Systems equipment. Nigel Church went on to discuss the PBT technology used to treat patients, often with tumours that are difficult to target using photon-based radiotherapy, and the key Varian ProBeam equipment being installed at both new centres to enable this, notably: n The cyclotron, which can accelerate the hydrogen protons down the beam line to the gantry at two-thirds the speed of light.
n The electromagnets, which focus the proton beams towards the gantry.
n The gantry itself, which can rotate 360˚ around the patient to position the delivery ‘nozzle’.
n The nozzle, ‘a 21,000 lb magnet that guides the beam to the patient’.
Practical and logistical challenges In the presentation’s second half, Stuart Keen discussed the practical challenges of constructing the new PBT centre, which is being built on the UCLH central campus. Giving some idea of its scale, he explained that the new 80,000 m3
building will have a floor area of some 37,900 m2 .
Construction work will take place to a depth of 28.5 m, as deep as London’s Northern Line Underground line.
Key facilities
As to the facilities, he explained that Basement Level 4 will incorporate the four proton beam therapy rooms and other shared Varian Medical Systems and UCLH spaces, while Basement Level 1 will house facilities including eight operating theatres, two of them laminar flow, recovery areas, and laboratories. The
ground floor will accommodate the ‘drop- off area’ and main reception, 3T MRI and CT imaging facilities, HV switchgear, security controls, a delivery yard, and cycle and bin stores, while the first floor will house 10 critical care beds, short-stay wards and single rooms, and Surgery Admissions. Levels 2 and 3 will both accommodate 34 haemato-oncology rooms and ancillary and office/MDT spaces, and Level 4 a further 14 haemato- oncology bedrooms, and, along with Level 5, private patient facilities. The design and construction of the new UCLH PBT building had, he explained, involved extensive use of Level 2 BIM.
Delivering and installing the cyclotron One of the project’s major logistical challenges had been co-ordinating the delivery and installation of the cyclotron to an extremely precise schedule. Stuart Keen said: “The site’s very confined nature means we simply do not have storage space, and hence the cyclotron needed to be delivered on 19 June this year. Moreover, my colleagues within the Trust’s Communication and Marketing Department had prepared a day of activities, including the build-up to the naming of the cyclotron, and a count- down to the lift. We had senior representatives from the Mayor’s office, our partners, clinical staff, patients, three television film crews, and our CEO and Chairman for a morning event, and then to witness the lift at 1.00 pm. It was a big day for UCLH, and one that required careful planning.”
Meticulous planning
He went on to explain that the cyclotron, weighing around 90 tonnes, had to be delivered within ‘an environmentally controlled steel box weighing about 32 tonnes’, and was first transported by road on a 25.5 m long, 147 tonne tractor-trailer from Varian’s production facility in Troisdorf near Cologne to Zeebrugge on the Belgian coast. From there it was shipped to Tilbury, and thereafter taken
October 2018 Health Estate Journal 23
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