Being a therapeutic radiography student was very much like riding a racehorse, when things go wrong you have to get back on again right away. It’s also sometimes counterintuitive but the harder you pull, the faster you go! I also take a brief look at equine and veterinary radiotherapy too!


I was 39 and had never sat on a horse bar a donkey on the beach in Eastbourne on an early holiday with my parents as a very young child. My friend who had recently introduced me to the delights of going horse racing and betting a couple of years earlier had prompted some primordial crazy instinct deep in my DNA to ride a horse at my age.

People thought I was mad but the jodhpurs and chaps looked pretty cool and so I decided to have some lessons. The owner of the local yard where my mate was learning convinced me that dressage would be my calling, probably as I convinced her that jumping fences was not for me! For some reason I took to it like a duck to water and quickly became one of her favourite students, even hacking out from time to time on her or another owner’s horse. I learnt some of the less complex dressage moves but it was decided quickly that I needed a bigger, better horse of my own. They would say that!

My friend eventually gave up only a few years later while I went on to be taught to jump proper fences by a then journey-man jump jockey who now starts the Epsom Derby and Grand National live on national TV. More on that later.

Pic: Red Rum, left and training on the sand at Southport beach!

I was introduced to ‘Hector’, a powerful Irish draft Thoroughbred cross who had been regularly ridden out with the Berks and Bucks Drag-hounds, whose owner was moving overseas and had suggested that I might like to take him on. I agreed, saddled up, went into the ménage, started my dressage moves and woke up in the tack-room, concussed and drinking very sweet tea laced with whisky!

Not one to give up that easily, I decided that the issue was not mine or the horse’s but the location of a Vietnamese pot belly pig in a pen next to the school that spooked him and so we moved equine yards to another just down the road but this time run by one of the ‘Masters of the Drag-hounds’ and where Hector originally lived. This didn’t work out either and so Hector and I parted company and he was sold. Half a tonne of uncontrolled, bolting horseflesh is not for the faint hearted and as in my title the harder you pull, the faster they go. Slowing a racehorse is not simplistic, if they want to go, they will. It boils down to confidence, experience, coercion and very subtle give and take! After all they weigh a lot more than you and are generally far more stupid and where a large tractor or passing RAF jet aeroplane is not as issue but a small bird flying out of a bush can make them behave very badly indeed.

Anyway, I was now horseless while the owner of the new yard had some casts off from the hunt that she thought I might like and so my introduction to the world of riding ex-racehorses and Thoroughbreds started.

Pic: Red Rum wins the 1997 Grand National at Aintree for the third time (he also won in ‘73 and ‘74)

Amadeus, whose real racing name (you need to go onto the Racing Post website where all racehorses are recorded and where they all share the same birthday, that is the 1st January) was ‘Amadeus Le Grand’, and who a few years earlier had won a Men’s Open point to point race off top weight but was now 15 and retired from racing.

Out of interest all Thoroughbreds also have a Wetherby’s passport for ID purposes that the vet signs off when drugs are given and that are required for access to the racecourse on race days.

I spent many a day riding in the Chiltern Hills and galloping up some steep slopes (this also helps with braking) and in the school having further lessons where I eventually learnt the ropes of racehorse riding. He was put out to grass a few years later when the owner decided he wanted a new pet for his kids and so I sadly said goodbye.

My next ex race-horse was Merlin or ‘Merlin Rocket’ officially if you care to look him up who had even raced at Cheltenham over hurdles and was owned by a good friend who wanted to give him a new home. She had seen my confidence grow riding Thoroughbreds and thought I had the perfect ‘soft-hands’ for riding Merlin sympathetically and so he was given to me as a birthday present! He was a real ‘double-handful’ but we got on just fine and had a few good years together until sadly he was put down due to Laminitis, a condition that paradoxically occurs if they eat too much rich grass.

So now I was on the lookout for racehorse number three. I had joined the ROR or ‘Retraining of Racehorses’ charity that puts people in touch with retired animals that need a new home. Around 4,000 racehorses are retired annually and so a problem exists with where to put them. Some go to specialist schools where people with learning difficulties or mental health conditions to whom just sitting on a horse and being led around means so much to them to others who like to ride out with the local hunt, perform dressage or just have a pet to hack out on. Others not so lucky end up being euthanised and so this is very much a contentious area within racing and one that needs much further work on but we will save that for another day.

Pic: Two ‘Late Starters’ in sunny Scotland

However, before I could get to consider one the local estate agent who had put our house on the market informed me that her daughter had a 13-year old Thoroughbred who had been out to grass for a year or so at a point to point yard near Silverstone. What they didn’t tell me was that the reason he was out to grass was that he was considered to be a bit crazy and not for the faint hearted. I rode him not knowing this as no one told me, we got on great and so I took him on.

I had Beau, who’s racing name was ‘Late Starter’ and a bit like me and so very well named, for 9 years. He lasted until he was almost 22, very old for a racehorse, we hunted a few times with the Berks and Bucks Drag-hounds, even meeting Ian Balding (Clare’s father) and riding around his famous Kingsclere gallops where the derby winner Mill Reef was trained. He moved with us to Scotland, then back down to England when we rented a property down south and so was very well travelled.

I should point out that Drag-hounds hunt aniseed! Someone called a ‘runner’ goes out an hour before the hunt, and creates a few miles of trail using a bag full of smells that hounds like, this is called the drag! You simply ride each drag following the hounds who chase the scent, jump some fences, gates or hedges on the route and then rest and start another. No foxes get hurt and everyone has a nice time in theory although Beau pulled my hands off for much of my days out due to his enthusiasm to not be stopped at any stage.

Pic: Me working Beau a few months before the end, sadly

When I first got Beau, I was helped to jump properly by Robbie Supple, who at that time kept some of his family’s horses and point to pointers on the yard, was a retired jump-jockey and whose more ‘famous’ brother Willie won the Lockinge Stakes, a group one race on the flat over a mile held at Newbury and rode regularly for Godolphin and who’s other brother Gerry rode regularly for Martin Pipe, the legendary jumps trainer.

Robbie, who I still see from time to time when I’m at the races is now the BHB senior starter and starts horse races from a basic selling-plater race at Exeter right up to the Grand National and Epsom Derby! Ironically, the money he gets paid per race is the same no matter which race it is he starts!

A complete novice as a student radiographer and racehorse rider

I went from being a complete novice who had never sat on a horse to a regular rider of ex-racehorses in a few years, in my early forties. I could go on and on but will leave it there however when I became a radiotherapy radiography student in my early twenties, I was a complete novice then too.

When becoming a student radiographer I went from being a rather lanky, care free and long haired 20 year old who had seriously disappointed with my A-level results and had started and quite quickly ended various jobs and courses into someone thrust into the very strict and serious planning department of the Meyerstein Institute of Radiotherapy at the Middlesex Hospital. The only obvious change in such a short space of time from successful interview to being put in front of cancer patients was a good haircut and a white coat!

This was just what I needed and after a few days of seeing that I was not going to be able to push any boundaries aside from using my obvious charm occasionally (only joking) and being the only male in a largely female environment, neither which bothered me at all, I knew I had made the right career move.

Pic: The Meyerstien Institute of Radiotherapy façade was saved when the Middlesex Hospital was demolished and become Fitzroy Place in 2015

However, radiotherapy was a different world in 1980 where many patients came armed not only with their cancer but often with the reasons why they had it. Surgical interventions prior to radiotherapy were often debilitating and patients died before, during and after treatment, often presenting with nasty later stage tumours, some due to ignoring symptoms and others due to a lack then of any form of well organised national screening services that abound today.

As mentioned in previous blogs I still recall as if it were yesterday the name, spouse and children of the first patient in my care who died of Brain metastases following a secondment on the 250 KV unit where we often treated these cases during a break from planning for a few days. Patients were often very ill and I had to deal with that, no recourse was given to me having just arrived, the busy radiographic staff knew that this was the best way for me to learn but importantly they also valued my help as part of the team, right from the start.

Just like riding a racehorse, where you needed to get back on again right after a fall, there were many reasons why as a novice 20 year old student radiographer working in a busy London radiotherapy centre you might want to give up but the diploma and largely vocational nature of the course made this form of “apprenticeship” right up my street. Being part of the team was just as important as learning and so I missed the time in the department when lectures were given but this was purposely mixed up so that learning, studying and working with patients often became a few days off and a few on and so every time I fell off, I simply climbed back on.

When I now see meetings advertising the need to look a retention, recruitment and student experience I often wonder whether radiotherapy has become too technical, reducing interaction with the patients and education too virtual and less hands on but apprenticeships based at a specific hospital so that you are part of that specific team are in my mind a fundamental route to recreating a profession that suffers less from the important and worrying staffing problems above. A decline in staffing numbers but an increase in demand for further additional new equipment and new centres being built doesn’t add up and needs very careful consideration. I have always been happy to be part of a national working party looking into retention of radiographic staff and recruitment of students in radiotherapy, one is desperately needed now and am not sure why it hadn’t happened yet. Anyway, I have been banging on about this for many years and this is the last time, I’ll stop now!

In order to get some of the views of today’s student radiographers I am launching via RadPro a scheme whereby any student can submit a blog on their past or present experiences of training and or working in radiotherapy or their hopes and plans for the future, whether with a one-off, weekly or monthly headline, all will be accepted. There will be a prize for the best one at the end of the year and so if you are a student and have things to say and publish, RadPro is here for you, just email me at admin@RadPro.org.uk at any time with some good ideas.

Having looked at being a student and comparing that to riding a horse, I guess the next step logical would be to look very briefly look at current trends in radiotherapy treatment from the eyes of an animal!

I saw this headline when compiling the curated news-feed for our monthly radiotherapy industry newsletter and used it as one of our feature articles.

Golden retriever has party to celebrate end of radiotherapy due to brain tumour

‘Nine-year-old golden retriever Claude was diagnosed with a brain tumour in 2018, and has been through years of gruelling treatments to try and save him. Part of this therapy included a course of radiotherapy on a machine normally only used humans, which his owners and vets believed would go some way to reducing the tumour and prolonging Claude’s life.

After hearing about a new machine called a ‘linear accelerator’ for radiotherapy treatment at The Royal (Dick) School of Veterinary Studies, Edinburgh, his owners Anita and Ian Greenfield asked RVC and Southfields Veterinary specialists to investigate and were fortunate enough to get Claude the treatment. This new machine is extremely precise and is able to treat very accurately with a treatment technique known as ‘stereotactic’ and due to its marked precision spares the normal tissues surrounding the tumour and focuses radiation in the mass’

Pic: Claude in party hat mode

Read more: https://metro.co.uk/2020/10/20/golden-retriever-has-party-to-celebrate-end-of-radiotherapy-due-to-brain-tumour-13450237/?ito=cbshare

Following up on this story it seems that there are 6 Veterinary establishments offering radiotherapy to animals in the UK and so not an insignificant number of sites and that there is certainly money to be made in treating animals who have cancer, especially as there is no NHS for them and essentially are all privately insured practices.

When I ran my Intra-Operative radiotherapy managed service company for treating breast cancer, I had written to some sites to explore whether they would be interested in using our service for animals, with a dedicated veterinary machine and so I am pleased to see that new radiotherapy equipment and practices are now impacting on animal health. As a cat lover I am aware that my pets are just as important to me than my family and so if you have the funds, you would do anything to help them, wouldn’t you?

These are the six locations that offer animal radiotherapy in the UK and all have a working linear accelerator:

The University of Edinburgh Veterinary School

The University of Liverpool Veterinary School

The University of Cambridge Veterinary School

The University of Glasgow Veterinary School

Southfields Veterinary Specialists, Essex

Animal Health Trust, Newmarket – just closed in July 2020 and discussed below.

There is also a group of UK physicists who have left the NHS and provide dosimetry and QA support services for the radiotherapy machines.

The following is a brief summary of the services and equipment installed at these six sites and some recent news items:

University of Liverpool Equine Hospital becomes the first in the UK to offer radiotherapy to its equine patients using the Xoft Axxent Electronic Brachytherapy system – June 2017

‘The Equine Hospital of the University of Liverpool at Leahurst provides world-leading, evidence-based care to horses presenting with a vast range of signs and conditions and is now leading the way with this innovative technology for the treatment of equine tumours in the UK. Two patients have received radiotherapy treatment for sarcoid tumours thus far with very promising results’.

Pic: Xoft Axxent machine

‘Horses, like humans, are at risk of developing skin cancer as they spend too much time in the sun. Skin cancer accounts for nearly 50 percent of all equine cancers. The 3 most frequently encountered superficial tumours in horses are sarcoids, squamous cell carcinomas and melanomas, which up until recently have been treated most frequently with surgical excision, chemotherapy (drugs and creams) and cryotherapy. Brachytherapy, a form of radiotherapy is now being successfully employed to treat equine tumours’.

This site also has a Varian Linac for treating small animals too with external beam radiotherapy.

https://www.liverpool.ac.uk/media/livacuk/equine/documents/Animal,Therapy,Magazine,Summer,2017,Brachytherapy,Article.pdf

New era of radiotherapy for pets in the UK – Dec 2019

‘The installation of the Varian Medical Systems VitalBeam linear accelerator in the Hospital for Small Animals, heralds a new era of radiotherapy for pets in the UK.

The Linear accelerator at Royal (Dick) School of Veterinary Studies in Edinburgh is first to offer the same cutting-edge radiation treatment options found in a human hospital’.

Pic: New Linac in Edinburgh

‘The Hospital for Small Animals has introduced new technology, which places it at the forefront of veterinary cancer treatment in Europe. The Varian Medical Systems VitalBeam linear accelerator offers the same cutting-edge radiation treatment options you would find in any human hospital’

This new Linac has Cone beam CT and IMRT delivery capability too, you can read more below!

https://www.vettimes.co.uk/news/new-era-of-cancer-treatment-for-uk-pets-announced/

Animal Health Trust to close, board confirms – July 2020

The Animal Health Trust (AHT), based in Kentford, announced its closure last week – blaming a lack of funding.

The charity ceased services from March as a result of the coronavirus pandemic, although has since confirmed it will no longer operate as the struggle to secure funding continued.

Pic: Princess Anne was a trustee of the AHT and President.

In a statement, a charity spokesman said: “It is with deep regret that today we have announced to our colleagues that the Animal Health Trust’s board of trustees have concluded that the trust needs to close and next week will formally begin the process to wind-up the AHT.

“The decision to cease operations has been reached after several months of trying to secure funding. Although substantial progress was made, the charity has been unable to secure the significant funds it needs to have a long-term viable future.”

The spokesman added further announcements will be made in due course.

Founded in 1942, the charity provides care to sick and injured dogs, cats and horses. It was awarded a Royal Charter in 1963.

The Queen had served as the charity’s patron from 1959 until 2016, while Princess Anne has been its president since 1991 and has visited its Suffolk headquarters on numerous occasions.

This centre had a Varian Clinac for treating small animals and a GammaMed Ir192 HDR remote afterloading system for equine radiotherapy. It is a great shame that such a leading animal hospital based in the heart of the UK’s main horse racing centre in Newmarket with locally based wealthy owners and trainers simply runs out of funding. I am sure the impact of coronavirus has taken its toll but this site led the way in equine health and will be sadly missed. Watch this space if we get some good news and something rises from the ashes.

https://www.eadt.co.uk/news/animal-health-trust-to-close-amid-pandemic-1-6731360

Glasgow University

The Small Animal Hospital in Glasgow contains the only Siemens Linear Accelerator in the UK dedicated to treatment of pet animals. This radiotherapy facility complements the other treatment modalities for cancer offered by the hospital including conventional chemotherapy and advanced surgery.

https://www.gla.ac.uk/schools/vet/sah/services/radiotherapy/

Cambridge University

The Cancer Therapy Unit at QVSH is an internationally recognised centre of excellence for the diagnosis and treatment of cancer in cats and dogs. It offers a complete, integrated multidisciplinary approach to the cancer patient from diagnosis to all aspects of treatment including radiotherapy on one site.

The site has a Varian Clinac Linear Accelerator

Services offered include:

• Multidiscipinary approach to all cancer cases

• Advanced imaging for diagnostic and planning purposes

• Megavoltage radiotherapy with photon beam & electron capacity

• 3D computer assisted radiation planning

• Photodynamic therapy, for superficial carcinomas eg SCC nasal planum in cats

• Chemotherapy, conventional, metronomic and tyrosine kinase inhibitors

• On site flow cytometry service for diagnosis of leukaemia and lymphoma

• Free advice / helpline

• Options for shared care with local practitioners

https://www.hospital.vet.cam.ac.uk/small-animal-services/oncology

Lastly, Southfields Veterinary Services Group offer oncology and radiotherapy services as follows:

Definitive radiotherapy treatment, also known as curative-intent treatment, which is usually the protocol of choice for most cancers as it gives the best chance of long-term tumour control.

Palliative radiotherapy treatment (also known as hypo-fractionated treatment), which delivers a lower dose of radiotherapy that is sufficient to slow the tumour’s growth or reduce associated pain

Low dose radiation therapy (LDRT) for osteoarthritis (OA), which is available for dogs to control chronic, unresponsive pain in the long-term.

Equipment and facilities include:

A Varian linear accelerator for external beam radiotherapy.

Sophisticated planning software, specifically to decide on correct treatment plans and ensure optimal treatment of cancer with minimal side effects and complications.

Specialist vacuum bags for patient positioning to ensure accurate treatment.

https://www.southfields.co.uk/veterinary-professionals/our-services/Radiotherapy

Duncan Hynd – November 2020 Blog

A Radiographers Life… A 40-year career in Radiotherapy