I moved to Mount Vernon Hospital from the Middlesex in 1985, located in Northwood, Greater London as the Lead Senior 1 Radiographer in charge of mould room services and under the auspices of the then Head of Radiotherapy Physics- Dr Ray Hudson, missing completely the Senior 2 level and a whopping circa £7k salary! Ray was a very likeable boss who really helped form the rest of my career in radiotherapy in that he gave me the confidence to make my own decisions on the best solution for each patient we saw and then to attend conferences and exhibitions to promote and publish our innovative work. This led to me meeting lots of key contacts and companies who would play a huge part in my next position selling high-value radiotherapy equipment.
Wish you were here!
Northwood, a brief snapshot.
Northwood was famous for being the location where popular BBC sitcom “The Good Life” was filmed and also the Eastern Atlantic NATO military command structure was established at the Northwood Headquarters where the Falklands War was coordinated. NATO still operate a base there today. It was also where Sarah and I had our first flat and so very handy as only a 2 mile walk to work each day as we didn’t have a car!
The Good Life!
Clinging on to Radium Moulds
The late Dr Paul Strickland was still a consultant and specialised in “radium moulds” for treating rather large skin cancers located close to bone such as the scalp and other superficial tumours along with latterly having an eponymous scanner centre! Having now switched to using Caesium needles, my task was to create a suitable vehicle to hold them in place. We essentially created the first “remote after-loading” moulds in that the impression compound we used was called Polyform, a white splinting compound made by Smith and Nephew, similar to that used to immobilise fractures. This pliable splinting material was heated in warm water and then set cold similar to todays thermoplastics but was solid with no perforations. The impression was used as the “mask” structure and the rest cut out and fitted with a handle and groves for the needles. The “mask” was simply fitted to the patient and then the treatment component simply fitted to the mask in special locators every day for a set period of time using the handle and was safely stored when not in use. This eliminated extensive handling of the isotope when fitting the mould.
First site to trial Orfit
Polyform was a vital tool in the Mount Vernon mould room in that we also decided to use that for the impressions to make the head and neck clear plastic “immobilisation shells”. This eliminated the need to take a plaster of Paris impression and so much kinder to the patient. The wet plaster was poured into the set Polyform mould and a clear plastic mask vacuumed formed on top as usual. We were also the first ever site in the UK in 1987 to trial the “Orfit” perforated thermoplastic material but this was used strictly for palliative cases to start with but is now in routine clinical use though out the world. We presented our initial findings at the Med-XRay meeting now called UKRCO and located then in the Birmingham Indoor Arena.
Intra-Oral electron applicators were also sited using a Polyform based head mask and the electron metal cone fixed in the mask on a special bridge and seated each day when treatment was required. This initiative was designed in combination with Dr Jane Maher. Lead cut outs for electrons also had a permanent Polyform seat so that the electron applicator could be aligned with minimal stand-off and in the same angle and position each day.
I would also train students from outlying London training centres that did not have a dedicated mould room facility.
Did you know?
The concrete bunker at Mount Vernon for the original MEL SL75/10 Linac in 1986 when I arrived had a patio window, standard lamp and sofa for the patient to undress and change their clothes on and sit until we were ready! The view from the window over the woods was spectacular but I believe a one off. The window was at first floor level and the controlled area stretched across the lawn. This changed when the bunker was upgraded in the 90’s and concreted over!
MEL Linac and in-room furniture as I remember it!
Ray retired and Edwin Aird became Director of Medical Physics at Mount Vernon Cancer Centre. In October 2011 Edwin retired after 40 years-service at the hospital. During his time there he faced the challenge of huge technical changes. The Cancer Centre grew to its present nine linear accelerators. There were major advances in cancer treatment, most recently the arrival of brachytherapy and CyberKnife. It was a great honour to work with both of them and I still see Edwin today from time to time!
Theratronics (formerly AECL) and a very cold Ottawa
In 1990 and now 8 years after qualifying I decided to join the ranks of the corporate radiotherapy world and applied for a job to be the UK product manager for a range of high value radiotherapy equipment manufactured in Ottawa. This range included Theraplan, a world leading treatment planning system about to become 3D, Theratron, a world-renowned Cobalt 60 treatment machine that was now computer controlled and with a 100cm SSD and CT-SIM the first ever CT scanner-based simulator system with what was then advanced virtual simulation software.
Treatment planning goes “3D”
The Theraplan 500 series was the latest offering with innovative “version 5” software that was the companies first venture into 3D planning with an interactive Beams Eye View, Multi-Planar Reconstruction or MPR, an irregular field program called IRREG for basic MLC calculations and some simple organ rendering functionality and the ability to calculate a DVH. There was even a program called OSCAR (created by Shlomo Shalev in Winnipeg) that calculated areas or coloured images of regret where the plan did not meet all the initial criteria and so a small start on the road to inverse planning. Theraplan was not that common in the UK but was very popular internationally and its software added 3D functionality certainly from a visualisation perspective if not dose calculation.
UK TPS wars
Other systems that were popular in the UK were Targit 2 from GE, more popular in the UK than elsewhere and Multi-Data, a more basic lower cost PC based system along with Nodecrest (or No-DEC-Rest as they referred to us!)
Essentially it was a battle of algorithms and hardware platforms in that Theraplan was based on Jack Cunningham’s acclaimed EQTAR model but older 32-bit DEC hardware but with an additional 64-bit array processor for speedy dose calculation while Targit 2, Bentley-Milan based but with a new SPARC 64-bit CPU for which both really extended a 2D beam model into what was really 2.5D or lots of 2D plans joined together. It was not until the offering from Helax in Sweden called TMS a year or so later that “real” 3D planning hit the UK. There were 3 sites in the UK with Theraplan (Belfast, Liverpool and Leeds) and others in Europe.
MLC on its way
MLC was only just starting to be delivered with Elekta and Varian Linacs in a basic form and so the ability to plan this interactively started to become far more important and a key factor in TPS choice with companies such as CMS, ROCS, ADAC and Nucletron Plato system and others creating a very competitive market. With IMRT firmly on the Linac manufacturers horizon and dedicated IMRT systems such as NOMOS-Peacock already out there, the world of treatment planning was about to undergo a huge paradigm shift towards real 3D, IMRT, Monte-Carlo calculations, pencil beams and inverse planning. (I’ll come to 3D planning next month!)
Early BREXIT warning
I had a Theraplan 500 demonstration system that I became proficient with having spent a week in Ottawa in the winter training. However, the system was located and built into a large desk unit that made taking it out on the road very challenging! Ottawa in winter was a shock in that the windchill was around -40 and I was dressed for London! Taking this equipment abroad for events required a rental van and a long drive and having to carry a “carnet” that required stamping at every single customs border across Europe including the UK on the way out and way back and added hours to a journey. For those who voted for BREXIT…be warned!
A European adventure
As Theraplan had international appeal I was promoted to manage not only the UK but also Benelux (that’s Belgium, Holland and Luxemburg for those not in the know) and so spent many weeks a year travelling on the continent.
In the UK, explaining to Radiotherapy Service Managers that in the near future and in my humble opinion each UK centre would have a CT scanner-based simulator and not a conventional one went down like a lead balloon. Very few people believed me and even less were happy to contemplate this scenario but in Belgium, one forward thinking clinical oncologist at a private site in Gent did and purchased the first ever CT-SIM machine in Europe.
This CT Scanner linked directly to the Theraplan version 5 3D software and allowed a 3D multi-slice CT based plan to be created online while an integrated rotating laser in the tunnel marked up the patient and beam entry points without the need for conventional simulation. This might seem slightly outdated now but then it was truly ground-breaking!
Later on, Mount Vernon Hospital also went down this route and bought the UK’s first CT-SIM but this was really used primarily as a CT facility for radiotherapy until much later on but it was fun taking Edwin Aird to Florida in December and contemplating radiotherapy in a hotel hot tub at midnight. The system was manufactured by MHTI in Clearwater and so no hardship visiting the factory with my prospects.
Selling Cobalt machines was more problematical in that the NHS was really trying to phase them out, however, against this move St Thomas’ Hospital in London purchased two new very modern isocentric, high dose rate and computer controlled Theratron 1000 units from me saving the Trust money and providing fast and ready access to treatment for many patients.
The art of selling
I also went on various sales training courses and while some had what could only be called “religious fervour” associated with the trainers I did find them useful and learnt one thing that has been at the forefront of my mind throughout my business career which was “ People buy people first” and this proved vital in raising funds for my own start-up companies from various angel investors or venture capitalists. It’s a good philosophy to follow, trust me!
Next month. Its now 1996 and have just been made redundant from my Theratronics role by the then dealer CIS and so the next day I woke up created Duncan Hynd Associates Limited and started out in business on my own. I’ll focus on advances in 3D treatment planning and my first visit to “Dragons Den” to raise funds for my new company and products where William Rees-Mogg was one of the potential investors, the famous Times correspondent and yes, Jacobs father! (Can’t keep away BREXIT, even then)