The South West Wales Cancer Centre in Swansea has become the UK leader in using the best and most effective form of radiotherapy possible.
A higher proportion of patients now receive Intensity-Modulated Radiotherapy Therapy, or IMRT, than anywhere else in the country.
IMRT allows a high dose of radiotherapy to be targeted more closely at the tumour, while sparing surrounding healthy tissue.
The percentage of patients receiving this technique is one of the quality metrics for radiotherapy centres around the UK – and, at 73 percent, the centre at Singleton Hospital has achieved first place.
This has been made possible by advances in technology, the hard work of the centre’s expert teams – and in part by the Covid-19 pandemic.
IMRT can be used for planned radiotherapy, for all cancers. Swansea started using it in 2012, treating around 20 patients. That number has now grown to around 2,000 a year.
From now on, everyone who would benefit from IMRT will receive it.
Radiotherapy is delivered by a linear accelerator, or linac for short. Using IMRT, the linac rotates 360 degrees around the patient, with the radiotherapy comprising as many as 200 individual beams.
These beams change shape and intensity to target the tumour while sparing nearby tissue.
This provides a better quality of life after radiotherapy, with fewer long-term side effects and hopefully a significantly improved chance of patients being cured of the cancer.
Head of Radiotherapy Physics at Singleton Hospital, Dr Ryan Lewis, said: “Previously we used three or four different techniques, some of which involved more patient contact than others.
“At the start of the pandemic, for various reasons – patient benefit, but also the simplicity of having one system across the centre – we decided to do IMRT for all planned radiotherapy.
“It’s a much better treatment but in the past we have not had the physical resources. But we bit the bullet and did it.”
Once cancer has been confirmed, patients undergo a series of scans to identify the site of the tumour.
Their oncologist will then outline the tumour for it to be treated with the highest possible dose of radiotherapy.
Next, the medical physics team outlines areas of risk around the tumour, such as normal tissue, which need to be spared as much as possible.
From that, a bespoke treatment plan is produced. When IMRT was first introduced, this was a long and labour-intensive process which limited the number of procedures the cancer centre could carry out.
However, huge improvements in image quality and computing power, coupled with a research agreement being signed with technology giant Philips in 2019, opened the way for a step change in IMRT use.
Dr Lewis explained: “We invested in a £1 million computer a few years ago, and that now does most of the work.
“We also had Philips Medical Systems help set that computer up to be the best it possibly can be, and automate some of the processes.
“We tell the computer what we want and it comes up with a result. We look at it and will make adjustments to the doses. This can be done maybe 30 to 50 times.
“In the old days, all the recalculations had to be done manually. You couldn’t do it in less than a day, maybe two, depending on the tumour. Now we can do it in around two hours.
“Everything is independently checked to make sure the planned treatment is safe and deliverable.”
The intention has always been to build towards using IMRT for all planned radiotherapy treatments. But the pandemic created an opportunity, albeit unwanted, to put that progression on the fast track.
“We had a 25 per cent drop in patient referrals and we thought, if we are ever going to do this, it’s now,” said Dr Lewis.
“We decided to invest in development time to provide the best possible treatment for everyone. We must have spent a total of 1,000 hours between different staff members working on this.”
What the team did was to create a series of library plans of different tumour sites.
These library plans are now used as a starting point for treatment plans, adapted to suit each individual patient based on the same process as used previously – only with the time involved significantly reduced.
“We spent weekends and weekday nights testing them, measuring the radiation in different places, reviewing our outlining to know that what we had outlined was exactly what we wanted,” added Dr Lewis.
“It took a huge amount of work but we reap the benefits now because each patient takes less time.”
Cancer centre Clinical Oncologist and Radiotherapy Lead Dr Russell Banner said: “The time invested means all our patients who need high-quality planned treatment can receive IMRT.
“We now find ourselves at the top of the UK leader board, which is great news for us and for patients. They are brilliant radiotherapy plans, much better than they were even five years ago.”
(Lead image: Swansea Bay NHS)
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Plans for Vascular Hybrid Theatre at Morriston Hospital get a major boost
Plans for a state-of-the-art new operating theatre at Morriston Hospital which combines a traditional operating room with advanced medical imagery, have taken a huge step forward.
Health and Social Services Minister Eluned Morgan has endorsed the high level multi million pound proposal. This means Swansea Bay University Health Board can now develop the next-stage detailed business case for the Vascular Hybrid Theatre for South West Wales.
Vascular surgery treats patients with diseased arteries and veins. Blocked arteries can result in limb loss (amputation) and swollen blood vessels (aneurysms) which can burst, resulting in sudden death.
The Vascular Hybrid Theatre, the first in South West Wales, will combine operating theatre functionality and state of the art X-ray imaging equipment. It will treat around 500 patients a year, and some patients who currently need to go to England for treatment will be able to have their care in Swansea instead. The theatre could open early in 2025.
The new theatre will be used by Morrison Hospital’s vascular surgeons and radiologists to carry out minimally invasive techniques, often known as ‘keyhole surgery.
Compared with traditional surgery, hybrid operating theatre surgery is less invasive and less traumatic for patients. The hybrid approach will give patients quicker access to surgery and in some cases could mean the difference between limbs, and lives, being saved.
Currently, a significant number of South West Wales’ patients undergo staged procedures during their care, which can lead to multiple or prolonged stays in hospital.
Swansea bay University Health Board say that access to these new advanced surgical technologies will allow Morriston’s vascular surgeons to perform both minimally-invasive image guided procedures, as well as traditional open surgery. This will not only improve the overall patient experience, but reduce the risk of amputation, reduce the length of stay in hospital and cut waiting times.
The hybrid theatre will treat patients from the Swansea Bay, Hywel Dda and Powys health board areas.
Investment in the new theatre will also save a significant amount of money for the health service because the surgical techniques the hybrid model supports not only improve patient outcomes, they are also much more efficient.
The hybrid theatre will also support the clinical staff teaching.
Huma Stone, Swansea Bay UHB’s Associate Service Director, Clinical Support Services for Morriston Hospital, said: “We welcome this long awaited development and are excited that we will be able to treat patients using a combination of traditional surgery and the latest minimally invasive (keyhole) treatments at the same time, saving lives and limbs. This also reduces the number of times a patient is admitted, and shortens the patient stay in hospital.”
Senior Consultant Vascular Surgeon Louis Fligelstone said: “This brings state of the art facilities to west Wales that will enable optimal treatment of patients with swollen blood vessels (aneurysms) and blocked blood vessels and will save lives and limbs, whilst reducing the time patients spend in hospital.”
(Lead image: Swansea Bay NHS)
Mayor of Llandovery raises over £2k for air ambulance after surviving freak cycling accident
The Mayor of Llandovery in Carmarthenshire has raised over £2,000 for Wales Air Ambulance after surviving a freak cycling accident that left him unconscious at the side of the road and saw TWO air ambulances sent to his aid.
Mayor Handel Davies and his wife Margaret raised £2,280 during the annual Mayors Charity Ball.
The successful ball, which included an auction of rugby related paraphernalia and a raffle, also raised funds for Llandovery Hospital League of Friends.
Over 110 guests enjoyed an evening of entertainment, which included ‘an excellent address’ from Wales Air Ambulance chair of trustees David Gilbert. Over £4,500 was raised during the evening for the two good causes.
The Mayor and Mayoress presented the cheque to David Gilbert at a recent base visit at the Wales Air Ambulance’s headquarters in Llanelli.
The mayor has had personal experience of the essential service the Wales Air Ambulance provides after the Charity’s medics were called out to him during the pandemic.
Handel was involved in a freak accident when a dog ran out in front of him whilst out cycling. He was knocked unconscious for 15 minutes and despite two air ambulances being called out to him, luckily for Handel he didn’t need to be airlifted to hospital.
Mr Davies said: “A sheepdog literally appeared from nowhere at full speed in the blink of an eye hitting the front wheel of my bike at right angles causing me to fall immediately. It happened so quickly I do not remember hitting the road, but the eyewitness commented that had I not been wearing a helmet I would not have survived. The shattered interior of the helmet is evidence of this.
“It took 6-9 months to really recover and get over the impact, which following another serious cycling accident when I was 18, has led me to decide to ‘hang up’ my bicycle and instead attend ‘spin classes’ at the local leisure centre.”
The Wales Air Ambulance Charity needs to raise £8 million every year to keep its emergency helicopters in the air and its rapid response vehicles on the road.
The 24/7 emergency service offers advanced critical care and is often described as a ‘Flying ED’. The on-board consultants and critical care practitioners are highly skilled and carry some of the most pioneering medical equipment in the world. They can deliver blood transfusions, administer anaesthesia, and undertake emergency operations at the scene of the incident, before flying the patient directly to specialist care.
Reflecting on why the 24/7 Charity was chosen to benefit from the Mayor’s charity Ball, he added: “I have the utmost respect for the incredible and invaluable work the Wales Air Ambulance undertake and as we live in a beautiful part of north Carmarthenshire next to road which is very popular with both cyclists and motor bikers, over the last 25 years we have seen many accidents along this stretch of the A4069 particularly at weekends.
“It seems that almost every weekend during the summer months a Wales Air Ambulance flies overhead to attend to an incident.”
Jane Griffiths Wales Air Ambulance’s Community Fundraising Manager said: “It was lovely to meet the Mayor and Mayoress of Llandovery during their recent base visit. They’ve raised a fantastic amount for two important causes and we’re extremely grateful for them choosing the Wales Air Ambulance as one of the charities to benefit from the Mayors Charity Ball.
“It’s lovely to hear that the mayor has recovered from his freak accident, and we wish him well for the future. Your support of our lifesaving Charity is much appreciated and will help us to continue to be there for the people of Wales when they need us most.”
£2.5m investment aims to help tackle hospital waiting lists in Swansea Bay by expanding care after surgery
Swansea Bay University Health Board say a £2.5million investment in a new service that provides enhanced recovery support for patients following some types of complex surgery, will open the way for Singleton and Neath Port Talbot hospitals to do even more to tackle waiting lists.
In the wake of the two-year+ pandemic, pressure on waiting lists is higher than ever. Changes to how Swansea Bay University Health Board delivers services; and investment in staff and equipment, are aimed at bringing those waits down the health board says.
One of the key investments is focused on expanding enhanced post-operative care facilities, which offer a step up from general ward care for patients who need extra support immediately after their operation.
This includes offering patients advanced pain relief, blood pressure monitoring and oxygen support in the immediate 24-48 hour post-operative period.
These facilities and services are not as intensive as high dependency or intensive care units. However, this additional layer of care will offer Swansea Bay hospitals greater flexibility over where that surgery can be carried out.
Opening these services in Singleton and Neath Port Talbot hospitals mean they will soon be able to offer a wider range of certain surgeries which are currently only carried out in Morriston Hospital.
Pankaj Kumar, Deputy Group Medical Director, Morriston Hospital and the project lead said: “In providing these enhanced post-operative care facilities, the health board is providing right-sized, fit for purpose, post-operative care that is responsive to every patients’ needs and is efficient in its delivery of care.
“It will lead to improved patient care and better clinical outcomes for patients, and will also reduce the time they spend in hospital.”
The health board says that expanding these services will also ease the pressure on critical care units located on the Morriston site, and reduce the risk of a scheduled operation being cancelled at the last minute because an emergency patient needed the bed.
Singleton Hospital, which already carries out some complex surgery, will benefit from four enhanced post-operative recovery beds to begin with (eventual plan is for six beds) offering the enhanced post-operative recovery facilities particularly for colorectal and gynaecology patients.
Neath Port Talbot’s plan to become the Orthopaedic Centre of Excellence will be supported by enhanced recovery unit beds being introduced in phase two, with the commissioning of three beds. This development will also help urology surgical patients.
Morriston Hospital already has advanced post-operative care beds as part of post-anaesthetic care unit services to complement its higher level of critical care beds.
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