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Oxford University Hospitals NHS Foundation Trust
Cancer Services

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About our service

The department

The department is equipped with the following, within the PFI Managed Equipment Service.

  • Six Varian iX2100 linear accelerators (1 with ExacTrac®, 4 with OBI capacity and 5 with respiratory gating)
  • One of the linacs is identified as a service efficiency linac
  • GE 16 slice CT scanner with 4DCT
  • Acuity Simulator
  • Eclipse treatment planning systems
  • Somavision virtual simulation
  • High Dose Rate (HDR) Brachytherapy service

All equipment is networked by the Varian Aria patient management system.

Opening hours

Radiotherapy Department

  • Pre-treatment planning: 8.30am - 5.00pm
  • Treatment delivery: 8.00am - 6.30pm

Our staff

Consultant Radiographers

  • Gynaeoncology
  • Information and treatment review

Advanced Practitioners

  • Palliative
  • Head and neck
  • Neuro-oncology
  • Information and support

Other key radiographer roles

  • Imaging
  • Training
  • Research
  • Mould Room
  • Dosimetry

Training

The department has a designated training radiographer to support new and existing staff throughout all aspects of their professional development, and the opportunity to undertake clinical supervision is offered to all. Many staff have found this to be an extremely beneficial processes and it has repeatedly provided an invaluable chance to help understand and extend professional development and performance.

Other key roles

Nursing Team

The radiotherapy nurse practitioners work as part of the team alongside the therapy radiographers and the doctors to deliver a high standard of clinical practice providing holistic care to patients receiving out-patient radiotherapy treatment.

They manage their own case load of patients and assess, plan, implement and evaluate care for radiotherapy patients with complex needs, providing the link with other members of the multi-disciplinary team (MDT). The Holistic Needs Assessment (HNA) tool is used to help with assessing any concerns and assist in referrals for appropriate support in a timely fashion.

They are available to review patients whilst they are undergoing radiotherapy treatment. These reviews are usually planned in advance with the treatment schedule according to a protocol and given to patients with the appointment letter.

They also deliver care as the need arises, i.e. for skin care, complex dressings, advice or support, or symptom management and any support and guidance to anyone undergoing radiotherapy or care givers. If needed, they can make referrals to district nurses, other clinical nurse specialists and liaise with other hospitals, which would ensure care is continued once radiotherapy is completed.

Dietitians

Our team of Oncology Dietitians provides specialist advice to support the nutrition of patients during their cancer journey. They work closely with our Oncologists, Specialist Nurses and Radiographers. Nutrition is important before, during and after treatment.

The Dietitian can provide:

  • specialist advice on improving nutrition according to symptoms affecting absorption of nutrients or ability to eat and drink
  • strategies to help improve eating and drinking
  • advice on nutritional supplements
  • support with tube feeding problems
  • advice on recovery after completing treatment.

An appointment can be made during treatment with one of our Dietitians, and a referral to a Dietitian closer to home is possible if necessary, for ongoing support after treatment has finished.

Speech and Language Therapist

The Speech and Language Therapist is available for people experiencing swallowing or speech problems during their treatment.

She can provide:

  • exercises to encourage movement of the muscles involved in speech and swallowing
  • strategies to make eating and drinking as safe and as comfortable as possible
  • advice on strategies to manage any voice or speech problems that arise
  • advice on possible recovery of speech and swallowing.

The speech and language therapist is based in the Head and Neck Cancer team, but can see anyone having treatment for other forms of cancer.

Pre-treatment

With the exception of patients requiring radiotherapy for skin lesions, all patients have planning scans performed using the department's GE CT scanner. For a few tumour sites, routine planning is undertaken on the Radiology Department's PET CT.

The department has Varian RPM gating software and regularly performs 4DCT scans to assess tumour motion for lung, oesophagus and pancreas patients using the 4DCT facility providing time averaged contours for outlining.

The radiographers perform the majority of the critical structure contouring using Varian's Eclipse software. This is also used to produce virtually simulated plans for the majority of palliative cases.

Radiographers are also responsible for the administration of contrast media.

In conjunction with physics and the relevant clinicians, the pre-treatment radiographers produce forward planned IMRT plans for all breast patients and perform image fusion for a variety of tumour sites.

All staff, apart from section heads, rotate through the pre-treatment section of the Department.

We welcome comments and suggestions to help improve our service.

Mould Room

This service is provided by therapy radiographers. This enables us to create the immobilisation and beam modification devices most appropriate for our patients. We pride ourselves on producing quality products, whilst ensuring the patient has a pleasant, stress-free experience. We create personalised immobilisation using a combination of thermoplastic, PETG, plaster of Paris impressions, vac-bags and individualised support cushions for a variety of treatment sites from head to toe.

We produce beam modifiers using LMPA and lead, customising both electron endplates and producing LMPA shielding. We work closely with the clinicians to plan the radiotherapy treatment for skin lesions. The Mould Room team work alongside the doctors, physicists, engineers and treatment and planning radiographers to develop the service provided to meet the changing needs of the department, ensuring the best care and level of expertise is provided at all stages.

Imaging

IGRT is an integral aspect of radiotherapy treatments and, as advances are made and implemented into routine treatment delivery, the importance and significance of verification imaging increases dramatically.

During the implementation and development of techniques and technology it is paramount that the goal always surrounds patient experience and, more importantly, patient outcome.

When the all Varian equipped Radiotherapy Department opened, it created the ideal opportunity to develop our IGRT services into an online, radiographer-led process. All our linear accelerators have MV imaging capabilities and currently four have on-board imaging allowing for kV planar imaging as well as cone beam CT, which is now in routine clinical use for a number of treatment sites including lung, bladder, endometrium and pancreas.

Quality Assurance

At the heart of valuing the future needs and expectations of all oncology patients, and those who commission healthcare on their behalf, and earning their confidence in our service, we:

  • provide a patient service as outlined in the Manual of Cancer Service Standards (2008 version 2)
  • meet all legal and statutory requirements and are committed to continual improvement
  • actively seek patient involvement
  • contribute to the development of cancer services across the network through the Thames Valley Cancer Network Radiotherapy Provider-based Operational Delivery Group.
The Quality System

The Radiotherapy Department achieved BS EN ISO 9001:2000 accreditation in August 1998 via Lloyd's Register LRQA (Certificate No: LRQ 0960167) and the Radiotherapy Physics Service (on the same certificate) in September 2004.

The achievement of high and consistent quality standards has been maintained since by taking a quality approach as underpinned by the standard, and in July 2016 transitioned to ISO 9001:2015 Certificate Identity Number 10004579.

There is an annual periodic audit process which follows the patient pathway and audits are reviewed through the Radiotherapy Governance group which meets monthly. There are further audits to comply with legislation (IRR 1999 and IR(ME)R 2000) which are also reviewed through the Governance group.

Equipment

Quality control testing assessment is carried out in the department on a daily, weekly, monthly, quarterly and annual basis.

Patient involvement

The Oncology service seeks to establish the needs and expectations of patients by analysis of Patient Satisfaction Questionnaires, and the rigorous review of compliments, complaints and incidents to enhance our learning.

We have involved representatives from the Cancer Services Patient and Carer Panel in service developments such as our range of cancer patient leaflets.

The involvement and communication with all members of our staff helps us to continually evaluate this feedback, and to implement patient-focused improvements valuing the connection between patient and professional staff.

Technical services

The department includes a well-equipped Technical Support Section which provides a comprehensive, first-line support and repair service for the Linear Accelerators and associated equipment.

The team provides cover for the complete treatment day and also carries out the preparatory 'run up' process for the machines, pre-clinical calibration and out of hours repairs.

Radiotherapy Physics

The Radiotherapy Physics Department plays a key role in delivering safe and accurate radiotherapy treatment to patients in an oncology department. Typical tasks include commissioning of all radiotherapy treatment equipment such as the treatment units and the treatment planning system used to plan the treatments and on-going quality control of the equipment to make sure it is fit for purpose.

The physics team also play an important role in using the treatment planning system to optimise patient radiotherapy treatment ensuring the dose is maximised to the treatment area and minimised to all normal tissue.

As well as routine tasks, physicists are also involved in research and development work, used to implement new techniques aimed at improving and modernising the treatment we deliver. A suitably qualified physicist is state registered with the Health and Care Professions Council (HCPC) as a clinical scientist.