Help! I’m (not) a leader, get me out of here!

Elizabeth Loney

Do you ever wonder how you got where you are? Are you sure you see yourself as others do? 

Dr Elizabeth Loney, Consultant Radiologist and Associate Medical Director,  reflects on imposter syndrome and offers tips on how to manage it.

 

How many times have you sat in a meeting and looked around the room thinking, “what on earth am I doing here? Everyone else knows way more about this than I do, and they know it!”

The first senior management meeting that I attended started with reviewing the minutes of the last. As I read through the document, I realised I had no idea what much of it said—death by TLAs (three letter acronyms!). I nudged the person next to me and said, “what does … stand for?” They shrugged their shoulders and whispered to the person on their other side “what does … mean?” It took five people down the line before someone knew what it was! I found that reassuring, but also slightly scary. The fact that other people were in the same boat made me feel less like an idiot, but at the same time, how could such a senior group not understand the jargon and why had they said nothing? So… lesson one: be curious and not afraid to ask questions. You’re probably just asking what most people are thinking anyway!

About six months ago I started the Nye Bevan Programme with the NHS Leadership Academy. If I pass, I will allegedly have proven myself ready for an NHS executive leadership role. There are around 48 others in my cohort, all senior leaders in different areas of the NHS. What the heck am I doing there?! I’m just a doctor, not a leader. I might sort things out for people as Clinical or Divisional Director but I’ve never felt more like a “public servant” than when in a “leadership role”. I had serious Imposter Syndrome. The first residential was entitled “Knowing Yourself and Others” and was all about the impact you have on others as a leader and why you act as you do—unconscious bias and all. It was a traumatic experience for me. I did so much “reflecting” I felt like a mirror! I couldn’t do it—just give me a few scans to report! I’m not a leader—get me out of here. However, I got chatting to others that week and realised that pretty much everyone else in the room felt the same. Most people suffer with this issue at some time—and if you don’t, why not? A little humility is a wonderful thing.

Are you affected by low self-confidence? At times like this, seeking peer feedback can be helpful. As part of the course I had to send out a questionnaire asking others I had led on a work programme for anonymous feedback. That was scary! I asked questions including “what do I do well?” and “what could I do better?” I half expected to be slated but, to my surprise, the feedback was really positive. My view of myself was distorted. I may not see myself as a leader but apparently others do! So… lesson two: when you feel like an imposter remember that many others in the room feel the same way. There must be a reason why you are there. What do others see in you, that you do not? What is your role in the group? ‘If not you… who?’

So ends my first blog as Chair of the BIR Leadership and Management SIG… another position I find myself in wondering how I got here! What do I know about leadership? I’m not an expert. However, I do have a passion for self-improvement and a curious nature. Why not join me on my journey to “managerial enlightenment”? We have such a lot to learn from one another.

I hope to meet you in person at the BIR Annual Congress where we will gain inspiration from excellent speakers covering topics on “practical” and “personal” management, including an interactive session by Philips based on their “Insights” programme—expect to be up on your feet! We are also holding our first annual event on leadership, “Leadership 2020” on 31 January 2020. Come along and join us for more opportunities to learn, network and ask questions.

See you there!

Dr Elizabeth Loney,

Chair of the BIR Leadership and Management Special Interest Group

BIR ANNUAL CONGRESS 7 and 8 November 2019 

 

BIR LEADERSHIP 2020 event 31 January 2020

More about the BIR leadership and management SIG here 

Join the open SIG here  (BIR member only)

About Dr Elizabeth Loney

Dr Elizabeth Loney is Chair of the BIR Leadership and Management Special Interest Group (SIG). She is a Consultant Radiologist and Associate Medical Director and Consultant Radiologist at Calderdale and Huddersfield NHS Foundation Trust.

 

Getting the taste for radiology

Deepsha Agrawal 3

 

Dr Deepsha Agrawal reflects on how a taster week at her local hospital was the first step on her journey to qualifying as a radiologist.

 

 

Having read several narratives of Röntgen’s glowing cardboard screen and the mysterious Crooke’s tube, I have always found myself fascinated by radiology. I often wondered what radiologists do in their secretly tucked away dark rooms and how those digital blueprints and monochrome scans make sense. The evolution of radiology from giant X-ray tubes to present day dynamic scans and angio seals, prompted me to consider a career in radiology. And so valuable was my taster week experience that my interest has now transformed into a drive to become a radiologist.

I am an international medical graduate doing my Foundation Year 2 Clinical Fellowship. Although I had done a two week elective in radiology during my internship (the Indian equivalent of FY1), I was keen on doing a taster week before entering specialty training in the UK.

How I arranged it:

A taster week can be a great opportunity to give a useful insight into a specialty and connect to trainees and consultants who are currently working in the specialty. I arranged my taster week by emailing a radiology consultant in my hospital who kindly accepted and set things up for me promptly.

After a quick discussion with the radiology consultant, I emailed my rota manager who was very generous to grant me study leave for a week.

My experience:

Deepsha Agrawal 1My week was spread between plain film, ultrasound, CT, MRI and some interventional radiology sessions. While the plain film sessions were useful to carry into my regular job, the IR experience in the theatre was quite thrilling. Interventional radiologists are clinicians with those magic wands (catheters) who practice some seemingly futuristic medicine. It was an absolutely inspiring experience for me.

Spending a week in radiology gave me a lot of clarity on my doubts and misconceptions about the specialty.

Artificial intelligence (AI) won’t replace radiologists: Every time I had expressed my interest in radiology, I was told that it will soon be replaced by AI and radiologists will be left with no jobs. My experience tells me that AI will only alter the job of a radiologist and not replace it. Radiologists do more than reading and interpreting images. They recreate the patient’s clinical story when they look at a scan. AI can recognize but never interpret an image.

Radiology is a core clinical specialty: I was under the impression that radiology is mainly technical and has only a slight clinical edge to it. During one of my initial sessions  I mentioned the same to a radiology consultant and amusingly but legitimately he got quite upset and told me there’s a reason it’s called “Clinical Radiology”. A week into radiology, I realised that there is in-depth clinical processing in radiology with every scan.

Radiologists touch the lives of their patients every day: It might be true that radiologists see fewer patients than an average clinician but with every scan interpretation a radiologist is affecting the life of a patient. They add value by not only interpreting the scans but also consulting with other physicians on diagnosis and treatment, treating diseases with intervention and relating findings clinically and from lab tests.

More recognition within the healthcare system: I was fortunate to attend a surgical and respiratory Multi-disciplinary Team Meeting (MDT) during the week. These meetings gave me insight into the role of a present day radiologist. The traditional view of the radiologist as a physician who sits in the dark room defining technical parameters of imaging procedures and interpreting diagnostic images is now outdated. Radiologists have now come to the forefront with multi-disciplinary meetings where they are valued and recognized for their opinion in deciding the course of treatment for patients.

Deepsha Agrawal 2Radiologists are happy people: Having rotated through various departments during my internship and experiencing a few departments in the NHS, I found a striking difference in how radiologists see their work. They work as a team, care for each other and are very encouraging. Don’t be surprised if your fellow consultant is making you a cup of coffee! Also, the trainees fairly support medical students and junior doctors in walking the path to enter specialty training. Overall, I felt that the happiness index of radiologists was higher than other specialists and they truly enjoy their work.

Although I entered as a slightly confused junior doctor, I have come out more aware and orientated to work towards a career in radiology with audits, academic projects and day-to-day learning ideas. In summary, I thoroughly enjoyed my taster week and am pleased with my experience. For a radiologist, no two days are the same. There is immense learning and fun in radiology. I am already dreaming of holding the needles and being on the dictaphone. I highly recommend a taster week to all junior doctors considering a career in this specialty.

I would like to add a special note of thanks to Dr. Amit Patel, Consultant Radiologist, Queen Elizabeth University Hospitals, Glasgow, who kindly accepted me as a taster week student and scheduled my sessions.

– Deepsha Agrawal, FY2 Clinical Fellow, Neurosurgery, Queen Elizabeth University Hospitals, Glasgow.


About Deepsha

I am an FY2 Clinical Fellow in Queen Elizabeth University Hospital in Glasgow. After graduating from India in 2018, I moved to the UK for further training with a keen interest in Radiology. My journey has been great so far and I look forward to bringing innovations to medicine as a radiologist.

Radiotherapy: 40 years from tracing paper to tomotherapy

NHS

Physicist Andy Moloney and Clinical Oncologist David Morgan reflect on how radiotherapy developed since their early careers

 

We first met in the autumn of 1981, when the NHS was, at 33 years from its inception, but a youngster. Andy had recently joined the Radiotherapy Physics staff at Nottingham General Hospital after graduating in Physics from the University of Nottingham, and David was returning to the clinical Department of Radiotherapy and Oncology after a year’s Fellowship at the Institut Gustave-Roussy in France. A firm friendship rapidly developed, one that continues to this day.

On reflection, joining the radiotherapy fraternity at that time was a leap of faith. The perceived wisdom amongst many of our scientific and clinical colleagues at the time was that this treatment technique was outdated and overshadowed by radical surgical procedures, new chemotherapy agents and biological modifiers poised to reduce radiotherapy to the history books.

picture 063This was a time when, in this Cinderella of specialties, physics planning was achieved by the superposition of two dimensional radiation plots (isodoses) ,using tracing paper and pencils, to produce summated maps of the distribution. The crude patient outlines were derived from laborious isocentric distance measurements augmented by the essential “flexicurve”. The whole planning process was slow and labour intensive fraught with errors and ridiculed by colleagues in the perceived prestigious scientific and clinical disciplines. The principal platform for external beam radiotherapy delivery, the Linear Accelerator (LinAc), had also reached something of a plateau of development, albeit with improved reliability, but few fundamental changes. Caesium tubes were transported from the “radium safe”, locked in an underground vault, to the operating theatre in a lead-lined trolley, where they were only loaded into “central tubes” and “ovoids” after the examination under anaesthetic (which was performed with the patient in the knee-chest position); they were then manually placed into the patient, who went to be nursed on an open ward, albeit behind strategically placed lead barriers.

For no sites outside the cranium was Computer Tomography (CT) scanning available. Magnetic Resonance Imaging (MRI) was still a vision seen only by a small number of enthusiasts.

All these limitations were met by a developing team of scientific and clinical enthusiasts believing in the future of radiotherapy if only technology could deliver solutions to address an improving understanding of the differing cancers and their radiobiology.

picture 066In the latter half of the eighties these solutions began to crystallise. Computers were being introduced across the NHS and their impact was not lost in radiotherapy. Pads of tracing paper were replaced with the first generation of planning computers. The simple “Bentley-Milan” algorithms could account for patient outlines accurately and speedily and optimising different beam configurations became practical. Consideration of Organs at Risk, as defined by the various International Commission on Radiation Units (ICRU) publications, became increasingly relevant. Recognition of the importance of delineating the target volumes and protecting normal tissue required improved imaging and this was provided by the new generation of CT scanners. In the nineties these were shared facilities with diagnostic radiology departments. However, the improvements provided by this imaging, enabling accurate 3-dimensional mapping of the disease with adjacent normal tissues and organs at risk, dictated their inclusion into every radiotherapy department soon after the millennium. The added bonus of using the grey scale pixel information, or Hounsfield numbers, to calculate accurate radiation transport distributions soon followed when the mathematical and computer technology caught up with the task. The value of MR and Positron Emission Tomography (PET) imaging was also recognised in the diagnosis, staging and planning of radiotherapy and the new century saw all of these new technologies embedded within the department.

Mould room technology was also improving with “instant” thermoplastic immobilisation shells replacing the uncomfortable plaster and vacuum forming methods. Custom shielding with low melting high density alloys was becoming routine and it was not long before these techniques were married with the emerging CT planning to provide “conformal” treatments.

picture 067LinAc technology also received added impetus. Computers were firstly coupled as a front end to conventional LinAcs as a safety interface to reduce the potential for “pilot error”. Their values were soon recognised by the manufacturers and were increasingly integrated into the machine, monitoring performance digitally and driving the new developments of Multi Leaf Collimators (MLC) and On Board Imaging (OBI).

The dominos for the radiotherapy renaissance were stacked up, but it needed the radiographers, clinicians and scientists to decide on the direction of travel. Computer power coupled with advanced electro-mechanical design had transformed MLC efficiency and resolution. Conventional conformal planning was now progressively superseded by sophisticated planning algorithms using merged CT and MR images. Intensity Modulated RadioTherapy (IMRT) had arrived in its evolving guises of multiple fixed field, dynamic arc therapy (RapidArc) or Tomotherapy. Whichever technique, they all offered the radiotherapy “Holy Grail” of providing three dimensional homogeneous dose distributions conformed to the Planning Target Volume (PTV) whilst achieving the required dose constraints for organs at risk and normal tissue preservation.

The tools had arrived, but an infrastructure to introduce these “toys” safely into a complex clinical background had also developed alongside. Quality standards (ISO9000), Clinical Trials, Multi Disciplinary Teams and Peer Review were governance mandates for all oncology departments and radiotherapy was leading the way. In forty years, radiotherapy had lost the “Cinderella” image and had been invited back to the clinical ball. Noticeably, breast and prostate adenocarcinoma constituted half of the radical workload.

The question remains of how and why did this transformation occur? Obviously the developing computer power and technology were the pre-requisites for many of the developments, but a key catalyst was the foresight of all of the radiotherapy family from which enduring friendships have been forged. The working lives of the clinicians and physicists involved in radiotherapy planning have probably changed more dramatically than those of any other medical and paramedical groups over the last 35 years.

We may have retired, but we still cogitate about the future direction and science behind this developing and essential cancer treatment and look forward to our younger colleagues enjoying their careers as much as we enjoyed ours.

 


About David Morgan

david morganDr David A L Morgan began training in Radiotherapy & Oncology as a Registrar in 1977, and in 1982 was appointed a Consultant in the specialty in Nottingham, continuing to work there until his retirement in 2011. He joined the BIR in 1980 and at times served as Chair of its Oncology Committee and a Member of Council. He was elected Fellow of the BIR in 2007. He is author or co-author of over 100 peer-reviewed papers on various aspects of Oncology and Radiobiology.

 

About Andrew Moloney

andy moloneyAndy Moloney completed his degree in Physics at Nottingham University in 1980 before joining the Medical Physics department at the Queens Medical Centre in the same city. After one year’s basic training in evoked potentials and nuclear medicine, he moved to the General Hospital in Nottingham to pursue a career in Radiotherapy Physics and achieved qualification in 1985. Subsequently, Andy moved to the new radiotherapy department at the City Hospital, Nottingham, where he progressed up the career ladder until his promotion as the new head of Radiotherapy Physics at the North Staffordshire Royal Infirmary in Stoke-on-Trent. Over the next twenty years Andy has acted as Clinical Director for the oncology department and served on the Radiation Physics and Oncology Committees at the BIR and was appointed a Fellow in 2007. He has been the author and co-author of multiple peer reviewed articles over the years prior to his retirement in 2017.

 

A revolution in imaging: radiology memories for #NHS70

NHS

Professor Adrian K Dixon was born in the same year that the NHS began. Here he reflects on what the NHS has given him and the revolution he has experienced in the world of radiology.

 

Adrian Dixon

Professor Adrian K Dixon

I was born in 1948 and, 70 years on, I remain one of the most passionate supporters of the NHS. Like many of my generation, I have received huge personal benefit from the NHS over the years; both my elbow fractures were brilliantly treated in Accident and Emergency Units; joint replacements for osteoarthritis have provided renewed mobility latterly; audiology services have looked after my long-term inherited deafness and allowed me to function reasonably well so far.

Training in medicine in Cambridge (1966–9) and London (St Bartholomew’s Hospital, 1969–72) was very different from nowadays. On hour one, day one, as a young houseman, sister said to me: “There are three patients for myelography today –  there are three trays set up for lumbar puncture – all you have to do is to send some cerebrospinal (CSF) fluid off to the lab and instil the Myodil before they go down to radiology where Professor du Boulay will be waiting….!” I had not even seen a lumbar puncture at that stage but I learnt quickly at the hands of an excellent registrar. Then I went off for training in General Medicine at Nottingham General Hospital in the excellent Professorial Unit led by Professor Mitchell and Dr (later Professor) Hampton. Any patient over 65 then was ‘geriatric’. I well remember one elderly lady recovering from a cardiac event who was not quite well enough to go home where she lived alone – I said: “I think you need a few days in our convalescent home in Cleethorpes (yes, the NHS provided such things in those days!)”. Her reply: “Oh lovely; I have never seen the sea”. No package holidays or low-cost flights back then!

I was extremely lucky to train in radiology during the 1970s and to be involved with the beginning of the revolution in imaging, namely the introduction of ultrasound, CT and MRI. These advances were truly miraculous compared with the fluoroscopic techniques of old. Indeed image intensification was only just becoming sophisticated while I was training and I did my fair share of barium work using direct fluoroscopy following dark adaptation with red goggles! This even persisted after my move to Cambridge when I was given responsibility for imaging services at the local geriatric hospital where the ageing equipment was nearly as old as some of the patients!

Picture1

After a brief spell in paediatric radiology, I became fascinated by Computed Tomography and I was lucky to be appointed as a Research Fellow at St Bartholomew’s Hospital. There, Dr Ian Kelsey Fry had the foresight to install one cranial and one whole body CT systeminto 2 standard X-ray rooms (an excellent strategy – replacing old technology rather than merely adding on the new). This gave me the experience to be appointed as a young lecturer/Honorary Consultant at the newly emerging Clinical School in Cambridge (thanks to the risk taken by my lifelong friend Professor Tom Sherwood).

In partnership with NHS radiological stars in Cambridge (Desmond Hawkins and Chris Flower, to name but two), Tom Sherwood forged a highly successful combined University/NHS Radiology Department which continues to this day. I was fortunate to be given free rein to develop Body CT and the townspeople generously raised the money for a machine which was opened by HRH the Prince of Wales in 1981. But the NHS was not quite ready for CT! Not only did the town-based charity have to pay for the building, it also had to provide running costs for the first five years; we only received subsequent NHS funding in 1986 after a thorough Department of Health Audit of our work. Even then the local NHS was sceptical; the local oncologists saved the day by suggesting that they could manage more of their patients as outpatients if CT was available. The outstanding local fundraisers were so successful that the charity was able to fund top-of-the range MRI systems in Cambridge for some decades thereafter. Although there was one generous distribution of NHS funding for CT systems on the back of Sir Mike Richards’ cancer initiatives, NHS funding for high-end equipment has never really been properly addressed.


About Professor Adrian K Dixon

BIR Toshiba Mayneord Adrian Dixon 4

Professor Adrian K Dixon

Professor Dixon is Emeritus Professor of Radiology at the University of Cambridge and a retired Consultant Radiologist. He has published extensively on Computed Tomography and Magnetic Resonance Imaging and has edited several textbooks. He was Warden of the Royal College of Radiologists (Clinical Radiology, 2002–2006) and MR Clinical Guardian to the UK Department of Health (2004–2007). He has been awarded honorary Fellowship/Membership of Radiological Societies in Austria, Australia & New Zealand, France, Hungary, Ireland, Sweden, Switzerland and the USA. He was Editor-in-Chief of European Radiology 2007–12 and was awarded the Gold Medal of the European Society of Radiology in 2014. He has been awarded Honorary Degrees by Munich and Cork. He was Master of Peterhouse, University of Cambridge 2008–2016.

On foot through Chernobyl with Medical Physicists

Katharine Thomson shares her experience of visiting the abandoned exclusion zone Chernobyl.

Picture1It’s a two hour drive to Chernobyl from the Ukrainian capital, Kiev, through mile after mile of flat, pine-covered countryside. There’s no indication that we’re approaching the site of the worst nuclear power disaster in history; even when we reach the edge of the Exclusion Zone, 30km from the ruined reactor, there’s nothing visible beyond the checkpoint except the long, flat road between the trees.

Soldiers check each passport carefully and wave us through. As our minibus crosses into the Zone, our guide reminds us of the rules: no eating, no touching, no souvenirs.

If the destination is unconventional, our group is equally eccentric. We’re a group of nine: eight British physicists, for whom the prospect of visiting a nuclear disaster zone is not bizarre but compelling, and one game partner. Our visit was organised by Henry Lawrence and the UK Monte Carlo Radiation Transport User Group; most of us work in hospital radiology and radiotherapy departments, and we’re used to dealing with low level radiation incidents, from faulty x-ray equipment to spilt radioactive drugs. Chernobyl, however, is on another scale.Picture5

The first thing that strikes you is the trees: all we can see above three decades of forest are the tops of apartment blocks and the uppermost yellow carriages of a Ferris wheel. We park on the empty road and step into thick undergrowth, passing in single file down tracks that were once highways.

It’s a changeable day, sunny with sudden showers. Yellow butterflies dance around us, and the air is heavy with the smell of pine trees in the heat. Away from the derelict buildings and rusting industrial junk, this is a strangely pleasant place for a walk.

Picture12Our guide sweeps his Geiger counter slowly near the ground; the clicking accelerates as it passes over “hotspots”, otherwise indistinguishable from surrounding earth. I think we’re less impressed than he hoped – many of us do something similar at work, detecting small radioactive spillages.

A dilapidated building looms out of the trees.

“No touching,” our guide reminds us. “Your feet can touch the ground – that’s all.”

We peer through dirty windowpanes. The floorboards have collapsed in splinters and books spill out onto the damp earth, Cyrillic lettering still clear. They look like science schoolbooks, rejected by looters. We step around them carefully – it feels wrong to tread on books. A brightly coloured calendar still hangs on one wall, with drummers marching beneath the date – 1986.

The Accident and Aftermath

1986: in the early hours of the 26 April, Chernobyl Nuclear Power Plant’s Reactor 4 exploded during a safety test. The fire raged for days, releasing clouds of radioactive material into the atmosphere. This fell largely on surrounding countryside and towns, with some carried further across Ukraine, Belarus and Russia, and beyond.

One of the most significant contaminants was iodine-131, a radionuclide which is taken up by the human thyroid. This process is used in hospitals under carefully controlled conditions to treat thyroid conditions including cancer, usually with excellent results. Its half-life is eight days; 31 years on, we have nothing to worry about, but uncontrolled ingestion soon after the accident would lead to a huge increase in thyroid cancer across Ukraine, Belarus and Russia, particularly in children.

Also affected were the plant workers and “liquidators” brought in to battle the fire and contain the spread of contamination; many received very high radiation doses, and 28 died of radiation sickness within three months. The longer term impact, however, is harder to assess, given the hundreds of thousands of evacuees and liquidators, and the delay of years or decades before radiation-induced cancers can occur. However, the UN Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) has concluded that, with the notable exception of thyroid cancer, “there is no clearly demonstrated increase in the incidence of solid cancers or leukaemia due to radiation in the exposed populations”. The enormous psychological stress of evacuation, however, is not in doubt.
Picture9What about the risk to visitors? Our radiation doses were surprisingly small. Our guide’s personal monitor recorded 10µSv over our two day visit, which might translate, given generally used estimates, to a cancer risk of very roughly 1 in 2 million. I have some scepticism about this measurement – background radiation in the UK is about 7µSv per day, so I apparently received a lower dose in Chernobyl than I would have got sitting on my sofa at home. There’s also the risk of contamination, for which we were checked every few hours. However, the biggest radiation dose from this trip probably came from my flight to Kiev.

Picture10Pripyat and the Nuclear Power Plant

We tramp on through the overgrown outskirts of Pripyat, the Soviet city purpose-built for plant workers and their families. This was once a good place to live; the streets were spacious, with a striking range of amenities: a Cultural Palace, swimming pools, gyms and a supermarket where dusty signs still hang above the aisles. A shop we pass is full of cracked televisions, huge and box-like; the one next door houses dozens of upright pianos.

Picture13We are visiting not just another time, but a country that no longer exists: the Ukrainian Soviet Socialist Republic, gone since 1991. Trees grow so dense that sixteen-story apartment blocks are barely visible until we get close, their empty windows gaping black. Broken glass crunches under our feet. We are surrounded by the effects of abandonment, but without our Geiger counter clicking in excited bursts it would be impossible to guess why these people left so suddenly.

Outside Pripyat stands what’s left of Chernobyl Nuclear Power Plant: an unfinished cooling tower, industrial buildings and, most prominently, the smooth white semicylinder of the new sarcophagus concealing the remains of Reactor 4.

The dose rate here, about 100 yards from the sarcophagus at the only permitted photo spot, is 1µSv/hr – remarkably low considering what’s hidden underneath. For comparison, in hospital nuclear medicine departments, staff might come into (brief) contact with levels at least ten times higher, from patients having radionuclide therapy.

Picture15

Duga-1 Radar Station

Back in the minibus, we drive on in search of the most mysterious place within the Zone: the abandoned Soviet radar station, Duga-1.  Part of an early-warning system for anti-ballistic missiles, this colossal array of caged radar transmitters is vast almost beyond comprehension, stretching hundreds of metres up and as far as the eye can see. Despite this, it’s almost invisible until you are right upon it, carefully hidden from the road by forest.

The station and attached settlement went unmarked on maps, passed off as a children’s holiday camp complete with fake, brightly-muralled bus stop. The school is real, though; toys and gas masks litter the ground beneath posters of great classical composers still hanging on the walls: Tchaikovsky, Beethoven, Rimsky-Korsakov.

Thirty-one years ago Duga-1 would have been closely guarded, with soldiers on watch while in the school their children learned classical music. Now, no one protests as British physicists with cameras walk past.

Picture4Our minibus is waiting beyond the checkpoint, but first we are checked one last time for contamination, stepping in turn between detectors. All clear: the turnstile clicks open and we’re through. With a last look back, we climb into the minibus, shaking the dust of Chernobyl from our feet.

 

The Future

What does the future hold for Chernobyl? As the Zone enters its fourth decade, the need for a long term plan is ever more pressing. Decontamination work continues, but the buildings are now so dilapidated that they present a real hazard, and a decision must be made soon on whether they should be pulled down. That would be a complicated process, potentially releasing large quantities of radioactive dust.

These same buildings also provide an unlikely source of income for the Ukrainian government. Since its opening in 2011, thousands of visitors have entered the Exclusion Zone annually, drawn by professional curiosity, historical interest or the lure of the unusual. Visitors must be part of accredited tours and entry is strictly controlled. Tourists usually visit Kiev too, bringing much needed income to an industry badly hit by the fighting in eastern Ukraine.

The Ukrainian government faces a quandary: entering abandoned buildings is officially forbidden, but it is an open secret that visitors want to do more than peer through broken windows. As buildings crumble, it’s only a matter of time before someone is injured by collapsing walls or falls through floorboards. On the other hand, will tourists still come if all they can see are pine trees?

There are possibilities, however, for Chernobyl’s future. One is to make some of the more impressive structures safe for authorised visits while others are demolished. Over the border, the Belarusian share of the Exclusion Zone is now a huge wildlife reserve, the Polesie State Radioecological Reserve. Research into environmental effects of radiation continues, and there is even talk of inclusion on the UNESCO World Heritage List. Others have mooted using the Zone as a huge solar farm: a fitting future for energy production’s most notorious disaster site.


 

Sources

https://www.iaea.org/sites/default/files/strategy_for_recovery.pdf 

http://www.unscear.org/docs/reports/2000/Volume%20II_Effects/AnnexJ_pages%20451-566.pdf

http://www.who.int/ionizing_radiation/chernobyl/backgrounder/en/

http://www.who.int/ionizing_radiation/chernobyl/20110423_FAQs_Chernobyl.pdf?ua=1

http://www.brogers.dsl.pipex.com/Wpecker5.html

http://www.unis.unvienna.org/unis/en/pressrels/2011/unisinf398.html

 


 

About Katharine Thomson

Katharine Thomson is a member of the BIR Radiation Safety Special Interest Group (SIG) and also represents the BIR at the Society of Radiological Protection’s International Committee, which connects the UK radiation protection community with the worldwide scene. She is Principal Physicist at Derriford Hospital, Plymouth.

 

 

 

Radiotherapy – learning about the HERO project

Head of Radiotherapy PhysicsThe Health Economics in Radiation Oncology (HERO) project was set up by the European Society for Therapeutic Radiation Oncology (ESTRO) in order to gain a better understanding of the availability and need for radiotherapy in Europe. It also provides health information to inform decision makers on the costs and cost effectiveness of radiotherapy services. Dr Keith Langmack, member of the BIR Oncology and Radiotherapy Special Interest Group (SIG), reports on a recent meeting in Brussels where a new costing model was introduced. He makes the case for multidisciplinary teams to work together to use the model in the UK.

“I was invited to represent the BIR at the ESTRO headquarters on 5 December 2017, one of many representatives from all over Europe all very excited to see the newly developed costing model for radiotherapy and then to go to the European Parliament to discuss the gap in radiotherapy provision across Europe.

The day started with an overview of the HERO project from Professor Cai Grau (Professor of Radiation Oncology at the Institute of Clinical Medicine at Aarhus University, Director of the Danish National Centre for Interventional Research in Radiation Oncology and Chair of the HERO project). He told us that the HERO project had 4 phases: to define the need for radiotherapy, evaluate the current access to radiotherapy, to calculate the cost of radiotherapy, and finally to determine the cost-effectiveness of radiotherapy at a European level. He presented some of the results from phases 1 and 2 [1-4]. These included the conclusion that radiotherapy is only given to around 70% of the patients who could benefit as defined by current guidelines and best-practice, and that socio-economic factors play a big role in the provision of radiotherapy across Europe.

RadiotherapyMost of the rest of the day was taken up with an introduction to the newly developed costing tool by Noémie Defourny, the health economist who has had a major input into developing the model. She explained that this model has been designed to take national level data (e.g. staffing, equipment profile, fractionation) and predict the cost of external beam radiotherapy at a national level. Once base-line data is in place then the effect of changing the parameters on cost (e.g. dose-fractionation, provision of equipment) can be predicted. The cost of brachytherapy and chemotherapy are not included in the model. She then demonstrated the model using a fictional country, Europalia. We then had an opportunity to run the model for ourselves.

The final part of the workshop consisted of presentations from Drs. J F Daisne (Belgium) and Zoltán Takácsi-Nagy (Hungary) to illustrate how they had been piloting the model in their respective countries. This involved a large amount of work collecting the data, however progress was being made. This part of the day was concluded by Professor Josep M. Borras (Director of the Regional Government of Catalonia’s Cancer Plan and Scientific Coordinator of the Spanish Ministry of Health’s Strategy on Cancer) summarising the need for producing national level cancer plans and linking this to the need for effective economic modelling.

We then travelled to the European Parliament for a meeting entitled “Radiation oncology cures cancer today – Help us close the gap in access to radiotherapy and make a difference!” hosted by Mrs Lieve Wierinck MEP (member of the MEPs Against Cancer group). This consisted of a number of presentations from the HERO project. There was then a panel debate chaired by Peter O’Donnell (Associate Editor, European Voice) where a number of learned academic and industry speakers from across Europe talked about meeting the need for radiotherapy in the region.

So what next? As a participant in the workshop it means the BIR has access to the costing model. In the UK we have good data to put into the model. However it would require a multi-professional team to populate all the required data fields. The next step would be looking at the best way to tackle this collaboratively. Having talked with the people involved in developing the model, I am sure ESTRO would be supportive of the implementation of the model at the UK level. It is a very interesting enabler for research on the effects of changes in service delivery. It would be timely to use it with a new radiotherapy service specification being introduced in England.”


Dr Keith LAngmack is Head of Radiotherapy Physics at Nottingham University Hospitals NHS Trust.


References

  1. Lievens Y and Grau C. Health Economics in Radiation Oncology: Introducing the ESTRO HERO project. Radiotherapy and Oncology 103 (2012) 109–112.
  2. Grau C, Defourny N, Malicki J, et al. Radiotherapy equipment and departments in the European countries: Final results from the ESTRO-HERO survey. Radiotherapy and Oncology 112 (2014) 155–164.
  3. Dunscombe P, Grau C, Defourny N et al. Guidelines for equipment and staffing of Radiotherapy facilities in the European countries: Final results of the ESTRO-HERO survey. Radiotherapy and Oncology 112 (2014) 165–177.
  4. Lievens Y, Defourny N, Coffey M, et al. Radiotherapy staffing in the European countries: Final results from the ESTRO-HERO survey. Radiotherapy and Oncology 112 (2014) 178–186.

Remembering Baby exhibition highlights role of MRI in foetal and neonatal post-mortem

Dr Elspeth Whitby reflects on the changing shape of her clinical practice, after a research project and the curation of an exhibition which has opened up new ways to engage the public with her work and medical imaging.

RB-PR sheet8This month I am involved in the launch of a new exhibition, Remembering Baby: Life, Loss and Post-Mortem which opens in London (3-14 November 2017) and then in Sheffield (5-14 December 2017). The exhibition is a result of the “‘End of’ or ‘Start of’ Life’” research project which explores how Magnetic Resonance Imaging (or MRI) techniques are starting to be applied to post-mortem practice – including pregnancy loss and neonatal death. This is an important initiative as it is a technique which is less invasive and arguably less distressing for all involved.

This interdisciplinary collaboration has provided an insight into aspects of my work as a radiologist that I would never normally be aware of, and it has highlighted the importance of understanding parents’ needs at a time when they may be anxious, upset, stressed, concerned and affected by a whole range of emotions. I have learnt how ‘little’ things mean so much to families who experience baby loss, and that these can have a huge impact on how they live with their child’s death.

Making visible the often hidden care practices enacted by health professionals who look after babies and their families following a foetal or neonatal death, is a key aim of the Remembering Baby exhibition. Our research team has worked in collaboration with the BIR artist in residence, Hugh Turvey and sound artist Justin Wiggan, to create exhibits related to early-life loss.

remembering-baby-exhibition-workshop-imagesbanners2 (1)Remembering Baby seeks to make these encounters more visible and features a collection of visual images, physical objects and sound installations that sensitively explore what happens when a baby dies, from both parental and professional perspectives. By talking with Hugh about our study, he has been able to interpret and creatively represent some key themes and findings from the research – including MRI’s role in the developing landscape of minimally invasive post-mortem for babies. In the pieces there is also a broader focus on care practices and memorialisation.

As part of the research project we ran a Lasting Impressions workshop. We invited bereaved parents and relatives from the local area to bring along items that were precious to them and related to their baby. The individuals who came were amazing. They talked very openly to us and to each other about their babies and the memory objects they had bought. Guided by Hugh the participants made paper impressions and rubbings of their items and donated their work to us for the exhibition. Those that came to the workshop were at different stages of their bereavement – for some the loss was very recent, for others it was many years ago – and they all had very different experiences. There was not a single person in the room who did not have tears in their eyes at some point during the workshop, but they were not all sad tears.

HughTurvey_WP_20170912_09_55_03_Pro_LIIt made me realise that as professionals we have improved greatly over the years in terms of how we include families in decision-making and with regard to the support we provide, but we can still do more. During the workshop a parent shared how one item held sad memories for her because it was associated with seeing a spot of blood on her child’s Babygro as they were preparing for the memorial service. This is something I will never forget, and something that could have been avoided. I now look at things in detail beyond the medical side, and consider if there is there anything more we can do to ensure that we avoid additional sadness however small it seems.

In my blog The Role of a Radiologist when a Baby Dies I mentioned the difference between what I understood by the question “what happens to my baby?” and what the parent really wanted to know. We now have leaflets in all our patient packs explaining who looks after the baby, who dresses it, cares for it and where. The midwives have the information for parents when they ask and some of the uncertainties have been removed.

Volunteers have been linked with professionals and support groups so that the items they create meet the needs of all these groups.
Where next? We plan to run educational events for health professionals and support groups, and to continue to work in collaboration and extend our work to looking at consent.

Throughout my career I have been taught that experience is the most important learning tool. This work has highlighted that it is not just the medical experience but my journey with each individual patient, what their needs are and what they can teach me for my future interactions with other patients and relatives.

For more information: https://www.rememberingbaby.co.uk/
Details of the exhibition workshops: https://www.rememberingbaby.co.uk/workshops/

This project is funded by the Economic and Social Research Council (ESRC) and is a close collaboration with colleagues in Sociological Studies at the University of Sheffield – Kate Reed (project lead) and Julie Ellis (researcher)

Images courtesy of Hugh Turvey


ew2Dr Elspeth Whitby is a senior lecturer at the University of Sheffield and an honorary consultant at Sheffield teaching Hospitals NHS Foundation trust. Her clinical and research interests are based around MR Imaging of the foetus and neonate. She provides a national service for foetal MRI and is an integral part of the team at Sheffield Children’s hospital, which has set up the world’s first clinical service for minimally invasive autopsy for the foetal and neonatal age group. Her research provides the necessary data to assess the value of new MRI techniques and then to support the transitions from research to service. The multidisciplinary nature of her more recent work is changing her as well as influencing clinical practice.

She was the ex-Vice President for Education at the BIR. Whilst in this role Elspeth helped to improve the educational scope and methods of delivery of educational events for all BIR members.