1
00:00:04,985 --> 00:00:06,155
- Physics world.
2
00:00:07,515 --> 00:00:10,625
- Hello and welcome to the
Physics World Weekly Podcast.
3
00:00:11,205 --> 00:00:12,305
I'm Hamish Johnston.
4
00:00:12,775 --> 00:00:17,065
This episode focuses on
environmental sustainability in
5
00:00:17,065 --> 00:00:21,465
medical physics, and it's
produced in partnership with IPEM,
6
00:00:21,765 --> 00:00:23,305
the Institute of Physics
7
00:00:23,525 --> 00:00:25,465
and Engineering in Medicine,
8
00:00:25,955 --> 00:00:29,785
which owns the journal Physics
in Medicine and Biology.
9
00:00:30,885 --> 00:00:33,305
Here's physics world's Tammy Freeman.
10
00:00:33,525 --> 00:00:37,265
In conversation with the
medical physicists Rob Shooter
11
00:00:37,565 --> 00:00:40,425
and Carrie Tendra, who explain
12
00:00:40,565 --> 00:00:42,585
how their profession is embracing
13
00:00:42,975 --> 00:00:44,825
environmental sustainability.
14
00:00:51,775 --> 00:00:54,145
- Climate change poses a major threat both
15
00:00:54,145 --> 00:00:55,545
to our planet and to our health.
16
00:00:56,295 --> 00:00:59,225
Environmental changes can
alter disease patterns,
17
00:00:59,515 --> 00:01:02,065
while increased air
pollution can cause a rise in
18
00:01:02,065 --> 00:01:04,425
respiratory and cardiovascular diseases.
19
00:01:05,215 --> 00:01:07,665
Extreme weather events
can also impact medical
20
00:01:07,665 --> 00:01:09,945
infrastructure and
services across the globe.
21
00:01:10,115 --> 00:01:11,745
Healthcare provision in itself,
22
00:01:11,745 --> 00:01:14,545
however, also contributes
to carbon emissions,
23
00:01:14,965 --> 00:01:16,865
and there's a pressing need to find
24
00:01:17,005 --> 00:01:19,985
and implement new ways to
reduce the carbon footprint
25
00:01:20,045 --> 00:01:21,145
of delivering healthcare.
26
00:01:22,445 --> 00:01:23,465
So I'm joined today
27
00:01:23,605 --> 00:01:27,065
by Rob Shooter from the Christie
NHS Foundation Trust in the
28
00:01:27,165 --> 00:01:30,825
uk, and Carrie Tander up
from R University in Denmark
29
00:01:31,325 --> 00:01:35,065
to discuss environmental
sustainability in medical physics.
30
00:01:35,875 --> 00:01:36,985
Hello, Rob and Carrie.
31
00:01:37,555 --> 00:01:38,745
- Hello.
- Hi.
32
00:01:39,565 --> 00:01:42,625
So climate change is obviously
a substantial challenge
33
00:01:42,625 --> 00:01:43,945
that impacts everyone,
34
00:01:44,525 --> 00:01:47,625
but in what ways does
medical physics in particular
35
00:01:47,635 --> 00:01:49,425
contribute to carbon emissions?
36
00:01:49,525 --> 00:01:50,905
Can you give a few examples?
37
00:01:51,775 --> 00:01:54,025
- Sort of in the same way
that we all do really.
38
00:01:54,205 --> 00:01:57,305
So it's through our kind of
traveling, our electricity use,
39
00:01:58,165 --> 00:01:59,575
what we buy and what we use.
40
00:02:00,235 --> 00:02:02,255
Um, there's a statistic that says
41
00:02:02,255 --> 00:02:06,495
that one in every 25 road
miles is, is for the NHS.
42
00:02:06,875 --> 00:02:08,695
So whether it's patient
travel or staff travel.
43
00:02:09,355 --> 00:02:11,815
So yeah, travel is quite
a large part of it.
44
00:02:12,155 --> 00:02:14,095
And the conferences and
meetings that we also travel
45
00:02:14,115 --> 00:02:15,895
to another, another large part of it.
46
00:02:16,355 --> 00:02:19,255
- So looking for example, at
radiotherapy, which is one
47
00:02:19,255 --> 00:02:21,015
of the most prevalent cancer treatments,
48
00:02:21,675 --> 00:02:23,655
can you comment on the carbon footprint
49
00:02:23,655 --> 00:02:24,815
of the radiotherapy process?
50
00:02:25,395 --> 00:02:28,735
- One in, uh, so 120,000
patients a year get ready therapy
51
00:02:28,835 --> 00:02:30,895
in the uk that's about 50%
52
00:02:30,895 --> 00:02:32,655
of all cancer patients get
treated with radiotherapy.
53
00:02:33,375 --> 00:02:35,395
So we looked at the kind
of carbon footprint, um,
54
00:02:35,695 --> 00:02:37,675
of the treatment workflow
to see what it was,
55
00:02:37,735 --> 00:02:41,035
and it was about 250 kilograms, um,
56
00:02:41,475 --> 00:02:42,755
CO2 equivalent per patient.
57
00:02:43,295 --> 00:02:47,155
And we looked at imaging for
the patient, the energy use
58
00:02:47,155 --> 00:02:48,715
of the LINAC when it was treating the,
59
00:02:48,795 --> 00:02:50,875
delivering the patient treatment treatment
60
00:02:51,295 --> 00:02:54,515
and when it was just sitting
in idle power mode, um,
61
00:02:54,515 --> 00:02:56,675
which took the, um, gowns
62
00:02:56,675 --> 00:03:00,725
and masks that were being
used during covid Also, um,
63
00:03:00,725 --> 00:03:03,205
there's SF six gas leaks out of the LINAC,
64
00:03:03,745 --> 00:03:06,325
and that's 23,000 times as
effective at global warming
65
00:03:06,325 --> 00:03:07,965
as carbon dioxide is, which is
66
00:03:07,965 --> 00:03:09,765
what kinda water the
gases are normalized to.
67
00:03:10,745 --> 00:03:13,325
And we looked and
eventually it was about 78%
68
00:03:13,325 --> 00:03:15,485
of the total carbon footprint
was from patient travel.
69
00:03:16,395 --> 00:03:19,605
Also looked at staff travel,
which was kind of about 10%.
70
00:03:19,625 --> 00:03:20,645
So that was kind of quite high.
71
00:03:20,645 --> 00:03:21,525
There's a lot of these things,
72
00:03:21,525 --> 00:03:22,645
travel tends to be one of the highest.
73
00:03:23,155 --> 00:03:24,725
Yeah, and there's the,
there's quite a lot of work
74
00:03:24,725 --> 00:03:26,565
that's kind of ongoing to look at that.
75
00:03:27,225 --> 00:03:29,365
Um, one of the things that
is I think coming out soon is
76
00:03:29,485 --> 00:03:30,925
probably like a, a lifecycle analysis,
77
00:03:31,055 --> 00:03:33,205
which does it in much more
detail than, than we did.
78
00:03:34,335 --> 00:03:36,395
Um, and there's, there's
always more bits to do
79
00:03:36,395 --> 00:03:37,795
because I, we didn't look at the,
80
00:03:38,735 --> 00:03:40,435
the manufacture of the
equipment to start with.
81
00:03:40,435 --> 00:03:43,035
We didn't look at the bunk
design, so the ax always sitting
82
00:03:43,035 --> 00:03:44,595
with this, this big concrete bunker.
83
00:03:44,935 --> 00:03:46,395
We didn't look at the
carbon footprint of that.
84
00:03:46,975 --> 00:03:48,475
Um, so there's always more to do.
85
00:03:49,035 --> 00:03:50,755
I always say that as a
research level ,
86
00:03:51,735 --> 00:03:55,155
- And something that the is
actually also creeping in is
87
00:03:55,175 --> 00:03:58,635
the, uh, archival of data so and so,
88
00:03:58,775 --> 00:04:01,995
and that that is going to
depend a lot on our regulations
89
00:04:02,015 --> 00:04:04,235
and what we are forced to archive.
90
00:04:04,295 --> 00:04:08,555
And if we can, uh, succeed to
implement policies for, uh,
91
00:04:08,575 --> 00:04:10,755
for deletion of data in a successful way.
92
00:04:11,335 --> 00:04:14,515
So that can potentially
just increase and increase
93
00:04:14,515 --> 00:04:17,875
because we are increasingly
making more scans
94
00:04:17,935 --> 00:04:22,115
or higher resolution, uh,
that can potentially go out
95
00:04:22,115 --> 00:04:24,995
of control if our regulations
are, are requiring us
96
00:04:25,015 --> 00:04:27,195
to archive for 30 years or more.
97
00:04:27,775 --> 00:04:30,875
- So are there any sort of easy
ways that you could think of
98
00:04:30,875 --> 00:04:33,435
to reduce the carbon
footprint of radiotherapy?
99
00:04:34,025 --> 00:04:36,035
- There's never such thing
as easy as there .
100
00:04:36,335 --> 00:04:37,515
One of the things that's happening more
101
00:04:37,515 --> 00:04:39,395
and more in radiotherapy is, um, the use
102
00:04:39,395 --> 00:04:40,595
of hyper fractionated radiotherapy.
103
00:04:41,015 --> 00:04:43,115
So rather than traveling first say 20
104
00:04:43,175 --> 00:04:46,355
or 30 treatments, so all
radiotherapy is fractionated,
105
00:04:46,455 --> 00:04:48,155
so we tend to kind of travel for about 20
106
00:04:48,155 --> 00:04:50,705
or 30 fractions nowadays.
107
00:04:50,705 --> 00:04:52,825
There's, um, evidence
out there to show that
108
00:04:52,845 --> 00:04:55,745
that's equivalent to having higher doses,
109
00:04:55,745 --> 00:04:57,745
but in five fractions or
something, something similar.
110
00:04:58,605 --> 00:05:01,945
So by reducing that
patient travel by up 75%,
111
00:05:02,405 --> 00:05:04,505
we should be able to significantly
reduce the calm footprint
112
00:05:04,645 --> 00:05:06,905
of radiotherapy because travel
is such a large part of it,
113
00:05:07,095 --> 00:05:09,785
potentially if you can treat
patients close to home.
114
00:05:10,405 --> 00:05:12,985
So we tend to have at the moment
in the UK quite centralized
115
00:05:13,015 --> 00:05:15,905
centers, so big centers where
you kind of get radio therapy.
116
00:05:16,685 --> 00:05:17,985
If there can be smaller versions
117
00:05:17,985 --> 00:05:19,665
of those near a patient's houses, then
118
00:05:19,815 --> 00:05:21,185
that could reduce the carbon footprint.
119
00:05:21,825 --> 00:05:23,385
Building a big radiotherapy center
120
00:05:23,405 --> 00:05:25,545
or even a small one has quite
a large carbon footprint
121
00:05:25,815 --> 00:05:27,025
that is not less uk.
122
00:05:27,265 --> 00:05:30,065
The, the quickest, easiest
of wins a bit of work.
123
00:05:30,065 --> 00:05:32,425
We did recently showed that
within about 10 years though,
124
00:05:32,425 --> 00:05:34,665
that is kind of offset by the kinda travel
125
00:05:34,665 --> 00:05:35,865
that saved from patients,
126
00:05:36,285 --> 00:05:37,945
but that would re really vary depending on
127
00:05:37,945 --> 00:05:39,225
what your kind of catch on area was.
128
00:05:39,985 --> 00:05:42,905
Patients could potentially
stay in hotels near the
129
00:05:43,105 --> 00:05:45,825
hospitals, but they're
not quite sure whether
130
00:05:46,185 --> 00:05:47,225
patients would particularly like that.
131
00:05:47,725 --> 00:05:49,465
So as I think we'll talk
a about later about kind
132
00:05:49,465 --> 00:05:51,065
of proton therapy and that's potentially
133
00:05:51,065 --> 00:05:53,305
what happens in proton,
the therapy centers
134
00:05:53,875 --> 00:05:55,465
using public transport.
135
00:05:55,645 --> 00:05:57,460
So a bit of the work, we
looked at the carbon footprint
136
00:05:57,460 --> 00:06:00,085
and radiotherapy, we worked
at the center that's, um,
137
00:06:00,085 --> 00:06:02,045
guys in Thomas, which is near next
138
00:06:02,045 --> 00:06:03,205
to London Bridge train station.
139
00:06:04,065 --> 00:06:06,005
And their carbon footprint
was quite a lot lower
140
00:06:06,355 --> 00:06:09,205
because if 6% of your
patients travel by train,
141
00:06:09,265 --> 00:06:10,925
you lower the carbon
footprint quite significantly.
142
00:06:12,105 --> 00:06:14,165
But we talked to some
patients to the Christie
143
00:06:14,175 --> 00:06:16,685
where it's gonna be, it's kind
of outside of the center of
144
00:06:16,685 --> 00:06:20,085
of Manchester and getting
there by bus is pretty tricky.
145
00:06:20,105 --> 00:06:21,245
You have a change in the center of the
146
00:06:21,245 --> 00:06:23,165
town, no one likes doing that.
147
00:06:23,345 --> 00:06:25,935
All the patients are worried
about turning up late
148
00:06:25,935 --> 00:06:27,335
for their, their treatments.
149
00:06:28,035 --> 00:06:29,375
So they're kind of anxious about that.
150
00:06:30,365 --> 00:06:32,415
Also, as you kind of go
through treatment, um,
151
00:06:32,685 --> 00:06:34,055
side effects tend to get worse.
152
00:06:34,835 --> 00:06:35,975
So you are like two
153
00:06:35,975 --> 00:06:38,095
or three weeks in, you're
feeling kind of pretty,
154
00:06:38,275 --> 00:06:40,695
pretty bad, pretty ob quite a lot.
155
00:06:40,695 --> 00:06:42,815
The patients we spoke to
were prostate patient cancer
156
00:06:43,095 --> 00:06:44,295
patients, so they needed
to be near a toilet
157
00:06:44,295 --> 00:06:46,695
because you kinda get
bowel and bladder problems.
158
00:06:46,915 --> 00:06:48,815
If you're on a train
that's, it's, it's durable,
159
00:06:48,815 --> 00:06:51,495
but on a bus you've got
nowhere to go quite literally.
160
00:06:51,595 --> 00:06:53,415
So that's not great. Yeah.
161
00:06:53,415 --> 00:06:55,215
So there's, there are things we can do,
162
00:06:55,235 --> 00:06:56,575
but none of 'em particularly easy.
163
00:06:57,115 --> 00:06:58,535
Making public transport better
164
00:06:58,535 --> 00:06:59,575
would be a good start. Of course,
165
00:06:59,975 --> 00:07:02,455
- , - That just goes
by everything and everyone.
166
00:07:03,035 --> 00:07:04,895
- And maybe also on the equipment, um,
167
00:07:04,955 --> 00:07:06,055
on the equipment side.
168
00:07:06,115 --> 00:07:09,295
So construction and maintenance
of our linear accelerators
169
00:07:09,395 --> 00:07:12,935
and our scanners is potentially
also a large contributor.
170
00:07:13,235 --> 00:07:17,815
So our ability, uh, also to
update our equipment and uh,
171
00:07:18,195 --> 00:07:21,455
and the, uh, the vendors
also to have an agenda
172
00:07:21,925 --> 00:07:24,815
that updates, uh, keep
being possible is going
173
00:07:24,815 --> 00:07:25,975
to be important here.
174
00:07:26,575 --> 00:07:28,615
- I mean, I think that
the hyper fractionation
175
00:07:28,615 --> 00:07:30,775
that you mentioned, that's
really quite interesting
176
00:07:30,775 --> 00:07:33,855
because that, you know, in a
way that would reduce travel
177
00:07:34,115 --> 00:07:37,015
and you know, the
patient's time instantly.
178
00:07:37,285 --> 00:07:40,735
Yeah. And I know during the
pandemic, some places sort
179
00:07:40,735 --> 00:07:42,735
of brought that in just as a necessity
180
00:07:42,735 --> 00:07:43,735
to have less hospital,
181
00:07:43,735 --> 00:07:45,255
less patients in the hospitals at
182
00:07:45,255 --> 00:07:46,455
different times. And yeah,
183
00:07:46,455 --> 00:07:48,015
- Then it was, then it was reduce footfall
184
00:07:48,275 --> 00:07:50,095
and I think, I think quite a lot of,
185
00:07:50,095 --> 00:07:51,815
because it takes NHS quite a long time
186
00:07:51,815 --> 00:07:52,975
to implement stuff normally.
187
00:07:53,435 --> 00:07:55,895
Um, but a few things kind
of got put in quicker
188
00:07:55,895 --> 00:07:57,055
because they were reducing footfall
189
00:07:57,115 --> 00:07:58,055
and they were kind reducing
190
00:07:58,265 --> 00:07:59,575
staff contacts and stuff like that.
191
00:07:59,755 --> 00:08:00,815
And a lot of it stayed in
192
00:08:00,815 --> 00:08:02,575
because it, it just
helps, it helps everyone.
193
00:08:02,575 --> 00:08:05,215
It kind of equal in kind
of clinical outcome.
194
00:08:05,365 --> 00:08:09,135
There's less patient travel,
so they prefer it, it helps
195
00:08:09,135 --> 00:08:11,095
with kind of NHS resources as well.
196
00:08:11,395 --> 00:08:12,855
So it seems one of those kind of like very
197
00:08:12,855 --> 00:08:13,935
rare win win-wins.
198
00:08:14,195 --> 00:08:16,215
So, but it remains to be seen. Yeah.
199
00:08:16,555 --> 00:08:18,415
- You mentioned particle therapy as well.
200
00:08:18,475 --> 00:08:21,415
So we're increasingly
seeing, um, implementation
201
00:08:21,415 --> 00:08:23,495
of particle therapy for treating cancer.
202
00:08:24,355 --> 00:08:28,135
Now this requires large costly
machines with vast levels
203
00:08:28,235 --> 00:08:29,535
of surrounding infrastructure.
204
00:08:30,115 --> 00:08:33,055
So clearly ways to minimize
the carbon footprint
205
00:08:33,115 --> 00:08:36,055
of installing and running
particle therapy systems.
206
00:08:36,975 --> 00:08:39,135
- I think we're still,
we still need to map out,
207
00:08:39,375 --> 00:08:42,215
actually we don't, uh, we don't
have really good evidence at
208
00:08:42,215 --> 00:08:45,015
the moment for the biggest
contributors to the, uh,
209
00:08:45,335 --> 00:08:47,655
particle therapy as, as compared to, uh,
210
00:08:47,655 --> 00:08:49,495
classical x-ray, uh, therapy.
211
00:08:49,915 --> 00:08:52,735
Uh, likely the large
electricity consumption, uh,
212
00:08:52,765 --> 00:08:54,215
will play a role there
213
00:08:54,215 --> 00:08:56,685
because we do know that electricity bills
214
00:08:56,745 --> 00:08:58,085
for these centers are huge
215
00:08:58,625 --> 00:09:01,405
and for that, for us to do
anything on that side is,
216
00:09:01,425 --> 00:09:02,685
is going to become difficult
217
00:09:02,685 --> 00:09:06,325
because that depends of course
on a lot on availability of,
218
00:09:06,385 --> 00:09:10,245
uh, renewable, uh, energy,
something for our policy makers
219
00:09:10,305 --> 00:09:11,405
to make that possible.
220
00:09:11,705 --> 00:09:15,885
So, uh, some centers have been
exploring, uh, opportunities
221
00:09:16,065 --> 00:09:17,965
to install, uh, solar panels.
222
00:09:17,985 --> 00:09:20,325
Uh, I think every step
in that direction is,
223
00:09:20,385 --> 00:09:21,845
um, is just positive.
224
00:09:22,605 --> 00:09:24,485
- Particle centers tend
to treat more pediatric
225
00:09:24,485 --> 00:09:26,365
and kind of, um, cancer patients
226
00:09:26,865 --> 00:09:30,605
and they tend to get,
um, more anesthetic gases
227
00:09:30,605 --> 00:09:32,565
or something like that to try
and kinda knock them out while
228
00:09:32,565 --> 00:09:33,965
they have their treatment
because those, they regular
229
00:09:34,025 --> 00:09:36,685
and alo and acetic gases on the whole tend
230
00:09:36,685 --> 00:09:38,765
to have a really quite
high carbon footprint.
231
00:09:39,385 --> 00:09:42,005
So, and there's a kind of general
move, certainly in the NHS
232
00:09:42,005 --> 00:09:43,965
to try and move away from
things like des fluorine,
233
00:09:43,965 --> 00:09:45,165
which are really high, I think
234
00:09:45,165 --> 00:09:46,605
3000 times as effective as CO2.
235
00:09:47,465 --> 00:09:50,325
Um, so there there'll be
an impact there from that,
236
00:09:51,095 --> 00:09:55,585
like travel for com for, um,
so, uh, for proton centers is
237
00:09:56,425 --> 00:09:59,465
a bit different to, uh, to
the standard radiotherapy
238
00:10:00,255 --> 00:10:03,105
because there's only like two in the whole
239
00:10:03,105 --> 00:10:04,825
of the UK high energy ones.
240
00:10:05,485 --> 00:10:07,145
So patients have to travel from quite
241
00:10:07,165 --> 00:10:08,385
far away to go to those centers.
242
00:10:09,055 --> 00:10:10,385
They don't tend to travel backwards
243
00:10:10,385 --> 00:10:11,905
and forward each day because it's too far.
244
00:10:12,525 --> 00:10:13,945
So they tend to stay in hotels,
245
00:10:14,485 --> 00:10:16,025
but then looking at the
kinda the carbon footprint
246
00:10:16,025 --> 00:10:18,545
of a hotel stay versus
at home is different.
247
00:10:19,005 --> 00:10:21,345
So that, that is all a
bit different as well.
248
00:10:21,845 --> 00:10:25,025
Um, and I think they tend to
get like shuttle buses in, so
249
00:10:25,025 --> 00:10:28,185
that's kind of shared transport,
something that's better.
250
00:10:28,245 --> 00:10:30,185
So yeah, it, it all
remains to be seen really.
251
00:10:30,685 --> 00:10:32,465
Um, there is work being started on that,
252
00:10:32,525 --> 00:10:33,865
but we should have started a lot
253
00:10:33,865 --> 00:10:35,065
of this work like 10 years ago,
254
00:10:35,525 --> 00:10:37,265
but no one really cared
about it then .
255
00:10:37,265 --> 00:10:38,505
So it's still happening now instead.
256
00:10:39,645 --> 00:10:40,785
Is there the same level of
257
00:10:41,025 --> 00:10:42,705
- Fractionation with, uh, perton therapy?
258
00:10:43,385 --> 00:10:44,665
I think it's still pretty similar
259
00:10:44,665 --> 00:10:48,665
because, uh, with exploring
the, uh, the clinical benefit
260
00:10:48,845 --> 00:10:52,185
of, uh, of particle therapy,
there are many reasons to stay
261
00:10:52,185 --> 00:10:56,155
as close as possible to the,
the practice that we have today
262
00:10:56,255 --> 00:10:59,115
for, uh, x-ray, um, therapy.
263
00:10:59,535 --> 00:11:01,955
So, but, but I think it has also, given
264
00:11:01,955 --> 00:11:05,715
that it has weigh a lower
dose to normal tissue,
265
00:11:05,715 --> 00:11:07,435
there are many good arguments
266
00:11:07,435 --> 00:11:09,595
that this modality should work really well
267
00:11:09,595 --> 00:11:10,955
with hypo fractionation.
268
00:11:11,855 --> 00:11:16,075
And, uh, so hopefully,
hopefully the environmental
269
00:11:16,755 --> 00:11:19,515
argument is also going
to, to push the, the field
270
00:11:19,535 --> 00:11:21,475
to explore, uh, hyper fractionation
271
00:11:22,355 --> 00:11:23,355
- I suppose.
272
00:11:23,355 --> 00:11:24,515
I suppose the other thing about,
because if you've got lower
273
00:11:24,545 --> 00:11:28,485
dose to organs at risk,
which kind of proton, um,
274
00:11:28,485 --> 00:11:31,165
therapy does have, that means
you're more likely to have
275
00:11:31,875 --> 00:11:33,205
kind of lower side effects
276
00:11:33,225 --> 00:11:35,045
or less side effects or
even low side effects.
277
00:11:35,585 --> 00:11:37,525
And if they're treated with some sort
278
00:11:37,525 --> 00:11:40,325
of high carbon footprint
medicine, you could argue that
279
00:11:41,005 --> 00:11:44,115
a low proton therapies like
in a more comfort being
280
00:11:44,115 --> 00:11:46,835
intensive to deliver, maybe
it's offset by the fact
281
00:11:46,835 --> 00:11:48,555
that you kind of, then there's
less side effects afterwards.
282
00:11:49,215 --> 00:11:51,235
Um, so there's, there's,
there's the kind of a gets,
283
00:11:51,375 --> 00:11:53,340
if you look at the, in the
kinda broader picture sort
284
00:11:53,340 --> 00:11:54,805
of sense, it gets really even
285
00:11:54,805 --> 00:11:55,965
more complicated than we already thought
286
00:11:56,325 --> 00:11:57,325
- .
287
00:11:57,845 --> 00:11:59,685
- Absolutely. And then another key area
288
00:11:59,905 --> 00:12:03,725
of medical physics is the
diagnostic imaging, which is used
289
00:12:03,825 --> 00:12:06,645
to, um, diagnose or stage a disease.
290
00:12:07,265 --> 00:12:10,365
So for example, how, how
sustainable procedures such
291
00:12:10,365 --> 00:12:12,525
as positron emission tomography
292
00:12:12,625 --> 00:12:15,925
or pet, which involve
the use of radioisotopes.
293
00:12:16,105 --> 00:12:17,125
- So we did get a,
294
00:12:17,225 --> 00:12:19,645
an IE innovation award
to start doing that.
295
00:12:20,265 --> 00:12:22,725
Um, we're still kinda quite
in early days of it, but
296
00:12:22,725 --> 00:12:25,445
because it also depends
on where your center is
297
00:12:25,445 --> 00:12:27,485
and how close you can get
the kinda the manufacturer
298
00:12:27,485 --> 00:12:29,325
of the tracer to, to deliver it to you,
299
00:12:29,325 --> 00:12:30,805
whether it's kind on onsite in some,
300
00:12:30,825 --> 00:12:33,085
say some centers have
the, the manufacturer,
301
00:12:33,085 --> 00:12:35,605
the tracer on site says
there's always travel again,
302
00:12:35,995 --> 00:12:37,405
there's also the kind of the,
303
00:12:37,635 --> 00:12:39,605
there's always patient
travel involved in everything
304
00:12:40,335 --> 00:12:41,765
diagnostic CT wise
305
00:12:41,825 --> 00:12:44,565
and obviously, so PET always
comes with a CT scanner.
306
00:12:44,895 --> 00:12:45,925
There was a German
307
00:12:45,925 --> 00:12:47,805
and Swiss group that looked
at the comm footprint of,
308
00:12:48,025 --> 00:12:50,245
of the energy of a, of a CT scan.
309
00:12:50,825 --> 00:12:53,925
And that was about, um, 0.3
kilograms of CO2 equivalent
310
00:12:54,185 --> 00:12:55,485
to try and give an idea for that.
311
00:12:55,485 --> 00:12:57,485
For an MR scan, that's about four
312
00:12:57,485 --> 00:12:58,685
and a half kilograms of CO2.
313
00:12:59,435 --> 00:13:02,935
So an MR scan is a lot
more than a CT scan.
314
00:13:03,715 --> 00:13:05,575
And for things like the
MR Enact that I work on,
315
00:13:06,165 --> 00:13:09,015
that is quite significantly
different, especially
316
00:13:09,015 --> 00:13:11,775
as we make three scans per, per fraction.
317
00:13:12,475 --> 00:13:14,615
Um, so that can multiply up
quite diff quite quickly.
318
00:13:15,075 --> 00:13:17,455
But to kind of give you an idea of
319
00:13:17,455 --> 00:13:20,575
that 4.6 kilograms is relatively
320
00:13:20,575 --> 00:13:21,815
low compared to quite a
lot of the other things.
321
00:13:22,035 --> 00:13:26,815
So they say that in order to
stay below 1.5 degrees, um,
322
00:13:26,815 --> 00:13:30,935
as a, as a planet, we all
get 1.6 tons per year to use.
323
00:13:31,475 --> 00:13:33,415
So compared to that, it's
kind of relatively small,
324
00:13:33,435 --> 00:13:35,455
but you wouldn't need
many of them to get there.
325
00:13:36,035 --> 00:13:39,735
And physicists working in
diagnostic radiotherapy, uh,
326
00:13:39,735 --> 00:13:41,935
diagnostic imaging tend
to travel quite a lot
327
00:13:42,055 --> 00:13:43,855
'cause they work in big sort of networks.
328
00:13:44,165 --> 00:13:48,215
That value I just told you
is for a CT scan alone,
329
00:13:48,795 --> 00:13:50,695
not part of the kinda the kind of the, um,
330
00:13:51,035 --> 00:13:52,295
the service this it's part of.
331
00:13:52,795 --> 00:13:55,495
So that's gonna be definitely
the lower end of it.
332
00:13:55,995 --> 00:13:57,295
- And I think also for the imaging,
333
00:13:57,295 --> 00:14:01,215
it's also about choosing, uh,
wisely, uh, how much you want
334
00:14:01,215 --> 00:14:04,135
to image and, uh, with,
uh, how many sequences
335
00:14:04,135 --> 00:14:07,215
because there is actually
also a lot to achieve just
336
00:14:07,275 --> 00:14:08,775
by thinking if it is necessary.
337
00:14:09,435 --> 00:14:12,135
And that goes of course also on the, um,
338
00:14:12,915 --> 00:14:16,215
on the arch archival of data
that we discussed, uh, earlier,
339
00:14:16,405 --> 00:14:18,255
that the more you, the more you do,
340
00:14:18,355 --> 00:14:20,615
the more the more you need to archive.
341
00:14:20,715 --> 00:14:24,015
So, uh, yeah, we should really
think, well when we choose,
342
00:14:24,115 --> 00:14:25,615
we do a lot of imaging today.
343
00:14:26,165 --> 00:14:29,475
- Yeah, we do. Yeah.
- In the UK the
344
00:14:30,075 --> 00:14:33,555
National Health Service
aims to be net zero by 2040.
345
00:14:34,135 --> 00:14:35,875
Rob, do you know what steps are in place
346
00:14:35,935 --> 00:14:38,035
or what, how they're
planning to achieve this?
347
00:14:38,665 --> 00:14:42,035
- Yeah, so like each, each
center, each kind of trust has
348
00:14:42,035 --> 00:14:45,515
to have a green plan that has
to be seen by the board of
349
00:14:46,035 --> 00:14:47,915
trustees or the kind of the
board that runs the center.
350
00:14:48,915 --> 00:14:51,885
So that means it's kind of
supposed to have board approval.
351
00:14:52,505 --> 00:14:54,365
And that is partly put in place
352
00:14:54,365 --> 00:14:57,405
because a couple of years ago
the NHS became the first place
353
00:14:57,785 --> 00:15:00,165
to have it as kind of legislation
354
00:15:00,515 --> 00:15:01,885
that each center has to do this.
355
00:15:02,225 --> 00:15:04,205
So it's kind of by law
that each center has
356
00:15:04,205 --> 00:15:07,365
to think about sustainability
in its ins day-to-day running.
357
00:15:08,195 --> 00:15:09,365
That can be pretty tricky
358
00:15:09,445 --> 00:15:12,955
because of course it's got huge
amount of things to balance.
359
00:15:13,535 --> 00:15:15,395
The NHS is kinda struggling money-wise.
360
00:15:15,615 --> 00:15:17,675
So it's not actually kind
of up there with most of
361
00:15:17,675 --> 00:15:19,115
what people think about every day.
362
00:15:19,895 --> 00:15:20,995
But it is now kind
363
00:15:20,995 --> 00:15:23,755
of legally enforced in a way
that we have to be doing this.
364
00:15:24,335 --> 00:15:25,555
It used to be net zero by 2040,
365
00:15:26,295 --> 00:15:31,075
but it's aiming to be
80% of that between 2028
366
00:15:31,095 --> 00:15:32,195
and 2032.
367
00:15:32,895 --> 00:15:34,435
So it's not far away from that.
368
00:15:34,585 --> 00:15:36,755
Like the early end of it,
it was only four years away.
369
00:15:37,475 --> 00:15:39,955
I don't know quite how
far we've got in the last,
370
00:15:40,235 --> 00:15:42,195
I think it was like 2020
there was, it was announced
371
00:15:42,195 --> 00:15:43,675
that it was gonna happen, but yeah,
372
00:15:43,675 --> 00:15:44,795
we've got a long way to go.
373
00:15:45,295 --> 00:15:46,595
Um, and although there, there have kind
374
00:15:46,595 --> 00:15:50,035
of the green HS NHS have
laid out what the plans are.
375
00:15:50,095 --> 00:15:53,395
So one of it is kind of trying
to reduce patient travel,
376
00:15:54,175 --> 00:15:58,835
so it's staff travel, um,
as aspir inhalers that,
377
00:15:58,865 --> 00:16:00,395
that I use, they've got
378
00:16:00,395 --> 00:16:01,435
quite a large carbon improvement as well.
379
00:16:01,435 --> 00:16:02,875
So it's kinda moving those from the gas
380
00:16:02,905 --> 00:16:04,555
ones, the powder ones.
381
00:16:04,945 --> 00:16:07,235
There's just the kind of
decarbonization of the grid
382
00:16:07,235 --> 00:16:08,675
that's generally happening as well.
383
00:16:08,805 --> 00:16:11,915
It'll benefit from, but
I think there's about 25%
384
00:16:11,915 --> 00:16:14,875
of it is still just down as
innovation, um, which is,
385
00:16:14,875 --> 00:16:16,115
which is pretty terrifying.
386
00:16:16,115 --> 00:16:17,755
So there's the kind of,
there's, it's a lot of
387
00:16:18,755 --> 00:16:20,955
pressure on people like
me and people in HS to try
388
00:16:20,955 --> 00:16:23,235
and work out what the next 25% is.
389
00:16:24,095 --> 00:16:26,595
Um, but yeah, and then also they're kind
390
00:16:26,595 --> 00:16:29,395
of working quite heavily
with manufacturers to try
391
00:16:29,395 --> 00:16:32,275
and make sure that procurement,
so procurement is about 6%
392
00:16:32,275 --> 00:16:34,155
of the carbon footprint of the NHS.
393
00:16:35,415 --> 00:16:38,515
If we can reduce the carbon
footprint of what manufacturers
394
00:16:38,535 --> 00:16:40,195
and drugs companies are doing, then
395
00:16:40,945 --> 00:16:42,995
that will reduce the carbon
footprint of the NHS as well.
396
00:16:43,155 --> 00:16:44,435
A a lot of work to do.
397
00:16:44,505 --> 00:16:45,995
They, they aim to be ambitious so
398
00:16:45,995 --> 00:16:47,195
that it can of force change.
399
00:16:47,655 --> 00:16:49,195
If you just do it in a
kind of a manageable way,
400
00:16:49,195 --> 00:16:50,355
then people just don't wanna ignore it.
401
00:16:50,495 --> 00:16:53,155
So yeah. And they aiming
to be like the first
402
00:16:54,155 --> 00:16:55,595
national health service to be net zero,
403
00:16:55,595 --> 00:16:57,675
which is, well, I think
that's still the case. Okay.
404
00:16:57,835 --> 00:16:59,515
- I mean,
- Do, that's carried about
405
00:16:59,515 --> 00:17:00,795
to tell me that that's
the, not the case of dur.
406
00:17:01,235 --> 00:17:03,235
- I was just gonna say this
- Ahead, .
407
00:17:04,015 --> 00:17:06,315
- Carrie, do you know if
there's similar proposals
408
00:17:06,315 --> 00:17:07,435
in place in Denmark?
409
00:17:07,665 --> 00:17:09,835
- Well, we, we have a
national law so that we,
410
00:17:09,935 --> 00:17:13,635
we need a national reduction
of, uh, 70% by 2030.
411
00:17:13,975 --> 00:17:17,835
And a similar, uh, aim has been
put on the healthcare system
412
00:17:17,945 --> 00:17:22,635
with a 67% reduction of
carbon footprint from 18, uh,
413
00:17:22,815 --> 00:17:24,035
to, uh, 2030.
414
00:17:24,495 --> 00:17:26,475
And I think the, the good, uh,
415
00:17:26,475 --> 00:17:29,275
thing about the Danish plan is
that this actually includes,
416
00:17:29,335 --> 00:17:30,835
uh, all goods and services.
417
00:17:30,895 --> 00:17:33,435
So there are many different
ways to, I mean, you can,
418
00:17:33,435 --> 00:17:35,435
you can put all kinds of
percentages and years,
419
00:17:35,495 --> 00:17:37,555
but you need also to define which
420
00:17:38,315 --> 00:17:39,515
entities you include in that.
421
00:17:39,975 --> 00:17:41,915
So that actually includes, uh, goods
422
00:17:41,915 --> 00:17:44,955
and services, which is the
major part of the footprint
423
00:17:44,975 --> 00:17:47,475
of the healthcare, um,
of the healthcare system.
424
00:17:48,175 --> 00:17:52,545
So aims are, aims are in place,
yeah, almost 70% reduction,
425
00:17:52,765 --> 00:17:54,345
uh, at 2030.
426
00:17:55,015 --> 00:17:58,905
What concerns me is that
this has not yet been, uh,
427
00:17:58,905 --> 00:18:01,345
there are not yet any requirements on the
428
00:18:01,345 --> 00:18:02,785
individual departments.
429
00:18:02,925 --> 00:18:07,185
So there is a lot of, uh,
top down, uh, thoughts of
430
00:18:07,395 --> 00:18:09,385
where we need to reduce
431
00:18:09,485 --> 00:18:10,945
and also initiatives
432
00:18:10,945 --> 00:18:14,345
that concerns the entire
hospital infrastructure,
433
00:18:14,885 --> 00:18:17,145
but for the individual departments to to,
434
00:18:17,165 --> 00:18:18,585
to look at their workflows
435
00:18:18,585 --> 00:18:20,145
and to look at their procurements.
436
00:18:20,165 --> 00:18:22,825
And, um, that is not at all in place yet.
437
00:18:22,925 --> 00:18:26,985
So, so that is a threat for me
to, uh, to get to these, uh,
438
00:18:27,035 --> 00:18:28,705
goals by, uh, 2030.
439
00:18:28,885 --> 00:18:31,425
And then we have a net zero goal by 2050.
440
00:18:31,685 --> 00:18:34,385
So, so that is how it looks,
uh, for us. And then what,
441
00:18:35,005 --> 00:18:37,625
- So it might just about be
- . Yes.
442
00:18:38,165 --> 00:18:38,905
- I'm not, not quite sure
443
00:18:38,905 --> 00:18:40,145
who's accurately measuring it for us.
444
00:18:40,175 --> 00:18:41,905
Very, but still, yeah.
445
00:18:42,325 --> 00:18:43,785
- So I mean, another thing
446
00:18:43,785 --> 00:18:47,505
to think about is the
environmental impact of going
447
00:18:47,505 --> 00:18:49,025
to international conferences.
448
00:18:49,645 --> 00:18:51,265
So what are your thoughts on this?
449
00:18:51,365 --> 00:18:53,705
Should we switch to an all online approach
450
00:18:54,045 --> 00:18:56,985
or are there other ways to
reduce the carbon footprint
451
00:18:57,085 --> 00:18:59,305
of attending these very
important conferences?
452
00:19:00,215 --> 00:19:01,425
- It's controversial ,
453
00:19:01,925 --> 00:19:04,185
- Why It is really, this
is very, very difficult.
454
00:19:04,405 --> 00:19:06,225
Um, it's really difficult
455
00:19:06,225 --> 00:19:09,985
because this is also our
way to, uh, to develop our,
456
00:19:10,205 --> 00:19:12,025
our healthcare, high quality healthcare.
457
00:19:12,685 --> 00:19:16,865
So I think to, to answer
that question, uh, uh,
458
00:19:16,885 --> 00:19:20,345
in a good way, you, you need
to understand where does this,
459
00:19:20,525 --> 00:19:23,265
uh, carbon footprint, uh, come from.
460
00:19:23,485 --> 00:19:27,185
So, so what belongs to the
European, uh, traveling,
461
00:19:27,185 --> 00:19:29,625
what belongs to the
intercontinental traveling
462
00:19:29,685 --> 00:19:33,545
and, uh, what are actually
our options to do something
463
00:19:33,545 --> 00:19:36,825
that allows us to keep
value as well as possible,
464
00:19:37,245 --> 00:19:41,105
but also to, um, uh, to
understand how we can, um,
465
00:19:41,485 --> 00:19:42,985
reduce our carbon footprint.
466
00:19:43,825 --> 00:19:47,885
So, so to, to reduce European,
uh, traveling, the location
467
00:19:47,905 --> 00:19:50,645
of venue is very important
for facilitating, uh,
468
00:19:50,645 --> 00:19:52,685
train transport because
that is actually a way
469
00:19:52,705 --> 00:19:56,725
to have a low carbon footprint
while allowing for our, uh,
470
00:19:57,265 --> 00:20:00,765
for our collaboration
and for our networking.
471
00:20:01,425 --> 00:20:03,925
And also I think it's really
important to understand
472
00:20:03,925 --> 00:20:05,165
that 70%
473
00:20:05,165 --> 00:20:07,765
of the carbon footprint is
actually coming from the
474
00:20:07,765 --> 00:20:09,165
intercontinental traveling.
475
00:20:09,705 --> 00:20:13,125
So even if it is a
minority of our attendee
476
00:20:13,125 --> 00:20:15,565
that are coming from out of Europe,
477
00:20:15,955 --> 00:20:19,005
they are actually carrying
the largest carbon footprint.
478
00:20:19,065 --> 00:20:21,725
So maybe this is where we
should start focusing on.
479
00:20:22,185 --> 00:20:25,485
And then solutions are
stuff like digital access,
480
00:20:25,485 --> 00:20:27,125
which is indeed very important
481
00:20:27,125 --> 00:20:31,045
because if we can then
limit, uh, that contribution,
482
00:20:31,045 --> 00:20:34,765
but also solution like,
uh, conference hubs to go
483
00:20:34,865 --> 00:20:36,765
to the different regions, uh,
484
00:20:36,835 --> 00:20:39,365
with scientific dissemination can possibly
485
00:20:39,935 --> 00:20:41,765
limit the interest in traveling.
486
00:20:42,565 --> 00:20:44,645
- I think, again, we can
probably put like a number on it.
487
00:20:44,725 --> 00:20:46,485
I think there's a general kind of average
488
00:20:47,435 --> 00:20:51,045
that per participant, it's
about a ton of calm, calm,
489
00:20:51,045 --> 00:20:53,765
dark side equivalent that
you do per conference.
490
00:20:54,675 --> 00:20:57,815
So if you kind of remember
back to the 1.6 tons equivalent
491
00:20:57,815 --> 00:21:01,615
that we have each per year,
you've used up most of your,
492
00:21:01,885 --> 00:21:03,735
your kind of calm for a year
493
00:21:04,275 --> 00:21:05,615
on just going to one conference.
494
00:21:06,515 --> 00:21:09,095
So it just shows how big impact they are
495
00:21:09,675 --> 00:21:11,735
and how important it's to try
496
00:21:11,735 --> 00:21:13,095
and reduce that carbon footprint.
497
00:21:13,845 --> 00:21:16,855
- Yeah, I know for the, the
forthcoming ESTRO meeting,
498
00:21:16,905 --> 00:21:20,415
which is, um, in Glasgow,
so ESTRO is really trying
499
00:21:20,415 --> 00:21:22,975
to encourage people if they
can, to travel by train,
500
00:21:24,035 --> 00:21:25,775
you know, I mean, there's,
there's not huge amount.
501
00:21:25,775 --> 00:21:27,095
It depends where you're
coming from, but you know,
502
00:21:27,095 --> 00:21:28,935
they're sort of trying to encourage that.
503
00:21:29,235 --> 00:21:30,935
- And it, it is tricky 'cause um, me
504
00:21:30,935 --> 00:21:33,335
and Carrie went to, um, estro last year.
505
00:21:33,335 --> 00:21:34,455
It was in Vienna by train.
506
00:21:35,435 --> 00:21:38,055
Um, but that was like a
night train from Brussels
507
00:21:38,475 --> 00:21:40,335
and it was, it was like, it was expensive.
508
00:21:40,955 --> 00:21:43,935
It takes longer than it were to fly.
509
00:21:43,995 --> 00:21:46,175
So your department has
to approve the cost of it
510
00:21:46,315 --> 00:21:47,655
and extra time.
511
00:21:48,085 --> 00:21:49,815
There's also the capacity, there's like,
512
00:21:49,815 --> 00:21:51,975
there's not like infinite
number of, of trains running.
513
00:21:52,275 --> 00:21:53,335
In fact, there's not that many,
514
00:21:53,665 --> 00:21:55,015
especially compared to planes.
515
00:21:55,015 --> 00:21:56,135
They can, they can get and go back
516
00:21:56,135 --> 00:21:57,135
and forth quite a line a day.
517
00:21:57,475 --> 00:21:58,815
So capacity's also a problem
518
00:21:58,815 --> 00:22:00,535
because someone else tried
519
00:22:00,535 --> 00:22:01,975
to book on the same ni train mirror
520
00:22:01,975 --> 00:22:03,095
on and they couldn't get on.
521
00:22:03,095 --> 00:22:06,255
It was completely fully booked.
So it's so that the kind
522
00:22:06,255 --> 00:22:08,695
of train travel is, is nice,
523
00:22:08,915 --> 00:22:10,575
but I don't think it's
gonna solve this problem.
524
00:22:10,675 --> 00:22:12,215
It can redu only reduce it so far.
525
00:22:12,525 --> 00:22:15,375
Like Carrie said, if
everyone went by train and,
526
00:22:15,675 --> 00:22:17,815
and if everyone in Europe
kind of didn't travel at all,
527
00:22:18,315 --> 00:22:20,495
it was still only reduce like 20, 25%
528
00:22:20,495 --> 00:22:22,295
of the carbon footprint of vettra
529
00:22:22,295 --> 00:22:24,335
because most of the time
it's people flying from a,
530
00:22:24,525 --> 00:22:25,775
from, you know, internationally.
531
00:22:25,995 --> 00:22:29,575
That's the problem. Um,
so it's, it, it, I kind
532
00:22:29,575 --> 00:22:31,335
of really think that like online
533
00:22:31,875 --> 00:22:35,055
is the best approach really,
sadly, that then that means
534
00:22:35,055 --> 00:22:38,135
that kind of, yeah, networking
is reduced the kind of the,
535
00:22:38,195 --> 00:22:39,455
the man the kinda
536
00:22:40,015 --> 00:22:42,455
industry is then less engaged
in it and less keen on it.
537
00:22:42,715 --> 00:22:45,335
So it's, it's a really, it's
an unsolved problem at the
538
00:22:45,335 --> 00:22:47,895
moment, but I think it's
one that, yeah, he's,
539
00:22:47,895 --> 00:22:50,015
it's a really difficult
thing to balance quite a lot,
540
00:22:50,025 --> 00:22:51,495
quite a lot of societies kind of
541
00:22:52,075 --> 00:22:54,775
the funding comes at
least partly from holding
542
00:22:54,775 --> 00:22:55,975
that conference and the kind
543
00:22:55,975 --> 00:22:57,255
of industry involvement as well.
544
00:22:57,795 --> 00:22:59,415
So it is, it's really tricky.
545
00:22:59,755 --> 00:23:03,335
Um, but I think that's
where the, the awareness of
546
00:23:04,205 --> 00:23:06,785
the effect of climate change
is gonna have on everyone
547
00:23:07,565 --> 00:23:09,265
and on our patients, on our,
548
00:23:09,265 --> 00:23:11,865
on our kinda hospitals
is, is so important. What
549
00:23:11,865 --> 00:23:13,985
- About professional societies?
550
00:23:14,205 --> 00:23:18,065
Is is there a role for, um,
for them to help contribute
551
00:23:18,065 --> 00:23:21,105
to minimizing the environmental
impact to medical physics?
552
00:23:22,185 --> 00:23:22,905
- Absolutely. ,
553
00:23:23,495 --> 00:23:24,985
there's a role, there's
a role of everyone.
554
00:23:25,245 --> 00:23:29,785
So the kind of, um, start
groups, so in IFM, we started the
555
00:23:29,785 --> 00:23:32,625
around sustainability group
back in February, 2020
556
00:23:32,645 --> 00:23:33,745
before the world went crazy.
557
00:23:33,935 --> 00:23:35,385
That is a very good way of kind
558
00:23:35,385 --> 00:23:37,185
of getting like many people together to,
559
00:23:37,455 --> 00:23:38,785
because you can feel quite lonely
560
00:23:38,925 --> 00:23:40,585
and there's not that many
people doing this stuff.
561
00:23:41,055 --> 00:23:43,025
Whereas if you could form a group,
562
00:23:43,125 --> 00:23:45,570
you can make sure there's other,
you know, know, kind of try
563
00:23:45,570 --> 00:23:47,205
and bounce ideas off other, other people.
564
00:23:47,615 --> 00:23:49,165
We've now got an IPM group,
565
00:23:49,165 --> 00:23:50,245
so it's basically the physicists.
566
00:23:50,815 --> 00:23:52,685
We've got the RCR,
which are the conditions
567
00:23:52,745 --> 00:23:54,805
and the siting college
radiographers, which is the kind
568
00:23:54,805 --> 00:23:56,565
of the staff on the, the
radiographers, the staff,
569
00:23:56,565 --> 00:23:58,885
the Linux themselves working together on
570
00:23:58,885 --> 00:23:59,965
sustainability group as well.
571
00:24:00,665 --> 00:24:01,685
So you can really start kind
572
00:24:01,685 --> 00:24:04,245
of trying Tora raise awareness
within the different,
573
00:24:04,435 --> 00:24:05,885
different, uh, disciplines.
574
00:24:06,585 --> 00:24:09,925
You can also then start,
um, asking the, um,
575
00:24:10,625 --> 00:24:12,925
the different societies and
different institutes to try
576
00:24:12,925 --> 00:24:14,525
and think about what they can do.
577
00:24:15,255 --> 00:24:18,685
Start putting it into, um, curricular so
578
00:24:18,685 --> 00:24:20,485
that people get the kinda
students get taught it as well.
579
00:24:21,075 --> 00:24:23,285
Funding for research is important as well.
580
00:24:23,545 --> 00:24:25,765
So whereas we've just highlighted there's,
581
00:24:25,765 --> 00:24:27,565
there's quite a large amount
582
00:24:27,565 --> 00:24:28,845
of work that still needs to be done.
583
00:24:29,465 --> 00:24:31,965
If funding bodies can really
put their weight behind
584
00:24:31,965 --> 00:24:33,045
that, that makes a big difference.
585
00:24:33,505 --> 00:24:35,765
And it also shows that
they're taking it seriously
586
00:24:35,765 --> 00:24:37,245
and if funding bodies
start taking it seriously,
587
00:24:37,575 --> 00:24:39,085
other people take it
more seriously as well.
588
00:24:39,825 --> 00:24:42,725
And there's kind of another
thing we're trying to do as part
589
00:24:42,725 --> 00:24:44,045
of that, like why the group is
590
00:24:44,045 --> 00:24:47,485
to start accrediting radiotherapy
centers is, is kind of
591
00:24:47,485 --> 00:24:49,605
where we start because I'm
a radiotherapy physicist,
592
00:24:49,605 --> 00:24:51,285
so it's kind of where I can like look at,
593
00:24:52,025 --> 00:24:53,965
so we can start kinda
giving this bronze, silver,
594
00:24:53,985 --> 00:24:58,005
and gold award in sense saying
this department is this level
595
00:24:58,145 --> 00:25:00,965
of sustainable, it's
still in like progress,
596
00:25:01,025 --> 00:25:03,485
but that's kind of
something that we can do.
597
00:25:03,545 --> 00:25:07,565
And the, the different, um,
professional societies can kind
598
00:25:07,565 --> 00:25:09,645
of help badge that and help
kind of promote that as well.
599
00:25:10,165 --> 00:25:13,085
- IEM, which is the Institute of Physics
600
00:25:13,185 --> 00:25:16,005
and Engineering in Medicine,
um, based in the uk.
601
00:25:16,265 --> 00:25:18,965
So obviously, um, as you
say, they, they've, um,
602
00:25:19,335 --> 00:25:22,005
given you some funding for
research and and so on.
603
00:25:22,065 --> 00:25:23,805
So, um, Carrie, uh,
604
00:25:23,805 --> 00:25:26,365
are you involved in any
similar societies in Europe?
605
00:25:26,795 --> 00:25:30,525
- Yeah, so I'm, I'm involved
in the astro uh, green,
606
00:25:30,825 --> 00:25:31,885
uh, green efforts.
607
00:25:31,985 --> 00:25:36,125
Uh, so, so the society actually
wants it as well, recognizes
608
00:25:36,925 --> 00:25:40,165
recognizing that the, the
impact of the climate, uh,
609
00:25:40,165 --> 00:25:42,965
crisis is something that
everyone needs to care about.
610
00:25:43,105 --> 00:25:45,805
And, uh, we also know
that our colleagues, uh,
611
00:25:46,075 --> 00:25:47,605
care, uh, care about it.
612
00:25:47,705 --> 00:25:52,255
So ESTRO is now developing a
green, uh, policy that, uh,
613
00:25:52,255 --> 00:25:55,535
that has, uh, some key
elements where one of them is
614
00:25:55,595 --> 00:25:58,695
to facilitate that we
can learn from each other
615
00:25:58,835 --> 00:26:00,895
and, uh, facilitate, uh, research.
616
00:26:01,685 --> 00:26:04,185
And I think the, the awareness that, uh,
617
00:26:04,535 --> 00:26:06,905
that the professional space
is actually a great way
618
00:26:06,965 --> 00:26:10,145
to seek impact on carbon
emissions is something that we can
619
00:26:10,675 --> 00:26:14,785
teach our colleagues because
so many of us who are concerned
620
00:26:14,785 --> 00:26:17,065
and there is nothing worse than not being
621
00:26:17,215 --> 00:26:18,425
able to do anything.
622
00:26:19,605 --> 00:26:21,025
And if we think about it,
623
00:26:21,285 --> 00:26:24,265
and so these numbers are
very, uh, still uncertain,
624
00:26:24,325 --> 00:26:27,305
but if on average the
emission per radiotherapy is
625
00:26:27,305 --> 00:26:30,505
around 500 kilo of, uh, carbon equivalence
626
00:26:31,125 --> 00:26:33,985
in our department, we
treat 5,000 patients per
627
00:26:33,985 --> 00:26:35,105
year with radiotherapy.
628
00:26:35,605 --> 00:26:38,065
So it means that our
department is spending maybe
629
00:26:38,205 --> 00:26:40,185
2,500 hun per year.
630
00:26:40,765 --> 00:26:43,845
And if I compare that with
my personal car footprint
631
00:26:43,865 --> 00:26:46,405
of maybe five ton carbon equivalents, it,
632
00:26:46,985 --> 00:26:48,795
it's just a nice way to think that
633
00:26:48,795 --> 00:26:50,475
through my pro professional space,
634
00:26:50,595 --> 00:26:52,995
I can actually have
way more impact than in
635
00:26:53,015 --> 00:26:54,235
my personal space.
636
00:26:55,035 --> 00:26:58,215
And we need to do the
right things, uh, um,
637
00:26:58,245 --> 00:27:02,415
because if you just start,
uh, doing random, uh, stuff
638
00:27:02,415 --> 00:27:04,335
that we believe ourselves is important,
639
00:27:04,435 --> 00:27:06,215
we are not going to have effect.
640
00:27:06,795 --> 00:27:10,495
So we need to teach, um, we
need to teach our colleagues,
641
00:27:10,595 --> 00:27:12,335
uh, how to have the biggest,
642
00:27:12,615 --> 00:27:15,215
I impact in the most efficient ways.
643
00:27:15,395 --> 00:27:18,255
And, uh, I think our societies are, um,
644
00:27:18,365 --> 00:27:21,095
they are getting on board
that this is just as, uh,
645
00:27:21,095 --> 00:27:23,615
important as, uh, health
economics for instance.
646
00:27:23,675 --> 00:27:27,865
So this is, uh, environmental,
uh, the equivalent, uh,
647
00:27:28,045 --> 00:27:29,905
in environmental sustainability.
648
00:27:30,175 --> 00:27:32,665
- There's, there's a
small irony as well, some
649
00:27:32,665 --> 00:27:34,345
of the best places to
disseminate this work
650
00:27:34,365 --> 00:27:37,425
and this, this kind of, this
educate people is actually the
651
00:27:37,425 --> 00:27:39,185
conferences that are such
a big problem as well.
652
00:27:39,725 --> 00:27:42,185
Um, so I dunno quite how you solve that.
653
00:27:42,185 --> 00:27:44,065
But that , again,
I keep saying that a lot,
654
00:27:44,405 --> 00:27:45,825
but that's one of the
ironies of it as well.
655
00:27:46,895 --> 00:27:50,025
- Okay. So finally, what do you see
656
00:27:50,025 --> 00:27:51,545
as the most immediate risk
657
00:27:51,605 --> 00:27:54,585
to medical physics provision
from climate change?
658
00:27:55,305 --> 00:27:57,625
- I think I'd have said extreme weather,
659
00:27:58,055 --> 00:28:00,865
because there's already been
a case somewhere in London.
660
00:28:01,005 --> 00:28:02,145
One of the hospitals was over the,
661
00:28:02,145 --> 00:28:04,625
over like two summers ago it got so hot
662
00:28:04,625 --> 00:28:06,705
that their computer
servers just shut down.
663
00:28:07,595 --> 00:28:10,415
Um, and it meant there
were kind of, you know,
664
00:28:10,415 --> 00:28:12,135
back decades running
around with patient notes
665
00:28:12,195 --> 00:28:13,575
and everything was on paper
666
00:28:14,435 --> 00:28:16,415
and that was that, that's a big risk
667
00:28:16,675 --> 00:28:19,135
and extreme weather can bring
flooding as well, so that's
668
00:28:19,135 --> 00:28:22,455
where, that's flooding to
a linac or an MS scanner
669
00:28:22,595 --> 00:28:25,095
or again, to computers, that's your,
670
00:28:25,095 --> 00:28:26,495
that's a kinda a big risk.
671
00:28:27,075 --> 00:28:29,615
And there's also like
with just, um, you know,
672
00:28:29,615 --> 00:28:32,415
so there's a big snow snowstorm
or really big flooding
673
00:28:32,595 --> 00:28:35,335
or big storm and people can't get to work
674
00:28:35,395 --> 00:28:37,935
or can't get for treatment,
that is also quite a big risk.
675
00:28:37,935 --> 00:28:39,535
And I'd say that's probably
the most immediate ones
676
00:28:39,535 --> 00:28:40,615
we're gonna gonna face.
677
00:28:41,075 --> 00:28:44,855
- And I think the relevance
to radiotherapy is also, uh,
678
00:28:44,985 --> 00:28:46,375
particular because we are
679
00:28:46,375 --> 00:28:48,455
so dependent on our
fractionated treatments
680
00:28:48,475 --> 00:28:51,015
and patients staying on schedule, we are
681
00:28:51,275 --> 00:28:53,735
so dependent on not, uh, becoming delayed
682
00:28:53,735 --> 00:28:55,415
with cancer treatment altogether.
683
00:28:55,515 --> 00:28:58,525
So we are, we are part
of the healthcare system
684
00:28:58,525 --> 00:29:01,925
that is actually, uh, more
vulnerable to these, uh,
685
00:29:02,185 --> 00:29:04,885
to delays and, uh,
interruptions in our treatment
686
00:29:04,885 --> 00:29:08,045
because this is going on
for, uh, for one month
687
00:29:08,185 --> 00:29:11,645
and, uh, any delay will
have, uh, clinical impact
688
00:29:12,185 --> 00:29:13,325
- And that, that might be, again,
689
00:29:13,325 --> 00:29:15,685
where hyper vaccination is, is benefit
690
00:29:15,685 --> 00:29:17,365
because it's more robust to that probably.
691
00:29:18,065 --> 00:29:20,125
Um, because you're less
likely if you're already being
692
00:29:20,125 --> 00:29:21,245
treated for like a week
693
00:29:21,245 --> 00:29:23,525
or two, you, it's probably less likely
694
00:29:23,525 --> 00:29:25,285
to have an interruption
due to extreme weather.
695
00:29:25,865 --> 00:29:27,325
But yeah, who knows . Yeah.
696
00:29:28,035 --> 00:29:30,525
- Okay. So yes, there's
a lot of work to do,
697
00:29:30,705 --> 00:29:32,885
but it sounds like the, you know, it,
698
00:29:32,915 --> 00:29:36,045
it's in progress, it's
being worked on. So Yeah,
699
00:29:36,045 --> 00:29:37,685
- And I feel like we should
probably end on a bit
700
00:29:37,685 --> 00:29:39,965
of a positive note as well
because it's been quite negative
701
00:29:41,265 --> 00:29:44,005
and I kind of, the last
few year I've been kind
702
00:29:44,005 --> 00:29:45,085
of working on this stuff for a while
703
00:29:45,085 --> 00:29:46,125
and talking about this stuff for a while
704
00:29:46,185 --> 00:29:47,925
and it's, it's gonna been getting nowhere
705
00:29:48,595 --> 00:29:50,285
over the last couple of years.
706
00:29:50,305 --> 00:29:51,725
The door's definitely starting
707
00:29:51,725 --> 00:29:53,525
to get kind of more and more open.
708
00:29:54,195 --> 00:29:55,685
Like I don't think we've
been having a kind of a,
709
00:29:56,005 --> 00:29:57,285
a podcast about climate change
710
00:29:57,945 --> 00:30:01,285
in healthcare a couple five
years ago, but now we are.
711
00:30:01,625 --> 00:30:02,885
And it's getting more and more,
712
00:30:03,285 --> 00:30:04,285
everyone's getting more aware of
713
00:30:04,285 --> 00:30:05,325
it and more concerned about it.
714
00:30:05,425 --> 00:30:07,685
So it is, it is becoming into getting
715
00:30:07,685 --> 00:30:08,925
into people's minds more and more.
716
00:30:08,945 --> 00:30:11,085
We need to be everyone to
be thinking about it really.
717
00:30:11,625 --> 00:30:13,685
But it is, it's, that's a
positive for me at least.
718
00:30:13,745 --> 00:30:15,845
It feels like there is
some change happening,
719
00:30:16,355 --> 00:30:17,525
even if it should have been 10 years ago.
720
00:30:18,005 --> 00:30:20,965
I can appreciate. Hey, well thank you both
721
00:30:21,065 --> 00:30:22,325
for your time today.
722
00:30:22,585 --> 00:30:24,965
Thanks for speaking with us.
Thank you for inviting us.
723
00:30:24,985 --> 00:30:26,445
It was a pleasure. Thanks for inviting.
724
00:30:33,435 --> 00:30:34,645
- That was Rob Shooter
725
00:30:34,785 --> 00:30:38,605
and Carrie Tander up in
conversation with Tammy Freeman.
726
00:30:39,105 --> 00:30:42,005
You can find the journal
Physics in Medicine
727
00:30:42,105 --> 00:30:45,765
and Biology on the IOP science website.
728
00:30:46,545 --> 00:30:48,285
I'm afraid that's all the time we have
729
00:30:48,285 --> 00:30:51,525
for this week's podcast, which
was produced in partnership
730
00:30:51,525 --> 00:30:54,605
with IPEM, the Institute of Physics
731
00:30:55,145 --> 00:30:56,925
and Engineering in Medicine.
732
00:30:57,385 --> 00:30:59,245
Thanks to Rob, Carrie,
733
00:30:59,425 --> 00:31:02,165
and Tammy for a fascinating discussion.
734
00:31:02,705 --> 00:31:06,005
And a special thanks to
our producer Callum gel.
735
00:31:06,735 --> 00:31:08,245
We'll be back again next week,
736
00:31:08,465 --> 00:31:11,485
but in the meantime, do
check out the latest episode
737
00:31:11,665 --> 00:31:14,125
of the Physics World Stories podcast
738
00:31:14,915 --> 00:31:18,525
host Andrew Gluster is in
conversation with a composer,
739
00:31:18,945 --> 00:31:23,765
Amanda Lee Falkenberg,
who's the moon's Symphony,
740
00:31:23,975 --> 00:31:27,485
takes listeners on an epic
journey through the science
741
00:31:27,625 --> 00:31:30,685
and stories of the moons
of the solar system.
742
00:31:31,465 --> 00:31:34,405
The podcast includes
music from the symphony,
743
00:31:34,625 --> 00:31:37,565
and you can find it on
the physics world website
744
00:31:38,025 --> 00:31:40,885
or at your favorite podcast provider.
745
00:31:41,515 --> 00:31:44,525
Just look for the headline,
an orchestral trip
746
00:31:44,675 --> 00:31:47,165
through the moons of our solar system,
747
00:31:53,615 --> 00:31:54,745
physics world.
00:00:04,985 --> 00:00:06,155
- Physics world.
2
00:00:07,515 --> 00:00:10,625
- Hello and welcome to the
Physics World Weekly Podcast.
3
00:00:11,205 --> 00:00:12,305
I'm Hamish Johnston.
4
00:00:12,775 --> 00:00:17,065
This episode focuses on
environmental sustainability in
5
00:00:17,065 --> 00:00:21,465
medical physics, and it's
produced in partnership with IPEM,
6
00:00:21,765 --> 00:00:23,305
the Institute of Physics
7
00:00:23,525 --> 00:00:25,465
and Engineering in Medicine,
8
00:00:25,955 --> 00:00:29,785
which owns the journal Physics
in Medicine and Biology.
9
00:00:30,885 --> 00:00:33,305
Here's physics world's Tammy Freeman.
10
00:00:33,525 --> 00:00:37,265
In conversation with the
medical physicists Rob Shooter
11
00:00:37,565 --> 00:00:40,425
and Carrie Tendra, who explain
12
00:00:40,565 --> 00:00:42,585
how their profession is embracing
13
00:00:42,975 --> 00:00:44,825
environmental sustainability.
14
00:00:51,775 --> 00:00:54,145
- Climate change poses a major threat both
15
00:00:54,145 --> 00:00:55,545
to our planet and to our health.
16
00:00:56,295 --> 00:00:59,225
Environmental changes can
alter disease patterns,
17
00:00:59,515 --> 00:01:02,065
while increased air
pollution can cause a rise in
18
00:01:02,065 --> 00:01:04,425
respiratory and cardiovascular diseases.
19
00:01:05,215 --> 00:01:07,665
Extreme weather events
can also impact medical
20
00:01:07,665 --> 00:01:09,945
infrastructure and
services across the globe.
21
00:01:10,115 --> 00:01:11,745
Healthcare provision in itself,
22
00:01:11,745 --> 00:01:14,545
however, also contributes
to carbon emissions,
23
00:01:14,965 --> 00:01:16,865
and there's a pressing need to find
24
00:01:17,005 --> 00:01:19,985
and implement new ways to
reduce the carbon footprint
25
00:01:20,045 --> 00:01:21,145
of delivering healthcare.
26
00:01:22,445 --> 00:01:23,465
So I'm joined today
27
00:01:23,605 --> 00:01:27,065
by Rob Shooter from the Christie
NHS Foundation Trust in the
28
00:01:27,165 --> 00:01:30,825
uk, and Carrie Tander up
from R University in Denmark
29
00:01:31,325 --> 00:01:35,065
to discuss environmental
sustainability in medical physics.
30
00:01:35,875 --> 00:01:36,985
Hello, Rob and Carrie.
31
00:01:37,555 --> 00:01:38,745
- Hello.
- Hi.
32
00:01:39,565 --> 00:01:42,625
So climate change is obviously
a substantial challenge
33
00:01:42,625 --> 00:01:43,945
that impacts everyone,
34
00:01:44,525 --> 00:01:47,625
but in what ways does
medical physics in particular
35
00:01:47,635 --> 00:01:49,425
contribute to carbon emissions?
36
00:01:49,525 --> 00:01:50,905
Can you give a few examples?
37
00:01:51,775 --> 00:01:54,025
- Sort of in the same way
that we all do really.
38
00:01:54,205 --> 00:01:57,305
So it's through our kind of
traveling, our electricity use,
39
00:01:58,165 --> 00:01:59,575
what we buy and what we use.
40
00:02:00,235 --> 00:02:02,255
Um, there's a statistic that says
41
00:02:02,255 --> 00:02:06,495
that one in every 25 road
miles is, is for the NHS.
42
00:02:06,875 --> 00:02:08,695
So whether it's patient
travel or staff travel.
43
00:02:09,355 --> 00:02:11,815
So yeah, travel is quite
a large part of it.
44
00:02:12,155 --> 00:02:14,095
And the conferences and
meetings that we also travel
45
00:02:14,115 --> 00:02:15,895
to another, another large part of it.
46
00:02:16,355 --> 00:02:19,255
- So looking for example, at
radiotherapy, which is one
47
00:02:19,255 --> 00:02:21,015
of the most prevalent cancer treatments,
48
00:02:21,675 --> 00:02:23,655
can you comment on the carbon footprint
49
00:02:23,655 --> 00:02:24,815
of the radiotherapy process?
50
00:02:25,395 --> 00:02:28,735
- One in, uh, so 120,000
patients a year get ready therapy
51
00:02:28,835 --> 00:02:30,895
in the uk that's about 50%
52
00:02:30,895 --> 00:02:32,655
of all cancer patients get
treated with radiotherapy.
53
00:02:33,375 --> 00:02:35,395
So we looked at the kind
of carbon footprint, um,
54
00:02:35,695 --> 00:02:37,675
of the treatment workflow
to see what it was,
55
00:02:37,735 --> 00:02:41,035
and it was about 250 kilograms, um,
56
00:02:41,475 --> 00:02:42,755
CO2 equivalent per patient.
57
00:02:43,295 --> 00:02:47,155
And we looked at imaging for
the patient, the energy use
58
00:02:47,155 --> 00:02:48,715
of the LINAC when it was treating the,
59
00:02:48,795 --> 00:02:50,875
delivering the patient treatment treatment
60
00:02:51,295 --> 00:02:54,515
and when it was just sitting
in idle power mode, um,
61
00:02:54,515 --> 00:02:56,675
which took the, um, gowns
62
00:02:56,675 --> 00:03:00,725
and masks that were being
used during covid Also, um,
63
00:03:00,725 --> 00:03:03,205
there's SF six gas leaks out of the LINAC,
64
00:03:03,745 --> 00:03:06,325
and that's 23,000 times as
effective at global warming
65
00:03:06,325 --> 00:03:07,965
as carbon dioxide is, which is
66
00:03:07,965 --> 00:03:09,765
what kinda water the
gases are normalized to.
67
00:03:10,745 --> 00:03:13,325
And we looked and
eventually it was about 78%
68
00:03:13,325 --> 00:03:15,485
of the total carbon footprint
was from patient travel.
69
00:03:16,395 --> 00:03:19,605
Also looked at staff travel,
which was kind of about 10%.
70
00:03:19,625 --> 00:03:20,645
So that was kind of quite high.
71
00:03:20,645 --> 00:03:21,525
There's a lot of these things,
72
00:03:21,525 --> 00:03:22,645
travel tends to be one of the highest.
73
00:03:23,155 --> 00:03:24,725
Yeah, and there's the,
there's quite a lot of work
74
00:03:24,725 --> 00:03:26,565
that's kind of ongoing to look at that.
75
00:03:27,225 --> 00:03:29,365
Um, one of the things that
is I think coming out soon is
76
00:03:29,485 --> 00:03:30,925
probably like a, a lifecycle analysis,
77
00:03:31,055 --> 00:03:33,205
which does it in much more
detail than, than we did.
78
00:03:34,335 --> 00:03:36,395
Um, and there's, there's
always more bits to do
79
00:03:36,395 --> 00:03:37,795
because I, we didn't look at the,
80
00:03:38,735 --> 00:03:40,435
the manufacture of the
equipment to start with.
81
00:03:40,435 --> 00:03:43,035
We didn't look at the bunk
design, so the ax always sitting
82
00:03:43,035 --> 00:03:44,595
with this, this big concrete bunker.
83
00:03:44,935 --> 00:03:46,395
We didn't look at the
carbon footprint of that.
84
00:03:46,975 --> 00:03:48,475
Um, so there's always more to do.
85
00:03:49,035 --> 00:03:50,755
I always say that as a
research level ,
86
00:03:51,735 --> 00:03:55,155
- And something that the is
actually also creeping in is
87
00:03:55,175 --> 00:03:58,635
the, uh, archival of data so and so,
88
00:03:58,775 --> 00:04:01,995
and that that is going to
depend a lot on our regulations
89
00:04:02,015 --> 00:04:04,235
and what we are forced to archive.
90
00:04:04,295 --> 00:04:08,555
And if we can, uh, succeed to
implement policies for, uh,
91
00:04:08,575 --> 00:04:10,755
for deletion of data in a successful way.
92
00:04:11,335 --> 00:04:14,515
So that can potentially
just increase and increase
93
00:04:14,515 --> 00:04:17,875
because we are increasingly
making more scans
94
00:04:17,935 --> 00:04:22,115
or higher resolution, uh,
that can potentially go out
95
00:04:22,115 --> 00:04:24,995
of control if our regulations
are, are requiring us
96
00:04:25,015 --> 00:04:27,195
to archive for 30 years or more.
97
00:04:27,775 --> 00:04:30,875
- So are there any sort of easy
ways that you could think of
98
00:04:30,875 --> 00:04:33,435
to reduce the carbon
footprint of radiotherapy?
99
00:04:34,025 --> 00:04:36,035
- There's never such thing
as easy as there .
100
00:04:36,335 --> 00:04:37,515
One of the things that's happening more
101
00:04:37,515 --> 00:04:39,395
and more in radiotherapy is, um, the use
102
00:04:39,395 --> 00:04:40,595
of hyper fractionated radiotherapy.
103
00:04:41,015 --> 00:04:43,115
So rather than traveling first say 20
104
00:04:43,175 --> 00:04:46,355
or 30 treatments, so all
radiotherapy is fractionated,
105
00:04:46,455 --> 00:04:48,155
so we tend to kind of travel for about 20
106
00:04:48,155 --> 00:04:50,705
or 30 fractions nowadays.
107
00:04:50,705 --> 00:04:52,825
There's, um, evidence
out there to show that
108
00:04:52,845 --> 00:04:55,745
that's equivalent to having higher doses,
109
00:04:55,745 --> 00:04:57,745
but in five fractions or
something, something similar.
110
00:04:58,605 --> 00:05:01,945
So by reducing that
patient travel by up 75%,
111
00:05:02,405 --> 00:05:04,505
we should be able to significantly
reduce the calm footprint
112
00:05:04,645 --> 00:05:06,905
of radiotherapy because travel
is such a large part of it,
113
00:05:07,095 --> 00:05:09,785
potentially if you can treat
patients close to home.
114
00:05:10,405 --> 00:05:12,985
So we tend to have at the moment
in the UK quite centralized
115
00:05:13,015 --> 00:05:15,905
centers, so big centers where
you kind of get radio therapy.
116
00:05:16,685 --> 00:05:17,985
If there can be smaller versions
117
00:05:17,985 --> 00:05:19,665
of those near a patient's houses, then
118
00:05:19,815 --> 00:05:21,185
that could reduce the carbon footprint.
119
00:05:21,825 --> 00:05:23,385
Building a big radiotherapy center
120
00:05:23,405 --> 00:05:25,545
or even a small one has quite
a large carbon footprint
121
00:05:25,815 --> 00:05:27,025
that is not less uk.
122
00:05:27,265 --> 00:05:30,065
The, the quickest, easiest
of wins a bit of work.
123
00:05:30,065 --> 00:05:32,425
We did recently showed that
within about 10 years though,
124
00:05:32,425 --> 00:05:34,665
that is kind of offset by the kinda travel
125
00:05:34,665 --> 00:05:35,865
that saved from patients,
126
00:05:36,285 --> 00:05:37,945
but that would re really vary depending on
127
00:05:37,945 --> 00:05:39,225
what your kind of catch on area was.
128
00:05:39,985 --> 00:05:42,905
Patients could potentially
stay in hotels near the
129
00:05:43,105 --> 00:05:45,825
hospitals, but they're
not quite sure whether
130
00:05:46,185 --> 00:05:47,225
patients would particularly like that.
131
00:05:47,725 --> 00:05:49,465
So as I think we'll talk
a about later about kind
132
00:05:49,465 --> 00:05:51,065
of proton therapy and that's potentially
133
00:05:51,065 --> 00:05:53,305
what happens in proton,
the therapy centers
134
00:05:53,875 --> 00:05:55,465
using public transport.
135
00:05:55,645 --> 00:05:57,460
So a bit of the work, we
looked at the carbon footprint
136
00:05:57,460 --> 00:06:00,085
and radiotherapy, we worked
at the center that's, um,
137
00:06:00,085 --> 00:06:02,045
guys in Thomas, which is near next
138
00:06:02,045 --> 00:06:03,205
to London Bridge train station.
139
00:06:04,065 --> 00:06:06,005
And their carbon footprint
was quite a lot lower
140
00:06:06,355 --> 00:06:09,205
because if 6% of your
patients travel by train,
141
00:06:09,265 --> 00:06:10,925
you lower the carbon
footprint quite significantly.
142
00:06:12,105 --> 00:06:14,165
But we talked to some
patients to the Christie
143
00:06:14,175 --> 00:06:16,685
where it's gonna be, it's kind
of outside of the center of
144
00:06:16,685 --> 00:06:20,085
of Manchester and getting
there by bus is pretty tricky.
145
00:06:20,105 --> 00:06:21,245
You have a change in the center of the
146
00:06:21,245 --> 00:06:23,165
town, no one likes doing that.
147
00:06:23,345 --> 00:06:25,935
All the patients are worried
about turning up late
148
00:06:25,935 --> 00:06:27,335
for their, their treatments.
149
00:06:28,035 --> 00:06:29,375
So they're kind of anxious about that.
150
00:06:30,365 --> 00:06:32,415
Also, as you kind of go
through treatment, um,
151
00:06:32,685 --> 00:06:34,055
side effects tend to get worse.
152
00:06:34,835 --> 00:06:35,975
So you are like two
153
00:06:35,975 --> 00:06:38,095
or three weeks in, you're
feeling kind of pretty,
154
00:06:38,275 --> 00:06:40,695
pretty bad, pretty ob quite a lot.
155
00:06:40,695 --> 00:06:42,815
The patients we spoke to
were prostate patient cancer
156
00:06:43,095 --> 00:06:44,295
patients, so they needed
to be near a toilet
157
00:06:44,295 --> 00:06:46,695
because you kinda get
bowel and bladder problems.
158
00:06:46,915 --> 00:06:48,815
If you're on a train
that's, it's, it's durable,
159
00:06:48,815 --> 00:06:51,495
but on a bus you've got
nowhere to go quite literally.
160
00:06:51,595 --> 00:06:53,415
So that's not great. Yeah.
161
00:06:53,415 --> 00:06:55,215
So there's, there are things we can do,
162
00:06:55,235 --> 00:06:56,575
but none of 'em particularly easy.
163
00:06:57,115 --> 00:06:58,535
Making public transport better
164
00:06:58,535 --> 00:06:59,575
would be a good start. Of course,
165
00:06:59,975 --> 00:07:02,455
- , - That just goes
by everything and everyone.
166
00:07:03,035 --> 00:07:04,895
- And maybe also on the equipment, um,
167
00:07:04,955 --> 00:07:06,055
on the equipment side.
168
00:07:06,115 --> 00:07:09,295
So construction and maintenance
of our linear accelerators
169
00:07:09,395 --> 00:07:12,935
and our scanners is potentially
also a large contributor.
170
00:07:13,235 --> 00:07:17,815
So our ability, uh, also to
update our equipment and uh,
171
00:07:18,195 --> 00:07:21,455
and the, uh, the vendors
also to have an agenda
172
00:07:21,925 --> 00:07:24,815
that updates, uh, keep
being possible is going
173
00:07:24,815 --> 00:07:25,975
to be important here.
174
00:07:26,575 --> 00:07:28,615
- I mean, I think that
the hyper fractionation
175
00:07:28,615 --> 00:07:30,775
that you mentioned, that's
really quite interesting
176
00:07:30,775 --> 00:07:33,855
because that, you know, in a
way that would reduce travel
177
00:07:34,115 --> 00:07:37,015
and you know, the
patient's time instantly.
178
00:07:37,285 --> 00:07:40,735
Yeah. And I know during the
pandemic, some places sort
179
00:07:40,735 --> 00:07:42,735
of brought that in just as a necessity
180
00:07:42,735 --> 00:07:43,735
to have less hospital,
181
00:07:43,735 --> 00:07:45,255
less patients in the hospitals at
182
00:07:45,255 --> 00:07:46,455
different times. And yeah,
183
00:07:46,455 --> 00:07:48,015
- Then it was, then it was reduce footfall
184
00:07:48,275 --> 00:07:50,095
and I think, I think quite a lot of,
185
00:07:50,095 --> 00:07:51,815
because it takes NHS quite a long time
186
00:07:51,815 --> 00:07:52,975
to implement stuff normally.
187
00:07:53,435 --> 00:07:55,895
Um, but a few things kind
of got put in quicker
188
00:07:55,895 --> 00:07:57,055
because they were reducing footfall
189
00:07:57,115 --> 00:07:58,055
and they were kind reducing
190
00:07:58,265 --> 00:07:59,575
staff contacts and stuff like that.
191
00:07:59,755 --> 00:08:00,815
And a lot of it stayed in
192
00:08:00,815 --> 00:08:02,575
because it, it just
helps, it helps everyone.
193
00:08:02,575 --> 00:08:05,215
It kind of equal in kind
of clinical outcome.
194
00:08:05,365 --> 00:08:09,135
There's less patient travel,
so they prefer it, it helps
195
00:08:09,135 --> 00:08:11,095
with kind of NHS resources as well.
196
00:08:11,395 --> 00:08:12,855
So it seems one of those kind of like very
197
00:08:12,855 --> 00:08:13,935
rare win win-wins.
198
00:08:14,195 --> 00:08:16,215
So, but it remains to be seen. Yeah.
199
00:08:16,555 --> 00:08:18,415
- You mentioned particle therapy as well.
200
00:08:18,475 --> 00:08:21,415
So we're increasingly
seeing, um, implementation
201
00:08:21,415 --> 00:08:23,495
of particle therapy for treating cancer.
202
00:08:24,355 --> 00:08:28,135
Now this requires large costly
machines with vast levels
203
00:08:28,235 --> 00:08:29,535
of surrounding infrastructure.
204
00:08:30,115 --> 00:08:33,055
So clearly ways to minimize
the carbon footprint
205
00:08:33,115 --> 00:08:36,055
of installing and running
particle therapy systems.
206
00:08:36,975 --> 00:08:39,135
- I think we're still,
we still need to map out,
207
00:08:39,375 --> 00:08:42,215
actually we don't, uh, we don't
have really good evidence at
208
00:08:42,215 --> 00:08:45,015
the moment for the biggest
contributors to the, uh,
209
00:08:45,335 --> 00:08:47,655
particle therapy as, as compared to, uh,
210
00:08:47,655 --> 00:08:49,495
classical x-ray, uh, therapy.
211
00:08:49,915 --> 00:08:52,735
Uh, likely the large
electricity consumption, uh,
212
00:08:52,765 --> 00:08:54,215
will play a role there
213
00:08:54,215 --> 00:08:56,685
because we do know that electricity bills
214
00:08:56,745 --> 00:08:58,085
for these centers are huge
215
00:08:58,625 --> 00:09:01,405
and for that, for us to do
anything on that side is,
216
00:09:01,425 --> 00:09:02,685
is going to become difficult
217
00:09:02,685 --> 00:09:06,325
because that depends of course
on a lot on availability of,
218
00:09:06,385 --> 00:09:10,245
uh, renewable, uh, energy,
something for our policy makers
219
00:09:10,305 --> 00:09:11,405
to make that possible.
220
00:09:11,705 --> 00:09:15,885
So, uh, some centers have been
exploring, uh, opportunities
221
00:09:16,065 --> 00:09:17,965
to install, uh, solar panels.
222
00:09:17,985 --> 00:09:20,325
Uh, I think every step
in that direction is,
223
00:09:20,385 --> 00:09:21,845
um, is just positive.
224
00:09:22,605 --> 00:09:24,485
- Particle centers tend
to treat more pediatric
225
00:09:24,485 --> 00:09:26,365
and kind of, um, cancer patients
226
00:09:26,865 --> 00:09:30,605
and they tend to get,
um, more anesthetic gases
227
00:09:30,605 --> 00:09:32,565
or something like that to try
and kinda knock them out while
228
00:09:32,565 --> 00:09:33,965
they have their treatment
because those, they regular
229
00:09:34,025 --> 00:09:36,685
and alo and acetic gases on the whole tend
230
00:09:36,685 --> 00:09:38,765
to have a really quite
high carbon footprint.
231
00:09:39,385 --> 00:09:42,005
So, and there's a kind of general
move, certainly in the NHS
232
00:09:42,005 --> 00:09:43,965
to try and move away from
things like des fluorine,
233
00:09:43,965 --> 00:09:45,165
which are really high, I think
234
00:09:45,165 --> 00:09:46,605
3000 times as effective as CO2.
235
00:09:47,465 --> 00:09:50,325
Um, so there there'll be
an impact there from that,
236
00:09:51,095 --> 00:09:55,585
like travel for com for, um,
so, uh, for proton centers is
237
00:09:56,425 --> 00:09:59,465
a bit different to, uh, to
the standard radiotherapy
238
00:10:00,255 --> 00:10:03,105
because there's only like two in the whole
239
00:10:03,105 --> 00:10:04,825
of the UK high energy ones.
240
00:10:05,485 --> 00:10:07,145
So patients have to travel from quite
241
00:10:07,165 --> 00:10:08,385
far away to go to those centers.
242
00:10:09,055 --> 00:10:10,385
They don't tend to travel backwards
243
00:10:10,385 --> 00:10:11,905
and forward each day because it's too far.
244
00:10:12,525 --> 00:10:13,945
So they tend to stay in hotels,
245
00:10:14,485 --> 00:10:16,025
but then looking at the
kinda the carbon footprint
246
00:10:16,025 --> 00:10:18,545
of a hotel stay versus
at home is different.
247
00:10:19,005 --> 00:10:21,345
So that, that is all a
bit different as well.
248
00:10:21,845 --> 00:10:25,025
Um, and I think they tend to
get like shuttle buses in, so
249
00:10:25,025 --> 00:10:28,185
that's kind of shared transport,
something that's better.
250
00:10:28,245 --> 00:10:30,185
So yeah, it, it all
remains to be seen really.
251
00:10:30,685 --> 00:10:32,465
Um, there is work being started on that,
252
00:10:32,525 --> 00:10:33,865
but we should have started a lot
253
00:10:33,865 --> 00:10:35,065
of this work like 10 years ago,
254
00:10:35,525 --> 00:10:37,265
but no one really cared
about it then .
255
00:10:37,265 --> 00:10:38,505
So it's still happening now instead.
256
00:10:39,645 --> 00:10:40,785
Is there the same level of
257
00:10:41,025 --> 00:10:42,705
- Fractionation with, uh, perton therapy?
258
00:10:43,385 --> 00:10:44,665
I think it's still pretty similar
259
00:10:44,665 --> 00:10:48,665
because, uh, with exploring
the, uh, the clinical benefit
260
00:10:48,845 --> 00:10:52,185
of, uh, of particle therapy,
there are many reasons to stay
261
00:10:52,185 --> 00:10:56,155
as close as possible to the,
the practice that we have today
262
00:10:56,255 --> 00:10:59,115
for, uh, x-ray, um, therapy.
263
00:10:59,535 --> 00:11:01,955
So, but, but I think it has also, given
264
00:11:01,955 --> 00:11:05,715
that it has weigh a lower
dose to normal tissue,
265
00:11:05,715 --> 00:11:07,435
there are many good arguments
266
00:11:07,435 --> 00:11:09,595
that this modality should work really well
267
00:11:09,595 --> 00:11:10,955
with hypo fractionation.
268
00:11:11,855 --> 00:11:16,075
And, uh, so hopefully,
hopefully the environmental
269
00:11:16,755 --> 00:11:19,515
argument is also going
to, to push the, the field
270
00:11:19,535 --> 00:11:21,475
to explore, uh, hyper fractionation
271
00:11:22,355 --> 00:11:23,355
- I suppose.
272
00:11:23,355 --> 00:11:24,515
I suppose the other thing about,
because if you've got lower
273
00:11:24,545 --> 00:11:28,485
dose to organs at risk,
which kind of proton, um,
274
00:11:28,485 --> 00:11:31,165
therapy does have, that means
you're more likely to have
275
00:11:31,875 --> 00:11:33,205
kind of lower side effects
276
00:11:33,225 --> 00:11:35,045
or less side effects or
even low side effects.
277
00:11:35,585 --> 00:11:37,525
And if they're treated with some sort
278
00:11:37,525 --> 00:11:40,325
of high carbon footprint
medicine, you could argue that
279
00:11:41,005 --> 00:11:44,115
a low proton therapies like
in a more comfort being
280
00:11:44,115 --> 00:11:46,835
intensive to deliver, maybe
it's offset by the fact
281
00:11:46,835 --> 00:11:48,555
that you kind of, then there's
less side effects afterwards.
282
00:11:49,215 --> 00:11:51,235
Um, so there's, there's,
there's the kind of a gets,
283
00:11:51,375 --> 00:11:53,340
if you look at the, in the
kinda broader picture sort
284
00:11:53,340 --> 00:11:54,805
of sense, it gets really even
285
00:11:54,805 --> 00:11:55,965
more complicated than we already thought
286
00:11:56,325 --> 00:11:57,325
- .
287
00:11:57,845 --> 00:11:59,685
- Absolutely. And then another key area
288
00:11:59,905 --> 00:12:03,725
of medical physics is the
diagnostic imaging, which is used
289
00:12:03,825 --> 00:12:06,645
to, um, diagnose or stage a disease.
290
00:12:07,265 --> 00:12:10,365
So for example, how, how
sustainable procedures such
291
00:12:10,365 --> 00:12:12,525
as positron emission tomography
292
00:12:12,625 --> 00:12:15,925
or pet, which involve
the use of radioisotopes.
293
00:12:16,105 --> 00:12:17,125
- So we did get a,
294
00:12:17,225 --> 00:12:19,645
an IE innovation award
to start doing that.
295
00:12:20,265 --> 00:12:22,725
Um, we're still kinda quite
in early days of it, but
296
00:12:22,725 --> 00:12:25,445
because it also depends
on where your center is
297
00:12:25,445 --> 00:12:27,485
and how close you can get
the kinda the manufacturer
298
00:12:27,485 --> 00:12:29,325
of the tracer to, to deliver it to you,
299
00:12:29,325 --> 00:12:30,805
whether it's kind on onsite in some,
300
00:12:30,825 --> 00:12:33,085
say some centers have
the, the manufacturer,
301
00:12:33,085 --> 00:12:35,605
the tracer on site says
there's always travel again,
302
00:12:35,995 --> 00:12:37,405
there's also the kind of the,
303
00:12:37,635 --> 00:12:39,605
there's always patient
travel involved in everything
304
00:12:40,335 --> 00:12:41,765
diagnostic CT wise
305
00:12:41,825 --> 00:12:44,565
and obviously, so PET always
comes with a CT scanner.
306
00:12:44,895 --> 00:12:45,925
There was a German
307
00:12:45,925 --> 00:12:47,805
and Swiss group that looked
at the comm footprint of,
308
00:12:48,025 --> 00:12:50,245
of the energy of a, of a CT scan.
309
00:12:50,825 --> 00:12:53,925
And that was about, um, 0.3
kilograms of CO2 equivalent
310
00:12:54,185 --> 00:12:55,485
to try and give an idea for that.
311
00:12:55,485 --> 00:12:57,485
For an MR scan, that's about four
312
00:12:57,485 --> 00:12:58,685
and a half kilograms of CO2.
313
00:12:59,435 --> 00:13:02,935
So an MR scan is a lot
more than a CT scan.
314
00:13:03,715 --> 00:13:05,575
And for things like the
MR Enact that I work on,
315
00:13:06,165 --> 00:13:09,015
that is quite significantly
different, especially
316
00:13:09,015 --> 00:13:11,775
as we make three scans per, per fraction.
317
00:13:12,475 --> 00:13:14,615
Um, so that can multiply up
quite diff quite quickly.
318
00:13:15,075 --> 00:13:17,455
But to kind of give you an idea of
319
00:13:17,455 --> 00:13:20,575
that 4.6 kilograms is relatively
320
00:13:20,575 --> 00:13:21,815
low compared to quite a
lot of the other things.
321
00:13:22,035 --> 00:13:26,815
So they say that in order to
stay below 1.5 degrees, um,
322
00:13:26,815 --> 00:13:30,935
as a, as a planet, we all
get 1.6 tons per year to use.
323
00:13:31,475 --> 00:13:33,415
So compared to that, it's
kind of relatively small,
324
00:13:33,435 --> 00:13:35,455
but you wouldn't need
many of them to get there.
325
00:13:36,035 --> 00:13:39,735
And physicists working in
diagnostic radiotherapy, uh,
326
00:13:39,735 --> 00:13:41,935
diagnostic imaging tend
to travel quite a lot
327
00:13:42,055 --> 00:13:43,855
'cause they work in big sort of networks.
328
00:13:44,165 --> 00:13:48,215
That value I just told you
is for a CT scan alone,
329
00:13:48,795 --> 00:13:50,695
not part of the kinda the kind of the, um,
330
00:13:51,035 --> 00:13:52,295
the service this it's part of.
331
00:13:52,795 --> 00:13:55,495
So that's gonna be definitely
the lower end of it.
332
00:13:55,995 --> 00:13:57,295
- And I think also for the imaging,
333
00:13:57,295 --> 00:14:01,215
it's also about choosing, uh,
wisely, uh, how much you want
334
00:14:01,215 --> 00:14:04,135
to image and, uh, with,
uh, how many sequences
335
00:14:04,135 --> 00:14:07,215
because there is actually
also a lot to achieve just
336
00:14:07,275 --> 00:14:08,775
by thinking if it is necessary.
337
00:14:09,435 --> 00:14:12,135
And that goes of course also on the, um,
338
00:14:12,915 --> 00:14:16,215
on the arch archival of data
that we discussed, uh, earlier,
339
00:14:16,405 --> 00:14:18,255
that the more you, the more you do,
340
00:14:18,355 --> 00:14:20,615
the more the more you need to archive.
341
00:14:20,715 --> 00:14:24,015
So, uh, yeah, we should really
think, well when we choose,
342
00:14:24,115 --> 00:14:25,615
we do a lot of imaging today.
343
00:14:26,165 --> 00:14:29,475
- Yeah, we do. Yeah.
- In the UK the
344
00:14:30,075 --> 00:14:33,555
National Health Service
aims to be net zero by 2040.
345
00:14:34,135 --> 00:14:35,875
Rob, do you know what steps are in place
346
00:14:35,935 --> 00:14:38,035
or what, how they're
planning to achieve this?
347
00:14:38,665 --> 00:14:42,035
- Yeah, so like each, each
center, each kind of trust has
348
00:14:42,035 --> 00:14:45,515
to have a green plan that has
to be seen by the board of
349
00:14:46,035 --> 00:14:47,915
trustees or the kind of the
board that runs the center.
350
00:14:48,915 --> 00:14:51,885
So that means it's kind of
supposed to have board approval.
351
00:14:52,505 --> 00:14:54,365
And that is partly put in place
352
00:14:54,365 --> 00:14:57,405
because a couple of years ago
the NHS became the first place
353
00:14:57,785 --> 00:15:00,165
to have it as kind of legislation
354
00:15:00,515 --> 00:15:01,885
that each center has to do this.
355
00:15:02,225 --> 00:15:04,205
So it's kind of by law
that each center has
356
00:15:04,205 --> 00:15:07,365
to think about sustainability
in its ins day-to-day running.
357
00:15:08,195 --> 00:15:09,365
That can be pretty tricky
358
00:15:09,445 --> 00:15:12,955
because of course it's got huge
amount of things to balance.
359
00:15:13,535 --> 00:15:15,395
The NHS is kinda struggling money-wise.
360
00:15:15,615 --> 00:15:17,675
So it's not actually kind
of up there with most of
361
00:15:17,675 --> 00:15:19,115
what people think about every day.
362
00:15:19,895 --> 00:15:20,995
But it is now kind
363
00:15:20,995 --> 00:15:23,755
of legally enforced in a way
that we have to be doing this.
364
00:15:24,335 --> 00:15:25,555
It used to be net zero by 2040,
365
00:15:26,295 --> 00:15:31,075
but it's aiming to be
80% of that between 2028
366
00:15:31,095 --> 00:15:32,195
and 2032.
367
00:15:32,895 --> 00:15:34,435
So it's not far away from that.
368
00:15:34,585 --> 00:15:36,755
Like the early end of it,
it was only four years away.
369
00:15:37,475 --> 00:15:39,955
I don't know quite how
far we've got in the last,
370
00:15:40,235 --> 00:15:42,195
I think it was like 2020
there was, it was announced
371
00:15:42,195 --> 00:15:43,675
that it was gonna happen, but yeah,
372
00:15:43,675 --> 00:15:44,795
we've got a long way to go.
373
00:15:45,295 --> 00:15:46,595
Um, and although there, there have kind
374
00:15:46,595 --> 00:15:50,035
of the green HS NHS have
laid out what the plans are.
375
00:15:50,095 --> 00:15:53,395
So one of it is kind of trying
to reduce patient travel,
376
00:15:54,175 --> 00:15:58,835
so it's staff travel, um,
as aspir inhalers that,
377
00:15:58,865 --> 00:16:00,395
that I use, they've got
378
00:16:00,395 --> 00:16:01,435
quite a large carbon improvement as well.
379
00:16:01,435 --> 00:16:02,875
So it's kinda moving those from the gas
380
00:16:02,905 --> 00:16:04,555
ones, the powder ones.
381
00:16:04,945 --> 00:16:07,235
There's just the kind of
decarbonization of the grid
382
00:16:07,235 --> 00:16:08,675
that's generally happening as well.
383
00:16:08,805 --> 00:16:11,915
It'll benefit from, but
I think there's about 25%
384
00:16:11,915 --> 00:16:14,875
of it is still just down as
innovation, um, which is,
385
00:16:14,875 --> 00:16:16,115
which is pretty terrifying.
386
00:16:16,115 --> 00:16:17,755
So there's the kind of,
there's, it's a lot of
387
00:16:18,755 --> 00:16:20,955
pressure on people like
me and people in HS to try
388
00:16:20,955 --> 00:16:23,235
and work out what the next 25% is.
389
00:16:24,095 --> 00:16:26,595
Um, but yeah, and then also they're kind
390
00:16:26,595 --> 00:16:29,395
of working quite heavily
with manufacturers to try
391
00:16:29,395 --> 00:16:32,275
and make sure that procurement,
so procurement is about 6%
392
00:16:32,275 --> 00:16:34,155
of the carbon footprint of the NHS.
393
00:16:35,415 --> 00:16:38,515
If we can reduce the carbon
footprint of what manufacturers
394
00:16:38,535 --> 00:16:40,195
and drugs companies are doing, then
395
00:16:40,945 --> 00:16:42,995
that will reduce the carbon
footprint of the NHS as well.
396
00:16:43,155 --> 00:16:44,435
A a lot of work to do.
397
00:16:44,505 --> 00:16:45,995
They, they aim to be ambitious so
398
00:16:45,995 --> 00:16:47,195
that it can of force change.
399
00:16:47,655 --> 00:16:49,195
If you just do it in a
kind of a manageable way,
400
00:16:49,195 --> 00:16:50,355
then people just don't wanna ignore it.
401
00:16:50,495 --> 00:16:53,155
So yeah. And they aiming
to be like the first
402
00:16:54,155 --> 00:16:55,595
national health service to be net zero,
403
00:16:55,595 --> 00:16:57,675
which is, well, I think
that's still the case. Okay.
404
00:16:57,835 --> 00:16:59,515
- I mean,
- Do, that's carried about
405
00:16:59,515 --> 00:17:00,795
to tell me that that's
the, not the case of dur.
406
00:17:01,235 --> 00:17:03,235
- I was just gonna say this
- Ahead, .
407
00:17:04,015 --> 00:17:06,315
- Carrie, do you know if
there's similar proposals
408
00:17:06,315 --> 00:17:07,435
in place in Denmark?
409
00:17:07,665 --> 00:17:09,835
- Well, we, we have a
national law so that we,
410
00:17:09,935 --> 00:17:13,635
we need a national reduction
of, uh, 70% by 2030.
411
00:17:13,975 --> 00:17:17,835
And a similar, uh, aim has been
put on the healthcare system
412
00:17:17,945 --> 00:17:22,635
with a 67% reduction of
carbon footprint from 18, uh,
413
00:17:22,815 --> 00:17:24,035
to, uh, 2030.
414
00:17:24,495 --> 00:17:26,475
And I think the, the good, uh,
415
00:17:26,475 --> 00:17:29,275
thing about the Danish plan is
that this actually includes,
416
00:17:29,335 --> 00:17:30,835
uh, all goods and services.
417
00:17:30,895 --> 00:17:33,435
So there are many different
ways to, I mean, you can,
418
00:17:33,435 --> 00:17:35,435
you can put all kinds of
percentages and years,
419
00:17:35,495 --> 00:17:37,555
but you need also to define which
420
00:17:38,315 --> 00:17:39,515
entities you include in that.
421
00:17:39,975 --> 00:17:41,915
So that actually includes, uh, goods
422
00:17:41,915 --> 00:17:44,955
and services, which is the
major part of the footprint
423
00:17:44,975 --> 00:17:47,475
of the healthcare, um,
of the healthcare system.
424
00:17:48,175 --> 00:17:52,545
So aims are, aims are in place,
yeah, almost 70% reduction,
425
00:17:52,765 --> 00:17:54,345
uh, at 2030.
426
00:17:55,015 --> 00:17:58,905
What concerns me is that
this has not yet been, uh,
427
00:17:58,905 --> 00:18:01,345
there are not yet any requirements on the
428
00:18:01,345 --> 00:18:02,785
individual departments.
429
00:18:02,925 --> 00:18:07,185
So there is a lot of, uh,
top down, uh, thoughts of
430
00:18:07,395 --> 00:18:09,385
where we need to reduce
431
00:18:09,485 --> 00:18:10,945
and also initiatives
432
00:18:10,945 --> 00:18:14,345
that concerns the entire
hospital infrastructure,
433
00:18:14,885 --> 00:18:17,145
but for the individual departments to to,
434
00:18:17,165 --> 00:18:18,585
to look at their workflows
435
00:18:18,585 --> 00:18:20,145
and to look at their procurements.
436
00:18:20,165 --> 00:18:22,825
And, um, that is not at all in place yet.
437
00:18:22,925 --> 00:18:26,985
So, so that is a threat for me
to, uh, to get to these, uh,
438
00:18:27,035 --> 00:18:28,705
goals by, uh, 2030.
439
00:18:28,885 --> 00:18:31,425
And then we have a net zero goal by 2050.
440
00:18:31,685 --> 00:18:34,385
So, so that is how it looks,
uh, for us. And then what,
441
00:18:35,005 --> 00:18:37,625
- So it might just about be
- . Yes.
442
00:18:38,165 --> 00:18:38,905
- I'm not, not quite sure
443
00:18:38,905 --> 00:18:40,145
who's accurately measuring it for us.
444
00:18:40,175 --> 00:18:41,905
Very, but still, yeah.
445
00:18:42,325 --> 00:18:43,785
- So I mean, another thing
446
00:18:43,785 --> 00:18:47,505
to think about is the
environmental impact of going
447
00:18:47,505 --> 00:18:49,025
to international conferences.
448
00:18:49,645 --> 00:18:51,265
So what are your thoughts on this?
449
00:18:51,365 --> 00:18:53,705
Should we switch to an all online approach
450
00:18:54,045 --> 00:18:56,985
or are there other ways to
reduce the carbon footprint
451
00:18:57,085 --> 00:18:59,305
of attending these very
important conferences?
452
00:19:00,215 --> 00:19:01,425
- It's controversial ,
453
00:19:01,925 --> 00:19:04,185
- Why It is really, this
is very, very difficult.
454
00:19:04,405 --> 00:19:06,225
Um, it's really difficult
455
00:19:06,225 --> 00:19:09,985
because this is also our
way to, uh, to develop our,
456
00:19:10,205 --> 00:19:12,025
our healthcare, high quality healthcare.
457
00:19:12,685 --> 00:19:16,865
So I think to, to answer
that question, uh, uh,
458
00:19:16,885 --> 00:19:20,345
in a good way, you, you need
to understand where does this,
459
00:19:20,525 --> 00:19:23,265
uh, carbon footprint, uh, come from.
460
00:19:23,485 --> 00:19:27,185
So, so what belongs to the
European, uh, traveling,
461
00:19:27,185 --> 00:19:29,625
what belongs to the
intercontinental traveling
462
00:19:29,685 --> 00:19:33,545
and, uh, what are actually
our options to do something
463
00:19:33,545 --> 00:19:36,825
that allows us to keep
value as well as possible,
464
00:19:37,245 --> 00:19:41,105
but also to, um, uh, to
understand how we can, um,
465
00:19:41,485 --> 00:19:42,985
reduce our carbon footprint.
466
00:19:43,825 --> 00:19:47,885
So, so to, to reduce European,
uh, traveling, the location
467
00:19:47,905 --> 00:19:50,645
of venue is very important
for facilitating, uh,
468
00:19:50,645 --> 00:19:52,685
train transport because
that is actually a way
469
00:19:52,705 --> 00:19:56,725
to have a low carbon footprint
while allowing for our, uh,
470
00:19:57,265 --> 00:20:00,765
for our collaboration
and for our networking.
471
00:20:01,425 --> 00:20:03,925
And also I think it's really
important to understand
472
00:20:03,925 --> 00:20:05,165
that 70%
473
00:20:05,165 --> 00:20:07,765
of the carbon footprint is
actually coming from the
474
00:20:07,765 --> 00:20:09,165
intercontinental traveling.
475
00:20:09,705 --> 00:20:13,125
So even if it is a
minority of our attendee
476
00:20:13,125 --> 00:20:15,565
that are coming from out of Europe,
477
00:20:15,955 --> 00:20:19,005
they are actually carrying
the largest carbon footprint.
478
00:20:19,065 --> 00:20:21,725
So maybe this is where we
should start focusing on.
479
00:20:22,185 --> 00:20:25,485
And then solutions are
stuff like digital access,
480
00:20:25,485 --> 00:20:27,125
which is indeed very important
481
00:20:27,125 --> 00:20:31,045
because if we can then
limit, uh, that contribution,
482
00:20:31,045 --> 00:20:34,765
but also solution like,
uh, conference hubs to go
483
00:20:34,865 --> 00:20:36,765
to the different regions, uh,
484
00:20:36,835 --> 00:20:39,365
with scientific dissemination can possibly
485
00:20:39,935 --> 00:20:41,765
limit the interest in traveling.
486
00:20:42,565 --> 00:20:44,645
- I think, again, we can
probably put like a number on it.
487
00:20:44,725 --> 00:20:46,485
I think there's a general kind of average
488
00:20:47,435 --> 00:20:51,045
that per participant, it's
about a ton of calm, calm,
489
00:20:51,045 --> 00:20:53,765
dark side equivalent that
you do per conference.
490
00:20:54,675 --> 00:20:57,815
So if you kind of remember
back to the 1.6 tons equivalent
491
00:20:57,815 --> 00:21:01,615
that we have each per year,
you've used up most of your,
492
00:21:01,885 --> 00:21:03,735
your kind of calm for a year
493
00:21:04,275 --> 00:21:05,615
on just going to one conference.
494
00:21:06,515 --> 00:21:09,095
So it just shows how big impact they are
495
00:21:09,675 --> 00:21:11,735
and how important it's to try
496
00:21:11,735 --> 00:21:13,095
and reduce that carbon footprint.
497
00:21:13,845 --> 00:21:16,855
- Yeah, I know for the, the
forthcoming ESTRO meeting,
498
00:21:16,905 --> 00:21:20,415
which is, um, in Glasgow,
so ESTRO is really trying
499
00:21:20,415 --> 00:21:22,975
to encourage people if they
can, to travel by train,
500
00:21:24,035 --> 00:21:25,775
you know, I mean, there's,
there's not huge amount.
501
00:21:25,775 --> 00:21:27,095
It depends where you're
coming from, but you know,
502
00:21:27,095 --> 00:21:28,935
they're sort of trying to encourage that.
503
00:21:29,235 --> 00:21:30,935
- And it, it is tricky 'cause um, me
504
00:21:30,935 --> 00:21:33,335
and Carrie went to, um, estro last year.
505
00:21:33,335 --> 00:21:34,455
It was in Vienna by train.
506
00:21:35,435 --> 00:21:38,055
Um, but that was like a
night train from Brussels
507
00:21:38,475 --> 00:21:40,335
and it was, it was like, it was expensive.
508
00:21:40,955 --> 00:21:43,935
It takes longer than it were to fly.
509
00:21:43,995 --> 00:21:46,175
So your department has
to approve the cost of it
510
00:21:46,315 --> 00:21:47,655
and extra time.
511
00:21:48,085 --> 00:21:49,815
There's also the capacity, there's like,
512
00:21:49,815 --> 00:21:51,975
there's not like infinite
number of, of trains running.
513
00:21:52,275 --> 00:21:53,335
In fact, there's not that many,
514
00:21:53,665 --> 00:21:55,015
especially compared to planes.
515
00:21:55,015 --> 00:21:56,135
They can, they can get and go back
516
00:21:56,135 --> 00:21:57,135
and forth quite a line a day.
517
00:21:57,475 --> 00:21:58,815
So capacity's also a problem
518
00:21:58,815 --> 00:22:00,535
because someone else tried
519
00:22:00,535 --> 00:22:01,975
to book on the same ni train mirror
520
00:22:01,975 --> 00:22:03,095
on and they couldn't get on.
521
00:22:03,095 --> 00:22:06,255
It was completely fully booked.
So it's so that the kind
522
00:22:06,255 --> 00:22:08,695
of train travel is, is nice,
523
00:22:08,915 --> 00:22:10,575
but I don't think it's
gonna solve this problem.
524
00:22:10,675 --> 00:22:12,215
It can redu only reduce it so far.
525
00:22:12,525 --> 00:22:15,375
Like Carrie said, if
everyone went by train and,
526
00:22:15,675 --> 00:22:17,815
and if everyone in Europe
kind of didn't travel at all,
527
00:22:18,315 --> 00:22:20,495
it was still only reduce like 20, 25%
528
00:22:20,495 --> 00:22:22,295
of the carbon footprint of vettra
529
00:22:22,295 --> 00:22:24,335
because most of the time
it's people flying from a,
530
00:22:24,525 --> 00:22:25,775
from, you know, internationally.
531
00:22:25,995 --> 00:22:29,575
That's the problem. Um,
so it's, it, it, I kind
532
00:22:29,575 --> 00:22:31,335
of really think that like online
533
00:22:31,875 --> 00:22:35,055
is the best approach really,
sadly, that then that means
534
00:22:35,055 --> 00:22:38,135
that kind of, yeah, networking
is reduced the kind of the,
535
00:22:38,195 --> 00:22:39,455
the man the kinda
536
00:22:40,015 --> 00:22:42,455
industry is then less engaged
in it and less keen on it.
537
00:22:42,715 --> 00:22:45,335
So it's, it's a really, it's
an unsolved problem at the
538
00:22:45,335 --> 00:22:47,895
moment, but I think it's
one that, yeah, he's,
539
00:22:47,895 --> 00:22:50,015
it's a really difficult
thing to balance quite a lot,
540
00:22:50,025 --> 00:22:51,495
quite a lot of societies kind of
541
00:22:52,075 --> 00:22:54,775
the funding comes at
least partly from holding
542
00:22:54,775 --> 00:22:55,975
that conference and the kind
543
00:22:55,975 --> 00:22:57,255
of industry involvement as well.
544
00:22:57,795 --> 00:22:59,415
So it is, it's really tricky.
545
00:22:59,755 --> 00:23:03,335
Um, but I think that's
where the, the awareness of
546
00:23:04,205 --> 00:23:06,785
the effect of climate change
is gonna have on everyone
547
00:23:07,565 --> 00:23:09,265
and on our patients, on our,
548
00:23:09,265 --> 00:23:11,865
on our kinda hospitals
is, is so important. What
549
00:23:11,865 --> 00:23:13,985
- About professional societies?
550
00:23:14,205 --> 00:23:18,065
Is is there a role for, um,
for them to help contribute
551
00:23:18,065 --> 00:23:21,105
to minimizing the environmental
impact to medical physics?
552
00:23:22,185 --> 00:23:22,905
- Absolutely. ,
553
00:23:23,495 --> 00:23:24,985
there's a role, there's
a role of everyone.
554
00:23:25,245 --> 00:23:29,785
So the kind of, um, start
groups, so in IFM, we started the
555
00:23:29,785 --> 00:23:32,625
around sustainability group
back in February, 2020
556
00:23:32,645 --> 00:23:33,745
before the world went crazy.
557
00:23:33,935 --> 00:23:35,385
That is a very good way of kind
558
00:23:35,385 --> 00:23:37,185
of getting like many people together to,
559
00:23:37,455 --> 00:23:38,785
because you can feel quite lonely
560
00:23:38,925 --> 00:23:40,585
and there's not that many
people doing this stuff.
561
00:23:41,055 --> 00:23:43,025
Whereas if you could form a group,
562
00:23:43,125 --> 00:23:45,570
you can make sure there's other,
you know, know, kind of try
563
00:23:45,570 --> 00:23:47,205
and bounce ideas off other, other people.
564
00:23:47,615 --> 00:23:49,165
We've now got an IPM group,
565
00:23:49,165 --> 00:23:50,245
so it's basically the physicists.
566
00:23:50,815 --> 00:23:52,685
We've got the RCR,
which are the conditions
567
00:23:52,745 --> 00:23:54,805
and the siting college
radiographers, which is the kind
568
00:23:54,805 --> 00:23:56,565
of the staff on the, the
radiographers, the staff,
569
00:23:56,565 --> 00:23:58,885
the Linux themselves working together on
570
00:23:58,885 --> 00:23:59,965
sustainability group as well.
571
00:24:00,665 --> 00:24:01,685
So you can really start kind
572
00:24:01,685 --> 00:24:04,245
of trying Tora raise awareness
within the different,
573
00:24:04,435 --> 00:24:05,885
different, uh, disciplines.
574
00:24:06,585 --> 00:24:09,925
You can also then start,
um, asking the, um,
575
00:24:10,625 --> 00:24:12,925
the different societies and
different institutes to try
576
00:24:12,925 --> 00:24:14,525
and think about what they can do.
577
00:24:15,255 --> 00:24:18,685
Start putting it into, um, curricular so
578
00:24:18,685 --> 00:24:20,485
that people get the kinda
students get taught it as well.
579
00:24:21,075 --> 00:24:23,285
Funding for research is important as well.
580
00:24:23,545 --> 00:24:25,765
So whereas we've just highlighted there's,
581
00:24:25,765 --> 00:24:27,565
there's quite a large amount
582
00:24:27,565 --> 00:24:28,845
of work that still needs to be done.
583
00:24:29,465 --> 00:24:31,965
If funding bodies can really
put their weight behind
584
00:24:31,965 --> 00:24:33,045
that, that makes a big difference.
585
00:24:33,505 --> 00:24:35,765
And it also shows that
they're taking it seriously
586
00:24:35,765 --> 00:24:37,245
and if funding bodies
start taking it seriously,
587
00:24:37,575 --> 00:24:39,085
other people take it
more seriously as well.
588
00:24:39,825 --> 00:24:42,725
And there's kind of another
thing we're trying to do as part
589
00:24:42,725 --> 00:24:44,045
of that, like why the group is
590
00:24:44,045 --> 00:24:47,485
to start accrediting radiotherapy
centers is, is kind of
591
00:24:47,485 --> 00:24:49,605
where we start because I'm
a radiotherapy physicist,
592
00:24:49,605 --> 00:24:51,285
so it's kind of where I can like look at,
593
00:24:52,025 --> 00:24:53,965
so we can start kinda
giving this bronze, silver,
594
00:24:53,985 --> 00:24:58,005
and gold award in sense saying
this department is this level
595
00:24:58,145 --> 00:25:00,965
of sustainable, it's
still in like progress,
596
00:25:01,025 --> 00:25:03,485
but that's kind of
something that we can do.
597
00:25:03,545 --> 00:25:07,565
And the, the different, um,
professional societies can kind
598
00:25:07,565 --> 00:25:09,645
of help badge that and help
kind of promote that as well.
599
00:25:10,165 --> 00:25:13,085
- IEM, which is the Institute of Physics
600
00:25:13,185 --> 00:25:16,005
and Engineering in Medicine,
um, based in the uk.
601
00:25:16,265 --> 00:25:18,965
So obviously, um, as you
say, they, they've, um,
602
00:25:19,335 --> 00:25:22,005
given you some funding for
research and and so on.
603
00:25:22,065 --> 00:25:23,805
So, um, Carrie, uh,
604
00:25:23,805 --> 00:25:26,365
are you involved in any
similar societies in Europe?
605
00:25:26,795 --> 00:25:30,525
- Yeah, so I'm, I'm involved
in the astro uh, green,
606
00:25:30,825 --> 00:25:31,885
uh, green efforts.
607
00:25:31,985 --> 00:25:36,125
Uh, so, so the society actually
wants it as well, recognizes
608
00:25:36,925 --> 00:25:40,165
recognizing that the, the
impact of the climate, uh,
609
00:25:40,165 --> 00:25:42,965
crisis is something that
everyone needs to care about.
610
00:25:43,105 --> 00:25:45,805
And, uh, we also know
that our colleagues, uh,
611
00:25:46,075 --> 00:25:47,605
care, uh, care about it.
612
00:25:47,705 --> 00:25:52,255
So ESTRO is now developing a
green, uh, policy that, uh,
613
00:25:52,255 --> 00:25:55,535
that has, uh, some key
elements where one of them is
614
00:25:55,595 --> 00:25:58,695
to facilitate that we
can learn from each other
615
00:25:58,835 --> 00:26:00,895
and, uh, facilitate, uh, research.
616
00:26:01,685 --> 00:26:04,185
And I think the, the awareness that, uh,
617
00:26:04,535 --> 00:26:06,905
that the professional space
is actually a great way
618
00:26:06,965 --> 00:26:10,145
to seek impact on carbon
emissions is something that we can
619
00:26:10,675 --> 00:26:14,785
teach our colleagues because
so many of us who are concerned
620
00:26:14,785 --> 00:26:17,065
and there is nothing worse than not being
621
00:26:17,215 --> 00:26:18,425
able to do anything.
622
00:26:19,605 --> 00:26:21,025
And if we think about it,
623
00:26:21,285 --> 00:26:24,265
and so these numbers are
very, uh, still uncertain,
624
00:26:24,325 --> 00:26:27,305
but if on average the
emission per radiotherapy is
625
00:26:27,305 --> 00:26:30,505
around 500 kilo of, uh, carbon equivalence
626
00:26:31,125 --> 00:26:33,985
in our department, we
treat 5,000 patients per
627
00:26:33,985 --> 00:26:35,105
year with radiotherapy.
628
00:26:35,605 --> 00:26:38,065
So it means that our
department is spending maybe
629
00:26:38,205 --> 00:26:40,185
2,500 hun per year.
630
00:26:40,765 --> 00:26:43,845
And if I compare that with
my personal car footprint
631
00:26:43,865 --> 00:26:46,405
of maybe five ton carbon equivalents, it,
632
00:26:46,985 --> 00:26:48,795
it's just a nice way to think that
633
00:26:48,795 --> 00:26:50,475
through my pro professional space,
634
00:26:50,595 --> 00:26:52,995
I can actually have
way more impact than in
635
00:26:53,015 --> 00:26:54,235
my personal space.
636
00:26:55,035 --> 00:26:58,215
And we need to do the
right things, uh, um,
637
00:26:58,245 --> 00:27:02,415
because if you just start,
uh, doing random, uh, stuff
638
00:27:02,415 --> 00:27:04,335
that we believe ourselves is important,
639
00:27:04,435 --> 00:27:06,215
we are not going to have effect.
640
00:27:06,795 --> 00:27:10,495
So we need to teach, um, we
need to teach our colleagues,
641
00:27:10,595 --> 00:27:12,335
uh, how to have the biggest,
642
00:27:12,615 --> 00:27:15,215
I impact in the most efficient ways.
643
00:27:15,395 --> 00:27:18,255
And, uh, I think our societies are, um,
644
00:27:18,365 --> 00:27:21,095
they are getting on board
that this is just as, uh,
645
00:27:21,095 --> 00:27:23,615
important as, uh, health
economics for instance.
646
00:27:23,675 --> 00:27:27,865
So this is, uh, environmental,
uh, the equivalent, uh,
647
00:27:28,045 --> 00:27:29,905
in environmental sustainability.
648
00:27:30,175 --> 00:27:32,665
- There's, there's a
small irony as well, some
649
00:27:32,665 --> 00:27:34,345
of the best places to
disseminate this work
650
00:27:34,365 --> 00:27:37,425
and this, this kind of, this
educate people is actually the
651
00:27:37,425 --> 00:27:39,185
conferences that are such
a big problem as well.
652
00:27:39,725 --> 00:27:42,185
Um, so I dunno quite how you solve that.
653
00:27:42,185 --> 00:27:44,065
But that , again,
I keep saying that a lot,
654
00:27:44,405 --> 00:27:45,825
but that's one of the
ironies of it as well.
655
00:27:46,895 --> 00:27:50,025
- Okay. So finally, what do you see
656
00:27:50,025 --> 00:27:51,545
as the most immediate risk
657
00:27:51,605 --> 00:27:54,585
to medical physics provision
from climate change?
658
00:27:55,305 --> 00:27:57,625
- I think I'd have said extreme weather,
659
00:27:58,055 --> 00:28:00,865
because there's already been
a case somewhere in London.
660
00:28:01,005 --> 00:28:02,145
One of the hospitals was over the,
661
00:28:02,145 --> 00:28:04,625
over like two summers ago it got so hot
662
00:28:04,625 --> 00:28:06,705
that their computer
servers just shut down.
663
00:28:07,595 --> 00:28:10,415
Um, and it meant there
were kind of, you know,
664
00:28:10,415 --> 00:28:12,135
back decades running
around with patient notes
665
00:28:12,195 --> 00:28:13,575
and everything was on paper
666
00:28:14,435 --> 00:28:16,415
and that was that, that's a big risk
667
00:28:16,675 --> 00:28:19,135
and extreme weather can bring
flooding as well, so that's
668
00:28:19,135 --> 00:28:22,455
where, that's flooding to
a linac or an MS scanner
669
00:28:22,595 --> 00:28:25,095
or again, to computers, that's your,
670
00:28:25,095 --> 00:28:26,495
that's a kinda a big risk.
671
00:28:27,075 --> 00:28:29,615
And there's also like
with just, um, you know,
672
00:28:29,615 --> 00:28:32,415
so there's a big snow snowstorm
or really big flooding
673
00:28:32,595 --> 00:28:35,335
or big storm and people can't get to work
674
00:28:35,395 --> 00:28:37,935
or can't get for treatment,
that is also quite a big risk.
675
00:28:37,935 --> 00:28:39,535
And I'd say that's probably
the most immediate ones
676
00:28:39,535 --> 00:28:40,615
we're gonna gonna face.
677
00:28:41,075 --> 00:28:44,855
- And I think the relevance
to radiotherapy is also, uh,
678
00:28:44,985 --> 00:28:46,375
particular because we are
679
00:28:46,375 --> 00:28:48,455
so dependent on our
fractionated treatments
680
00:28:48,475 --> 00:28:51,015
and patients staying on schedule, we are
681
00:28:51,275 --> 00:28:53,735
so dependent on not, uh, becoming delayed
682
00:28:53,735 --> 00:28:55,415
with cancer treatment altogether.
683
00:28:55,515 --> 00:28:58,525
So we are, we are part
of the healthcare system
684
00:28:58,525 --> 00:29:01,925
that is actually, uh, more
vulnerable to these, uh,
685
00:29:02,185 --> 00:29:04,885
to delays and, uh,
interruptions in our treatment
686
00:29:04,885 --> 00:29:08,045
because this is going on
for, uh, for one month
687
00:29:08,185 --> 00:29:11,645
and, uh, any delay will
have, uh, clinical impact
688
00:29:12,185 --> 00:29:13,325
- And that, that might be, again,
689
00:29:13,325 --> 00:29:15,685
where hyper vaccination is, is benefit
690
00:29:15,685 --> 00:29:17,365
because it's more robust to that probably.
691
00:29:18,065 --> 00:29:20,125
Um, because you're less
likely if you're already being
692
00:29:20,125 --> 00:29:21,245
treated for like a week
693
00:29:21,245 --> 00:29:23,525
or two, you, it's probably less likely
694
00:29:23,525 --> 00:29:25,285
to have an interruption
due to extreme weather.
695
00:29:25,865 --> 00:29:27,325
But yeah, who knows . Yeah.
696
00:29:28,035 --> 00:29:30,525
- Okay. So yes, there's
a lot of work to do,
697
00:29:30,705 --> 00:29:32,885
but it sounds like the, you know, it,
698
00:29:32,915 --> 00:29:36,045
it's in progress, it's
being worked on. So Yeah,
699
00:29:36,045 --> 00:29:37,685
- And I feel like we should
probably end on a bit
700
00:29:37,685 --> 00:29:39,965
of a positive note as well
because it's been quite negative
701
00:29:41,265 --> 00:29:44,005
and I kind of, the last
few year I've been kind
702
00:29:44,005 --> 00:29:45,085
of working on this stuff for a while
703
00:29:45,085 --> 00:29:46,125
and talking about this stuff for a while
704
00:29:46,185 --> 00:29:47,925
and it's, it's gonna been getting nowhere
705
00:29:48,595 --> 00:29:50,285
over the last couple of years.
706
00:29:50,305 --> 00:29:51,725
The door's definitely starting
707
00:29:51,725 --> 00:29:53,525
to get kind of more and more open.
708
00:29:54,195 --> 00:29:55,685
Like I don't think we've
been having a kind of a,
709
00:29:56,005 --> 00:29:57,285
a podcast about climate change
710
00:29:57,945 --> 00:30:01,285
in healthcare a couple five
years ago, but now we are.
711
00:30:01,625 --> 00:30:02,885
And it's getting more and more,
712
00:30:03,285 --> 00:30:04,285
everyone's getting more aware of
713
00:30:04,285 --> 00:30:05,325
it and more concerned about it.
714
00:30:05,425 --> 00:30:07,685
So it is, it is becoming into getting
715
00:30:07,685 --> 00:30:08,925
into people's minds more and more.
716
00:30:08,945 --> 00:30:11,085
We need to be everyone to
be thinking about it really.
717
00:30:11,625 --> 00:30:13,685
But it is, it's, that's a
positive for me at least.
718
00:30:13,745 --> 00:30:15,845
It feels like there is
some change happening,
719
00:30:16,355 --> 00:30:17,525
even if it should have been 10 years ago.
720
00:30:18,005 --> 00:30:20,965
I can appreciate. Hey, well thank you both
721
00:30:21,065 --> 00:30:22,325
for your time today.
722
00:30:22,585 --> 00:30:24,965
Thanks for speaking with us.
Thank you for inviting us.
723
00:30:24,985 --> 00:30:26,445
It was a pleasure. Thanks for inviting.
724
00:30:33,435 --> 00:30:34,645
- That was Rob Shooter
725
00:30:34,785 --> 00:30:38,605
and Carrie Tander up in
conversation with Tammy Freeman.
726
00:30:39,105 --> 00:30:42,005
You can find the journal
Physics in Medicine
727
00:30:42,105 --> 00:30:45,765
and Biology on the IOP science website.
728
00:30:46,545 --> 00:30:48,285
I'm afraid that's all the time we have
729
00:30:48,285 --> 00:30:51,525
for this week's podcast, which
was produced in partnership
730
00:30:51,525 --> 00:30:54,605
with IPEM, the Institute of Physics
731
00:30:55,145 --> 00:30:56,925
and Engineering in Medicine.
732
00:30:57,385 --> 00:30:59,245
Thanks to Rob, Carrie,
733
00:30:59,425 --> 00:31:02,165
and Tammy for a fascinating discussion.
734
00:31:02,705 --> 00:31:06,005
And a special thanks to
our producer Callum gel.
735
00:31:06,735 --> 00:31:08,245
We'll be back again next week,
736
00:31:08,465 --> 00:31:11,485
but in the meantime, do
check out the latest episode
737
00:31:11,665 --> 00:31:14,125
of the Physics World Stories podcast
738
00:31:14,915 --> 00:31:18,525
host Andrew Gluster is in
conversation with a composer,
739
00:31:18,945 --> 00:31:23,765
Amanda Lee Falkenberg,
who's the moon's Symphony,
740
00:31:23,975 --> 00:31:27,485
takes listeners on an epic
journey through the science
741
00:31:27,625 --> 00:31:30,685
and stories of the moons
of the solar system.
742
00:31:31,465 --> 00:31:34,405
The podcast includes
music from the symphony,
743
00:31:34,625 --> 00:31:37,565
and you can find it on
the physics world website
744
00:31:38,025 --> 00:31:40,885
or at your favorite podcast provider.
745
00:31:41,515 --> 00:31:44,525
Just look for the headline,
an orchestral trip
746
00:31:44,675 --> 00:31:47,165
through the moons of our solar system,
747
00:31:53,615 --> 00:31:54,745
physics world.
