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Hello, and welcome to the Physics World Weekly
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podcast, which is supported by Research
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Laboratories.
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I'm Hamish Johnston.
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Our theme this week is diagnosing and treating
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disease. How physicists
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keep you safe during health care procedures.
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This episode was created in collaboration with IPEM,
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the Institute
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of Physics and Engineering
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in Medicine,
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which owns the journal
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Physics in Medicine and Biology.
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Our guests are 2 medical physicists
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working at the heart of the UK's
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National Health Service
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or NHS.
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They are Mark Knight, who is chief health
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care scientist
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at the NHS Kent and Medway
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Integrated Care Board,
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and Fiammetta
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Fidele,
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who is head of non ionizing
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radiation
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at Geis and St. Thomas
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NHS Foundation Trust in London.
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They're in conversation with Physics World's Tammy Freeman,
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and that's coming up after this message from
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Research
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Laboratories.
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This podcast is supported by RaySearch Laboratories,
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which unifies industry solutions,
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empowering healthcare providers to deliver precise and effective
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radiotherapy
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treatment.
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RaySearch's
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AI driven solutions
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reshape cancer care by accelerating
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workflows,
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delivering consistent
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and reliable results, with less manual work.
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RayStation is a treatment planning system that brings
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tranquility
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to treatment planning.
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No more bouncing between different treatment machines,
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techniques and modalities.
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RayStation
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is a comprehensive software.
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RayCare is an oncology
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information system and a trusted ally.
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It automates and streamlines
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adaptive oncology
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workflows
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while securely
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guiding users through the entire
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patient treatment journey.
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Ray Intelligence
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empowers
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confident decision making
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by unifying clinical data into actionable insights.
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This cloud based oncology
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data analytics system
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offers a clear view of clinical
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operations.
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Raysearch products transform
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scattered technologies
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into clarity,
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elevating the radiotherapy
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industry.
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Many of the health care procedures routinely delivered
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in hospitals rely on the work of medical
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physicists.
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Medical physicists are responsible for developing and commissioning
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advanced diagnostic and treatment systems.
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They design radiotherapy plans that accurately target tumors,
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make sure that the hospital's imaging equipment is
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operating as expected, and much more.
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But one of their most important tasks is
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to ensure the safety of all these procedures
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for the patient as well as the health
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care staff.
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To discuss how physicists keep you safe during
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health care procedures,
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I'm joined today by Mark Knight,
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chief health care scientist at NHS Kent and
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Medway ICB,
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and Fiammetta Fidele,
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head of non ionizing radiation at Guy's and
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Saint Thomas NHS Foundation Trust.
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Welcome both to the podcast.
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Hello, Tammy.
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Hello.
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So looking at the safety of medical treatments,
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one of the first things that comes to
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mind is radiotherapy.
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So this involves firing beams of ionizing radiation
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at the patient to destroy cancer cells.
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So how do the medical physicists ensure that
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these treatments are safe?
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For example, that the patient doesn't receive too
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much radiation
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and that the radiation only hits the tumor
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and doesn't damage healthy parts of the body.
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Thank you, Tammy. So I thought the best
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way to look at this was to take
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a step by step approach through the radiotherapy
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process.
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So we start with a scan, which will
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show us precisely where the tumour is in
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the patient and what shape it is.
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And in the modern world, we might, use
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a hybrid imaging technique to do this. So
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a a CT scan perhaps which tells you
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where the anatomy is combined with a with
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a PET scan or an MRI scan, which
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might tell you more about the dynamics of
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the the tumor,
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physiology.
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So the the next stage is that a
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clinician will outline the tumor,
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to show us exactly where,
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that is on the visual image, and then
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they'll extend
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the size of those margins a bit to
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take account of microscopic
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disease,
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and uncertainties in the location of the tumor
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that that would come about through all sorts
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of,
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things during the treatment process. So the patient's
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bladder might be more full on one day,
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which could affect the position of the prostate,
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for example, in a prostate treatment.
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And the next stage then is to take
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a computerized treatment planning system,
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to plan a bespoke
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radiation treatment for every single patient. So based
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on that scan,
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the delineation of the tumor
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volume, we would then use a series of
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radiation beams to mathematically
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model,
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in a treatment planning system,
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a radiation dose to that tumor. And and
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the aim here then is to deliver the
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prescribed radiation dose, which comes from our clinician.
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We we want to deliver this much radiation
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to exactly that shape, and size of tumor,
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to,
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and whilst minimizing the organs,
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at risk,
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radiation exposure. So for example, we know that
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the bowel,
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the spinal cord, for example, are much more
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sensitive to radiation
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than other organs, and so we would need
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to ensure that, the dose is is minimized.
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So on a on a conventional
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radiotherapy treatment, we would use then a linear
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accelerator or LINAC to deliver those radiation treatments
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to the tumor.
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And we've got lots of technologies available. So
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for example,
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tiny,
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lead sheets, which are very
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thick but very narrow, which can be used
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to shape the radiation dose
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coming out of the machine.
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We can change the intensity
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of the radiation,
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and we can move the linear acceleration around
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the patient while we deliver
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the treatment. And all of that combines to
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give us a very precise delivery
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of radiation exposure to the tumor volume that
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we've decided we need to treat from our
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scans.
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Okay. Great. So that's, I mean, that's a
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super example of sort of physics based techniques
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for, as you say, shaping the radiation and
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planning where it needs to go exactly.
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Now x rays are also used for diagnosing
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medical conditions, and this includes
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conventional x-ray scans,
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CT images,
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mammography.
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Now here, the aim is very much not
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to destroy any tissue, but to create images.
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What are the potential risks of x-ray imaging,
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and and how are these addressed?
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So firstly, it's important to say that the
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risk to individuals
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from imaging with x rays are relatively small,
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and it's important to keep those risks in
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context.
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So for example, we expose ourselves to risk
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in everyday life through our day to day
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activities such as traveling in a car and,
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eating and drinking in excess of foods that
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that may be bad for us.
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And they they have risk to human health
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as well, but we tend to not worry
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about those so much as radiation risks,
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because that's a bit of an unknown thing.
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We we must remember as well that we're
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exposed to background radiation
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all the time,
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which comes from the outside the Earth's atmosphere
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and also in the food we eat and
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the air we breathe. So humans have evolved
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in an environment where we protect ourselves very
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well against dionising radiation exposure.
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A chest x-ray, for example, gives us the
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same radiation exposure as a few days of
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background radiation.
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So the key to protection of patients,
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is that each,
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medical imaging procedure is justified
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by an expert in medical imaging, and it
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would only go ahead if the benefit to
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the patient outweighs the risk from undertaking that
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exposure, and that is a legal requirement.
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Medical physics professionals
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are closely involved
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with the quality assurance of X-ray imaging equipment.
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And during this process,
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they'll review radiation dose, image quality,
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and check that all of the radiation dose
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saving devices for the patient are being used
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in an optimal manner. And this process then
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of balancing
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the reduction of radiation exposure,
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with the,
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best image quality
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is known as optimization.
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Optimization is a huge part of our daily
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work in medical physics. I should have said
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before, of course, that it's exactly the same
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in radiotherapy.
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Our our physicists are closely involved with all
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of the processes around inner accelerators,
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the treatment planning processes,
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and the scanning processes that go into delivering
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that safe therapy.
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And finally, we would reduce
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risk further by ensuring that all of the
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professionals connected
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with each imaging procedure
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are trained,
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and they follow best practice guidelines. So that
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would include our medical physics professionals who carry
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out that quality assurance and optimisation
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process,
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on the x-ray equipment itself.
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Okay. And and there's lots of other techniques
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used for diagnostic imaging,
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For example, ultrasound, which uses high frequency sound
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waves to create images inside the body.
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Now
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if this technique just uses sound waves, are
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there any safety concerns here? Fia, perhaps you
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could answer this question?
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Yes. Hi, Tommy. Good question. Yes. Ultrasound
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still produces some effects in the body. It
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produces some heat and can interact with gases
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in the body, like, for example, the air
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in the lungs.
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But sonographers in UK
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are trained to keep scanning times and as
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well the level of the sound waves that
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they use well below the levels that could
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produce any of these effects. And so it's
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perfectly safe to use. And the role of
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the medical physicist is that to make sure
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the scanners
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are working as they say they're supposed to
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work from manufacturers so that they can, keep
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those levels within the limits sonographers
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know.
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Okay. And you also work with a treatment
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technique called phototherapy,
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and this uses UV light to treat skin
284
00:11:22,559 --> 00:11:23,059
conditions.
285
00:11:23,759 --> 00:11:25,539
So how do you make sure that patients
286
00:11:25,600 --> 00:11:28,134
receive the correct dose to treat them and
287
00:11:28,134 --> 00:11:29,274
not to cause harm?
288
00:11:30,215 --> 00:11:32,715
Yeah. So phototherapy carbines are a bit like
289
00:11:33,095 --> 00:11:33,595
huge,
290
00:11:34,455 --> 00:11:35,674
UV ton inverts.
291
00:11:36,295 --> 00:11:36,795
And
292
00:11:37,654 --> 00:11:39,910
the point is that in that case, the
293
00:11:39,910 --> 00:11:42,149
UV is being given to the patients for,
294
00:11:43,110 --> 00:11:45,110
for treatment. But they need to have a
295
00:11:45,110 --> 00:11:46,169
precise dose.
296
00:11:46,470 --> 00:11:48,570
And what we do, we use light meters
297
00:11:48,790 --> 00:11:50,649
to check the output of the cabins.
298
00:11:51,029 --> 00:11:53,684
And then we can reassure the nurses, the
299
00:11:53,684 --> 00:11:56,485
specialist nurses that usually deliver this treatment. So
300
00:11:56,485 --> 00:11:58,325
what is the output of those units so
301
00:11:58,325 --> 00:12:00,264
that they can make sure that they
302
00:12:00,725 --> 00:12:02,725
register the dose, they track the dose, and
303
00:12:02,725 --> 00:12:04,565
so they know when it's time to complete
304
00:12:04,565 --> 00:12:06,424
the course of treatment for the patient?
305
00:12:08,009 --> 00:12:09,690
Okay. So it sounds like in a lot
306
00:12:09,690 --> 00:12:10,169
of these,
307
00:12:11,289 --> 00:12:13,690
techniques that the medical physicist, one of their
308
00:12:13,690 --> 00:12:16,029
big jobs is making sure that the equipment
309
00:12:16,169 --> 00:12:17,709
is working safely.
310
00:12:18,889 --> 00:12:21,004
But I guess, you can do that and
311
00:12:21,004 --> 00:12:21,745
and and
312
00:12:22,125 --> 00:12:23,504
there can still be issues.
313
00:12:24,204 --> 00:12:26,365
So another imaging technique that's used all the
314
00:12:26,365 --> 00:12:28,225
time in hospitals is MRI.
315
00:12:29,164 --> 00:12:32,764
And MRI scanners present a unique hazard due
316
00:12:32,764 --> 00:12:36,120
to their extremely strong static magnetic field.
317
00:12:36,660 --> 00:12:38,920
And there have been reports of some serious
318
00:12:38,980 --> 00:12:41,000
accidents caused by ferromagnetic
319
00:12:41,379 --> 00:12:43,879
metal objects being pulled into the scanner.
320
00:12:44,660 --> 00:12:46,340
So, you know, even if the scanner is
321
00:12:46,340 --> 00:12:49,904
working perfectly, sometimes these accidents can happen. So
322
00:12:49,904 --> 00:12:52,485
how do we present prevent this from happening?
323
00:12:53,584 --> 00:12:54,065
So,
324
00:12:54,464 --> 00:12:56,625
Tammy, linking to what we were discussing before
325
00:12:56,625 --> 00:12:58,884
measurements, but then another big,
326
00:12:59,504 --> 00:13:01,365
element of our job is training
327
00:13:01,985 --> 00:13:03,684
training of the clinical teams.
328
00:13:04,199 --> 00:13:07,240
So in MRI, for example, the at the
329
00:13:07,240 --> 00:13:07,980
key prevention
330
00:13:08,439 --> 00:13:08,939
is,
331
00:13:09,559 --> 00:13:11,879
training the staff, making sure that all those
332
00:13:11,879 --> 00:13:14,139
that can have access to MRI scanners,
333
00:13:15,079 --> 00:13:17,639
have had specific training that let them know
334
00:13:17,639 --> 00:13:19,695
of all the hazards that are connected
335
00:13:20,095 --> 00:13:22,355
with this huge magnet being there.
336
00:13:22,735 --> 00:13:25,375
And my colleagues that work in MRR, they
337
00:13:25,375 --> 00:13:28,014
run periodic colleague training sessions in,
338
00:13:28,894 --> 00:13:29,794
for geographers,
339
00:13:30,174 --> 00:13:30,674
researchers,
340
00:13:31,134 --> 00:13:33,269
everyone that might have access to that to
341
00:13:33,269 --> 00:13:34,009
those scans.
342
00:13:34,790 --> 00:13:37,830
2nd to training, there are the hazard control
343
00:13:37,830 --> 00:13:40,090
prevention measurements. So there's labeling.
344
00:13:40,550 --> 00:13:43,509
There's that indicates what are the higher risk
345
00:13:43,509 --> 00:13:44,009
areas.
346
00:13:44,870 --> 00:13:45,370
Whereabouts
347
00:13:45,934 --> 00:13:47,894
you have the limits when you can carry
348
00:13:47,894 --> 00:13:49,235
a magnetic objects?
349
00:13:49,934 --> 00:13:50,914
And, again,
350
00:13:52,574 --> 00:13:53,954
labeling of 8 entrances.
351
00:13:54,254 --> 00:13:55,934
Everything that makes it easy in a high
352
00:13:55,934 --> 00:13:56,914
pressure environment
353
00:13:57,454 --> 00:14:00,100
for those operating it to know that that
354
00:14:00,100 --> 00:14:00,600
it's,
355
00:14:01,539 --> 00:14:02,759
their limit of operation.
356
00:14:04,100 --> 00:14:05,459
Yeah. I mean, if if you if you
357
00:14:05,459 --> 00:14:08,259
see an MRI scanning area, there there's loads
358
00:14:08,259 --> 00:14:10,740
of big signs everywhere warning people to sort
359
00:14:10,740 --> 00:14:13,115
of make sure they're not bringing any objects
360
00:14:13,115 --> 00:14:15,214
near that they shouldn't. And then there's huge
361
00:14:15,355 --> 00:14:16,334
yellow labels,
362
00:14:17,115 --> 00:14:19,834
huge red labels on those pieces of equipment.
363
00:14:19,834 --> 00:14:21,914
You know, the ones that, yes, it's fine.
364
00:14:21,914 --> 00:14:23,995
That can go to ones that can't go.
365
00:14:23,995 --> 00:14:24,495
So.
366
00:14:26,350 --> 00:14:28,750
Okay. And then, I mean, I've seen sort
367
00:14:28,750 --> 00:14:30,850
of issues with things like, you know, oxygen
368
00:14:30,909 --> 00:14:33,070
cylinders being brought in that, that shouldn't be
369
00:14:33,070 --> 00:14:35,570
there and, and being attracted to the magnet.
370
00:14:36,110 --> 00:14:38,835
And obviously, as you say, training and making
371
00:14:38,835 --> 00:14:40,855
sure everyone knows about these hazards,
372
00:14:41,875 --> 00:14:43,495
that can help prevent that.
373
00:14:43,955 --> 00:14:46,115
But what about if the patient have got
374
00:14:46,274 --> 00:14:48,995
the patient has metallic implants that they can't
375
00:14:48,995 --> 00:14:49,889
remove? So
376
00:14:50,450 --> 00:14:53,009
if a patient has a pacemaker or a
377
00:14:53,009 --> 00:14:55,170
cochlear implant, something like that, is that a
378
00:14:55,170 --> 00:14:56,230
problem for MRI?
379
00:14:57,170 --> 00:14:59,090
Yes. It is a problem, and this is
380
00:14:59,090 --> 00:15:01,250
one of the biggest data that works for
381
00:15:01,250 --> 00:15:02,549
the MRI physicist,
382
00:15:03,264 --> 00:15:05,345
because they play a key role in advising
383
00:15:05,345 --> 00:15:06,485
the clinical team.
384
00:15:07,424 --> 00:15:08,884
First, they need to,
385
00:15:09,345 --> 00:15:09,845
determine
386
00:15:10,144 --> 00:15:12,485
whether that's how what's the classification
387
00:15:12,945 --> 00:15:15,524
of that specific implant? So the newest implant
388
00:15:15,584 --> 00:15:16,230
will be
389
00:15:16,709 --> 00:15:19,110
as being MRI safe, so they can go
390
00:15:19,110 --> 00:15:20,970
anywhere in an MRI environment.
391
00:15:21,429 --> 00:15:23,350
Then there'll be the ones that are called
392
00:15:23,350 --> 00:15:26,149
conditional, so they can be used under certain
393
00:15:26,149 --> 00:15:28,149
conditions. And then there are the ones that
394
00:15:28,149 --> 00:15:30,389
are called unsafe. So there are the ones
395
00:15:30,389 --> 00:15:31,769
where it's not
396
00:15:32,264 --> 00:15:34,684
recommended to have a patient in an MRI,
397
00:15:35,384 --> 00:15:35,884
scanner.
398
00:15:36,664 --> 00:15:39,544
And but also in those cases, it's always
399
00:15:39,544 --> 00:15:41,725
a discussion between a multidisciplinary
400
00:15:42,264 --> 00:15:44,424
team. So between the physics team and then
401
00:15:44,424 --> 00:15:47,139
the consultant and the clinical team to discuss
402
00:15:47,139 --> 00:15:49,139
the health benefit for the patient. Because you
403
00:15:49,139 --> 00:15:51,620
might have a patient that has an implant
404
00:15:51,620 --> 00:15:53,139
that is not one of those that is
405
00:15:53,139 --> 00:15:55,399
MRI safe, but it's really important
406
00:15:56,179 --> 00:15:57,959
for them to have their scanner.
407
00:15:58,339 --> 00:16:01,940
And the likelihood of something happen comparing to
408
00:16:01,940 --> 00:16:04,235
other implants might be lower if if it
409
00:16:04,235 --> 00:16:06,555
makes sense. So it's always a balance. It'd
410
00:16:06,555 --> 00:16:09,355
be like with ionizing radiation. There is always
411
00:16:09,355 --> 00:16:11,355
a balance, and the physicists have a key
412
00:16:11,355 --> 00:16:12,815
role in trying to explain
413
00:16:13,195 --> 00:16:15,695
to the medical teams what are they,
414
00:16:16,154 --> 00:16:17,514
the risk that they can,
415
00:16:17,915 --> 00:16:18,509
can have.
416
00:16:19,070 --> 00:16:21,950
Yeah. So it's the physicists working with the
417
00:16:21,950 --> 00:16:23,410
clinicians to sort
418
00:16:23,790 --> 00:16:24,610
of optimize
419
00:16:24,990 --> 00:16:26,529
optimize it. Okay.
420
00:16:27,629 --> 00:16:30,669
Now another area of health care, back onto
421
00:16:30,669 --> 00:16:34,290
ionizing radiation. There's another area called nuclear medicine,
422
00:16:34,565 --> 00:16:37,704
which includes things like PET, positron emission tomography.
423
00:16:38,404 --> 00:16:38,904
And
424
00:16:39,284 --> 00:16:42,644
here, the radioactive materials are actually introduced into
425
00:16:42,644 --> 00:16:44,664
the patient's body for diagnosis
426
00:16:45,125 --> 00:16:46,024
or for treatment.
427
00:16:46,804 --> 00:16:49,304
How do we ensure patient safety here?
428
00:16:50,610 --> 00:16:52,290
Thank you, Tammy. It's a it's a good
429
00:16:52,290 --> 00:16:55,330
question. So, it's probably worth having a think
430
00:16:55,330 --> 00:16:58,210
about how nuclear medicine and PET imaging work
431
00:16:58,210 --> 00:17:00,389
initially. So so as you say,
432
00:17:00,930 --> 00:17:02,230
radioactive substances
433
00:17:02,769 --> 00:17:04,950
are typically labeled onto a pharmaceutical,
434
00:17:05,944 --> 00:17:09,085
and that pharmaceutical is designed to target disease
435
00:17:09,144 --> 00:17:11,305
processes in the body. So so we're all
436
00:17:11,305 --> 00:17:14,184
familiar that when we take paracetamol or aspirin,
437
00:17:14,184 --> 00:17:16,585
that's able to seek out the pain areas
438
00:17:16,585 --> 00:17:19,244
and reduce the pain in that specific location.
439
00:17:20,019 --> 00:17:21,480
So we call that a radiopharmaceutical,
440
00:17:22,259 --> 00:17:23,319
and that's injected
441
00:17:23,859 --> 00:17:24,839
into the patient,
442
00:17:25,940 --> 00:17:28,200
and you would expect then that that concentrates
443
00:17:28,420 --> 00:17:29,720
in the process where,
444
00:17:30,179 --> 00:17:32,500
in the place where the disease process is
445
00:17:32,500 --> 00:17:33,904
most strong. So,
446
00:17:34,845 --> 00:17:36,684
when you then put that patient into a
447
00:17:36,684 --> 00:17:38,305
camera or a or a scanner,
448
00:17:38,845 --> 00:17:41,805
what you find is that the the areas
449
00:17:41,805 --> 00:17:42,785
where the radiopharmaceutical
450
00:17:43,725 --> 00:17:46,950
is concentrated will glow brighter than other areas,
451
00:17:46,950 --> 00:17:48,630
and that allows us to see where the
452
00:17:48,630 --> 00:17:49,130
disease,
453
00:17:49,829 --> 00:17:50,569
is happening.
454
00:17:51,109 --> 00:17:51,609
So,
455
00:17:51,990 --> 00:17:53,529
in simple terms then,
456
00:17:53,990 --> 00:17:57,269
medical physics professionals will be carrying out very
457
00:17:57,269 --> 00:17:58,250
similar optimization
458
00:17:58,630 --> 00:18:00,650
processes to those that we've discussed
459
00:18:01,365 --> 00:18:01,865
before.
460
00:18:02,244 --> 00:18:02,744
So,
461
00:18:03,445 --> 00:18:06,664
very broadly ensuring that the minimum radiation dose
462
00:18:06,884 --> 00:18:07,625
is given,
463
00:18:08,164 --> 00:18:10,984
to allow for the production of diagnostic quality
464
00:18:11,525 --> 00:18:13,445
images. But if we want to take a
465
00:18:13,445 --> 00:18:14,744
bit of a deeper dive
466
00:18:15,119 --> 00:18:17,039
into this, think about the physics a little
467
00:18:17,039 --> 00:18:17,700
bit more,
468
00:18:18,240 --> 00:18:19,460
we could think about,
469
00:18:20,799 --> 00:18:21,619
how do we
470
00:18:22,079 --> 00:18:24,019
design our radionuclide
471
00:18:24,880 --> 00:18:25,380
diagnostic
472
00:18:25,759 --> 00:18:26,259
processes
473
00:18:26,799 --> 00:18:27,539
to minimize
474
00:18:27,920 --> 00:18:30,455
that radiation dose. So let's let's take a
475
00:18:30,455 --> 00:18:32,295
think for a for a moment about the
476
00:18:32,295 --> 00:18:35,575
half life of the radioactive substance that we
477
00:18:35,575 --> 00:18:36,075
use,
478
00:18:36,615 --> 00:18:37,515
for our imaging.
479
00:18:38,134 --> 00:18:39,355
This is quite critical.
480
00:18:40,134 --> 00:18:42,855
It it takes up to 2 hours perhaps
481
00:18:42,855 --> 00:18:43,355
to,
482
00:18:44,339 --> 00:18:47,059
for the pharmaceutical to label onto the disease
483
00:18:47,059 --> 00:18:49,240
process once it's inside the patient.
484
00:18:50,019 --> 00:18:51,480
And during that 2 hour
485
00:18:51,779 --> 00:18:54,920
time period, the radioactive substance is decaying.
486
00:18:55,299 --> 00:18:58,274
So, obviously, if we use a radioactive substance
487
00:18:58,274 --> 00:19:00,214
with a half life that's too short,
488
00:19:00,914 --> 00:19:02,835
we we'll end up having to inject a
489
00:19:02,835 --> 00:19:05,474
very high activity at the start of the
490
00:19:05,474 --> 00:19:07,634
scan, which gives a high dose to the
491
00:19:07,634 --> 00:19:10,950
patient. And similarly, if we give a radioactive
492
00:19:11,170 --> 00:19:13,830
substance with a half life that's too long,
493
00:19:14,049 --> 00:19:15,730
it will remain in the body for a
494
00:19:15,730 --> 00:19:17,809
long time after the scan is finished. And
495
00:19:17,809 --> 00:19:20,850
again, we'll deliver a high radiation dose to
496
00:19:20,850 --> 00:19:22,710
the patient. So we need to optimise
497
00:19:23,330 --> 00:19:24,375
our half life.
498
00:19:24,934 --> 00:19:27,654
It's a similar argument with the energy of
499
00:19:27,654 --> 00:19:29,035
the radiation emitted.
500
00:19:29,494 --> 00:19:30,555
If we choose,
501
00:19:31,255 --> 00:19:34,615
radio radioactive substance with an energy that's too
502
00:19:34,615 --> 00:19:35,115
low,
503
00:19:35,414 --> 00:19:37,654
then the gamma rays won't be able to
504
00:19:37,654 --> 00:19:38,875
escape the body,
505
00:19:39,549 --> 00:19:41,789
and they'll just deliver a radiation dose and
506
00:19:41,789 --> 00:19:44,269
won't contribute to our useful image. But if
507
00:19:44,269 --> 00:19:46,289
we choose an energy that's too high,
508
00:19:46,830 --> 00:19:48,589
the gamma rays will pass straight through the
509
00:19:48,589 --> 00:19:51,330
imaging equipment and won't contribute to the image
510
00:19:51,630 --> 00:19:53,410
either. So we have to optimise
511
00:19:53,825 --> 00:19:56,384
the radiation energy that we use. And again,
512
00:19:56,384 --> 00:19:59,105
this is where our medical physics professionals come
513
00:19:59,105 --> 00:19:59,605
in
514
00:19:59,904 --> 00:20:02,884
and have a very interesting time thinking about
515
00:20:03,025 --> 00:20:04,244
all of those different
516
00:20:04,704 --> 00:20:07,045
physics processes that that make,
517
00:20:08,065 --> 00:20:09,929
up the image. And if I could just
518
00:20:09,929 --> 00:20:12,250
talk for a minute then about therapy, because
519
00:20:12,250 --> 00:20:14,990
we also use radioactive substances in therapy.
520
00:20:16,329 --> 00:20:18,650
It's a similar process. So we would either
521
00:20:18,650 --> 00:20:19,150
inject,
522
00:20:19,690 --> 00:20:21,710
or ask the patient to swallow a radioactive
523
00:20:21,929 --> 00:20:22,429
substance
524
00:20:22,994 --> 00:20:23,734
to treat,
525
00:20:24,194 --> 00:20:25,734
medical condition, usually
526
00:20:26,035 --> 00:20:26,535
cancer.
527
00:20:27,474 --> 00:20:29,795
So common treatment, and this one dates back
528
00:20:29,795 --> 00:20:32,194
to the middle of 20th century, is to
529
00:20:32,194 --> 00:20:33,015
use radioactive
530
00:20:33,315 --> 00:20:34,214
IID 131,
531
00:20:35,234 --> 00:20:36,855
following the surgical removement,
532
00:20:37,759 --> 00:20:39,539
removal of the thyroid
533
00:20:39,839 --> 00:20:40,339
gland.
534
00:20:40,720 --> 00:20:42,899
And so what happens is the iodine concentrates
535
00:20:43,119 --> 00:20:45,839
in any remaining tissue that's left after the
536
00:20:45,839 --> 00:20:46,339
surgery,
537
00:20:46,960 --> 00:20:49,519
and it's a it's a great radioactive substance
538
00:20:49,519 --> 00:20:51,940
for this purpose because it contains 2 elements,
539
00:20:52,575 --> 00:20:53,075
beta
540
00:20:53,454 --> 00:20:53,954
particles
541
00:20:54,414 --> 00:20:56,654
that that are, of course, don't travel very
542
00:20:56,654 --> 00:20:58,575
far in tissue. So they deliver a very
543
00:20:58,575 --> 00:21:00,994
high dose to the thyroid tissue that's left
544
00:21:01,134 --> 00:21:03,775
and minimize the radiation dose to other organs
545
00:21:03,775 --> 00:21:06,414
in the body. So we destroy the thyroid
546
00:21:06,414 --> 00:21:07,529
tissue that's left
547
00:21:08,730 --> 00:21:10,670
and and spare the other tissues.
548
00:21:11,609 --> 00:21:13,849
And it also contains a gamma emission, which
549
00:21:13,849 --> 00:21:15,849
is quite useful because we can then use
550
00:21:15,849 --> 00:21:17,150
that to image
551
00:21:17,450 --> 00:21:19,690
any of that leftover thyroid tissue at the
552
00:21:19,690 --> 00:21:20,990
end of the treatment.
553
00:21:21,454 --> 00:21:23,775
So with that particular treatment, we use high
554
00:21:23,775 --> 00:21:24,755
levels of radioactivity,
555
00:21:25,375 --> 00:21:27,055
and the patient would need to remain in
556
00:21:27,055 --> 00:21:30,434
a shielded bedroom with special bathroom and drainage
557
00:21:30,494 --> 00:21:33,214
arrangements for a few days after receiving the
558
00:21:33,214 --> 00:21:33,714
therapy.
559
00:21:34,630 --> 00:21:35,669
Yeah. I mean, that, that was going to
560
00:21:35,669 --> 00:21:37,429
be my next question. If the patient's got
561
00:21:37,429 --> 00:21:40,089
a radioactive source of some sort inside them,
562
00:21:40,549 --> 00:21:42,549
do they pose a risk to other people
563
00:21:42,549 --> 00:21:45,049
and, and what's done about this?
564
00:21:46,150 --> 00:21:49,755
That's absolutely right. So every medical procedure that
565
00:21:49,755 --> 00:21:51,534
involves the use of radioactive
566
00:21:51,914 --> 00:21:54,794
materials does carry a risk to members of
567
00:21:54,794 --> 00:21:56,794
staff and, of course, to members of the
568
00:21:56,794 --> 00:21:57,294
public.
569
00:21:57,595 --> 00:21:59,134
So as you would imagine,
570
00:22:00,075 --> 00:22:00,815
the procedures
571
00:22:01,115 --> 00:22:01,615
are,
572
00:22:02,480 --> 00:22:03,940
rigorously risk assessed.
573
00:22:04,480 --> 00:22:06,240
So somebody will look at all of the
574
00:22:06,240 --> 00:22:07,759
risks from that,
575
00:22:08,080 --> 00:22:11,039
procedure. So we think about the external radiation
576
00:22:11,039 --> 00:22:13,519
that comes from the radioactive substance. If the
577
00:22:13,519 --> 00:22:15,600
patient travels home on the bus, for example,
578
00:22:15,600 --> 00:22:18,404
someone will calculated what the radiation dose would
579
00:22:18,404 --> 00:22:20,805
be to somebody sitting next to them on
580
00:22:20,805 --> 00:22:21,464
the bus.
581
00:22:22,085 --> 00:22:24,825
The radioactive substances are also excreted,
582
00:22:25,845 --> 00:22:28,904
from the patient in in urine, in sweat,
583
00:22:29,400 --> 00:22:32,039
saliva, for example. So we need to do
584
00:22:32,039 --> 00:22:35,019
calculations to ensure that if those substances
585
00:22:35,320 --> 00:22:37,580
get into, the environment,
586
00:22:38,039 --> 00:22:39,559
that they're not going to give,
587
00:22:39,960 --> 00:22:42,440
an exposure to members of the public that
588
00:22:42,440 --> 00:22:43,180
are too
589
00:22:43,559 --> 00:22:44,059
high.
590
00:22:44,894 --> 00:22:45,394
So,
591
00:22:46,255 --> 00:22:47,154
for our therapeutic
592
00:22:47,455 --> 00:22:47,955
procedures,
593
00:22:48,494 --> 00:22:51,215
the risk can be be higher still. And
594
00:22:51,215 --> 00:22:54,494
for those procedures, we need a bespoke risk
595
00:22:54,494 --> 00:22:56,035
assessment for each individual
596
00:22:56,335 --> 00:22:56,835
patient.
597
00:22:57,375 --> 00:22:59,315
So for example, in the iodine
598
00:23:00,099 --> 00:23:02,200
therapy we we talked about earlier,
599
00:23:03,859 --> 00:23:05,559
there, is a risk,
600
00:23:06,259 --> 00:23:07,960
when the patient goes home
601
00:23:08,579 --> 00:23:10,200
from the external radiation
602
00:23:10,659 --> 00:23:11,639
and from contamination
603
00:23:12,099 --> 00:23:15,000
from their urine and and bodily fluids.
604
00:23:15,345 --> 00:23:15,845
So,
605
00:23:17,184 --> 00:23:20,704
we would need to do a bespoke risk
606
00:23:20,704 --> 00:23:21,204
assessment
607
00:23:21,744 --> 00:23:24,065
for for them, and that will be based
608
00:23:24,065 --> 00:23:26,625
on their own particular circumstances. So you can
609
00:23:26,625 --> 00:23:29,025
imagine somebody who works as a park keeper
610
00:23:29,025 --> 00:23:30,960
where they don't meet members of the public
611
00:23:30,960 --> 00:23:32,559
very much, they're in a big wide open
612
00:23:32,559 --> 00:23:33,680
space all day,
613
00:23:34,799 --> 00:23:37,359
is much less risky than a primary school
614
00:23:37,359 --> 00:23:40,099
teacher who's sitting very close to small children
615
00:23:40,400 --> 00:23:42,079
all day. And then they would then go
616
00:23:42,079 --> 00:23:44,240
home with a different set of restrictions on
617
00:23:44,240 --> 00:23:45,605
their their own,
618
00:23:47,184 --> 00:23:47,684
activities.
619
00:23:48,625 --> 00:23:51,605
Okay. And, is this the same for brachytherapy?
620
00:23:51,984 --> 00:23:53,984
Because that's it's slightly different, but it also
621
00:23:53,984 --> 00:23:54,484
involves
622
00:23:54,785 --> 00:23:57,125
putting radioactive sources inside people.
623
00:23:58,305 --> 00:23:59,924
That's right. So,
624
00:24:00,509 --> 00:24:03,150
for brachytherapy, it's probably worth having a think
625
00:24:03,150 --> 00:24:05,890
about the difference between sealed and unsealed radioactive
626
00:24:06,029 --> 00:24:08,349
sources to start with. So in our nuclear
627
00:24:08,349 --> 00:24:08,849
medicine,
628
00:24:09,630 --> 00:24:11,730
and PET procedures, we inject
629
00:24:12,190 --> 00:24:14,130
unsealed sources, so they're liquid
630
00:24:14,444 --> 00:24:16,845
radioactive substances. They're free to move around the
631
00:24:16,845 --> 00:24:19,005
body and free to come out in our
632
00:24:19,005 --> 00:24:21,024
bodily fluids. But in brachytherapy,
633
00:24:21,404 --> 00:24:24,284
we use sealed radioactive sources where all of
634
00:24:24,284 --> 00:24:24,944
the radioactivity
635
00:24:25,244 --> 00:24:26,065
is encapsulated
636
00:24:27,099 --> 00:24:27,599
inside,
637
00:24:28,539 --> 00:24:30,240
for example, a metal capsule.
638
00:24:30,700 --> 00:24:32,859
So, generally, there's no risk that those will
639
00:24:32,859 --> 00:24:35,259
be released into the environment, and that whole
640
00:24:35,259 --> 00:24:35,759
contamination
641
00:24:36,139 --> 00:24:36,639
risk,
642
00:24:37,259 --> 00:24:38,079
goes down,
643
00:24:38,619 --> 00:24:39,919
to to 0.
644
00:24:40,964 --> 00:24:42,025
Having said that,
645
00:24:43,365 --> 00:24:45,365
the sealed source then can be thought of
646
00:24:45,365 --> 00:24:47,224
a little bit like, an X-ray
647
00:24:47,605 --> 00:24:48,105
source,
648
00:24:48,884 --> 00:24:50,964
which which we would use in imaging or
649
00:24:50,964 --> 00:24:52,105
in our linear accelerators.
650
00:24:52,640 --> 00:24:54,640
The big difference is you can't switch it
651
00:24:54,640 --> 00:24:57,680
off. It's radioactive. It's gonna be there until
652
00:24:57,680 --> 00:24:58,420
it's decayed.
653
00:24:58,880 --> 00:25:02,240
So we do have particular issues with a
654
00:25:02,240 --> 00:25:02,740
brachytherapy.
655
00:25:04,080 --> 00:25:06,320
For example, we would do a treatment where
656
00:25:06,320 --> 00:25:08,340
a source goes into the patient
657
00:25:08,764 --> 00:25:10,764
for, say, a 5 minute period and then
658
00:25:10,764 --> 00:25:11,505
is withdrawn.
659
00:25:11,884 --> 00:25:14,304
It's a very high activity sealed source,
660
00:25:14,924 --> 00:25:17,105
but sometimes that source could become stuck,
661
00:25:17,724 --> 00:25:20,044
and that poses a very big risk to
662
00:25:20,044 --> 00:25:20,704
the patient,
663
00:25:21,559 --> 00:25:23,880
and of course to to the staff. So
664
00:25:23,880 --> 00:25:27,420
they have procedures in place with regular rehearsals
665
00:25:28,039 --> 00:25:30,059
to make sure that if that does happen,
666
00:25:30,359 --> 00:25:32,279
they're they're they're right ready to go or
667
00:25:32,279 --> 00:25:34,599
the equipment's ready. The staff know exactly what
668
00:25:34,599 --> 00:25:36,494
they're doing to go in and and do
669
00:25:36,494 --> 00:25:38,355
that emergency source removal.
670
00:25:39,615 --> 00:25:40,914
Okay. That's really interesting.
671
00:25:42,335 --> 00:25:43,474
Now looking
672
00:25:43,855 --> 00:25:45,154
ahead to the future,
673
00:25:47,134 --> 00:25:50,015
researchers are continually developing sort of innovative new
674
00:25:50,015 --> 00:25:53,029
medical techniques, both for diagnosis and treatment.
675
00:25:53,730 --> 00:25:56,049
How do we ensure the safety of these
676
00:25:56,049 --> 00:25:56,549
advanced
677
00:25:56,849 --> 00:25:59,409
approaches when when they're first introduced into the
678
00:25:59,409 --> 00:26:01,750
clinic? Maybe you could both comment on that.
679
00:26:03,250 --> 00:26:05,169
So maybe before Mark comes in, what I
680
00:26:05,169 --> 00:26:07,654
will say is not is not much different
681
00:26:07,654 --> 00:26:09,515
from what is done for drug trials.
682
00:26:09,974 --> 00:26:12,535
So before you introduce them in common use,
683
00:26:12,535 --> 00:26:14,394
you need to test them under control,
684
00:26:15,575 --> 00:26:16,795
technology trials.
685
00:26:17,494 --> 00:26:17,994
And
686
00:26:19,109 --> 00:26:20,309
and I don't know, you know, Mark, if
687
00:26:20,309 --> 00:26:22,390
you wanna say a bit more about normally
688
00:26:22,390 --> 00:26:25,049
the conditions we would do those tests.
689
00:26:26,789 --> 00:26:28,009
Yes. We're doing,
690
00:26:29,029 --> 00:26:30,089
trials. So,
691
00:26:31,505 --> 00:26:32,005
essentially,
692
00:26:32,384 --> 00:26:35,024
when we're introducing new technology, I think the
693
00:26:35,024 --> 00:26:36,625
key is that we need to we need
694
00:26:36,625 --> 00:26:37,845
to do it very carefully,
695
00:26:38,944 --> 00:26:40,005
and in a very,
696
00:26:40,544 --> 00:26:41,044
considered
697
00:26:41,664 --> 00:26:42,164
manner.
698
00:26:42,544 --> 00:26:43,044
So,
699
00:26:43,744 --> 00:26:45,125
for first of all,
700
00:26:45,740 --> 00:26:47,440
with any new technology,
701
00:26:48,380 --> 00:26:50,779
we don't know at the start immediately how
702
00:26:50,779 --> 00:26:52,320
how things are going to work,
703
00:26:52,700 --> 00:26:54,700
and how they're gonna affect our patients. So
704
00:26:54,700 --> 00:26:57,180
you do a very tightly controlled clinical trial
705
00:26:57,180 --> 00:26:58,240
under those circumstances,
706
00:26:58,954 --> 00:27:00,974
and and you would expect that there's ongoing
707
00:27:01,115 --> 00:27:01,615
research,
708
00:27:02,474 --> 00:27:02,954
and,
709
00:27:03,275 --> 00:27:07,055
clinical trials into how do those technologies perform
710
00:27:07,355 --> 00:27:08,894
over a period of time.
711
00:27:10,394 --> 00:27:10,894
Then,
712
00:27:11,674 --> 00:27:12,174
devices
713
00:27:12,555 --> 00:27:14,095
you would expect to be
714
00:27:14,419 --> 00:27:14,919
certified,
715
00:27:15,619 --> 00:27:18,339
and regulated where where before they go into
716
00:27:18,339 --> 00:27:21,220
use. So that is a a process where
717
00:27:21,220 --> 00:27:23,640
the device is is rigorously examined,
718
00:27:24,339 --> 00:27:26,039
and given a certification
719
00:27:26,579 --> 00:27:28,599
to ensure that it's safe to use
720
00:27:28,994 --> 00:27:29,734
on patients.
721
00:27:30,275 --> 00:27:32,615
So again, you you would need expert
722
00:27:32,914 --> 00:27:33,414
support
723
00:27:34,194 --> 00:27:36,355
in the in the process of introducing this.
724
00:27:36,355 --> 00:27:38,115
And I and I think to me, this
725
00:27:38,115 --> 00:27:38,694
is where
726
00:27:39,075 --> 00:27:39,575
multidisciplinary
727
00:27:40,755 --> 00:27:42,694
approach comes in in healthcare.
728
00:27:43,339 --> 00:27:46,220
For sure, you need your medical physics teams.
729
00:27:46,220 --> 00:27:48,299
They're they're gonna be very well versed on
730
00:27:48,299 --> 00:27:50,859
the the types of risks that might come
731
00:27:50,859 --> 00:27:52,960
from these new technologies. They can,
732
00:27:53,339 --> 00:27:56,779
do do, extensive calculations for you on on
733
00:27:56,779 --> 00:27:58,664
what it might mean when we start to
734
00:27:58,664 --> 00:27:59,884
use those in patients,
735
00:28:00,184 --> 00:28:01,865
and and they will need to lurk work
736
00:28:01,865 --> 00:28:02,365
alongside,
737
00:28:03,065 --> 00:28:03,805
the doctors,
738
00:28:04,585 --> 00:28:07,325
perhaps the radiographers who are delivering the treatments
739
00:28:07,625 --> 00:28:08,525
as a multidisciplinary
740
00:28:09,065 --> 00:28:09,565
group
741
00:28:09,865 --> 00:28:12,345
to really understand how we're gonna best implement
742
00:28:12,345 --> 00:28:14,419
that into our medical pathways.
743
00:28:16,559 --> 00:28:19,299
And sometimes, if it's a diagnostic technique,
744
00:28:20,240 --> 00:28:22,000
to be safe, what they will have to
745
00:28:22,000 --> 00:28:23,839
do is they will have to give the
746
00:28:23,839 --> 00:28:27,440
same exam they already give patients, and then
747
00:28:27,440 --> 00:28:29,375
they would have to to use the new
748
00:28:29,375 --> 00:28:30,434
device. So sometimes
749
00:28:31,134 --> 00:28:34,255
they will inform the patients. They can accept
750
00:28:34,255 --> 00:28:36,255
to take part in the trial or cannot
751
00:28:36,255 --> 00:28:37,934
not accept to take part in the trial.
752
00:28:37,934 --> 00:28:39,934
But if they're doing it, it's for future
753
00:28:39,934 --> 00:28:42,494
benefit, and they will be, having to stay
754
00:28:42,494 --> 00:28:43,794
a little longer. So,
755
00:28:44,149 --> 00:28:46,149
again, most people are very happy to help
756
00:28:46,149 --> 00:28:48,069
because, you know, they are are aware that
757
00:28:48,069 --> 00:28:49,109
they're doing it for,
758
00:28:50,149 --> 00:28:51,690
for the future of everyone.
759
00:28:53,829 --> 00:28:55,049
Okay. And then,
760
00:28:56,230 --> 00:28:57,210
also looking
761
00:28:57,589 --> 00:28:58,970
ahead into the future,
762
00:28:59,625 --> 00:29:01,724
can you comment on the use of artificial
763
00:29:01,945 --> 00:29:02,445
intelligence
764
00:29:02,904 --> 00:29:04,125
in medical procedures?
765
00:29:04,984 --> 00:29:07,865
So AI is increasingly being touted for things
766
00:29:07,865 --> 00:29:10,605
such as creating radiation treatment plans
767
00:29:10,984 --> 00:29:13,005
or analysing medical images.
768
00:29:13,950 --> 00:29:15,950
What do you think are the risks of
769
00:29:15,950 --> 00:29:18,049
introducing AI into health care?
770
00:29:20,509 --> 00:29:23,710
So AI is a hot topic. Course keeps
771
00:29:23,710 --> 00:29:25,250
being is one of those
772
00:29:25,630 --> 00:29:28,029
where we get all the ethical and all
773
00:29:28,029 --> 00:29:28,529
the
774
00:29:30,204 --> 00:29:30,704
questions.
775
00:29:32,605 --> 00:29:34,464
In the end, like for other techniques,
776
00:29:35,005 --> 00:29:35,904
is a matter
777
00:29:37,325 --> 00:29:38,224
of controlled
778
00:29:39,484 --> 00:29:39,984
trials
779
00:29:40,365 --> 00:29:43,264
under expert guidance and under standardized
780
00:29:44,284 --> 00:29:44,784
processes.
781
00:29:47,150 --> 00:29:47,650
And
782
00:29:48,910 --> 00:29:49,970
the point is
783
00:29:50,269 --> 00:29:51,730
we can't just
784
00:29:52,269 --> 00:29:52,769
have,
785
00:29:53,549 --> 00:29:54,529
a black box
786
00:29:55,309 --> 00:29:58,875
introduced in everyday use without knowing what that
787
00:29:58,954 --> 00:30:01,035
black box is supposed to do when comparing
788
00:30:01,035 --> 00:30:02,575
what what we have before.
789
00:30:03,994 --> 00:30:06,394
But then again, there's bigger ethical issues. So
790
00:30:06,394 --> 00:30:07,134
I don't know,
791
00:30:07,595 --> 00:30:10,015
Mark, if you'd like to pop in.
792
00:30:11,289 --> 00:30:13,849
Yeah. Thank you. So so I think it's
793
00:30:13,849 --> 00:30:16,650
it's gonna be really important to make sure
794
00:30:16,650 --> 00:30:19,549
that AI is introduced in an ethical manner.
795
00:30:19,849 --> 00:30:21,470
So so one of the big concerns,
796
00:30:22,250 --> 00:30:24,984
might be just as Fimeta said there,
797
00:30:25,684 --> 00:30:28,085
we may not know exactly how the AI
798
00:30:28,085 --> 00:30:29,625
is coming to its decisions,
799
00:30:30,325 --> 00:30:32,244
because that that's the nature of the the
800
00:30:32,244 --> 00:30:34,184
way in which these machines work.
801
00:30:35,125 --> 00:30:37,044
And therefore, what we can look at is
802
00:30:37,044 --> 00:30:39,410
the data that we've used to actually train
803
00:30:39,410 --> 00:30:39,910
that
804
00:30:40,369 --> 00:30:41,029
AI system
805
00:30:41,330 --> 00:30:43,570
to make those decisions in the first place.
806
00:30:43,570 --> 00:30:44,950
So if you look at example,
807
00:30:45,809 --> 00:30:47,670
where we might be trying to diagnose,
808
00:30:48,690 --> 00:30:51,650
medical conditions from chest X rays using an
809
00:30:51,650 --> 00:30:52,470
AI system,
810
00:30:53,345 --> 00:30:56,005
We have systems that have been trained
811
00:30:56,625 --> 00:30:58,164
on on huge populations,
812
00:30:58,545 --> 00:30:59,765
millions of patients,
813
00:31:00,224 --> 00:31:02,945
but but in India. And and how do
814
00:31:02,945 --> 00:31:06,144
we know that the population in India has
815
00:31:06,144 --> 00:31:06,884
the same
816
00:31:07,289 --> 00:31:08,990
anatomy, the same physiological,
817
00:31:10,330 --> 00:31:11,710
conditions, the same,
818
00:31:12,330 --> 00:31:14,830
medical conditions that we have in the UK.
819
00:31:15,049 --> 00:31:16,890
So we may we may have an issue
820
00:31:16,890 --> 00:31:17,390
there
821
00:31:17,690 --> 00:31:21,065
with introducing a system that's been trained using
822
00:31:21,065 --> 00:31:22,204
a different population
823
00:31:22,585 --> 00:31:24,585
from our own. We we need to think
824
00:31:24,585 --> 00:31:26,744
the same in the UK. We have a
825
00:31:26,744 --> 00:31:28,444
wide range of nationalities.
826
00:31:28,904 --> 00:31:30,585
We have, people of,
827
00:31:31,625 --> 00:31:32,365
both sexes
828
00:31:32,664 --> 00:31:34,470
in the UK. We we need to make
829
00:31:34,470 --> 00:31:36,549
sure that when we train the systems, the
830
00:31:36,549 --> 00:31:38,730
right data is used so that we get,
831
00:31:39,430 --> 00:31:41,369
the the the right diagnostic
832
00:31:41,990 --> 00:31:44,309
processes out. So again, I think, Fimete, you're
833
00:31:44,309 --> 00:31:47,130
right. It's the ongoing research, the clinical trials,
834
00:31:47,224 --> 00:31:50,045
and of course, incident reporting is really important.
835
00:31:50,424 --> 00:31:51,644
If you have an incident
836
00:31:52,025 --> 00:31:53,325
with a medical device,
837
00:31:53,785 --> 00:31:56,365
and report that to the to the regulators,
838
00:31:56,505 --> 00:31:58,125
it's something that then the whole,
839
00:31:58,585 --> 00:32:01,630
world can learn from those mistakes, those errors,
840
00:32:01,630 --> 00:32:03,549
and and fix it so that it doesn't
841
00:32:03,549 --> 00:32:04,049
happen
842
00:32:04,430 --> 00:32:04,930
again?
843
00:32:05,470 --> 00:32:07,250
As far as AI is introduced
844
00:32:08,029 --> 00:32:09,009
in this multidisciplinary
845
00:32:09,630 --> 00:32:12,769
team with the contribution of the medical physicist,
846
00:32:12,990 --> 00:32:15,355
the clinical engineers, but also the the team
847
00:32:15,514 --> 00:32:17,774
the clinical teams are going to use them
848
00:32:18,154 --> 00:32:19,835
is going to help us. Because in the
849
00:32:19,835 --> 00:32:21,274
end, we have to think that in the
850
00:32:21,274 --> 00:32:24,154
past, even some of the measure automatic measurements
851
00:32:24,154 --> 00:32:25,595
that we use these days and some of
852
00:32:25,595 --> 00:32:28,390
the technology that we use these days, they
853
00:32:28,390 --> 00:32:30,789
were at those times equivalent of what AI
854
00:32:30,789 --> 00:32:33,190
might be now. AI is just bringing this
855
00:32:33,190 --> 00:32:34,730
to the to next level.
856
00:32:35,109 --> 00:32:36,869
But on the other side, we know that
857
00:32:36,869 --> 00:32:38,410
we are at the time of,
858
00:32:38,789 --> 00:32:41,349
you know, time being pressured for time, being
859
00:32:41,349 --> 00:32:42,315
pressured for
860
00:32:42,714 --> 00:32:44,875
being able to see more patients, treat more
861
00:32:44,875 --> 00:32:48,654
patients. So any tool that enables our clinicians
862
00:32:48,954 --> 00:32:52,174
to reach those decisions in a quicker time,
863
00:32:52,474 --> 00:32:54,315
it's it's going to be of of good
864
00:32:54,315 --> 00:32:56,500
shape. So I'm one of those, and I
865
00:32:56,500 --> 00:32:57,700
I don't know about Mark, but I'm one
866
00:32:57,700 --> 00:32:59,799
of those that is very hopeful about AI,
867
00:32:59,940 --> 00:33:02,039
but if done in a co design
868
00:33:02,419 --> 00:33:03,400
way with
869
00:33:03,859 --> 00:33:04,839
health care staff
870
00:33:05,460 --> 00:33:08,039
and in in safe clinical trials.
871
00:33:09,700 --> 00:33:12,545
I I agree. I I think that's absolutely
872
00:33:12,545 --> 00:33:14,325
right. To to me,
873
00:33:14,705 --> 00:33:16,384
I think if we were sitting here in
874
00:33:16,384 --> 00:33:18,484
10 years' time having this discussion,
875
00:33:18,945 --> 00:33:20,625
the the the world will have changed. It's
876
00:33:20,625 --> 00:33:23,345
like when the the Internet was first introduced
877
00:33:23,345 --> 00:33:25,125
in the early 19 nineties,
878
00:33:26,230 --> 00:33:27,750
Maybe we didn't know what what we would
879
00:33:27,750 --> 00:33:29,910
use that for, but but today, nobody can
880
00:33:29,910 --> 00:33:32,169
imagine life without it. And I I imagine,
881
00:33:32,789 --> 00:33:34,410
myself that this will be,
882
00:33:34,950 --> 00:33:35,849
very similar.
883
00:33:36,710 --> 00:33:39,275
Excellent. Well, it's, it's great to find out
884
00:33:39,275 --> 00:33:41,194
what we may have to look forward to
885
00:33:41,194 --> 00:33:43,115
in the future and also to, you know,
886
00:33:43,115 --> 00:33:44,795
to learn about all the work that medical
887
00:33:44,795 --> 00:33:47,934
physicists are doing to keep everyone safe. So
888
00:33:48,154 --> 00:33:50,015
thank you both for joining me today.
889
00:33:50,875 --> 00:33:51,480
Thank you.
890
00:33:51,960 --> 00:33:52,700
Our pleasure.
891
00:33:59,319 --> 00:34:03,160
That was Fiamada Fidele and Mark Knight in
892
00:34:03,160 --> 00:34:04,940
conversation with Tammy Freeman.
893
00:34:05,595 --> 00:34:09,054
That interview is produced in collaboration with IPEM,
894
00:34:09,434 --> 00:34:10,894
which owns the journal
895
00:34:11,275 --> 00:34:13,775
Physics in Medicine and Biology.
896
00:34:14,554 --> 00:34:17,695
You can find the journal at IOP Science.
897
00:34:19,139 --> 00:34:23,079
Next week, the scholarly publishing community is celebrating
898
00:34:23,699 --> 00:34:26,679
peer review week. And here on the podcast,
899
00:34:26,900 --> 00:34:29,299
we will be looking at how journals can
900
00:34:29,299 --> 00:34:29,799
eliminate
901
00:34:30,500 --> 00:34:31,000
unhelpful
902
00:34:31,539 --> 00:34:33,239
or outright rude
903
00:34:33,585 --> 00:34:36,644
reviewer comments from the peer review process.
904
00:34:37,744 --> 00:34:40,324
That episode will go live on Tuesday,
905
00:34:40,784 --> 00:34:41,284
24th
906
00:34:41,905 --> 00:34:42,405
September
907
00:34:42,945 --> 00:34:45,204
instead of the usual Thursday.
908
00:34:46,029 --> 00:34:47,569
That's because on Thursday,
909
00:34:47,949 --> 00:34:48,449
26th,
910
00:34:48,829 --> 00:34:52,369
we are presenting the future of particle physics.
911
00:34:52,909 --> 00:34:55,170
This is a physics world live event
912
00:34:55,469 --> 00:34:57,650
produced in partnership with the journal
913
00:34:57,949 --> 00:35:00,289
reports on progress in physics.
914
00:35:00,905 --> 00:35:02,525
The live panel discussion
915
00:35:03,065 --> 00:35:06,344
will feature Tara Shears of the University of
916
00:35:06,344 --> 00:35:06,844
Liverpool,
917
00:35:07,545 --> 00:35:10,525
Phil Burrows at the University of Oxford,
918
00:35:11,065 --> 00:35:13,565
and Talika Bowes of the University
919
00:35:14,025 --> 00:35:14,764
of Wisconsin,
920
00:35:15,385 --> 00:35:15,885
Madison.
921
00:35:16,739 --> 00:35:19,940
They will explore what the future holds for
922
00:35:19,940 --> 00:35:23,400
high energy physics, and where the next particle
923
00:35:23,460 --> 00:35:23,960
collider
924
00:35:24,340 --> 00:35:25,320
should be built.
925
00:35:25,860 --> 00:35:28,360
You can register now for this free event
926
00:35:28,500 --> 00:35:30,255
on the Physics World website.
927
00:35:30,795 --> 00:35:33,855
Just click on the Physics World Live tab
928
00:35:34,155 --> 00:35:36,655
at the top right of the home page.
929
00:35:37,195 --> 00:35:39,114
I'm afraid that's all the time we have
930
00:35:39,114 --> 00:35:41,994
for this week's podcast, which was produced in
931
00:35:41,994 --> 00:35:43,534
partnership with IPEM.
932
00:35:44,280 --> 00:35:46,140
Thanks to Fiammetta Fideli,
933
00:35:46,920 --> 00:35:47,900
Mark Knight,
934
00:35:48,360 --> 00:35:50,699
and Tammy Freeman for a fascinating
935
00:35:51,000 --> 00:35:51,500
conversation.
936
00:35:52,360 --> 00:35:54,460
And a special thanks to our producer,
937
00:35:54,840 --> 00:35:55,820
Fred Iles.
938
00:35:56,574 --> 00:35:59,074
And we would like to acknowledge the support
939
00:35:59,535 --> 00:36:00,434
of RaySearch
940
00:36:00,815 --> 00:36:01,315
Laboratories
941
00:36:02,094 --> 00:36:03,074
for this podcast.
942
00:36:10,210 --> 00:36:13,110
This podcast is supported by RaySearch Laboratories,
943
00:36:14,050 --> 00:36:14,949
which unifies
944
00:36:15,250 --> 00:36:16,309
industry solutions,
945
00:36:16,849 --> 00:36:18,550
empowering healthcare providers
946
00:36:18,929 --> 00:36:21,190
to deliver precise and effective
947
00:36:21,809 --> 00:36:22,309
radiotherapy
948
00:36:22,690 --> 00:36:23,190
treatment.
949
00:36:24,204 --> 00:36:24,704
RaySearch's
950
00:36:25,484 --> 00:36:26,625
AI Driven solutions
951
00:36:27,244 --> 00:36:29,824
reshape cancer care by accelerating
952
00:36:30,204 --> 00:36:30,704
workflows,
953
00:36:31,484 --> 00:36:32,545
delivering consistent
954
00:36:32,925 --> 00:36:34,464
and reliable results,
955
00:36:34,764 --> 00:36:36,545
with less manual work.
956
00:36:37,659 --> 00:36:41,099
RayStation is a treatment planning system that brings
957
00:36:41,099 --> 00:36:41,599
tranquility
958
00:36:42,059 --> 00:36:43,360
to treatment planning.
959
00:36:44,140 --> 00:36:47,199
No more bouncing between different treatment machines,
960
00:36:47,500 --> 00:36:49,039
techniques, and modalities.
961
00:36:50,114 --> 00:36:50,614
RayStation
962
00:36:50,914 --> 00:36:52,054
is a comprehensive
963
00:36:52,355 --> 00:36:52,855
software.
964
00:36:54,114 --> 00:36:55,894
RayCare is an oncology
965
00:36:56,275 --> 00:36:59,255
information system and a trusted ally.
966
00:36:59,795 --> 00:37:01,574
It automates and streamlines
967
00:37:02,355 --> 00:37:02,855
adaptive
968
00:37:03,155 --> 00:37:03,655
oncology
969
00:37:04,034 --> 00:37:04,534
workflows
970
00:37:04,914 --> 00:37:07,159
while securely guiding users
971
00:37:07,460 --> 00:37:08,440
through the entire
972
00:37:08,820 --> 00:37:10,519
patient treatment journey.
973
00:37:11,619 --> 00:37:12,359
Ray Intelligence
974
00:37:12,980 --> 00:37:13,480
empowers
975
00:37:13,780 --> 00:37:15,400
confident decision making
976
00:37:15,780 --> 00:37:19,880
by unifying clinical data into actionable insights.
977
00:37:20,835 --> 00:37:22,454
This cloud based oncology
978
00:37:22,835 --> 00:37:24,454
data analytics system
979
00:37:24,914 --> 00:37:27,974
offers a clear view of clinical operations.
980
00:37:28,755 --> 00:37:30,375
Research products transform
981
00:37:30,755 --> 00:37:31,894
scattered technologies
982
00:37:32,434 --> 00:37:33,335
into clarity,
983
00:37:33,940 --> 00:37:35,480
elevating the radiotherapy
984
00:37:36,019 --> 00:37:36,519
industry.
00:00:08,080 --> 00:00:10,880
Hello, and welcome to the Physics World Weekly
2
00:00:10,880 --> 00:00:13,539
podcast, which is supported by Research
3
00:00:13,839 --> 00:00:14,339
Laboratories.
4
00:00:15,275 --> 00:00:16,654
I'm Hamish Johnston.
5
00:00:17,274 --> 00:00:20,574
Our theme this week is diagnosing and treating
6
00:00:20,635 --> 00:00:22,254
disease. How physicists
7
00:00:22,714 --> 00:00:25,454
keep you safe during health care procedures.
8
00:00:26,394 --> 00:00:30,175
This episode was created in collaboration with IPEM,
9
00:00:30,769 --> 00:00:31,510
the Institute
10
00:00:31,970 --> 00:00:33,829
of Physics and Engineering
11
00:00:34,210 --> 00:00:34,869
in Medicine,
12
00:00:35,490 --> 00:00:36,950
which owns the journal
13
00:00:37,409 --> 00:00:39,829
Physics in Medicine and Biology.
14
00:00:40,770 --> 00:00:43,445
Our guests are 2 medical physicists
15
00:00:43,905 --> 00:00:46,164
working at the heart of the UK's
16
00:00:46,704 --> 00:00:48,164
National Health Service
17
00:00:48,545 --> 00:00:49,445
or NHS.
18
00:00:50,625 --> 00:00:53,905
They are Mark Knight, who is chief health
19
00:00:53,905 --> 00:00:54,804
care scientist
20
00:00:55,184 --> 00:00:57,924
at the NHS Kent and Medway
21
00:00:58,460 --> 00:00:59,920
Integrated Care Board,
22
00:01:00,219 --> 00:01:01,119
and Fiammetta
23
00:01:01,500 --> 00:01:02,000
Fidele,
24
00:01:02,619 --> 00:01:05,200
who is head of non ionizing
25
00:01:05,659 --> 00:01:06,159
radiation
26
00:01:06,619 --> 00:01:08,799
at Geis and St. Thomas
27
00:01:09,180 --> 00:01:12,000
NHS Foundation Trust in London.
28
00:01:12,685 --> 00:01:16,145
They're in conversation with Physics World's Tammy Freeman,
29
00:01:16,444 --> 00:01:19,805
and that's coming up after this message from
30
00:01:19,805 --> 00:01:20,305
Research
31
00:01:20,605 --> 00:01:21,105
Laboratories.
32
00:01:28,409 --> 00:01:31,390
This podcast is supported by RaySearch Laboratories,
33
00:01:32,170 --> 00:01:34,510
which unifies industry solutions,
34
00:01:35,129 --> 00:01:39,390
empowering healthcare providers to deliver precise and effective
35
00:01:39,930 --> 00:01:40,430
radiotherapy
36
00:01:40,810 --> 00:01:41,310
treatment.
37
00:01:42,454 --> 00:01:42,954
RaySearch's
38
00:01:43,494 --> 00:01:44,795
AI driven solutions
39
00:01:45,415 --> 00:01:48,075
reshape cancer care by accelerating
40
00:01:48,454 --> 00:01:48,954
workflows,
41
00:01:49,575 --> 00:01:50,795
delivering consistent
42
00:01:51,174 --> 00:01:54,795
and reliable results, with less manual work.
43
00:01:55,810 --> 00:01:59,250
RayStation is a treatment planning system that brings
44
00:01:59,250 --> 00:01:59,750
tranquility
45
00:02:00,209 --> 00:02:01,590
to treatment planning.
46
00:02:02,290 --> 00:02:05,349
No more bouncing between different treatment machines,
47
00:02:05,730 --> 00:02:07,270
techniques and modalities.
48
00:02:08,305 --> 00:02:08,805
RayStation
49
00:02:09,105 --> 00:02:11,044
is a comprehensive software.
50
00:02:12,305 --> 00:02:14,085
RayCare is an oncology
51
00:02:14,465 --> 00:02:17,444
information system and a trusted ally.
52
00:02:17,985 --> 00:02:19,764
It automates and streamlines
53
00:02:20,719 --> 00:02:21,860
adaptive oncology
54
00:02:22,159 --> 00:02:22,659
workflows
55
00:02:23,199 --> 00:02:24,099
while securely
56
00:02:24,400 --> 00:02:26,659
guiding users through the entire
57
00:02:26,960 --> 00:02:28,659
patient treatment journey.
58
00:02:29,760 --> 00:02:30,580
Ray Intelligence
59
00:02:31,120 --> 00:02:31,620
empowers
60
00:02:32,000 --> 00:02:33,620
confident decision making
61
00:02:33,985 --> 00:02:38,084
by unifying clinical data into actionable insights.
62
00:02:38,944 --> 00:02:40,644
This cloud based oncology
63
00:02:41,025 --> 00:02:42,644
data analytics system
64
00:02:43,104 --> 00:02:45,364
offers a clear view of clinical
65
00:02:45,664 --> 00:02:46,164
operations.
66
00:02:46,864 --> 00:02:48,644
Raysearch products transform
67
00:02:49,230 --> 00:02:49,969
scattered technologies
68
00:02:50,669 --> 00:02:51,569
into clarity,
69
00:02:52,110 --> 00:02:53,650
elevating the radiotherapy
70
00:02:54,270 --> 00:02:54,770
industry.
71
00:03:02,344 --> 00:03:04,985
Many of the health care procedures routinely delivered
72
00:03:04,985 --> 00:03:07,224
in hospitals rely on the work of medical
73
00:03:07,224 --> 00:03:07,724
physicists.
74
00:03:08,664 --> 00:03:11,965
Medical physicists are responsible for developing and commissioning
75
00:03:12,025 --> 00:03:14,365
advanced diagnostic and treatment systems.
76
00:03:14,939 --> 00:03:18,319
They design radiotherapy plans that accurately target tumors,
77
00:03:18,939 --> 00:03:21,099
make sure that the hospital's imaging equipment is
78
00:03:21,099 --> 00:03:23,519
operating as expected, and much more.
79
00:03:24,139 --> 00:03:26,300
But one of their most important tasks is
80
00:03:26,300 --> 00:03:28,400
to ensure the safety of all these procedures
81
00:03:28,860 --> 00:03:30,795
for the patient as well as the health
82
00:03:30,795 --> 00:03:31,534
care staff.
83
00:03:32,875 --> 00:03:35,514
To discuss how physicists keep you safe during
84
00:03:35,514 --> 00:03:36,495
health care procedures,
85
00:03:37,034 --> 00:03:39,375
I'm joined today by Mark Knight,
86
00:03:39,675 --> 00:03:42,474
chief health care scientist at NHS Kent and
87
00:03:42,474 --> 00:03:43,375
Medway ICB,
88
00:03:44,210 --> 00:03:45,590
and Fiammetta Fidele,
89
00:03:46,050 --> 00:03:48,530
head of non ionizing radiation at Guy's and
90
00:03:48,530 --> 00:03:50,789
Saint Thomas NHS Foundation Trust.
91
00:03:51,330 --> 00:03:52,870
Welcome both to the podcast.
92
00:03:53,810 --> 00:03:54,629
Hello, Tammy.
93
00:03:55,250 --> 00:03:55,750
Hello.
94
00:03:56,944 --> 00:03:59,685
So looking at the safety of medical treatments,
95
00:03:59,745 --> 00:04:01,264
one of the first things that comes to
96
00:04:01,264 --> 00:04:02,485
mind is radiotherapy.
97
00:04:03,344 --> 00:04:06,544
So this involves firing beams of ionizing radiation
98
00:04:06,544 --> 00:04:08,884
at the patient to destroy cancer cells.
99
00:04:09,560 --> 00:04:12,039
So how do the medical physicists ensure that
100
00:04:12,039 --> 00:04:13,340
these treatments are safe?
101
00:04:13,719 --> 00:04:16,040
For example, that the patient doesn't receive too
102
00:04:16,040 --> 00:04:16,860
much radiation
103
00:04:17,240 --> 00:04:19,639
and that the radiation only hits the tumor
104
00:04:19,639 --> 00:04:21,899
and doesn't damage healthy parts of the body.
105
00:04:23,164 --> 00:04:24,764
Thank you, Tammy. So I thought the best
106
00:04:24,764 --> 00:04:26,285
way to look at this was to take
107
00:04:26,285 --> 00:04:28,625
a step by step approach through the radiotherapy
108
00:04:28,845 --> 00:04:29,345
process.
109
00:04:29,884 --> 00:04:32,044
So we start with a scan, which will
110
00:04:32,044 --> 00:04:34,685
show us precisely where the tumour is in
111
00:04:34,685 --> 00:04:36,785
the patient and what shape it is.
112
00:04:37,519 --> 00:04:39,680
And in the modern world, we might, use
113
00:04:39,680 --> 00:04:41,919
a hybrid imaging technique to do this. So
114
00:04:41,919 --> 00:04:44,000
a a CT scan perhaps which tells you
115
00:04:44,000 --> 00:04:46,879
where the anatomy is combined with a with
116
00:04:46,879 --> 00:04:48,800
a PET scan or an MRI scan, which
117
00:04:48,800 --> 00:04:51,214
might tell you more about the dynamics of
118
00:04:51,214 --> 00:04:52,334
the the tumor,
119
00:04:52,654 --> 00:04:53,154
physiology.
120
00:04:54,014 --> 00:04:55,774
So the the next stage is that a
121
00:04:55,774 --> 00:04:57,794
clinician will outline the tumor,
122
00:04:59,214 --> 00:05:01,074
to show us exactly where,
123
00:05:01,694 --> 00:05:04,574
that is on the visual image, and then
124
00:05:04,574 --> 00:05:05,394
they'll extend
125
00:05:05,889 --> 00:05:08,210
the size of those margins a bit to
126
00:05:08,210 --> 00:05:09,589
take account of microscopic
127
00:05:09,970 --> 00:05:10,470
disease,
128
00:05:10,930 --> 00:05:13,170
and uncertainties in the location of the tumor
129
00:05:13,170 --> 00:05:15,569
that that would come about through all sorts
130
00:05:15,569 --> 00:05:16,069
of,
131
00:05:16,449 --> 00:05:19,009
things during the treatment process. So the patient's
132
00:05:19,009 --> 00:05:21,464
bladder might be more full on one day,
133
00:05:21,464 --> 00:05:23,725
which could affect the position of the prostate,
134
00:05:23,785 --> 00:05:25,564
for example, in a prostate treatment.
135
00:05:26,745 --> 00:05:28,524
And the next stage then is to take
136
00:05:28,584 --> 00:05:31,084
a computerized treatment planning system,
137
00:05:31,785 --> 00:05:33,245
to plan a bespoke
138
00:05:33,920 --> 00:05:37,040
radiation treatment for every single patient. So based
139
00:05:37,040 --> 00:05:38,020
on that scan,
140
00:05:38,800 --> 00:05:40,660
the delineation of the tumor
141
00:05:41,120 --> 00:05:43,520
volume, we would then use a series of
142
00:05:43,520 --> 00:05:45,779
radiation beams to mathematically
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model,
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in a treatment planning system,
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a radiation dose to that tumor. And and
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the aim here then is to deliver the
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prescribed radiation dose, which comes from our clinician.
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We we want to deliver this much radiation
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to exactly that shape, and size of tumor,
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to,
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and whilst minimizing the organs,
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at risk,
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radiation exposure. So for example, we know that
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the bowel,
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the spinal cord, for example, are much more
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sensitive to radiation
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than other organs, and so we would need
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to ensure that, the dose is is minimized.
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So on a on a conventional
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radiotherapy treatment, we would use then a linear
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accelerator or LINAC to deliver those radiation treatments
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to the tumor.
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And we've got lots of technologies available. So
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for example,
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tiny,
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lead sheets, which are very
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thick but very narrow, which can be used
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to shape the radiation dose
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coming out of the machine.
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We can change the intensity
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of the radiation,
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and we can move the linear acceleration around
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the patient while we deliver
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the treatment. And all of that combines to
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give us a very precise delivery
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of radiation exposure to the tumor volume that
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we've decided we need to treat from our
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scans.
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Okay. Great. So that's, I mean, that's a
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super example of sort of physics based techniques
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for, as you say, shaping the radiation and
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planning where it needs to go exactly.
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Now x rays are also used for diagnosing
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medical conditions, and this includes
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conventional x-ray scans,
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CT images,
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mammography.
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Now here, the aim is very much not
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to destroy any tissue, but to create images.
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What are the potential risks of x-ray imaging,
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and and how are these addressed?
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So firstly, it's important to say that the
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risk to individuals
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from imaging with x rays are relatively small,
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and it's important to keep those risks in
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context.
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So for example, we expose ourselves to risk
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in everyday life through our day to day
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activities such as traveling in a car and,
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eating and drinking in excess of foods that
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that may be bad for us.
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And they they have risk to human health
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as well, but we tend to not worry
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about those so much as radiation risks,
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because that's a bit of an unknown thing.
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We we must remember as well that we're
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exposed to background radiation
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all the time,
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which comes from the outside the Earth's atmosphere
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and also in the food we eat and
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the air we breathe. So humans have evolved
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in an environment where we protect ourselves very
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well against dionising radiation exposure.
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A chest x-ray, for example, gives us the
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same radiation exposure as a few days of
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background radiation.
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So the key to protection of patients,
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is that each,
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medical imaging procedure is justified
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by an expert in medical imaging, and it
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would only go ahead if the benefit to
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the patient outweighs the risk from undertaking that
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exposure, and that is a legal requirement.
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Medical physics professionals
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are closely involved
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with the quality assurance of X-ray imaging equipment.
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And during this process,
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they'll review radiation dose, image quality,
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and check that all of the radiation dose
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saving devices for the patient are being used
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in an optimal manner. And this process then
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of balancing
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the reduction of radiation exposure,
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with the,
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best image quality
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is known as optimization.
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Optimization is a huge part of our daily
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work in medical physics. I should have said
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before, of course, that it's exactly the same
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in radiotherapy.
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Our our physicists are closely involved with all
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of the processes around inner accelerators,
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the treatment planning processes,
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and the scanning processes that go into delivering
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that safe therapy.
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And finally, we would reduce
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risk further by ensuring that all of the
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professionals connected
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with each imaging procedure
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are trained,
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and they follow best practice guidelines. So that
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would include our medical physics professionals who carry
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out that quality assurance and optimisation
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process,
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on the x-ray equipment itself.
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Okay. And and there's lots of other techniques
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used for diagnostic imaging,
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For example, ultrasound, which uses high frequency sound
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waves to create images inside the body.
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Now
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if this technique just uses sound waves, are
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there any safety concerns here? Fia, perhaps you
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could answer this question?
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Yes. Hi, Tommy. Good question. Yes. Ultrasound
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still produces some effects in the body. It
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produces some heat and can interact with gases
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in the body, like, for example, the air
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in the lungs.
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But sonographers in UK
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are trained to keep scanning times and as
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well the level of the sound waves that
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they use well below the levels that could
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produce any of these effects. And so it's
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perfectly safe to use. And the role of
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the medical physicist is that to make sure
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the scanners
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are working as they say they're supposed to
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work from manufacturers so that they can, keep
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those levels within the limits sonographers
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know.
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Okay. And you also work with a treatment
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technique called phototherapy,
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and this uses UV light to treat skin
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conditions.
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So how do you make sure that patients
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receive the correct dose to treat them and
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not to cause harm?
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Yeah. So phototherapy carbines are a bit like
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huge,
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UV ton inverts.
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And
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the point is that in that case, the
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UV is being given to the patients for,
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for treatment. But they need to have a
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precise dose.
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And what we do, we use light meters
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to check the output of the cabins.
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And then we can reassure the nurses, the
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specialist nurses that usually deliver this treatment. So
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what is the output of those units so
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that they can make sure that they
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register the dose, they track the dose, and
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so they know when it's time to complete
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the course of treatment for the patient?
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Okay. So it sounds like in a lot
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of these,
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techniques that the medical physicist, one of their
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big jobs is making sure that the equipment
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is working safely.
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But I guess, you can do that and
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and and
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there can still be issues.
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So another imaging technique that's used all the
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time in hospitals is MRI.
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And MRI scanners present a unique hazard due
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to their extremely strong static magnetic field.
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And there have been reports of some serious
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accidents caused by ferromagnetic
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metal objects being pulled into the scanner.
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So, you know, even if the scanner is
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working perfectly, sometimes these accidents can happen. So
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how do we present prevent this from happening?
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So,
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Tammy, linking to what we were discussing before
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measurements, but then another big,
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element of our job is training
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training of the clinical teams.
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So in MRI, for example, the at the
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key prevention
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is,
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training the staff, making sure that all those
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that can have access to MRI scanners,
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have had specific training that let them know
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of all the hazards that are connected
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with this huge magnet being there.
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And my colleagues that work in MRR, they
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run periodic colleague training sessions in,
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for geographers,
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researchers,
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everyone that might have access to that to
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those scans.
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2nd to training, there are the hazard control
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prevention measurements. So there's labeling.
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There's that indicates what are the higher risk
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areas.
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Whereabouts
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you have the limits when you can carry
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a magnetic objects?
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And, again,
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labeling of 8 entrances.
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Everything that makes it easy in a high
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pressure environment
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for those operating it to know that that
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it's,
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their limit of operation.
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Yeah. I mean, if if you if you
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see an MRI scanning area, there there's loads
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of big signs everywhere warning people to sort
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of make sure they're not bringing any objects
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near that they shouldn't. And then there's huge
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yellow labels,
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huge red labels on those pieces of equipment.
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You know, the ones that, yes, it's fine.
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That can go to ones that can't go.
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So.
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Okay. And then, I mean, I've seen sort
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of issues with things like, you know, oxygen
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cylinders being brought in that, that shouldn't be
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there and, and being attracted to the magnet.
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And obviously, as you say, training and making
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sure everyone knows about these hazards,
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that can help prevent that.
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But what about if the patient have got
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the patient has metallic implants that they can't
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remove? So
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if a patient has a pacemaker or a
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cochlear implant, something like that, is that a
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problem for MRI?
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Yes. It is a problem, and this is
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one of the biggest data that works for
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the MRI physicist,
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because they play a key role in advising
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the clinical team.
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First, they need to,
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determine
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whether that's how what's the classification
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of that specific implant? So the newest implant
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will be
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as being MRI safe, so they can go
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anywhere in an MRI environment.
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Then there'll be the ones that are called
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conditional, so they can be used under certain
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conditions. And then there are the ones that
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are called unsafe. So there are the ones
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where it's not
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recommended to have a patient in an MRI,
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scanner.
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And but also in those cases, it's always
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a discussion between a multidisciplinary
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team. So between the physics team and then
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00:15:44,424 --> 00:15:47,139
the consultant and the clinical team to discuss
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the health benefit for the patient. Because you
403
00:15:49,139 --> 00:15:51,620
might have a patient that has an implant
404
00:15:51,620 --> 00:15:53,139
that is not one of those that is
405
00:15:53,139 --> 00:15:55,399
MRI safe, but it's really important
406
00:15:56,179 --> 00:15:57,959
for them to have their scanner.
407
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And the likelihood of something happen comparing to
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other implants might be lower if if it
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makes sense. So it's always a balance. It'd
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00:16:06,555 --> 00:16:09,355
be like with ionizing radiation. There is always
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a balance, and the physicists have a key
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role in trying to explain
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to the medical teams what are they,
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the risk that they can,
415
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can have.
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Yeah. So it's the physicists working with the
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clinicians to sort
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of optimize
419
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optimize it. Okay.
420
00:16:27,629 --> 00:16:30,669
Now another area of health care, back onto
421
00:16:30,669 --> 00:16:34,290
ionizing radiation. There's another area called nuclear medicine,
422
00:16:34,565 --> 00:16:37,704
which includes things like PET, positron emission tomography.
423
00:16:38,404 --> 00:16:38,904
And
424
00:16:39,284 --> 00:16:42,644
here, the radioactive materials are actually introduced into
425
00:16:42,644 --> 00:16:44,664
the patient's body for diagnosis
426
00:16:45,125 --> 00:16:46,024
or for treatment.
427
00:16:46,804 --> 00:16:49,304
How do we ensure patient safety here?
428
00:16:50,610 --> 00:16:52,290
Thank you, Tammy. It's a it's a good
429
00:16:52,290 --> 00:16:55,330
question. So, it's probably worth having a think
430
00:16:55,330 --> 00:16:58,210
about how nuclear medicine and PET imaging work
431
00:16:58,210 --> 00:17:00,389
initially. So so as you say,
432
00:17:00,930 --> 00:17:02,230
radioactive substances
433
00:17:02,769 --> 00:17:04,950
are typically labeled onto a pharmaceutical,
434
00:17:05,944 --> 00:17:09,085
and that pharmaceutical is designed to target disease
435
00:17:09,144 --> 00:17:11,305
processes in the body. So so we're all
436
00:17:11,305 --> 00:17:14,184
familiar that when we take paracetamol or aspirin,
437
00:17:14,184 --> 00:17:16,585
that's able to seek out the pain areas
438
00:17:16,585 --> 00:17:19,244
and reduce the pain in that specific location.
439
00:17:20,019 --> 00:17:21,480
So we call that a radiopharmaceutical,
440
00:17:22,259 --> 00:17:23,319
and that's injected
441
00:17:23,859 --> 00:17:24,839
into the patient,
442
00:17:25,940 --> 00:17:28,200
and you would expect then that that concentrates
443
00:17:28,420 --> 00:17:29,720
in the process where,
444
00:17:30,179 --> 00:17:32,500
in the place where the disease process is
445
00:17:32,500 --> 00:17:33,904
most strong. So,
446
00:17:34,845 --> 00:17:36,684
when you then put that patient into a
447
00:17:36,684 --> 00:17:38,305
camera or a or a scanner,
448
00:17:38,845 --> 00:17:41,805
what you find is that the the areas
449
00:17:41,805 --> 00:17:42,785
where the radiopharmaceutical
450
00:17:43,725 --> 00:17:46,950
is concentrated will glow brighter than other areas,
451
00:17:46,950 --> 00:17:48,630
and that allows us to see where the
452
00:17:48,630 --> 00:17:49,130
disease,
453
00:17:49,829 --> 00:17:50,569
is happening.
454
00:17:51,109 --> 00:17:51,609
So,
455
00:17:51,990 --> 00:17:53,529
in simple terms then,
456
00:17:53,990 --> 00:17:57,269
medical physics professionals will be carrying out very
457
00:17:57,269 --> 00:17:58,250
similar optimization
458
00:17:58,630 --> 00:18:00,650
processes to those that we've discussed
459
00:18:01,365 --> 00:18:01,865
before.
460
00:18:02,244 --> 00:18:02,744
So,
461
00:18:03,445 --> 00:18:06,664
very broadly ensuring that the minimum radiation dose
462
00:18:06,884 --> 00:18:07,625
is given,
463
00:18:08,164 --> 00:18:10,984
to allow for the production of diagnostic quality
464
00:18:11,525 --> 00:18:13,445
images. But if we want to take a
465
00:18:13,445 --> 00:18:14,744
bit of a deeper dive
466
00:18:15,119 --> 00:18:17,039
into this, think about the physics a little
467
00:18:17,039 --> 00:18:17,700
bit more,
468
00:18:18,240 --> 00:18:19,460
we could think about,
469
00:18:20,799 --> 00:18:21,619
how do we
470
00:18:22,079 --> 00:18:24,019
design our radionuclide
471
00:18:24,880 --> 00:18:25,380
diagnostic
472
00:18:25,759 --> 00:18:26,259
processes
473
00:18:26,799 --> 00:18:27,539
to minimize
474
00:18:27,920 --> 00:18:30,455
that radiation dose. So let's let's take a
475
00:18:30,455 --> 00:18:32,295
think for a for a moment about the
476
00:18:32,295 --> 00:18:35,575
half life of the radioactive substance that we
477
00:18:35,575 --> 00:18:36,075
use,
478
00:18:36,615 --> 00:18:37,515
for our imaging.
479
00:18:38,134 --> 00:18:39,355
This is quite critical.
480
00:18:40,134 --> 00:18:42,855
It it takes up to 2 hours perhaps
481
00:18:42,855 --> 00:18:43,355
to,
482
00:18:44,339 --> 00:18:47,059
for the pharmaceutical to label onto the disease
483
00:18:47,059 --> 00:18:49,240
process once it's inside the patient.
484
00:18:50,019 --> 00:18:51,480
And during that 2 hour
485
00:18:51,779 --> 00:18:54,920
time period, the radioactive substance is decaying.
486
00:18:55,299 --> 00:18:58,274
So, obviously, if we use a radioactive substance
487
00:18:58,274 --> 00:19:00,214
with a half life that's too short,
488
00:19:00,914 --> 00:19:02,835
we we'll end up having to inject a
489
00:19:02,835 --> 00:19:05,474
very high activity at the start of the
490
00:19:05,474 --> 00:19:07,634
scan, which gives a high dose to the
491
00:19:07,634 --> 00:19:10,950
patient. And similarly, if we give a radioactive
492
00:19:11,170 --> 00:19:13,830
substance with a half life that's too long,
493
00:19:14,049 --> 00:19:15,730
it will remain in the body for a
494
00:19:15,730 --> 00:19:17,809
long time after the scan is finished. And
495
00:19:17,809 --> 00:19:20,850
again, we'll deliver a high radiation dose to
496
00:19:20,850 --> 00:19:22,710
the patient. So we need to optimise
497
00:19:23,330 --> 00:19:24,375
our half life.
498
00:19:24,934 --> 00:19:27,654
It's a similar argument with the energy of
499
00:19:27,654 --> 00:19:29,035
the radiation emitted.
500
00:19:29,494 --> 00:19:30,555
If we choose,
501
00:19:31,255 --> 00:19:34,615
radio radioactive substance with an energy that's too
502
00:19:34,615 --> 00:19:35,115
low,
503
00:19:35,414 --> 00:19:37,654
then the gamma rays won't be able to
504
00:19:37,654 --> 00:19:38,875
escape the body,
505
00:19:39,549 --> 00:19:41,789
and they'll just deliver a radiation dose and
506
00:19:41,789 --> 00:19:44,269
won't contribute to our useful image. But if
507
00:19:44,269 --> 00:19:46,289
we choose an energy that's too high,
508
00:19:46,830 --> 00:19:48,589
the gamma rays will pass straight through the
509
00:19:48,589 --> 00:19:51,330
imaging equipment and won't contribute to the image
510
00:19:51,630 --> 00:19:53,410
either. So we have to optimise
511
00:19:53,825 --> 00:19:56,384
the radiation energy that we use. And again,
512
00:19:56,384 --> 00:19:59,105
this is where our medical physics professionals come
513
00:19:59,105 --> 00:19:59,605
in
514
00:19:59,904 --> 00:20:02,884
and have a very interesting time thinking about
515
00:20:03,025 --> 00:20:04,244
all of those different
516
00:20:04,704 --> 00:20:07,045
physics processes that that make,
517
00:20:08,065 --> 00:20:09,929
up the image. And if I could just
518
00:20:09,929 --> 00:20:12,250
talk for a minute then about therapy, because
519
00:20:12,250 --> 00:20:14,990
we also use radioactive substances in therapy.
520
00:20:16,329 --> 00:20:18,650
It's a similar process. So we would either
521
00:20:18,650 --> 00:20:19,150
inject,
522
00:20:19,690 --> 00:20:21,710
or ask the patient to swallow a radioactive
523
00:20:21,929 --> 00:20:22,429
substance
524
00:20:22,994 --> 00:20:23,734
to treat,
525
00:20:24,194 --> 00:20:25,734
medical condition, usually
526
00:20:26,035 --> 00:20:26,535
cancer.
527
00:20:27,474 --> 00:20:29,795
So common treatment, and this one dates back
528
00:20:29,795 --> 00:20:32,194
to the middle of 20th century, is to
529
00:20:32,194 --> 00:20:33,015
use radioactive
530
00:20:33,315 --> 00:20:34,214
IID 131,
531
00:20:35,234 --> 00:20:36,855
following the surgical removement,
532
00:20:37,759 --> 00:20:39,539
removal of the thyroid
533
00:20:39,839 --> 00:20:40,339
gland.
534
00:20:40,720 --> 00:20:42,899
And so what happens is the iodine concentrates
535
00:20:43,119 --> 00:20:45,839
in any remaining tissue that's left after the
536
00:20:45,839 --> 00:20:46,339
surgery,
537
00:20:46,960 --> 00:20:49,519
and it's a it's a great radioactive substance
538
00:20:49,519 --> 00:20:51,940
for this purpose because it contains 2 elements,
539
00:20:52,575 --> 00:20:53,075
beta
540
00:20:53,454 --> 00:20:53,954
particles
541
00:20:54,414 --> 00:20:56,654
that that are, of course, don't travel very
542
00:20:56,654 --> 00:20:58,575
far in tissue. So they deliver a very
543
00:20:58,575 --> 00:21:00,994
high dose to the thyroid tissue that's left
544
00:21:01,134 --> 00:21:03,775
and minimize the radiation dose to other organs
545
00:21:03,775 --> 00:21:06,414
in the body. So we destroy the thyroid
546
00:21:06,414 --> 00:21:07,529
tissue that's left
547
00:21:08,730 --> 00:21:10,670
and and spare the other tissues.
548
00:21:11,609 --> 00:21:13,849
And it also contains a gamma emission, which
549
00:21:13,849 --> 00:21:15,849
is quite useful because we can then use
550
00:21:15,849 --> 00:21:17,150
that to image
551
00:21:17,450 --> 00:21:19,690
any of that leftover thyroid tissue at the
552
00:21:19,690 --> 00:21:20,990
end of the treatment.
553
00:21:21,454 --> 00:21:23,775
So with that particular treatment, we use high
554
00:21:23,775 --> 00:21:24,755
levels of radioactivity,
555
00:21:25,375 --> 00:21:27,055
and the patient would need to remain in
556
00:21:27,055 --> 00:21:30,434
a shielded bedroom with special bathroom and drainage
557
00:21:30,494 --> 00:21:33,214
arrangements for a few days after receiving the
558
00:21:33,214 --> 00:21:33,714
therapy.
559
00:21:34,630 --> 00:21:35,669
Yeah. I mean, that, that was going to
560
00:21:35,669 --> 00:21:37,429
be my next question. If the patient's got
561
00:21:37,429 --> 00:21:40,089
a radioactive source of some sort inside them,
562
00:21:40,549 --> 00:21:42,549
do they pose a risk to other people
563
00:21:42,549 --> 00:21:45,049
and, and what's done about this?
564
00:21:46,150 --> 00:21:49,755
That's absolutely right. So every medical procedure that
565
00:21:49,755 --> 00:21:51,534
involves the use of radioactive
566
00:21:51,914 --> 00:21:54,794
materials does carry a risk to members of
567
00:21:54,794 --> 00:21:56,794
staff and, of course, to members of the
568
00:21:56,794 --> 00:21:57,294
public.
569
00:21:57,595 --> 00:21:59,134
So as you would imagine,
570
00:22:00,075 --> 00:22:00,815
the procedures
571
00:22:01,115 --> 00:22:01,615
are,
572
00:22:02,480 --> 00:22:03,940
rigorously risk assessed.
573
00:22:04,480 --> 00:22:06,240
So somebody will look at all of the
574
00:22:06,240 --> 00:22:07,759
risks from that,
575
00:22:08,080 --> 00:22:11,039
procedure. So we think about the external radiation
576
00:22:11,039 --> 00:22:13,519
that comes from the radioactive substance. If the
577
00:22:13,519 --> 00:22:15,600
patient travels home on the bus, for example,
578
00:22:15,600 --> 00:22:18,404
someone will calculated what the radiation dose would
579
00:22:18,404 --> 00:22:20,805
be to somebody sitting next to them on
580
00:22:20,805 --> 00:22:21,464
the bus.
581
00:22:22,085 --> 00:22:24,825
The radioactive substances are also excreted,
582
00:22:25,845 --> 00:22:28,904
from the patient in in urine, in sweat,
583
00:22:29,400 --> 00:22:32,039
saliva, for example. So we need to do
584
00:22:32,039 --> 00:22:35,019
calculations to ensure that if those substances
585
00:22:35,320 --> 00:22:37,580
get into, the environment,
586
00:22:38,039 --> 00:22:39,559
that they're not going to give,
587
00:22:39,960 --> 00:22:42,440
an exposure to members of the public that
588
00:22:42,440 --> 00:22:43,180
are too
589
00:22:43,559 --> 00:22:44,059
high.
590
00:22:44,894 --> 00:22:45,394
So,
591
00:22:46,255 --> 00:22:47,154
for our therapeutic
592
00:22:47,455 --> 00:22:47,955
procedures,
593
00:22:48,494 --> 00:22:51,215
the risk can be be higher still. And
594
00:22:51,215 --> 00:22:54,494
for those procedures, we need a bespoke risk
595
00:22:54,494 --> 00:22:56,035
assessment for each individual
596
00:22:56,335 --> 00:22:56,835
patient.
597
00:22:57,375 --> 00:22:59,315
So for example, in the iodine
598
00:23:00,099 --> 00:23:02,200
therapy we we talked about earlier,
599
00:23:03,859 --> 00:23:05,559
there, is a risk,
600
00:23:06,259 --> 00:23:07,960
when the patient goes home
601
00:23:08,579 --> 00:23:10,200
from the external radiation
602
00:23:10,659 --> 00:23:11,639
and from contamination
603
00:23:12,099 --> 00:23:15,000
from their urine and and bodily fluids.
604
00:23:15,345 --> 00:23:15,845
So,
605
00:23:17,184 --> 00:23:20,704
we would need to do a bespoke risk
606
00:23:20,704 --> 00:23:21,204
assessment
607
00:23:21,744 --> 00:23:24,065
for for them, and that will be based
608
00:23:24,065 --> 00:23:26,625
on their own particular circumstances. So you can
609
00:23:26,625 --> 00:23:29,025
imagine somebody who works as a park keeper
610
00:23:29,025 --> 00:23:30,960
where they don't meet members of the public
611
00:23:30,960 --> 00:23:32,559
very much, they're in a big wide open
612
00:23:32,559 --> 00:23:33,680
space all day,
613
00:23:34,799 --> 00:23:37,359
is much less risky than a primary school
614
00:23:37,359 --> 00:23:40,099
teacher who's sitting very close to small children
615
00:23:40,400 --> 00:23:42,079
all day. And then they would then go
616
00:23:42,079 --> 00:23:44,240
home with a different set of restrictions on
617
00:23:44,240 --> 00:23:45,605
their their own,
618
00:23:47,184 --> 00:23:47,684
activities.
619
00:23:48,625 --> 00:23:51,605
Okay. And, is this the same for brachytherapy?
620
00:23:51,984 --> 00:23:53,984
Because that's it's slightly different, but it also
621
00:23:53,984 --> 00:23:54,484
involves
622
00:23:54,785 --> 00:23:57,125
putting radioactive sources inside people.
623
00:23:58,305 --> 00:23:59,924
That's right. So,
624
00:24:00,509 --> 00:24:03,150
for brachytherapy, it's probably worth having a think
625
00:24:03,150 --> 00:24:05,890
about the difference between sealed and unsealed radioactive
626
00:24:06,029 --> 00:24:08,349
sources to start with. So in our nuclear
627
00:24:08,349 --> 00:24:08,849
medicine,
628
00:24:09,630 --> 00:24:11,730
and PET procedures, we inject
629
00:24:12,190 --> 00:24:14,130
unsealed sources, so they're liquid
630
00:24:14,444 --> 00:24:16,845
radioactive substances. They're free to move around the
631
00:24:16,845 --> 00:24:19,005
body and free to come out in our
632
00:24:19,005 --> 00:24:21,024
bodily fluids. But in brachytherapy,
633
00:24:21,404 --> 00:24:24,284
we use sealed radioactive sources where all of
634
00:24:24,284 --> 00:24:24,944
the radioactivity
635
00:24:25,244 --> 00:24:26,065
is encapsulated
636
00:24:27,099 --> 00:24:27,599
inside,
637
00:24:28,539 --> 00:24:30,240
for example, a metal capsule.
638
00:24:30,700 --> 00:24:32,859
So, generally, there's no risk that those will
639
00:24:32,859 --> 00:24:35,259
be released into the environment, and that whole
640
00:24:35,259 --> 00:24:35,759
contamination
641
00:24:36,139 --> 00:24:36,639
risk,
642
00:24:37,259 --> 00:24:38,079
goes down,
643
00:24:38,619 --> 00:24:39,919
to to 0.
644
00:24:40,964 --> 00:24:42,025
Having said that,
645
00:24:43,365 --> 00:24:45,365
the sealed source then can be thought of
646
00:24:45,365 --> 00:24:47,224
a little bit like, an X-ray
647
00:24:47,605 --> 00:24:48,105
source,
648
00:24:48,884 --> 00:24:50,964
which which we would use in imaging or
649
00:24:50,964 --> 00:24:52,105
in our linear accelerators.
650
00:24:52,640 --> 00:24:54,640
The big difference is you can't switch it
651
00:24:54,640 --> 00:24:57,680
off. It's radioactive. It's gonna be there until
652
00:24:57,680 --> 00:24:58,420
it's decayed.
653
00:24:58,880 --> 00:25:02,240
So we do have particular issues with a
654
00:25:02,240 --> 00:25:02,740
brachytherapy.
655
00:25:04,080 --> 00:25:06,320
For example, we would do a treatment where
656
00:25:06,320 --> 00:25:08,340
a source goes into the patient
657
00:25:08,764 --> 00:25:10,764
for, say, a 5 minute period and then
658
00:25:10,764 --> 00:25:11,505
is withdrawn.
659
00:25:11,884 --> 00:25:14,304
It's a very high activity sealed source,
660
00:25:14,924 --> 00:25:17,105
but sometimes that source could become stuck,
661
00:25:17,724 --> 00:25:20,044
and that poses a very big risk to
662
00:25:20,044 --> 00:25:20,704
the patient,
663
00:25:21,559 --> 00:25:23,880
and of course to to the staff. So
664
00:25:23,880 --> 00:25:27,420
they have procedures in place with regular rehearsals
665
00:25:28,039 --> 00:25:30,059
to make sure that if that does happen,
666
00:25:30,359 --> 00:25:32,279
they're they're they're right ready to go or
667
00:25:32,279 --> 00:25:34,599
the equipment's ready. The staff know exactly what
668
00:25:34,599 --> 00:25:36,494
they're doing to go in and and do
669
00:25:36,494 --> 00:25:38,355
that emergency source removal.
670
00:25:39,615 --> 00:25:40,914
Okay. That's really interesting.
671
00:25:42,335 --> 00:25:43,474
Now looking
672
00:25:43,855 --> 00:25:45,154
ahead to the future,
673
00:25:47,134 --> 00:25:50,015
researchers are continually developing sort of innovative new
674
00:25:50,015 --> 00:25:53,029
medical techniques, both for diagnosis and treatment.
675
00:25:53,730 --> 00:25:56,049
How do we ensure the safety of these
676
00:25:56,049 --> 00:25:56,549
advanced
677
00:25:56,849 --> 00:25:59,409
approaches when when they're first introduced into the
678
00:25:59,409 --> 00:26:01,750
clinic? Maybe you could both comment on that.
679
00:26:03,250 --> 00:26:05,169
So maybe before Mark comes in, what I
680
00:26:05,169 --> 00:26:07,654
will say is not is not much different
681
00:26:07,654 --> 00:26:09,515
from what is done for drug trials.
682
00:26:09,974 --> 00:26:12,535
So before you introduce them in common use,
683
00:26:12,535 --> 00:26:14,394
you need to test them under control,
684
00:26:15,575 --> 00:26:16,795
technology trials.
685
00:26:17,494 --> 00:26:17,994
And
686
00:26:19,109 --> 00:26:20,309
and I don't know, you know, Mark, if
687
00:26:20,309 --> 00:26:22,390
you wanna say a bit more about normally
688
00:26:22,390 --> 00:26:25,049
the conditions we would do those tests.
689
00:26:26,789 --> 00:26:28,009
Yes. We're doing,
690
00:26:29,029 --> 00:26:30,089
trials. So,
691
00:26:31,505 --> 00:26:32,005
essentially,
692
00:26:32,384 --> 00:26:35,024
when we're introducing new technology, I think the
693
00:26:35,024 --> 00:26:36,625
key is that we need to we need
694
00:26:36,625 --> 00:26:37,845
to do it very carefully,
695
00:26:38,944 --> 00:26:40,005
and in a very,
696
00:26:40,544 --> 00:26:41,044
considered
697
00:26:41,664 --> 00:26:42,164
manner.
698
00:26:42,544 --> 00:26:43,044
So,
699
00:26:43,744 --> 00:26:45,125
for first of all,
700
00:26:45,740 --> 00:26:47,440
with any new technology,
701
00:26:48,380 --> 00:26:50,779
we don't know at the start immediately how
702
00:26:50,779 --> 00:26:52,320
how things are going to work,
703
00:26:52,700 --> 00:26:54,700
and how they're gonna affect our patients. So
704
00:26:54,700 --> 00:26:57,180
you do a very tightly controlled clinical trial
705
00:26:57,180 --> 00:26:58,240
under those circumstances,
706
00:26:58,954 --> 00:27:00,974
and and you would expect that there's ongoing
707
00:27:01,115 --> 00:27:01,615
research,
708
00:27:02,474 --> 00:27:02,954
and,
709
00:27:03,275 --> 00:27:07,055
clinical trials into how do those technologies perform
710
00:27:07,355 --> 00:27:08,894
over a period of time.
711
00:27:10,394 --> 00:27:10,894
Then,
712
00:27:11,674 --> 00:27:12,174
devices
713
00:27:12,555 --> 00:27:14,095
you would expect to be
714
00:27:14,419 --> 00:27:14,919
certified,
715
00:27:15,619 --> 00:27:18,339
and regulated where where before they go into
716
00:27:18,339 --> 00:27:21,220
use. So that is a a process where
717
00:27:21,220 --> 00:27:23,640
the device is is rigorously examined,
718
00:27:24,339 --> 00:27:26,039
and given a certification
719
00:27:26,579 --> 00:27:28,599
to ensure that it's safe to use
720
00:27:28,994 --> 00:27:29,734
on patients.
721
00:27:30,275 --> 00:27:32,615
So again, you you would need expert
722
00:27:32,914 --> 00:27:33,414
support
723
00:27:34,194 --> 00:27:36,355
in the in the process of introducing this.
724
00:27:36,355 --> 00:27:38,115
And I and I think to me, this
725
00:27:38,115 --> 00:27:38,694
is where
726
00:27:39,075 --> 00:27:39,575
multidisciplinary
727
00:27:40,755 --> 00:27:42,694
approach comes in in healthcare.
728
00:27:43,339 --> 00:27:46,220
For sure, you need your medical physics teams.
729
00:27:46,220 --> 00:27:48,299
They're they're gonna be very well versed on
730
00:27:48,299 --> 00:27:50,859
the the types of risks that might come
731
00:27:50,859 --> 00:27:52,960
from these new technologies. They can,
732
00:27:53,339 --> 00:27:56,779
do do, extensive calculations for you on on
733
00:27:56,779 --> 00:27:58,664
what it might mean when we start to
734
00:27:58,664 --> 00:27:59,884
use those in patients,
735
00:28:00,184 --> 00:28:01,865
and and they will need to lurk work
736
00:28:01,865 --> 00:28:02,365
alongside,
737
00:28:03,065 --> 00:28:03,805
the doctors,
738
00:28:04,585 --> 00:28:07,325
perhaps the radiographers who are delivering the treatments
739
00:28:07,625 --> 00:28:08,525
as a multidisciplinary
740
00:28:09,065 --> 00:28:09,565
group
741
00:28:09,865 --> 00:28:12,345
to really understand how we're gonna best implement
742
00:28:12,345 --> 00:28:14,419
that into our medical pathways.
743
00:28:16,559 --> 00:28:19,299
And sometimes, if it's a diagnostic technique,
744
00:28:20,240 --> 00:28:22,000
to be safe, what they will have to
745
00:28:22,000 --> 00:28:23,839
do is they will have to give the
746
00:28:23,839 --> 00:28:27,440
same exam they already give patients, and then
747
00:28:27,440 --> 00:28:29,375
they would have to to use the new
748
00:28:29,375 --> 00:28:30,434
device. So sometimes
749
00:28:31,134 --> 00:28:34,255
they will inform the patients. They can accept
750
00:28:34,255 --> 00:28:36,255
to take part in the trial or cannot
751
00:28:36,255 --> 00:28:37,934
not accept to take part in the trial.
752
00:28:37,934 --> 00:28:39,934
But if they're doing it, it's for future
753
00:28:39,934 --> 00:28:42,494
benefit, and they will be, having to stay
754
00:28:42,494 --> 00:28:43,794
a little longer. So,
755
00:28:44,149 --> 00:28:46,149
again, most people are very happy to help
756
00:28:46,149 --> 00:28:48,069
because, you know, they are are aware that
757
00:28:48,069 --> 00:28:49,109
they're doing it for,
758
00:28:50,149 --> 00:28:51,690
for the future of everyone.
759
00:28:53,829 --> 00:28:55,049
Okay. And then,
760
00:28:56,230 --> 00:28:57,210
also looking
761
00:28:57,589 --> 00:28:58,970
ahead into the future,
762
00:28:59,625 --> 00:29:01,724
can you comment on the use of artificial
763
00:29:01,945 --> 00:29:02,445
intelligence
764
00:29:02,904 --> 00:29:04,125
in medical procedures?
765
00:29:04,984 --> 00:29:07,865
So AI is increasingly being touted for things
766
00:29:07,865 --> 00:29:10,605
such as creating radiation treatment plans
767
00:29:10,984 --> 00:29:13,005
or analysing medical images.
768
00:29:13,950 --> 00:29:15,950
What do you think are the risks of
769
00:29:15,950 --> 00:29:18,049
introducing AI into health care?
770
00:29:20,509 --> 00:29:23,710
So AI is a hot topic. Course keeps
771
00:29:23,710 --> 00:29:25,250
being is one of those
772
00:29:25,630 --> 00:29:28,029
where we get all the ethical and all
773
00:29:28,029 --> 00:29:28,529
the
774
00:29:30,204 --> 00:29:30,704
questions.
775
00:29:32,605 --> 00:29:34,464
In the end, like for other techniques,
776
00:29:35,005 --> 00:29:35,904
is a matter
777
00:29:37,325 --> 00:29:38,224
of controlled
778
00:29:39,484 --> 00:29:39,984
trials
779
00:29:40,365 --> 00:29:43,264
under expert guidance and under standardized
780
00:29:44,284 --> 00:29:44,784
processes.
781
00:29:47,150 --> 00:29:47,650
And
782
00:29:48,910 --> 00:29:49,970
the point is
783
00:29:50,269 --> 00:29:51,730
we can't just
784
00:29:52,269 --> 00:29:52,769
have,
785
00:29:53,549 --> 00:29:54,529
a black box
786
00:29:55,309 --> 00:29:58,875
introduced in everyday use without knowing what that
787
00:29:58,954 --> 00:30:01,035
black box is supposed to do when comparing
788
00:30:01,035 --> 00:30:02,575
what what we have before.
789
00:30:03,994 --> 00:30:06,394
But then again, there's bigger ethical issues. So
790
00:30:06,394 --> 00:30:07,134
I don't know,
791
00:30:07,595 --> 00:30:10,015
Mark, if you'd like to pop in.
792
00:30:11,289 --> 00:30:13,849
Yeah. Thank you. So so I think it's
793
00:30:13,849 --> 00:30:16,650
it's gonna be really important to make sure
794
00:30:16,650 --> 00:30:19,549
that AI is introduced in an ethical manner.
795
00:30:19,849 --> 00:30:21,470
So so one of the big concerns,
796
00:30:22,250 --> 00:30:24,984
might be just as Fimeta said there,
797
00:30:25,684 --> 00:30:28,085
we may not know exactly how the AI
798
00:30:28,085 --> 00:30:29,625
is coming to its decisions,
799
00:30:30,325 --> 00:30:32,244
because that that's the nature of the the
800
00:30:32,244 --> 00:30:34,184
way in which these machines work.
801
00:30:35,125 --> 00:30:37,044
And therefore, what we can look at is
802
00:30:37,044 --> 00:30:39,410
the data that we've used to actually train
803
00:30:39,410 --> 00:30:39,910
that
804
00:30:40,369 --> 00:30:41,029
AI system
805
00:30:41,330 --> 00:30:43,570
to make those decisions in the first place.
806
00:30:43,570 --> 00:30:44,950
So if you look at example,
807
00:30:45,809 --> 00:30:47,670
where we might be trying to diagnose,
808
00:30:48,690 --> 00:30:51,650
medical conditions from chest X rays using an
809
00:30:51,650 --> 00:30:52,470
AI system,
810
00:30:53,345 --> 00:30:56,005
We have systems that have been trained
811
00:30:56,625 --> 00:30:58,164
on on huge populations,
812
00:30:58,545 --> 00:30:59,765
millions of patients,
813
00:31:00,224 --> 00:31:02,945
but but in India. And and how do
814
00:31:02,945 --> 00:31:06,144
we know that the population in India has
815
00:31:06,144 --> 00:31:06,884
the same
816
00:31:07,289 --> 00:31:08,990
anatomy, the same physiological,
817
00:31:10,330 --> 00:31:11,710
conditions, the same,
818
00:31:12,330 --> 00:31:14,830
medical conditions that we have in the UK.
819
00:31:15,049 --> 00:31:16,890
So we may we may have an issue
820
00:31:16,890 --> 00:31:17,390
there
821
00:31:17,690 --> 00:31:21,065
with introducing a system that's been trained using
822
00:31:21,065 --> 00:31:22,204
a different population
823
00:31:22,585 --> 00:31:24,585
from our own. We we need to think
824
00:31:24,585 --> 00:31:26,744
the same in the UK. We have a
825
00:31:26,744 --> 00:31:28,444
wide range of nationalities.
826
00:31:28,904 --> 00:31:30,585
We have, people of,
827
00:31:31,625 --> 00:31:32,365
both sexes
828
00:31:32,664 --> 00:31:34,470
in the UK. We we need to make
829
00:31:34,470 --> 00:31:36,549
sure that when we train the systems, the
830
00:31:36,549 --> 00:31:38,730
right data is used so that we get,
831
00:31:39,430 --> 00:31:41,369
the the the right diagnostic
832
00:31:41,990 --> 00:31:44,309
processes out. So again, I think, Fimete, you're
833
00:31:44,309 --> 00:31:47,130
right. It's the ongoing research, the clinical trials,
834
00:31:47,224 --> 00:31:50,045
and of course, incident reporting is really important.
835
00:31:50,424 --> 00:31:51,644
If you have an incident
836
00:31:52,025 --> 00:31:53,325
with a medical device,
837
00:31:53,785 --> 00:31:56,365
and report that to the to the regulators,
838
00:31:56,505 --> 00:31:58,125
it's something that then the whole,
839
00:31:58,585 --> 00:32:01,630
world can learn from those mistakes, those errors,
840
00:32:01,630 --> 00:32:03,549
and and fix it so that it doesn't
841
00:32:03,549 --> 00:32:04,049
happen
842
00:32:04,430 --> 00:32:04,930
again?
843
00:32:05,470 --> 00:32:07,250
As far as AI is introduced
844
00:32:08,029 --> 00:32:09,009
in this multidisciplinary
845
00:32:09,630 --> 00:32:12,769
team with the contribution of the medical physicist,
846
00:32:12,990 --> 00:32:15,355
the clinical engineers, but also the the team
847
00:32:15,514 --> 00:32:17,774
the clinical teams are going to use them
848
00:32:18,154 --> 00:32:19,835
is going to help us. Because in the
849
00:32:19,835 --> 00:32:21,274
end, we have to think that in the
850
00:32:21,274 --> 00:32:24,154
past, even some of the measure automatic measurements
851
00:32:24,154 --> 00:32:25,595
that we use these days and some of
852
00:32:25,595 --> 00:32:28,390
the technology that we use these days, they
853
00:32:28,390 --> 00:32:30,789
were at those times equivalent of what AI
854
00:32:30,789 --> 00:32:33,190
might be now. AI is just bringing this
855
00:32:33,190 --> 00:32:34,730
to the to next level.
856
00:32:35,109 --> 00:32:36,869
But on the other side, we know that
857
00:32:36,869 --> 00:32:38,410
we are at the time of,
858
00:32:38,789 --> 00:32:41,349
you know, time being pressured for time, being
859
00:32:41,349 --> 00:32:42,315
pressured for
860
00:32:42,714 --> 00:32:44,875
being able to see more patients, treat more
861
00:32:44,875 --> 00:32:48,654
patients. So any tool that enables our clinicians
862
00:32:48,954 --> 00:32:52,174
to reach those decisions in a quicker time,
863
00:32:52,474 --> 00:32:54,315
it's it's going to be of of good
864
00:32:54,315 --> 00:32:56,500
shape. So I'm one of those, and I
865
00:32:56,500 --> 00:32:57,700
I don't know about Mark, but I'm one
866
00:32:57,700 --> 00:32:59,799
of those that is very hopeful about AI,
867
00:32:59,940 --> 00:33:02,039
but if done in a co design
868
00:33:02,419 --> 00:33:03,400
way with
869
00:33:03,859 --> 00:33:04,839
health care staff
870
00:33:05,460 --> 00:33:08,039
and in in safe clinical trials.
871
00:33:09,700 --> 00:33:12,545
I I agree. I I think that's absolutely
872
00:33:12,545 --> 00:33:14,325
right. To to me,
873
00:33:14,705 --> 00:33:16,384
I think if we were sitting here in
874
00:33:16,384 --> 00:33:18,484
10 years' time having this discussion,
875
00:33:18,945 --> 00:33:20,625
the the the world will have changed. It's
876
00:33:20,625 --> 00:33:23,345
like when the the Internet was first introduced
877
00:33:23,345 --> 00:33:25,125
in the early 19 nineties,
878
00:33:26,230 --> 00:33:27,750
Maybe we didn't know what what we would
879
00:33:27,750 --> 00:33:29,910
use that for, but but today, nobody can
880
00:33:29,910 --> 00:33:32,169
imagine life without it. And I I imagine,
881
00:33:32,789 --> 00:33:34,410
myself that this will be,
882
00:33:34,950 --> 00:33:35,849
very similar.
883
00:33:36,710 --> 00:33:39,275
Excellent. Well, it's, it's great to find out
884
00:33:39,275 --> 00:33:41,194
what we may have to look forward to
885
00:33:41,194 --> 00:33:43,115
in the future and also to, you know,
886
00:33:43,115 --> 00:33:44,795
to learn about all the work that medical
887
00:33:44,795 --> 00:33:47,934
physicists are doing to keep everyone safe. So
888
00:33:48,154 --> 00:33:50,015
thank you both for joining me today.
889
00:33:50,875 --> 00:33:51,480
Thank you.
890
00:33:51,960 --> 00:33:52,700
Our pleasure.
891
00:33:59,319 --> 00:34:03,160
That was Fiamada Fidele and Mark Knight in
892
00:34:03,160 --> 00:34:04,940
conversation with Tammy Freeman.
893
00:34:05,595 --> 00:34:09,054
That interview is produced in collaboration with IPEM,
894
00:34:09,434 --> 00:34:10,894
which owns the journal
895
00:34:11,275 --> 00:34:13,775
Physics in Medicine and Biology.
896
00:34:14,554 --> 00:34:17,695
You can find the journal at IOP Science.
897
00:34:19,139 --> 00:34:23,079
Next week, the scholarly publishing community is celebrating
898
00:34:23,699 --> 00:34:26,679
peer review week. And here on the podcast,
899
00:34:26,900 --> 00:34:29,299
we will be looking at how journals can
900
00:34:29,299 --> 00:34:29,799
eliminate
901
00:34:30,500 --> 00:34:31,000
unhelpful
902
00:34:31,539 --> 00:34:33,239
or outright rude
903
00:34:33,585 --> 00:34:36,644
reviewer comments from the peer review process.
904
00:34:37,744 --> 00:34:40,324
That episode will go live on Tuesday,
905
00:34:40,784 --> 00:34:41,284
24th
906
00:34:41,905 --> 00:34:42,405
September
907
00:34:42,945 --> 00:34:45,204
instead of the usual Thursday.
908
00:34:46,029 --> 00:34:47,569
That's because on Thursday,
909
00:34:47,949 --> 00:34:48,449
26th,
910
00:34:48,829 --> 00:34:52,369
we are presenting the future of particle physics.
911
00:34:52,909 --> 00:34:55,170
This is a physics world live event
912
00:34:55,469 --> 00:34:57,650
produced in partnership with the journal
913
00:34:57,949 --> 00:35:00,289
reports on progress in physics.
914
00:35:00,905 --> 00:35:02,525
The live panel discussion
915
00:35:03,065 --> 00:35:06,344
will feature Tara Shears of the University of
916
00:35:06,344 --> 00:35:06,844
Liverpool,
917
00:35:07,545 --> 00:35:10,525
Phil Burrows at the University of Oxford,
918
00:35:11,065 --> 00:35:13,565
and Talika Bowes of the University
919
00:35:14,025 --> 00:35:14,764
of Wisconsin,
920
00:35:15,385 --> 00:35:15,885
Madison.
921
00:35:16,739 --> 00:35:19,940
They will explore what the future holds for
922
00:35:19,940 --> 00:35:23,400
high energy physics, and where the next particle
923
00:35:23,460 --> 00:35:23,960
collider
924
00:35:24,340 --> 00:35:25,320
should be built.
925
00:35:25,860 --> 00:35:28,360
You can register now for this free event
926
00:35:28,500 --> 00:35:30,255
on the Physics World website.
927
00:35:30,795 --> 00:35:33,855
Just click on the Physics World Live tab
928
00:35:34,155 --> 00:35:36,655
at the top right of the home page.
929
00:35:37,195 --> 00:35:39,114
I'm afraid that's all the time we have
930
00:35:39,114 --> 00:35:41,994
for this week's podcast, which was produced in
931
00:35:41,994 --> 00:35:43,534
partnership with IPEM.
932
00:35:44,280 --> 00:35:46,140
Thanks to Fiammetta Fideli,
933
00:35:46,920 --> 00:35:47,900
Mark Knight,
934
00:35:48,360 --> 00:35:50,699
and Tammy Freeman for a fascinating
935
00:35:51,000 --> 00:35:51,500
conversation.
936
00:35:52,360 --> 00:35:54,460
And a special thanks to our producer,
937
00:35:54,840 --> 00:35:55,820
Fred Iles.
938
00:35:56,574 --> 00:35:59,074
And we would like to acknowledge the support
939
00:35:59,535 --> 00:36:00,434
of RaySearch
940
00:36:00,815 --> 00:36:01,315
Laboratories
941
00:36:02,094 --> 00:36:03,074
for this podcast.
942
00:36:10,210 --> 00:36:13,110
This podcast is supported by RaySearch Laboratories,
943
00:36:14,050 --> 00:36:14,949
which unifies
944
00:36:15,250 --> 00:36:16,309
industry solutions,
945
00:36:16,849 --> 00:36:18,550
empowering healthcare providers
946
00:36:18,929 --> 00:36:21,190
to deliver precise and effective
947
00:36:21,809 --> 00:36:22,309
radiotherapy
948
00:36:22,690 --> 00:36:23,190
treatment.
949
00:36:24,204 --> 00:36:24,704
RaySearch's
950
00:36:25,484 --> 00:36:26,625
AI Driven solutions
951
00:36:27,244 --> 00:36:29,824
reshape cancer care by accelerating
952
00:36:30,204 --> 00:36:30,704
workflows,
953
00:36:31,484 --> 00:36:32,545
delivering consistent
954
00:36:32,925 --> 00:36:34,464
and reliable results,
955
00:36:34,764 --> 00:36:36,545
with less manual work.
956
00:36:37,659 --> 00:36:41,099
RayStation is a treatment planning system that brings
957
00:36:41,099 --> 00:36:41,599
tranquility
958
00:36:42,059 --> 00:36:43,360
to treatment planning.
959
00:36:44,140 --> 00:36:47,199
No more bouncing between different treatment machines,
960
00:36:47,500 --> 00:36:49,039
techniques, and modalities.
961
00:36:50,114 --> 00:36:50,614
RayStation
962
00:36:50,914 --> 00:36:52,054
is a comprehensive
963
00:36:52,355 --> 00:36:52,855
software.
964
00:36:54,114 --> 00:36:55,894
RayCare is an oncology
965
00:36:56,275 --> 00:36:59,255
information system and a trusted ally.
966
00:36:59,795 --> 00:37:01,574
It automates and streamlines
967
00:37:02,355 --> 00:37:02,855
adaptive
968
00:37:03,155 --> 00:37:03,655
oncology
969
00:37:04,034 --> 00:37:04,534
workflows
970
00:37:04,914 --> 00:37:07,159
while securely guiding users
971
00:37:07,460 --> 00:37:08,440
through the entire
972
00:37:08,820 --> 00:37:10,519
patient treatment journey.
973
00:37:11,619 --> 00:37:12,359
Ray Intelligence
974
00:37:12,980 --> 00:37:13,480
empowers
975
00:37:13,780 --> 00:37:15,400
confident decision making
976
00:37:15,780 --> 00:37:19,880
by unifying clinical data into actionable insights.
977
00:37:20,835 --> 00:37:22,454
This cloud based oncology
978
00:37:22,835 --> 00:37:24,454
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979
00:37:24,914 --> 00:37:27,974
offers a clear view of clinical operations.
980
00:37:28,755 --> 00:37:30,375
Research products transform
981
00:37:30,755 --> 00:37:31,894
scattered technologies
982
00:37:32,434 --> 00:37:33,335
into clarity,
983
00:37:33,940 --> 00:37:35,480
elevating the radiotherapy
984
00:37:36,019 --> 00:37:36,519
industry.
