On Friday 22nd July, a select group of Pro-Manchester members were treated to an excellent presentation detailing the progress of the first NHS UK Proton Beam Therapy unit.
Sponsored by Mills & Reeve LLP and hosted by Manchester Metropolitan University at their Birley Fields campus, Pro-Manchester had assembled an impressive panel to explore three critical facets of this ground breaking project.
The talk commenced with Professor Karen Kirkby – Richard Rose Chair for Proton Therapy Physics at The Christie NHS Foundation Trust, explaining how Proton beam Therapy (PBT) had developed to address some of the shortcomings of conventional X-Ray treatment.
At the heart of all Cancer treatments is the desire to kill the tumour whilst attempting to limit the collateral damage to the surrounding healthy tissue. The most common form of current radiotherapy treatment uses X-rays for this purpose. Whilst the technology is excellent and has evolved over many years to provide a highly focussed beam of radiation which delivers its maximum dose at the site of the tumour, the very nature of X-rays is such that damage is inevitably inflicted to healthy tissue through which the beam must travel on its way in to and out of the target. Growing children are particularly sensitive to this damage which can also lead to secondary cancers many years after the treatment.
PBT is radically different. Using the some of the same technology as that employed in the Hadron Collider at CERN, a cyclotron (super-cooled to just 4o above absolute zero) accelerates ionised hydrogen atoms to 2/3 the speed of light before firing the resulting protons into the patient. The unique characteristic of these particles is that the destructive energy released by the particles can be controlled so that it is released within the tumour at the end of the particle trajectory. This means that the particles can pass through surrounding tissue causing relatively little damage before they interact with the cancer cells and release all their energy. This degree of control produces far less collateral damage and enables the clinicians to treat cancers that had previously been out of reach. It also allows them to treat cancers very close to critical organs which are very difficult to treat by more conventional means. As a result the intended case load for the PBT unit will be around 40% children.
With the science taken care of, it was the turn of Phil Shaw – Construction Director for Interserve Construction North West to explain just what extraordinary an achievement of construction this is.
Work commenced on site at the Christie in 2015, but planning for the project commenced more than 6 years earlier in 2009, when the potential of building a PBT unit at the Christie was first tabled. Working with Architects HKS and engineers Arup, Interserve engaged in a world tour of pioneering PBT units to learn from the teams involved. Through hours of interaction, the team learned how to overcome the many technical challenges faced by a construction team.
Those technical challenges are severe. The generation of the Proton Beam, requires the placement of a 4x4m, 280 tonne Cyclotron right at the heart of the building. To put that into context, this is equivalent to manoeuvring of a small family saloon which weighs the same as a 747 jet! Then there are the 3 gantries which provide the final focussing and patient treatment are 10m in diameter and weigh 10 tons each.
The neutron radiation, which is a by-product of the medical procedure, requires concrete walls up to 6m thick in places to contain it safely. This equated to over 20,000m3 of concrete to shield the three treatment rooms, research room and cyclotron.
All of this had to be achieved within incredibly tight tolerances. Settlement of less than 1.2mm had to be achieved. Real-time monitoring of temperatures deep within the concrete to avoid cracking needed to be undertaken. And all of this need to happen right in the middle of a working hospital delivering lifesaving treatment to patients where any disruption could have dire consequences.
The experience gained in the early days of globe-trotting proved invaluable in managing the unique challenges faced at the Christie with its constrained site and suburban location.
Ultimately, perhaps the real secret to achieving the successful outcomes experienced to date, has been the partnering which was fostered between the Christie, Interserve, The design team and the subcontractors. Subcontractors were brought on board early which allowed them to “Up-Skill” the local workforce. The design team used the latest Building Information Management systems to allow them to track and eliminate the millions of potential clashes between services, reinforcement, structure and equipment. Interserve liaised constantly with the Christie to avoid disruption to their clinicians and The Christie continue to maintain a constant dialogue with local residents.
Finally Jason Dawson – Director of Estates, Facilities and Capital at The Christie NHS Foundation Trust helped place the whole project in the context of Manchester and the world.
The Christie has been at the forefront of cancer research from its very inception and follows in Manchester’s long history for innovation- Manchester’s 25 Nobel prizes place it well ahead of its rivals, with only 7 countries (countries not cities!) able to boast more prizes.
Innovation has been applied at every level, not just in the science and construction, but even the means of procurement (Which required tough negotiation with the NHS to ensure that the model chosen- partnering through the P21+ framework, was adopted). In contrast it was noted that the second PBT unit, planned for London, has followed a traditional route and is showing some signs of stress and delayed delivery.
This innovation, which is central to the Christie ethos, has ensured that the hospital has successfully secured projects such as PBT, and with these projects has been able to attract world class clinicians and researchers to take advantage of Manchester’s Universities and co-located general hospitals.
With construction now well underway, the project is on course to commence the installation of the Proton Beam equipment in June 2017. Varian, The equipment supplier then has 10 months to install the equipment, before final commissioning takes place for 3 months in early 2018. The first patients are expected to be treated in mid 2018. Then the real fun begins!
This project is driven by the needs of patients, not the construction industry. This need requires that the technology disappears into the background. This is not an easy task. This treatment is so new that The Christie has had to develop new patient pathways and even re-imagine the interior design to form the most appropriate patient environments and ensure that the best clinical outcomes can be achieved. But with the Cyclotron up and running and the patients’ needs addressed, there remain still further opportunities. The Cyclotron will run 24-7 offering researchers a unique opportunity to develop new technology, fine tune the existing treatments and develop new ones in parallel with existing treatments.
This is a genuinely world class facility which sits comfortably alongside Manchester’s reputation for stunning innovation and application dating back to the industrial revolution. Now in 2016 we can echo the bold statement that originated with Ernest Rurtherford’s unique research in 1909, that Manchester is once again “The home of the proton”.
Author Gareth Banks- AHR Architects