You are lying on the treatment table, about to start 20 minutes of radiation therapy. A high tech machine rotates above and around you. Because your treatment involves radiation, you are actually in a concrete bunker. But the room feels light and airy. On the wall in front of you is a huge photo of a New Zealand forest, with majestic tall-trunked trees so real you feel your mind can go for a walk among them. And when you glance up at the ceiling, you are looking through overhanging branches of leafy green trees and into a beautiful blue sky.
A multi-million dollar linear accelerator and a $30,000 grant from the Dry July Charity are combining to improve service delivery and treatment experience for radiation therapy patients at Waikato Hospital.
Waikato Hospital has four linear accelerators (known as linacs) for radiation treatment, housed in four bunkers in Lomas Building on the hospital campus.
These are highly specialised, very expensive and critically important pieces of equipment. To keep them updated and eventually replaced in a planned way there is ongoing schedule of mid-life cycle upgrade and replacement at about 10 years. This ensures the equipment keeps up with the latest technology in linear accelerators and that patients are receiving the best treatment available.
The removal of the oldest linear accelerator and its replacement with the latest Varian TrueBeam model was scheduled back in July last year so planning could ensure the least impact on delivery of treatment.
Starting in April 2016, the process involved renovating the room, decommissioning, stripping down and then taking out the existing machine and then bringing in the new machine, putting it together and commissioning it. Normally the commissioning of a new machine, which includes precise measurements of data for multiple combinations of treatment size, is done in-house but this time a team from USA did the work in just one week to minimise the impact on staff and patients of having one machine not in action. This work was overseen by our medical physics team who had recently returned from training in America on how to keep our machine calibrated and safe for patients.
The renovation of the treatment room was also an opportunity to refresh its theme and add a sky ceiling made possible by a grant from the Dry July Charity, whose aim is to raise money to enhance the experience of cancer patients. A sky ceiling is an illuminated false skylight, using a backlit photo of a lovely spring sky with some overhanging upper branches of trees to provide a very realistic impression of a sky scene for someone lying on the treatment bed. Sky ceilings are produced by American company Sky Factory and imported through an Australia-based agent.
Local Hamilton firm Vivid Images has come to the party (as they have on previous occasions) by donating large wall hangings of natural scenes for the walls of the room. The feature wall photographs are a beautiful forest scene by Rob Suisted, award winning New Zealand photographer.
Each treatment room is colour-coded with its own “look and feel” – this one is Green Room. Yellow Room has a coastal/beach theme, Blue Room has three large panels of pink blossoms with blue sky that was taken by a staff member at the Hamilton Gardens, and Pink Room has a nature theme with lots of small canvas photo prints of flowers, insects and animals taken by staff.
The whole idea is to provide a positive experience for patients during treatment which can take from 10 to 60 minutes. Radiation Therapy team leader Michael Taylor says most treatments are 10 to 20 minutes long, but some patients can be in the room for over an hour. The images have a calming effect, with photos carefully chosen by the radiation therapy team to give a positive and interesting scene for patients to focus on if they wish.
So although technically the rooms are concrete bunkers to secure the radiation, they have been transformed into warm and light spaces with a strong link to nature – and this environment is supported by the friendly, caring and professional attitude of the staff.
The new linac is one of a new generation of linear accelerators. Taylor points out that all the DHB’s linacs provide the same treatment to the same high standard, but the advantage of the new model is that it is more efficient in the way it sequences the treatment fields. “That means the treatment can be shorter, and so more patients can be treated in the same amount of time,” he says.
The new model also comes with a much more streamlined system of monitors, which the staff use to do real-time checking and oversight of a radiation therapy treatment session. As well as less clutter in the control room, the new system makes it easier for staff to see all aspects of the treatment and data.
Members of the team often most closely involved with the person receiving treatment are the radiation therapists, and as part of the commissioning of the new linac two staff members Jenna Davidson, supervisor radiation therapist, and Mikayla Beetsma, radiation therapist, were sent on an intense four-day training with Varian Medical Systems, the company that makes the linacs, in America.
“It was invaluable,” they say. “The hands-on training and the ability to ask questions helped to solidify the information we were given and apply this to our current workflow.” They are now condensing this information and creating a training programme to upskill other radiation therapists.
The Dry July Charity grant also allowed the team to purchase a massage chair and some other new seating for the radiation treatment waiting room, as well as a PlayStation for the adolescent and young adult hub on Ward M5.
As part of the planned replacement programme, the next new linac is scheduled for 2018 for Yellow Room. The team will again take the opportunity to renovate and are hopeful a similar grant or donations will allow them to install a sky ceiling in that room as well.
Precision machine needed precision delivery
The new linear accelerator is a 6.1 tonne, multi-million dollar piece of highly sensitive precision equipment, and so its installation also requires highly expert and precise manoeuvring – made even trickier because it had to be lowered by crane through a tiny aperture in the bunker ceiling. Thanks to the expertise of Waikato Cranes – crane driver Damian Heather and ground crew Hans Spangers and Peter Ware – the new linear accelerator was successfully lowered through the small aperture in the bunker roof with just 15mm clearance on each side, in a process that started at 5.30am on 14 May and was completed by 9am. Peter Ware modestly describes it as an “easy job”. “It was a calm morning, no wind, which meant it was just a matter of positioning it right then lowering it down.” No pressure!
Shout Out for Dry July NZ
The Dry July Charity has supported Waikato Hospital, so we encourage people to support them. It is not just about the health benefits of giving up alcohol – the aim of Dry July is to raise funds for cancer patients and their carers, and donations are welcome whether you choose to “go dry” or not.
And Waikato Hospital Radiation Therapy department has a Dry July team page fundraising for the Dry July Charity this year: