Hazel Pennington - Protons coming home to Manchester

I wasn’t around when Ernest Rutherford first discovered protons at Manchester University in the early twentieth century. However, 100 years later I have the privilege and amazing opportunity to be involved in developing the first UK NHS high energy national proton service at The Christie in Manchester.

My journey started in 2014 as the lead radiographer in the project. In fact, I was the only radiographer for a few years. This may have been viewed as a challenge in a profession where we usually work in radiographic teams, but I thrived on the opportunity to work closely with other professions. Initially, I worked with the clinical lead, a consultant clinical oncologist, the head of physics and the lead engineer. We all got to know each well after many hours spent together in meetings, on trains to London, on long-haul flights to conferences and overseas hospitals, and evenings talking over a beer in a new city about what we had seen and learnt that day about protons and our vision for the future. Unbelievably, we all still get along!

As well as my clinical and physics tag team, I worked with project managers, lawyers and the finance department to acquire the proton equipment. Proton equipment procurement has a reputation for litigation, and for some countries legal challenges have significantly delayed their progress. The team worked hard to ensure a smooth process and to avoid legal challenges. The learning curve was huge and I was often in overdrive: not only were protons new to me, but the project processes were also new.

Next to learn about were concrete and cranes! Who would have thought as a student radiographer that 25 years later I would be discussing the logistics of the crane size needed to get an 90-tonne cyclotron (the bit of equipment that generates the actual protons) into place and how we needed part of the external wall removing on the first floor to get the MRI scanner into place as it was too large for the corridors. I now know what a ‘crane oversailing license’ is (a license allowing a tower crane to oversail property adjoining the site) and that a ‘joggle joint’ ensures each concrete element locks together securely to prevent radiation leakage at stop ends. I spent many an hour with architects, engineers, the construction team and designers.

Did I lose sight of the patient in all this project work, I hear you ask? I hope not. I created a patient representative group of patients, from children to octogenarians and their carers, who had received proton therapy overseas. They blew me away. I can’t find the words to describe how incredible they were. They gave up their free time to explain what it was like being away from home for a couple of months for treatment, the best type of accommodation, how to keep up with school work, ideas for how the centre should feel and look, and the best types of patient information. We took all this vital information on board and have hopefully created a patient-centred service, which includes every patient having a named key worker (specialist nurse or radiographer) who telephones patients before they arrive for their first appointment (talking was the best type of patient information). Only this week, I was gratified to hear that one of our five-year-old proton patients on his first visit said the centre was the ‘best place ever’ and he couldn’t wait to come back next week to show his mum. Ultimately, everything we do as healthcare professionals should be about the patient.

How do I feel now the service is operational? Exhausted! Seriously, first and foremost I am immensely proud of everyone who worked tirelessly to start the service. The success of the project has been down to the hard work and collaborative working of the whole team. It is one of the aspects of the project, and now operational service, that I enjoy the most. We have a close team, not only of radiographers, physicists and doctors, but of nurses, theatre practitioners, anaesthetists, support workers, secretaries, play specialists, allied health professionals, social workers, MDT co-coordinators, complementary therapists, governance officers and domestic staff. They are all, without exception, brilliant. I have a huge amount of knowledge and respect for the other professions. I’ve learnt a lot from my co-workers and I take great pride in calling them my colleagues.