Lab work one day, scanning patients the next: the life of a clinician scientist - Dr James O’Connor

Dr James O’Connor - clinician scientist at The Christie and The University of Manchester

Dr James O’Connor

‘So what exactly do you do?’ That’s a question I get asked a lot. Colleagues at work, as well as family and friends, all want to know what a clinician scientist actually is. In short, my job is a mixture of being a researcher and being a medic. And the two parts of the job go hand in hand. 

I spend most of my time in the lab as a researcher, developing new ways of imaging cancer.

But one day a week I work as a consultant radiologist at The Christie. As a doctor, I use my experience and judgement to diagnose cancer, see where it has spread to and decide if tumours are responding to therapy. And keeping an eye on both these areas is really important.

Being a medic helps me to identify limitations in the scans used to diagnose and monitor patients with cancer. Being a scientist lets me take those limitations and develop and test new ideas in my lab that could solve these problems.

And if we find something that could work then, I’m in the perfect position to help make sure these new approaches can be tested in the clinic and potentially benefit patients quickly.

One great thing about being a clinician scientist is variety – no two days are ever the same. Some days are spent in the lab; others in meetings; others writing funding proposals or turning data into papers. 

In some ways it is a bit like being self-employed. 

Although I have several staff funded by my grants, I need to attract more funding to build a research group that’s at the cutting edge of imaging science research. So I am always looking out for new ideas, new studies and new collaborators.

This aspect is really different from clinical work. Thinking outside the box is crucial.

It’s never nine to five, but I like that! Being a clinician scientist lets me organise my day to fit in around home life too. This is busy – we have four young children – but it can work well. I (nearly) never miss school assemblies or plays. I often do the school run. But it does mean that evenings and weekends are often filled with ‘working from home’.  

The scans and technology used to diagnose cancer can seem a bit removed from having contact with patients. And when you’re looking at new versions of this technology in the lab it can seem even more distant. 

But I’ve had some wonderful encounters with patients during my research. They have generously given their time to take part in my studies, which has not only shaped my research, but has also given me a crucial understanding of what it’s like to live with cancer.  

And that’s why we do the work that we do.

The Christie is one of the largest single centre cancer sites in Europe. Every year, around 2,000 of our patients take part in trials of new therapies that may alter how a tumour behaves, but not necessarily shrink it. Sometimes it can be difficult to work out why that’s happening and this is where my research comes in. 

Current scanning methods often can’t match the best treatment for each individual, or detect which patients are responding to a new therapy. My research group is developing new scanning methods that try to address these problems. We use advanced MRI scans to map different biological properties within different regions of tumours. 

And we’re beginning to see some promising results.

We recently developed a new way of measuring oxygen levels inside tumours which is something that has been difficult to do before.

Being able to see areas of low oxygen – called hypoxia – is really important. These regions can suggest whether a tumour might be more aggressive and likely to spread, and spotting them could signal where to target new treatments. 

These encouraging early results have allowed us to move this technique into two trials in patients with lung and rectal cancers.

It’s early days, but this method looks really promising! One day this technique could help doctors select the best therapy for each patient and monitor how tumours respond to new drugs and radiotherapy.

And it’s great to be in a position to see that discovery move from the lab and into the clinic.

Imaging scientists must show that scans are affordable and can improve patient care. There is no shortage of people developing clever ideas but these ideas must produce techniques that directly benefit patients.

It’s critical that our best imaging scientists work together to keep the UK at the forefront of cancer imaging. Cancer Research UK and the Engineering and Physical Sciences Research Council (EPSRC) have invested a substantial amount of money to help make this happen.  This initiative has helped me build collaborations with colleagues across the country, combining the strengths of all our scientists. 

Research is all about communication and building relationships with other academics. As well as collaborating with UK colleagues, I also work closely with many other scientists in the USA and Europe. This is one of the most enjoyable aspects of my work.  

Only by sharing ideas and working together will we truly crack the big challenges in research.

My job is challenging, but it’s great fun and is never boring! I love the balance of seeing patients and also having the opportunity to take an idea and hopefully turn it into something that improves people’s lives.  

Coughs and sneezes spread diseases - Jo Taylor

Christie patient Jo Taylor

Jo Taylor - Christie patient

On 1st October this year I was scheduled in for a regular appointment with my GP, while I was there he asked me if I would like my flu jab. Without hesitation I said ‘yes’!

I was 38 and married with two young children when I was diagnosed with breast cancer. My daughter was five months old and my son was two and a half. It was a HUGE shock. Before being diagnosed I’d always suffered respiratory problems which have made me susceptible to infections and coughs and colds. I had my tonsils out when I was 21 and since then I’ve not have the defences needed to stop chest infections.

Having my flu jab made total sense.

As a patient, the last thing I want is to be unnecessarily ill and forced to delay my treatment for any reason. This is why it’s so amazing that The Christie tries so hard to make sure as many staff as possible have the flu jab. The nurses I’ve spoken to are determined to keep the patients as well as possible. Last year The Christie vaccinated the second highest number of staff in the country and this year they want to hit the top spot.

Last year, during my chemotherapy treatment, I caught the flu and it was horrendous. I was so ill I couldn’t even leave my bed, I was incredibly lucky not to have been hospitalised. And for some vulnerable people that catch it, the flu can be life threatening. 

It’s so encouraging to know that everyone I come into contact with at The Christie will have been offered the flu vaccination. The Christie is an amazing place for treatment and the staff are well aware of the risks of flu.  They know their patients have a weakened immune system and need all the help they can get to stay well during treatment. I wouldn't want to be treated anywhere else, the clinicians and nursing staff - in fact everyone I have met - are the most welcoming and understanding of cancer.  And to know that they are so willing to go the extra mile to make sure their patients are safe by getting their flu jab is so reassuring. 

Although I wouldn’t have expected anything less…it's The Christie way.

Maggie’s and The Christie are working in partnership to create cancer support of the highest quality - Sinead Collins

Sinead Collins - Centre Head of Maggie’s at The Christie 

Sinead Collins

I’m delighted to introduce myself as Centre Head of the new Maggie’s Centre which will be opening its doors on Kinnaird Road in Spring next year. Readers might recognise me from my previous role at The Christie in surgical oncology. I had 12 wonderful years at The Christie but I am very excited about my new role with Maggie’s.

I’m sure readers will have noticed the rather unique-looking building as it has grown since we broke ground in April this year. I have heard people asking ‘what is Maggie’s?’, ‘what will happen inside this new building?’ and ‘how will this new support help me and my colleagues?’

I’m hoping this blog will give readers a good overview of Maggie’s and the support we’ll be providing, I’ll also be available in person to answer any questions at Grand Round on December 18th and I’ll be hosting an information stand on the glass corridor the week commencing 21st December and again in January. 

So, just to make a start; Maggie’s is a charity that provides completely free practical, emotional and social support for people affected by cancer and their family and friends. Our aim is to support people with all of the issues that cancer brings into their lives. 

Maggie's Centre design

We currently have 18 centres across the UK, online and abroad, each built in the grounds of specialist NHS cancer hospitals. All of our centres are unique, warm and welcoming places. From these centres we offer Maggie’s evidence-based core programme of support which has been developed to complement and add value to the excellent medical treatment and support that  is provided for patients here at The Christie day-in and day-out.

In my new role as Maggie’s Centre Head I will oversee everything that happens in the centre, supporting the needs of anyone who walks through the door, ensuring our programme of support is meeting the needs of the people being treated at The Christie and working with my team to create as warm and welcoming an environment as possible. 

Alongside myself, the new Maggie’s Centre will also be staffed with a team of qualified professionals including a psychologist, cancer support specialists, a benefits advisor, relaxation specialists as well as experts in a particular field who will come into the centre to provide sessions on nutrition, art therapy, tai chi, yoga and creative writing. 

The programme of support we’ll be offering will include psychological support, guidance on nutrition, benefits advice and exercise and has been shown to improve physical and emotional wellbeing.

Support at Maggie's

Any Christie patients and their loved ones will be welcome to access this support at the centre for free and without an appointment as we’ll be offering drop-in cancer support every weekday from 9am-5pm as well as a scheduled daily timetable of courses and workshops. 

As for the centre itself; Maggie’s Centres are intended to feel more like a home than a hospital and are designed to feel non clinical to help make our visitors feel safe, valued and comfortable in an atmosphere that stimulates their imagination and lifts their spirits. 

The new centre at The Christie has been designed by world-renowned architect, Lord Norman Foster, who was born and grew up in Manchester and will be surrounded by a garden designed by landscape designer Dan Pearson. We hope the space will provide patients and their family and friends with a friendly place to meet other people who are in a similar situation as well as offering a calming space where they can simply sit quietly with a cup of tea if that’s what they need.

If any readers have any questions about the new centre and the support we offer or would like to arrange a time for us to meet and to have a look round the centre then please don’t hesitate to get in touch with me on sinead.collins@maggiescentres.org or 07584680575. I look forward to catching up with everyone soon.

For further information on Maggie’s programme of support please visit 

www.maggiescentres.org/how-maggies-can-help/ 

Christmas is a special time of the year for the children at Beaver Road and The Christie has a very special place in all our hearts - Holly Myers

Holly Myers - Subject Leader for Music at Beaver Road Primary School

Holly Myres

On Tuesday 8th December, the members of the Beaver Road Primary Choir in Years 3 and 4 will be performing in The Christie Charity Christmas Concert at Manchester Cathedral. 

This will be the third year that our choir has been invited to take part in the Christie Concert. We loved performing at Gorton Monastery the last two years, but we are really excited about singing in the cathedral. It is a very special venue and I am sure that it will be another amazing experience for our pupils. 

We have been enjoying practising the songs for our performances in our choir rehearsals. We will be singing the traditional carol Away in a Manger, and a lively song called Sparkle and Shine from the film Nativity. We are also looking forward to performing alongside the professional performers and other community groups in some other songs.

Christmas is a special time of the year for the children, parents and staff at Beaver Road and The Christie has a very special place in all our hearts. For me, the Christmas season begins with The Christie Concert. We are proud once again to have our school choir invited to join this wonderful celebration.

Beaver Road Choir performing at
Gorton Monastery last year.

Lots of the children here are really excited about performing in the cathedral and are very enthusiastic about supporting The Christie. One of our Year 4 members of the choir Rosie Cooke is delighted to be singing at the cathedral. She did a yard sale recently which raised £24 for the Christie and she loves being part of the choir. She is delighted that our school has been invited to sing for The Christie again this Christmas. 

The school has lots of other exciting events coming up this month. The Year 5 and 6 members of the choir will be singing in care and residential homes in the local area. They will also be entertaining patients in the dining room at The Christie.

We are also extremely excited to be invited to perform on the Blue Peter Christmas Special. The children will be filmed at the BBC studios at Media City on the 10th December and the show will be broadcast on Thursday 17th December. 

The choir and I are really looking forward to all of our performances, and we can’t wait to spread some festive cheer in the local community and beyond!

I’ve really valued the emotional support from everyone around me, especially the team at The Christie - Katie Stephenson

Katie Stephenson – Parotid Gland Cancer Patient (Mammary Analogue Secretory Carcinoma)

Katie Stephenson

I’m 30 years old and November 2015 marks four years since I began treatment for parotid gland cancer. 

I live in Chorley, Lancashire and I work in Public Relations for the NHS. I remember the moment I found my first tumour like it was yesterday. It was July 2011 and I was having a lovely lunch in a beer garden in Lancaster (fish and chips if you were wondering!) when I felt a lump on my jaw. Always the hypochondriac, I dramatically said to my friend, "feel this lump, it must be a tumour!"

The lump didn’t go away and after weeks of poking and prodding by various doctors and a few courses of antibiotics in case it was a cyst, I had an ultrasound. I’d done a lot of research by this point and pretty much knew every eventual outcome so when he told me it was a solid mass I was as prepared as I could be to hear that news. After a fine needle aspiration, which basically meant a doctor stuck a tiny needle into the lump and drew some fluid from it to test, the results were inconclusive so I was delivered the news that I’d need a major operation to the side of my face to remove the lump (most likely a tumour) and half of my parotid gland. 

The parotid is part of a family of three salivary glands and it sits just below your ear. Again, I’d done my research and found that salivary gland cancer is rare with approximately 550 cases being diagnosed each year, most commonly in people over 50. The exact cause of this cancer is unknown and in most cases, tumours in salivary glands are benign. 

With any surgery there were also side effects and with mine these included facial paralysis, numbness and problems with the salivary function. Although these were worrying to me, I was only 26 at the time so my main concern was about the gigantic scar I’d have running down my face.

I had my surgery done in Preston and I cried the first time I looked in a mirror. I’m not an overly vain person (my friends might correct me on this!) but I had 40 stitches down the side of my ear and down my neck, a huge dent in my face where part of the gland had been removed and little to no movement in half of my lip. 

Katie post surgery

Despite this I waited patiently for the results of the tests…..I waited and I waited….20 weeks later I was delivered the news that it was a malignant tumour however it had been removed with clear margins which meant that they believed they had got it all. The reason for the delay was that it was a newly described tumour and not many labs had seen one before. Eventually I was given its definitive name; Mammary Analogue Secretory Carcinoma.

Almost a year to the day of finding the original lump, I found, and had removed a second tumour. Luckily this one was a lot closer to the surface and the surgery was nowhere near as invasive. At the same time as this surgery I received Botox injections to my face as I’d developed a relatively rare side effect of the surgery known as Frey’s Syndrome. This is basically a mutation of your salivary glands so instead of your mouth watering on the inside, I was getting a moist cheek – not a good look when you’re stood in front of a tasty buffet and your cheek starts watering!

Following the removal of the second tumour I was referred to The Christie to discuss my treatment options. As it was a relatively recently named tumour there was some uncertainty as to what the treatment should be. At the initial consultation we discussed the different options available to me; further surgery to remove the rest of the gland or a course of radiotherapy, both of which carried further risks and complications. In the end we decided that I would be a “watch and wait” patient, meaning I’d have scans and check-ups instead of treatment. 

This course of action didn’t initially sit well with me. I’d really struggled emotionally during the wait for my initial results and I didn’t think I had the strength and resilience to do it again, but with the support of my consultant we decided to go ahead. I now have bi-annual MRIs to my head and neck and I visit The Christie four times a year for check-ups. I won’t lie, sometimes it’s really hard to just sit back and wait. I check the area every day and I’m just waiting for the time I feel another lump. I did have a scare last year but thankfully it was just scar tissue from my original surgery on the move.

Throughout my experience I decided to document this by blogging (www.apainintheparotid.wordpress.com). I struggled to find a lot of UK based information about the condition so thought I’d share my experiences with anyone else who was going through this too. I post pictures, tips and updates and I find writing about my day, hospital appointments, scar progress (and the occasional whinge) extremely therapeutic.

I’ve also really valued the emotional support from everyone around me, especially the team at The Christie – shout out to Professor Slevin! Whilst I might not be having visible treatment, people should never underestimate the emotional impact a cancer diagnosis can have and the compassion and care from the team at The Christie has been second to none.

After my surgery I was left scarred, unable to smile on one side of my face and feeling very self-conscious. I became extremely anxious and pretty much ate my feelings, putting on over six stone in weight in the process. Over the last 18 months I have really seen an improvement emotionally, and finally managed to get some focus back in my life. I even went back to university to study for a postgraduate qualification, something I could not have imagined doing three years ago. 

If I was to give one piece of advice to anyone reading this who is going through something similar, it would be to never underestimate the power of emotional support. I know all too well how easy it is to retreat and want to deal with it on your own, but please just talk to someone. I’m a very independent person and leaning on others for support didn’t come easily to me but I learnt that this doesn’t make you any less strong or unable to cope and, without that support, I wouldn’t be the person I am today. I have a much brighter outlook on life, my confidence is coming back and I’ve started to shift some of the weight that I’d put on. I’m still a way from eventual discharge (pending no new lumps – fingers crossed!) and visiting The Christie has just become part of my life routine, but without the fantastic support of the team at The Christie, my friends and my family I don’t think I would have come through this so strongly.   
  

How hypnotherapy can help our patients to overcome anxiety, claustrophobia, needle phobia, nausea and fear of pain - Peter Sandy

Peter Sandy - clinical hypnotherapist

Peter Sandy

Why is six scared of seven? Because seven, eight (ate) nine. This is my daughter’s favourite joke and you will find out why this is important when you read on. 

I’ve been a clinical hypnotherapist for eight years. For the last two and a half years I’ve been lucky enough to work in The Christie’s complementary therapies CALMs team with a talented group of experienced therapists supporting patients (and carers) to overcome a varied range of issues such as anxiety, claustrophobia, needle-phobia, nausea and fear of pain. 

I support patients undergoing a range of radiotherapy and chemotherapy treatments as well as MRI and CT scans. Radiotherapy patients are often most anxious during the mould making process prior to treatment and some of our patients need help with cannulation prior to having chemotherapy or other treatments and procedures.

Many people imagine hypnosis to be along the lines of the stage hypnotist in the TV programme Little Britain…“look into my eyes, not around my eyes” * click fingers * “you’re under!” 

Whilst the idea of a hypnotist having instant mind control may be entertaining (even a little scary), the reality is quite different. Nobody can tell you how to think, not even if you want them to. 

Hypnosis is an altered state of consciousness, a relaxing state of internal focus – a bit like daydreaming – where a person can feel calmer and become more in tune with their unconscious ideas, thoughts and beliefs. A skilled hypnotherapist will build rapport and have an understanding of how to use unconscious communication – verbal and non-verbal - to connect with, and then help discover new strategies, changes in emotional levels or alternative ways of thinking. 

We all have a vast collection of useful past experiences - some are easily remembered and some are buried deeper. These inner resources have been acquired over the years (like humour, stubbornness, intelligence, and a plethora of problem-solving skills), and the ability to imagine different ways of coping in the future. Hypnotherapeutic processes explore and utilise these pearls, and we are able to anchor and recall powerful resources using gestures, colours, words or aromas. 

There’s an old saying: “Give a man a fish and you feed him for a day, teach him to fish and he can feed himself for life”. The CALMs team can teach a variety of techniques and methods to help people become less anxious and feel calmer. This in turn can provide a long-term benefit, not only to the patient but also to everyone involved.  

If a patient is struggling with anxiety, we come alongside and invite them to try different self-soothing techniques to help them regain some control. Normally a patient who is panicking will be over-breathing so the first thing we might teach is a simple breathing technique, like breathing round a square shape to slow it down and keep it steady. We may ask them to close their eyes and vividly remember a special place and re-experience how they feel in that place (calm, relaxed, resilient, empowered) then use an aroma, object or even a hand gesture to retain and recall (anchor) the feeling. 

One of the things I really enjoy about working with patients is how often they teach us things.

I saw an 80-year-old man a few weeks back who was suffering from breathlessness. He was already halfway through radiotherapy on the lung and began the session looking out of sorts, slightly bent posture, struggling to breathe steadily. That was until we got onto the subject of Karate, of which he is an expert, and before I knew it, he was on his feet, chest out, showing me how to breathe in a way that allows you to take a punch to the stomach - which comes in handy when you have three kids! We swapped breathing techniques and this inspirational man quickly picked up how to do self-hypnosis so he can re-enter a useful relaxed state whenever he needs. 

Many of the radiotherapy patients we support will be receiving treatment focussed on the head and neck, lung or breast areas and they often have something in common – claustrophobia, the fear of confined spaces. 

Claustrophobia affects one in ten UK adults and, if severe, it can result in a full-blown panic attack. This type of phobia is awakened if the patient is required to wear a special mask that is closely moulded over their head, neck and shoulder areas and worn during each treatment to ensure they remain in exactly the same position for every session. Although this mask is an essential tool for the accuracy of treatment it is a very snug fit (and doesn’t look pretty either) so it’s not surprising that patients with high anxiety, pain, breathing issues or claustrophobia struggle to even have the mould made. 

Being able to help a patient get through the mould-making stage as smoothly as possible is important as it can reduce anxiety and make a significant difference to how that person feels about their future treatment. 

There are a number of ways we can help. I was asked to help a patient who suffered severe claustrophobia combined with neck pain issues from surgery who was shaking and hyperventilating in the waiting area outside the mould room. I recognised the signs of panic and quite naturally felt some of her anxiety rise in myself. As we spoke, I allowed my breathing rate to match hers so I could begin at her pace, and I invited her to take a sip of water and hold it in her mouth as research suggests that having a moist mouth tells the brain “you’re doing ok”. 

Next, I asked her to focus her attention on steadily clenching and then relaxing two squashy ‘stress-ball’ yellow stars in tune with her breathing, keeping in harmony with her as I slowed my own breathing and softened my voice. 

We agreed ways in which she could feel more comfortable and in control by establishing a clear stop signal. 

We discussed how she would like to feel in charge when we began to make the mould. We also spoke about things other people had found helpful, like slowly counting numbers down from 200 or focussing on rotating the yellow star and visiting places in her mind. We worked on releasing tension in her feet and legs by tensing and relaxing the large muscle areas involved in the fight-or-flight instinct.

Throughout the process, I continued to hold her hand and give her steady voice contact updating her on the mould process and directing her attention to all manner of other things. 

Having successfully completed her mould and the following CT scan, she thanked the radiologists and me and even laughed at my daughter’s favourite joke!

The Board of The Christie is focused on making it a world leading centre for cancer care and research - Kathryn Riddle

Kathryn Riddle - Christie non-executive director

Kathryn Riddle

I joined The Christie Board as an interim non-executive in May 2014 and became a substantive member of the Board a year later. From the very first day I was hooked!

I have been involved with the NHS as a non-executive for over 20 years, but in all that time I have never been directly involved with a hospital and I am delighted to have put that right.

The Christie is a very special place and part of that is undoubtedly because it is a specialist hospital. In other roles I have visited many hospitals and noticed that specialist hospitals or units have unique cultures because of the very specialised nature of their work.

Having said that, The Christie is both unique and very very special.

What makes it so special?

The staff and the patients undoubtedly, but also the volunteers and the people from Manchester and the surrounding areas. If I get a taxi to The Christie, within minutes the taxi driver is telling me how wonderful the hospital is and "how lucky we are to have such a great place on our door step." I have never encountered that sort of praise and loyalty anywhere else!

One day I had lunch in the hospital dinning room and found myself chatting to the man opposite. We both thought the cheese pudding was excellent! He told me that he came to eat here once a week because his wife had been a patient at The Christie for several years and they had made friends and grown to love the place. Now that she was no longer here, being back at The Christie made him feel close to her and he liked to check that the food and general feeling of the place was just as good as it had been for his wife.

The Board of The Christie is impressive, vibrant and totally focused on making the organisation a world leading centre for cancer care and research,  where patients feel safe, comfortable and reassured that they are ‘in the best place '.

The Governors from different surrounding areas want the very best for the patients and are rightly proud and protective of The Christie’s name and reputation.

I have been part of some appointment panels for new staff and have been hugely impressed by the calibre of people being interviewed, not only for their clinical expertise, experience and backgrounds, but for their genuinely caring and compassionate natures. Values matter!

I spent one lunch time with the director of nursing and quality, seeing how protected meal times work and the careful choice of food and quantities all tailored to individual patients’ needs.

On another walk about with fellow non-executive directors and staff, we discovered that chemotherapy treatments are also tailor made for individual patients - an absolute revelation which made me realise that I have so much to learn.

I love the gardens at The Christie, alongside the glass corridor, which are beautiful to look at and full of patients, families and even some staff on sunny days!

The volunteers and Friends of The Christie are truly amazing in their dedication and their extraordinarily imaginative ways of raising money. Bike rides, runs, abseiling, coffee mornings and evening events of all kinds to say nothing of the culinary expertise (my kitchen cupboard is full of Jean's special preserves! Her bramble jelly is just fabulous!) Like other members of the Board I am a Trustee of The Christie charity and I have been so impressed by the generosity of people who want to support the hospital. Through legacies, donations, and imaginative fundraising, thousands of people contribute to the work of this wonderful institution, and every single donation whether it be large or small is very much valued and appreciated.

This is a truly remarkable place, made so special by the people who work here and the patients they serve. I am proud to be a part of it and I have thoroughly enjoyed my first year on The Board.

As The Christie has played such an important part in developing radiography we are very proud to celebrate World Radiography Day - Rebekah Pearce

Rebekah Pearce - Christie Radiotherapist

Rebekah Pearce

World Radiography Day is celebrated on 8th November each year. Held annually, it provides an opportunity for radiographers worldwide to celebrate their profession, its importance within patient care, to promote the career to future students and increase public awareness of diagnostic imaging and radiation therapy.

So what is a radiographer and what do we do?

There are two different professions that share the umbrella term of ‘radiographer’ – diagnostic radiographer and a therapy radiographer. A diagnostic radiographer helps to diagnose any disease or condition and monitor internal changes. This is vital in diagnosing cancer and we have some very high tech facilities available at The Christie.

A diagnostic radiographer may use X-rays to look at bone anatomy assessment and cavity changes, to check if a bone is broken and if there are any foreign objects in the lung cavity; or they may use fluoroscopy to look at real-time images of the digestive system. Radiographers also use MRI and CT scans to build up two and three dimensional maps of body tissue; and angiography can be used to assess blood vessels. Ultrasound, most commonly used for checking the development of a baby during pregnancy, also has important applications at The Christie.

Therapeutic radiographers, or as they are better known, radiotherapists, work within the hospital oncology department. They use radiation to treat many different forms of cancer all around the body. This includes conventional External Beam Radiotherapy (EBRT) delivered by multi-beam treatments; brachytherapy where the radiation source is placed directly in the affected area; and stereotactic radiotherapy that allows small inoperable tumours to be treated in high dosages. 

For both types of radiographer, their knowledge base must include extensive understanding about the usage of high tech equipment, radiation dosages, pathology, anatomy and physiology of the human body. Moreover, the radiographer must have a caring personality. 

As The Christie has played such an important part in developing radiography over the years we are very proud to celebrate World Radiography Day and the vital work done by all radiographers around the world.

In 1901, The Christie was one of the first places to use X rays to treat cancer and in 1932 we developed the first international standards in radiation treatment – the Manchester Method. More recently, in 2002 we were the first place in the world to use image guided radiotherapy.

World Radiography Day is celebrated on 8 November to mark the anniversary of the discovery of x-radiation by Wilhelm Roentgen in 1895. Wilhelm experimented with passing an electrical current through a low-pressured gas which culminated in discovering and producing an electromagnetic radiation in the wavelength range now known as x-rays. 

He noticed that a number of objects could be penetrated by these rays, and that the projected image of his own hand showed a contrast between the opaque bones and the translucent flesh. This work resulted in him winning the Nobel Prize in physics.

He later used a photographic plate instead of a screen, and an image was captured. In this way, an extraordinary discovery had been made: that the internal structures of the body could be made visible without the necessity of surgery.

As World Radiography Day was on Sunday we decided to celebrate it in the hospital today with an information stand on display in the radiotherapy department with details about radiotherapy, how it works, how treatment is planned and examples of machinery.

Have you thought about a career as a therapy radiographer working in radiotherapy? If you are interested in finding out more details, please email RTEducation@christie.nhs.uk

Helping you to help yourself – our new web project will provide patients with an aid to managing their life with cancer - Dr Michael Leahy

Dr Michael Leahy - Consultant Medical Oncologist

Dr Mike Leahy

I'm delighted to announce the launch of a new project at The Christie which will provide patients who are living with advanced cancer access to a self-guided care plan to run alongside any medical treatment for their cancer.

The inspiration for this project came from the number of patients who kept asking consultants like me if there was anything else they could do to help themselves live with cancer.   

Alongside the modern up-to-date medical therapies being provided at The Christie, many people are interested in what else they can do to help themselves through diet, exercise, complementary therapies, talking therapies, mind and spirit and other activities.

A little research among patients attending one of our clinics demonstrated that many patients are already seeking out information on self-care for themselves, with many trying out something that they feel will be of benefit - from dietary changes to counselling or aromatherapy. However, our patients have told us that they feel there is more we could do in terms of giving advice and helping them make wise choices amidst the many therapies or products on offer that make claims of benefit.

It may surprise readers to know that there is increasing research showing that a well-rounded health and wellbeing programme focussing on improving and enhancing general health can have a significant impact, not only on quality of life, but also on survival. It seemed to us that there were things that people were missing out on that they could do to help themselves and we decided that, as their oncology team, we ought to be giving this more attention.

We applied for funding from the Manchester Cancer and Macmillan Innovation Fund for a one year project to develop a programme for patients with advanced stage cancer.  We were successful in our application and our project manager Liz Islam, started work in September.  We now have a year to construct a pilot programme, develop an interactive website and evaluate it with a group of patients. The working title for this project is PlanBe. 

The reason behind the name is that getting cancer is no-one's Plan A, but this programme is much more than a second thought - it is about being as well as you can for as long as you can; about being more in control of what is happening to you; about being more in the moment; about the idea of being responsible for your wellbeing.

We are really interested in people's comments and suggestions to help us in this project. What other activities do you participate in besides your cancer treatment? What have you found that has been really helpful, or not so helpful?  And, if you are living with advanced cancer, what help and advice about your PlanBe would you find useful? We'd love to hear from you about this project and what you think, so please email the project team at PlanBe@christie.nhs.uk

Legacies are vital in helping to fund the work that we do and the projects that we support - Ellen Hingley

Ellen Hingley - Legacy and Research Manager

Ellen Hingley

As legacy and research manager for The Christie charity, I have the pleasure of dealing with some of the most interesting and unexpected gifts that come into the charity every day.

Legacy gifts, those which are left in wills, have been an important part of the history of The Christie providing half of the original £10,000 needed to set the hospital up, and today they are vital in helping to fund the work that we do and the projects that we support.

Most recently our team has been working with an auction house based in Surrey, organising the auction of a collection of more than 20,000 prints and negatives left to us by renowned photographer Harry Goodwin who passed away following a short illness in 2013.

Harry was the official photographer for Top of the Pops from 1964 to 1973. Throughout his career Harry photographed the likes of The Beatles, Michael Jackson, David Beckham and many more pop, sporting and acting heroes. Alongside a monetary gift of £54,000, Harry generously decided to leave the majority of his photographic collection to The Christie.

This Friday, 30th October, at midday, anyone worldwide will be able to bid on pieces from the collection, the entire proceeds of which will come to The Christie. We're hoping to raise around £20,000 from the sale, so I'd encourage anyone interested in the collection to take a look.

The Beatles.jpg

One of the photos up for auction

Legacy gifts have long been an important source of funding for many charities, but it's only in recent years that charities have really started talking to people about them and letting people know how important they are. Research suggests that of those people who have written a will, around 17% have included a gift to a charity. Here at The Christie, we rely on gifts in wills for around one third of our charitable income each year, that's about £5 million a year.

My job is to talk to people about legacy gifts, and to promote them as a simple and empowering way to support a cause that you care about, well into the future. Understandably, when people think about wills and legacies, they often think about death, but in my job it's important to remember that wills are really about planning for the future. A will is the safest way to ensure that your money and property are left to those that you care about, whether that's family, friends, charities, or all three! When we talk to people about wills, it's important for us to let them know how grateful we are for any size of gift they might decide to leave to us, and that we really hope we won't receive it for many years to come.

In 2014, over 140 people took part in Make a Will Week, and helped us raise over £13,000. Nineteen people also took the opportunity to leave us a gift in their will, and were kind enough to let us know. This year's Will Week, which took place from 14th to 18th September was supported by 50 solicitors across the North West, and people making wills have already donated very generously in lieu of paying solicitors fees, so I'm hoping this campaign will be at least as successful, if not more so than last year.

It's a wonderful opportunity to make or update your will, whilst supporting The Christie, so you'll be pleased to hear we've already set the date for next year.

To see the full Harry Goodwin auction collection and register to bid on the items, visit http://bit.ly/1iYq6AY . If you would like to learn more about gifts left in wills to The Christie or next year's Make a Will Week, you can contact me on 0161 446 3178 or email ellen.hingley@christie.nhs.uk .

The gamma camera is making a big difference to the diagnosis and treatment of many Christie patients - David Hamiliton

David Hamiliton - Consultant Clinical Scientist and Group Leader in Nuclear Medicine

David Hamilton

Patients at The Christie are now benefitting from a state-of-the art gamma camera, thanks to the generosity of dozens of dedicated Christie supporters.

I am delighted to have been part of the Nuclear Medicine team which has delivered this exciting project and which seems to have really captured the support of many of our hard working fundraisers.

So, it was with great pleasure that we were able to invite many of our gamma camera fundraisers to a unique behind the scenes tour of the new facilities in the Nuclear Medicine department.

They were welcomed by our Chief Executive, Roger Spencer, and were given a presentation by Dr Prakash Manoharan, Clinical Lead, who explained how important their contribution will be for the pioneering work being undertaken in the department and with The University of Manchester.

The staff in the Nuclear Medicine department have been overwhelmed by the enthusiasm with which fundraisers have supported this project and were delighted to demonstrate for them the equipment that they have provided.

Nuclear medicine is a branch of radiology which produces images of radioactive pharmaceuticals that have been injected into the patient. These show function in different parts of the body rather than anatomy and are therefore very sensitive to changes caused by disease.

A gamma camera detects the gamma photon emissions from the radiopharmaceuticals which clearly reveal abnormal areas, including tumours.

This state-of-the art camera at The Christie will help us give patients a better diagnosis and better understanding of the staging of their cancer. We also have exciting plans to use it to provide better therapy in the future.

The gamma camera is a SPECT camera, which stands for Single Photon Emission Computed Tomography.

Just like in radiology, the patient does not feel the gamma photon emissions that are coming from their body, but the images they create clearly show the processes going on inside the body.

The individual areas that accumulate the radiopharmaceuticals can be very difficult to identify precisely, and the gamma camera incorporates a diagnostic quality CT scanner to overcome this.

The SPECT and the CT images are fused together by the computer. This helps the radiologist to view the two different images easily and manipulate both separately to reveal different details.

As well as accurately locating the cancer in anatomical structures, the CT also helps to identify what abnormal areas are. The patient only has to be scanned once as two types of image are being acquired in one procedure.

The new equipment incorporates advanced systems that allow best quality images to be acquired and links the two types of image together automatically with a very high degree of precision.

Christie patients are already benefiting from this significant improvement in image quality, as well as monitoring of the progress of any therapy provided.

Staff involved in the gamma camera project 

As well as providing diagnostic information, the gamma camera is used to show exactly which areas of the body are being treated when therapeutic radiopharmaceuticals are administered (a procedure called molecular radiotherapy).

This is a type of therapy where the radiopharmaceutical seeks out the disease areas in the body and delivers therapy in precisely the right place to kill the cancer. New medicines of this type have recently become available, and many more patients are now being given this new type of therapy. The Christie has a particularly large molecular radiotherapy capability and facilities are constantly being expanded and improved.

Tumours accumulate these medicines and retain them for varying times, with different radiation doses being delivered to different tumour areas.

By taking a number of images using the new gamma camera over a period of time, the level of the therapy in different areas of the body can be mapped to ensure the patient is getting the best treatment and that the dose given is not having adverse effects on healthy tissue.

The calculations involved in converting the gamma camera images to therapy maps are very complex and the new SPECT / CT system includes an internal radiation dosimetry computer to make these automatically.

The Christie is working very closely with The University of Manchester to improve the accuracy of these calculations using this equipment.

This work will eventually allow personal therapy plans to be produced for patients undergoing some types of molecular radiotherapy, which will mean that their tumours get the most effective therapy and that normal tissues are protected.

There is no doubt that this is a very exciting time to be working in nuclear medicine at The Christie and my work on the gamma camera has been hugely rewarding.

I am delighted that so many fundraisers have enthusiastically backed this project and was delighted to show them the tangible progress we have made. The gamma camera will make a huge difference to the diagnosis and therapy of many Christie patients in the future and will hopefully help thousands to successfully beat theircancer.

The Christie charity supports the work of The Christie NHS Foundation Trust through its fundraising activities, and delivers projects, equipment and improvements that are over and above what the NHS funds. The charity has over 30,000 supporters who helped raise   £13.3m last year.  

Treatment outcomes of surgery, radiotherapy and chemotherapy are all improved for patients who stop smoking and drinking alcoho - Charlotte Finchettl

Charlotte Finchett - Health Promotion Advisor

Charlotte Finchett - Health Promotion Advisor

As many people will know, October is Stoptober and there have been lots of adverts on the TV featuring the likes of Al Murray and Bill Bailey encouraging people to give up smoking.

We all know that smoking and drinking to excess are bad for our health. And if you have cancer it can even slow down or harm your recovery and limit your chances of a good long term recovery. That's why I find my role at The Christie as a Health Promotion Advisor so rewarding. I know I can make a real difference to people's lives.

Let me tell you about a 61 year old (let's call him Tom) who was due to start chemotherapy treatment at the beginning of 2015. When I first met Tom, he explained that he had been drinking 80 units of alcohol a week (the recommended weekly allowance for a man is three to four units per day if drinking on a regular basis). As I sat and listened to him, it became apparent that he was not really upset about his cancer diagnosis, but that his wife had left him through his ongoing alcohol problem.

We talked about his alcohol history, how much he drank and came up with a plan to reduce his alcohol intake. We contacted his GP to provide further help and support with reducing his alcohol consumption and his current home-life situation. The GP was very supportive and arranged an urgent appointment with Tom. I am happy to finish Tom's story by saying his wife is back living with him and she is supporting him through his cancer treatment.

Being able to help Tom and hundreds of others like him is what makes my job at The Christie so fulfilling.

I started working at The Christie in the medical records team, the day after I completed my last school exams back in June 1988. I have been fortunate to undertake various roles since then, including working in radiotherapy, and now as a Health Promotion Advisor. I feel honoured to work at such a valued organisation with such caring and approachable staff and am very lucky to be supported by a wide variety of health professionals.

The experiences I have gained in these previous roles have allowed me to gain an in-depth understanding how we treat patients at The Christie, the process they go through and what they experience when undergoing treatment for cancer. This knowledge and experience enables me to be an effective Health Promotion Advisor, supporting patients to live a healthier life, through their cancer treatment and beyond.

Treatment outcomes of surgery, radiotherapy and chemotherapy are all improved for patients who stop smoking and drinking alcohol. For example, smoking and alcohol can increase the impact of side effects during treatment, which in turn impacts on how well the patient can tolerate their treatment.

Patients who smoke and undergo surgery can take longer to recover due to the lower levels of oxygen within the blood. And, for patients with head and neck cancer, giving up smoking has a much greater impact on survival.

As a health promotion advisor I work with and support patients to make lifestyle changes with the aim of improving their treatment and recovery. I discuss smoking cessation and alcohol awareness with patients, carers and their families, and provide the relevant interventions they need to make changes. These can range from providing hypnotherapy to offering nicotine patches.

Some patients may not want to stop smoking, but whilst they are an inpatient they may not be able to leave the ward, so nicotine replacement is an option. Patients are encouraged to make their own choice and are given information about nicotine replacement.

Supporting patients emotionally and holistically is the key to any kind of therapy. Commonly patients have several concerns alongside their cancer diagnosis. For example, they may have financial concerns or have little social support. And it is important to remember that people smoke and drink for many reasons, such as stress. What I find is that they have associated the smoking habit with relaxation, as they are usually sitting down, relaxing, and taking time out from their day. I need to understand these reasons and understand how hard it is to make lifestyle changes so that I can identify all the support measures that are needed to help our patients through this process and ensure that everything possible is in place for them.

As a former smoker myself, I totally understand how difficult it is to change your behaviour and give up.

I'm so fortunate to part of The Christie's award winning complementary therapy team, led by the visionary Peter Mackereth. I feel supported by my manager Paula Maycock to go the extra mile to help our patients and am privileged to work closely with several departments, dedicated staff such as Professor Nick Slevin and Dr Andrew Sykes and the wider multi-disciplinary teams in place throughout The Christie. There are too many individuals to name, however staff at The Christie always go above and beyond the call of duty to put our patients and their families and carers first.

I can't even begin to tell you how wonderful it is to see patients smoke free and enjoying other ways of spending their money.

During the summer, I was speaking to a carer (let's call him Greg) who wanted to support his wife's smoking cessation by also stopping smoking himself. Greg explained that he used to ride his motorbike, but was unable to use it at the moment due to it being broken. He decided to save the money he would have spent on smoking to fix his motorbike - whilst supporting his wife. I saw him a few weeks ago and he and his wife are now smoke free and he got his bike fixed with the money that he saved.

Being able to help people like Tom and Greg are what drives me in my job. The difference it makes to people's lives is phenomenal.

Having cancer is a very difficult time for patients and their families or carers, but I know that if we support our patients to reduce their intake of alcohol and smoking it will improve the outcome of their treatment.

The patients are very receptive to talking with me and very grateful of the support that we provide. Every day is a different day but I enjoy it more and more. It is never too late make a lifestyle change. We are changing lives and supporting patients.