Healthcare Science Week: 14th -18th March 2022

What’s our role?

The Department of Clinical Technology provides specialist wide-ranging technical services across the healthcare community in Cornwall; this includes (but is not limited to) The Royal Cornwall Hospitals Trust and Cornwall Partnership Foundation Trust. The service provides whole-life management of medical equipment from pre-purchase assessment through safety and maintenance issues to end-of-life disposal. Fully integrated into DCT, a Medical Equipment Library provides a comprehensive and efficient loan equipment service for the RCHT.

Our staff work hand-in-hand with the clinical services every step of the way with regards to the application and exploitation of available technologies, including the identification of equipment to meet need, trials and evaluation, equipment roll-out, planned and reactive servicing, upgrades and future replacement. Where equipment is supported by a 3rd party, DCT will monitor the compliance of such contracted support.

Who are our people?

DCT has 24 technical staff of varying backgrounds, qualifications and specialisms, with enormous collective experience and expertise. DCT has embraced a greater diversity of backgrounds than would be the case in many typical Trusts, and is a firm believer of casting the net as widely as possible into the talent pool of technical expertise.

We have numerous staff who developed their engineering skills on technologies as wide-ranging as military aircraft, yacht building, radar systems and food production lines, all of whom have been able to successfully re-apply their skills through re-training and mentorship – into healthcare technology. We strongly encourage professional development and are currently running numerous technical apprenticeship programmes at Levels 3, 4 and 5.

DCT also has a team of dedicated support staff for business and contract administration, equipment pick-up and delivery, front-of-house operations and technical stores and logistics.

What equipment do we deal with?

The array of equipment types that we deal with is so large that our workshops are broken down into functionally-based teams, who each look after associated technologies:

• Monitoring & Treatment – largely (but not exclusively) electronic and look after such things as patient monitoring and infusion pumps.
• Engineering – largely (but not exclusively) mechanical and look after motive systems such as trollies, treatment couches and beds, but also some dental and UV-therapy technology.
• Critical Care – looks after very high risk technologies such as anaesthetics and ventilation. We also have dedicated expertise in the field of renal technology.

What about our response to the pandemic?

The pandemic has been a major challenge to the entire healthcare sector, and DCT has proactively adjusted and reprioritised in order to meet the ever-changing clinical need as the Trust has responded to Covid. It has played a pivotal role in the procurement and commissioning of over 5,000 additional medical devices, and has worked closely with Critical Care consultants and staff to ensure Cornwall was leading the way in preparing for potential challenges of ventilation and other aspects of care for seriously ill patients.

What are our challenges and directions for the future?

DCT will continue to adapt to new priorities and new ways of working as the requirements of Covid change. The huge increase in equipment held will continue to drive the need to look for potential ways to improve the efficiency of our services. It is an exciting time at the Trust when it comes to medical equipment, with huge new investment projects both planned and underway.

Current programmes include the replacement of the majority of volumetric pumps, anaesthetic machines, and the Trust’s entire holding of patient monitoring systems – all with state-of-the-art technology. Many other projects are planned. DCT will continue to play a pivotal role in this, developing its staff’s skillsets to diversify its abilities and grow its specialisations, so as to offer excellent support to clinicians and thus the best care to the people of Cornwall.

The clinical chemistry laboratory at RCHT is staffed by a mix of laboratory assistants, assistant practitioners and biomedical scientists who provide a 24/7 service every day of the year. We perform a wide range of tests on blood (serum and plasma), urine, stool, CSF, and other bodily fluid samples to provide information that contributes towards the diagnosis, monitoring, treatment, and prognosis of patients’ conditions. The majority of our tests are performed using automated analysers, the running of which includes carrying out routine maintenance tasks, inventory management, calibrating tests and regularly performing and reviewing quality control checks.

When patient samples are tested on the analysers, any results that fall outside set ranges are held by laboratory software for authorisation; this involves a qualified biomedical scientist reviewing the results to determine whether they are valid and able reported. This is the point where issues such as sample contamination from IV fluids are identified. Results outside set reference ranges are telephoned to wards and GP surgeries to alert clinicians to results that may require urgent attention. We also perform a range of tests which require more manual techniques, requiring a high level of skill and training to perform.

A duty biochemist reviews and authorises results falling outside set ranges and they may add further investigations and comments to requests. The laboratory receives, prepares, and sends samples to external laboratories when a requested test is not currently performed in-house. The clinical chemistry team is very dedicated and hard-working one, and always aims to offer the best service it can provide.

As Vascular Scientists the majority of our work involves doing ultrasound scans of arteries and veins in the body. This contributes to the diagnosis and management of many conditions including stroke or mini-stroke, peripheral arterial disease, deep vein thrombosis, and venous incompetence to name just a few. Our scans help determine which patients may be suitable for surgery, as well as other methods of treatment.

You may have heard the terms “Doppler” or “Duplex” used when referring to our scans. In many of our investigations we measure the speed of the blood in the body, and this is possible due to a phenomenon called the Doppler effect. An example of this is when the siren of an ambulance or fire engine changes pitch as it travels away from you. The name “Doppler” can also be used for when the pulses are listened to, usually in the feet, as well as when blood pressure cuffs are placed around the arms and ankles of a patient to detect possible arterial narrowings or blockages.

Below is an image taken from one of our scans. The red area demonstrates blood flow in a superficial femoral artery, and the waveform below this tells us more information about the blood flow throughout the whole leg.

What is Pathology?

There are 19 different specialities under the umbrella of Pathology, including:

• Clinical biochemistry
• Haematology
• Medical microbiology
• Transfusion medicine
• Histopathology
• Cytopathology
• Immunology
• And many more…

Did you know…

• Around 95% of clinical pathways rely on patients having access to pathology services.
• 14 tests for each person in England and Wales are performed annually.
• 300,000 tests are performed every working day, that’s around 1 billion tests per year
• These tests cost around £2.2 billion a year

Our staff are amazing, all the time, across many staff groups:

• Medical laboratory support workers
• Medical laboratory assistants
• Secretarial and administrative
• Associate practitioners
• Trainees
• Phlebotomists
• Anatomical pathology technicians
• Biomedical scientists
• Clinical scientists
• Clinical fellows
• Consultant pathologists

Pathology has also been involved in looking after the environment. Historically, Pathology has employed a single containment system for submitted bloods from primary care by use of plastic bags. Over the course of a year almost 780,000 specimen bags are sent to the Blood Sciences laboratories which is more than enough to fill an Olympic sized swimming pool!

The radiotherapy physics team is a multi-disciplinary organisation consisting of clinical scientists, treatment planners, and engineers. The team works closely with clinical and support staff to ensure the best outcomes for patients, and the continued development and progression of radiotherapy treatment. They are responsible for various activities within RCHT and the Sunrise Centre, including:

• Providing scientific and technical support to the Radiotherapy Department.
• Maintaining and servicing all Radiotherapy equipment, to ensure accurate and consistent treatment delivery.
• Planning individual radiotherapy treatment for some 2,000 patients each year.
• Providing specialised IT support across Radiotherapy and Oncology.
• Taking part in national and international clinical trials.
• Collaborating with other Cancer Centres in the South West Peninsula to provide support and share expert knowledge.

The radiotherapy department in the Sunrise Centre is modern, containing various pieces of state-of-the-art equipment for treatment delivery, planning, and patient management. As mentioned above, the radiotherapy physics team are responsible for these:

• Two Varian TrueBeam Linear Accelerators with 6-degrees-of-freedom couches for accurate patient positioning.
• One Xstrahl superficial therapy machine.
• One Philips wide-bore CT scanner.
• Pinnacle v16 Treatment Planning System.
• Aria Oncology Information System for the management of information and images of cancer patients at RCHT.

Adam Spoors

I am a Biomedical Scientist who works in the Clinical Chemistry laboratory of the Royal Cornwall Hospital. Covid-19 has had a large impact on the way we work across the whole of Pathology. In Chemistry it led to us implementing a new blood test to look for Covid-19 antibodies in patients to determine whether they had been exposed to the virus in the last 14 days and whether they may have built up some kind of immunity. We were also involved in a large scale research study called the Siren project where volunteers had regular blood samples taken and their antibody levels were tested – this is still ongoing at the moment and should help us to understand the virus much better.

As for my day to day work – we offer a 24/7 service where there is always a Biomedical Scientist in the department to allow for a rapid turnaround of blood sample results. The main focus of our working is testing blood samples for various body chemistry functions which allow us to determine a patients kidney or liver function, whether a patient has had a heart attack, various hormone levels, drug levels that a patient has taken (either prescribed or other types of drugs such as paracetamol overdoses) and tumour markers for different kinds of cancers.

Whilst the main bulk of our work is blood samples we also process urine samples (both as a single collection, or sometimes over a 24 hour period), faecal samples, sweat testing, cerebral spinal fluid and even on the rare occasion eyeball fluid! All of these have important functions – for instance, when we test spinal fluid we can help to rule out whether a subarachnoid haemorrhage has occurred -bleeding on the brain from a head injury.

It is a very busy working environment which has a variety of different challenges on a daily basis. For me, one of the most difficult and yet rewarding times is when I work on-call and am the only person in the laboratory overnight or at the weekends. This means that I am responsible for all of the samples that come through the laboratory and for providing a rapid turnaround of results in order to support the A+E department and other critical wards across the hospital.

What is the STP?

The NHS scientist training program (STP) is a program that aims to produce graduates who will possess the essential knowledge, skills, experience, and attributes required of a newly qualified and registered clinical scientist. By the end of the training the trainee should be competent to undertake complex scientific and clinical roles, defining and choosing investigative options, making key judgements about complex facts and clinical situations within a quality assurance framework.

The program aims to achieve this by part academic study (for an MSc) and part work-based training learning and training. As a first year Medical Physics trainee I spent the first year rotating between the four key branches of Medical Physics in the UK:

• Radiotherapy
• Diagnostic imaging with ionising radiation
• Diagnostic imaging with non-ionising radiation
• Radiation safety

Once the rotational year was completed, I chose a specialism which I will work and train in for two more years.

I am currently a second-year trainee who has chosen Radiotherapy as his specialism, much of my day as a trainee involves observing competent clinical scientists perform their duties, aiding them and maintaining a journal of my experiences in a series of written documents.

How does Radiotherapy work?

The aim of Radiotherapy is to use high energy radiation to damage cancerous tissues and destroy their ability to divide and grow. It may be delivered using machines called linear accelerators or via radiation sources positioned on or in the patient on a temporary or permanent basis.

As radiation passes through a patient is deposits its energy to the patient, we call the deposition of the radiation’s energy per unit mass of the patient, a dose of radiation. A dose of radiation is called a Gray (Gy).

In Radiotherapy, we are typically interested in how this deposited dose interacts with human tissue. The absorbed dose or energy deposited by radiation via to a patient can cause the initiation of a chain of events which can result in tissue damage.

The chain of events that can occur because of absorption from radiation with sufficient energy to cause the freeing of an electron.

	TIME	EVENT
Physics Stage	10-18 sec	Energy absorption
	10-16 sec	Physical Events Ionization Excitation
Chemical Stage	10-12 sec	Physio-chemical Events Free radical formation Breakage of chemical bonds
	10-12 sec – 10-16 sec	Chemical Events Reaction of radicals
Biological Stage	Minutes to hrs	Biochemical/Cellular Processes Repair Division Delay Chromosome damage
	Days to months	Tissue Damage Late tissue damage Bone marrow syndrome Cardiovascular syndrome Birth defects
	Years	Late Somatic Effects Cataracts Carcinogenesis
	Generations	Genetic Effects

Tissue damage can result from damage caused to the DNA of the cells which make up the tissue. Damage to DNA can occur as the result of two effect direct action and indirect action.

Direct action is when an electron resulting from the absorption of a high energy photon directly damages the DNA. For indirect action, the electron generated by the high energy photon instead interacts with a water molecule in the body to produce a free radical. Free radicals are highly chemically reactive, and so it goes on to damage the DNA.

The damage caused to DNA can be in the form of single strand break (SSB) or a double strand break (DSB). SSBs are typically of little biological consequence as they are repaired readily using the opposing strand as a template. It can however be repaired incorrectly and lead to mutation. DSBs are less readily repaired and considered the most important lesions produced in chromosomes and may result in cell necrosis, carcinogenesis or mutation.

To summarise so far, ionising radiation can deposit energy to a patient. This energy deposition causes the freeing of electrons, which can cause damage to cells and subsequently tissues via direct or indirect action. The natural question is, why do we expose the patient to radiation in radiotherapy if it causes damage to normal healthy tissue?

To oversimplify, the answer is that tumour cells are, typically, more radiosensitive than normal tissue cells. This means that is can be more easily damaged than normal tissue for a given dose of radiation. The principle of radiotherapy is to deliver sufficient radiation to the tumour to damage its DNA cells and destroy it, without irradiating normal tissue to a dose that will cause serious complications (morbidity) to its healthy cells.

Highlighting some of the Cardiac team

Joshua Morton

I am currently on my 3rd year of the Scientific Training Programme (STP) to become a clinical scientist, working within the Cardiac Outpatient Department. Within our department we have three main areas to work:

• Cardiographer – runs services and diagnostic tests that include but not limited to: ECGS, Ambulatory ECG and BPs, bookings, downloading and the first assessor of test data collected
• Sonography – completing ultrasound scans of the heart either with a probe on the chest or down the throat. Sonographers use their skill to look for abnormalities in the heart structure
• Rhythm management – dealing with the electrics and plumbing of the heart, whether it is implanting a pacemaker (device that utilises electrical impulses to stimulate the heart) or working within the cardiac cath labs (a place to treat patients that are having a heart attack)

I am very lucky to have been able to gain experience in all areas. Currently my favourite role is completing exercise treadmill testing and working with the labs, as patients can deteriorate without warning I need to recognise the signs are be proactive in keeping the patient safe. My course has also taken me around the hospital including respiratory and vascular departments. Experiencing the roles of others gives a vital understand to the areas around me and what a patient may go through during their individual diagnostic and treatment pathway.

Bradley Cock

I am a cardiac scientist apprentice working in the cardiac outpatient department. The apprenticeship scheme is a brilliant programme where I learn on the job gaining skills and completing competencies as well as carrying out academic studies to a degree level.

I want to be a qualified healthcare scientist because I have a passion for both people and science. As a cardiac scientist, you are in a privileged position where you can form excellent patient relationships, especially with those who require ongoing care, as well as performing interesting diagnostic procedures. The role is varied and I can honestly say no two days are ever the same whether it’s the excitement of an emergency procedure or the analysis of patient data; it’s never a boring day! However, the factor that makes it a special field of work is the incredible team of people that you have the opportunity to work with. I’m so proud to work alongside such inspirational, innovative people who all combine to provide the best patient care possible.

Samantha Kodola

My name is Sam and I work for the Cardiac Department in Treliske Hospital. I am a Trainee Cardiac Scientist, completing a degree apprenticeship in partnership with UWE Bristol. The course is a NHS Practitioner Training Programme (PTP) which entails full-time study and integrated workplace-based training for three years.

So far, the course has incorporated the other healthcare science specialisms into our academic studies. This has provided me with a broader understanding of the healthcare science sector and how they link together. Having the workplace-based learning has been invaluable and where most of the development and learning is noticeable.

Working in the healthcare science sector is very rewarding as you are a part of the diagnostic and treatment pathway for a patient. You get to work in a variety of settings, with different equipment and encounter diverse experiences. Working to better the lives of patients is the core purpose of the job. The sector is advancing rapidly with new evolving technology and scientific approaches to improve the outcomes of patient treatment.