The Royal Marsden Diagnosis and treatment

Our pioneering technology: radiotherapy and radiology

Over the years, The Royal Marsden’s research into radiotherapy and radiology has laid the foundations for today’s pioneering technology

Leading the way: Consultant Radiologist Dr Mike King

2011

First CyberKnife machine funded

This year, the MR Linac is due to treat its first patient. This moment will be the culmination of decades of advances in both radiotherapy and radiology, with the two sciences coming together in the first-ever technology to combine real-time magnetic resonance imaging (MRI) with a state-of-the-art radiotherapy delivery system.

The MR Linac precisely locates and targets tumours with radiation, even as they move. This will allow doctors to increase the radiation dose delivered to a tumour while ensuring that surrounding healthy tissues receive a lower dose, thus reducing side effects.

The Royal Marsden and the Institute of Cancer Research (ICR) are the first institutions in the UK to install an MR Linac. We are part of an international consortium, and our team is taking a leading role in developing the technology for use on a number of tumour sites before it is routinely used to treat patients.

We now have four CT scanners and five MRI scanners across our Chelsea and Sutton sites

Dr Mike King, Consultant Radiologist

New techniques

The Royal Marsden has a proud history of leading the development of new radiotherapy techniques. In the 1990s, we conducted one of the first trials of conformal radiotherapy, which later evolved into intensity-modulated radiotherapy (IMRT).

In 2011, The Royal Marsden Cancer Charity funded our first CyberKnife machine, which delivers stereotactic body radiotherapy (SBRT) to moving tumours.

It uses X-rays to track the position of the tumour and sensors that monitor the patient’s breathing, enabling the machine to reposition the radiotherapy beam during treatment in order to minimise damage to healthy tissue.

Today, we’re leading the international PACE trial, which is comparing SBRT with robotic surgery and standard radiotherapy for the treatment of prostate cancer.

We hope to show that CyberKnife is effective over a shorter time and results in fewer side effects than the standard treatments.

Imaging expertise

Over the past four decades, we have also been at the forefront of radiology, developing and trialling new ways of imaging cancer.

Dr Mike King, Consultant Radiologist at The Royal Marsden, joined the Chelsea hospital as a consultant in 1979, when, he says, it had “no CT, no MRI and a single early ultrasound machine”.

At that time, it was one of only a handful of hospitals in the country performing mammography. Our Sutton site had become the location of the first CT full-body scanner in the country – and one of the first in the world – in 1978, with Chelsea following in 1983, both thanks to charitable funding.

“Until that point, in order to see lymph nodes, we had to inject dye into patients’ feet, which would travel to their lymph nodes so that we could diagnose lymphoma and spread of pelvic and abdominal cancer,” says Dr King. “With the new CT scanner, we could now examine the whole body and could see inside the liver, kidneys and lymph nodes for the first time.

“Many of the tests we did in the early  days were invasive – inserting tubes into patients and injecting X-ray dye – but thanks to cross-sectional imaging by CT, MRI and more recently PET/CT scanning, we can now non-invasively scan the whole body in minutes. We now have four CT scanners and five MRI scanners across our Chelsea and Sutton sites.”

1978

We get first CT full-body scanner in UK

Global collaboration

The scale of the MR Linac project – made possible by a £10 million grant from the Medical Research Council to the ICR and support from The Royal Marsden Cancer Charity – is significant, explains Professor Uwe Oelfke, Head of the Joint Department of Physics at The Royal Marsden and the ICR.

“It not only requires collaboration internally between radiotherapy and radiology departments and researchers and clinical staff, but also on a larger scale with the manufacturers and the seven other cancer centres worldwide that also have an MR Linac,” he says.

“The first clinical trial to involve the imaging of volunteers on the MR Linac is currently going through research and development. The information we gain from this will help us prepare for studies treating patients. But first we need to evaluate the system’s capabilities.”

For some patients – children, for example – the reduction of radiation exposure is paramount. There are those who have tumours that are challenging to distinguish from healthy tissue, such as liver or pancreatic cancers. Some have moving tumours – in the abdomen and pelvis, for example. And others have tumours that may change over the course of radiotherapy, such as gynaecological cancer patients.

The MR Linac technology has the potential to benefit all of these patients – which is why this combination of radiotherapy and radiology is so revolutionary.

Our Radiology services

MRI

Magnetic resonance imaging uses strong magnetic fields and radio waves to produce detailed anatomical images. Planning radiotherapy using MRI, as with the MR Linac, is an area of increasing development. We have three 1.5T and two 3T MRI scanners across both sites.

CT

A computerised tomography scan uses X-rays and a bank of detectors to create detailed images for aiding diagnosis, staging and response during and after treatment. We have four Siemens scanners across both sites, offering dual-source energy and interventional CT capabilities.

Mammography

Mammograms use an X-ray system to visualise the breast tissue. We are about to introduce two brand-new tomosynthesis machines, which use 3D imaging to aid in the early detection and diagnosis of breast cancer.

Ultrasound

Ultrasound scans use high-frequency sound waves to create images. We have state-of-the-art equipment at both sites and can also perform ultrasound-guided biopsies on a wide range of body parts.

Interventional radiology

Interventional procedures performed by radiologists include angioplasty, chemoembolisation, colonic and urological stent insertions, and oesophageal dilation. This 24-hour emergency on-call service is consultant-led and available at Chelsea only.