The Nuclear Medicine Physics Department is located within the St Luke’s Wing of the Royal Surrey County Hospital.  We provide comprehensive scientific support to diagnostic nuclear medicine and PET services both within the Trust and across Surrey and Sussex, and we also coordinate and administer molecular radiotherapy treatments at the Royal Surrey.  The department is also responsible for the Regional Radiopharmacy, which serves several local hospitals and other external providers.

The Department is headed by a consultant Clinical Scientist, and is staffed by:

  • 8 Clinical Scientists
  • 1 Admin Manager
  • 2 Trainee Clinical Scientists
  • 4 Radiopharmacy specialists
  • Medical Physics Trainees on rotational placements
  • Industrial placement students from the University of Surrey (Physics and Computing)

The following therapies are performed by Nuclear Medicine Physics:

1. Radioiodine Therapy for Thyrotoxicosis

Radioiodine therapy is commonly used to treat thyrotoxicosis (an over-active thyroid) and has been used successfully for several decades. It is a non-invasive alternative to surgery. The radioiodine is given as a capsule, and accumulates naturally in thyroid tissue, in the same way that iodine in food is taken up by the thyroid. The radiation released by the radioiodine damages the thyroid tissue, which reduces the amount of thyroid hormones produced, alleviating the symptoms of thyrotoxicosis.

Radionuclide therapy for thyrotoxicosis is carried out on an outpatient basis at the Nuclear Medicine department of the Royal Surrey County Hospital. During the week before having the treatment, patients attend the Nuclear Medicine department for a thyroid uptake scan and a consultation with a Nuclear Medicine doctor. The doctor uses the scan to check that radioiodine therapy is suitable.  If the doctor decides that the therapy is suitable, it takes place the following week. The radioiodine is given orally in the form of a capsule by a Medical Physicist, who will also give advice on radiation protection precautions that need to be followed after the therapy.

The radiation protection advice given will depend on the amount of radioiodine that you receive and what your home and work circumstances are. In general, this will involve restricting close contact with other people for up to three weeks.

More detailed information on this therapy can be found in the Patient Information Leaflet.

 

2. Radium-223 (Xofigo®) Therapy for Bone Metastases

Radium-223 Dichloride (Xofigo®) therapy is used to treat prostate cancer patients whose cancer has spread to the bones (metastases). It is a palliative therapy used to help relieve bone pain caused by the bone metastases, but in clinical trials it has also been shown to extend life expectancy by an average of a few months.

As bones grow and repair, they use calcium. This is also true of bones metastases; in fact, they take up a lot more calcium than normal bone. Xofigo® is a calcium analogue, and as such it accumulates in the bones. The radiation that Radium-223 emits is very short-range alpha particles, which destroy cells in a very localised way. Because much more Xofigo® accumulates in the bone metastases than in normal bone, it destroys the cancer cells whilst sparing those in the normal bone.  In some cases, the bone marrow can be affected leading to a reduced blood cell count.  This is monitored by the doctors and can be treated if it happens.

This treatment is carried out on an outpatient basis in the Nuclear Medicine Department of the Royal Surrey County Hospital. All patients have a pre-therapy appointment in Nuclear Medicine. This is at least one week before the planned date for the first therapy cycle. This involves a blood test and possibly a Nuclear Medicine bone scan as well. A doctor and a Medical Physicist discuss all aspects of the therapy and are able to answer any questions. The doctor determines whether the therapy is suitable based on the blood test and scan results.

Patients receive six injections of Xofigo®, four weeks apart. All patients are required to have a blood test the week before each planned therapy cycle to ensure that they are still fit for therapy.

Each therapy appointment lasts approximately 30 minutes, with a 30 minute wait beforehand while the injection is prepared. This is because the injection is based on your weight, and we use your weight on the day of treatment to prepare each injection individually.  The injection is given by a doctor or a radiographer. During this appointment a radiation protection advice card will be issued by a Medical Physicist. Some basic hygiene precautions need to be followed for four weeks following each injection, because body fluids will be slightly radioactive during this time. However, there are no restrictions on close contact as the radiation has only a very short range.

More detailed information on this therapy can be found in the Patient Information Leaflet.

 

3. Radioiodine Therapy for Thyroid Cancer

In most cases, patients diagnosed with thyroid cancer will have a thyroidectomy (surgery to remove the thyroid gland), followed by radioiodine treatment. Even when the whole thyroid gland is removed during surgery, it is possible for small remnants of thyroid tissue to be left behind.  In some cases it is also possible that some malignant thyroid tissue may be found elsewhere within the body. The radioiodine is given as a capsule, and accumulates naturally in both normal thyroid tissue and thyroid cancer, in the same way that iodine in food is taken up by the thyroid. The radiation released by the radioiodine destroys these thyroid cells wherever they are in the body.  As the radiation is short-range, damage to surrounding tissue is kept to a minimum.

In approximately one third patients, not all of the remnant thyroid tissue will be destroyed with one treatment and they may need to come back for a higher amount of radioiodine.

Radioiodine therapies for thyroid cancer are carried out on an inpatient basis on Onslow Ward at the Royal Surrey County Hospital. Stays are usually between one and four nights, depending upon the amount of radioiodine given and how quickly it clears from the body. The treatment is carried out by a Medical Physicist, who also gives radiation protection advice at discharge. An oncology doctor will also be involved in the therapy. The therapy itself is administered orally as a capsule. In order to ensure that the therapy is as effective as it can be, patients must reduce the amount of iodine in their diet for two weeks before the therapy.

The therapy will take place in a single en suite room and during the stay the patient must remain in the room at all times. Visitors are limited to one at a time and no pregnant women or children are allowed to visit the patients during this time.  No visitors are allowed in the first 24 hours after radioiodine treatment.

Radiation protection advice is given on discharge by a Medical Physicist.  The advice involves restricting close contact with other people for a period of time. The exact length of time depends on how quickly the iodine is cleared from the body, which is measured by the Medical Physicist during treatment.

After your therapy, you will have a scan in the Nuclear Medicine Department that will look at where the radioiodine has been taken up in your body. This information will help doctors decide whether you are likely to need further treatments.

More detailed information on this therapy and the low iodine diet can be found in the Patient Information Leaflet.

 

4. Radioembolisation Therapy for Liver Cancer

Radioembolisation is a procedure that uses microspheres (tiny glass or resin spheres) that contain the radionuclide Yttrium-90.  These are used to treat patients with liver cancer, and are injected via an artery directly into the liver.  Yttrium-90 releases short-range radiation that damages nearby cells. Because the microspheres accumulate to a greater extent in liver tumours than in normal liver tissue, the radiation damages the cancer whilst sparing nearby healthy tissue.  There are two types of microspheres used: SirSpheres® and Theraspheres®. They are both very similar in the way they work.  The procedure is carried out in two stages, usually one to three weeks apart. Both procedures are carried out in a theatre in the Radiology Department, and are followed by a scan in the Nuclear Medicine Department.

The first stage is called the “work-up”, or pre-therapy appointment. During the work-up stage, the treatment is simulated using a radioactive tracer injected into the liver via the hepatic artery. The tracer consists of tiny particles that get stuck in the small blood vessels in liver tumours. Once the tracer has been injected, the patient is scanned on a gamma camera in the Nuclear Medicine Department.  The pictures show whether the tracer has properly targeted the cancer, and checks to see if a significant amount has accumulated in the lungs. If this is the case, the therapy may not be able to go ahead as the radiation dose to the lungs would be too large.  After the scan, the patient may stay overnight on a ward or may be able to go home later the same day.

During the therapy stage, a similar procedure is followed, but this time the Yttrium-90 microspheres are injected. The microspheres get stuck in the small blood vessels and give a radiation dose to the liver tumours. The patient stays overnight on a ward and is scanned the following day in the Nuclear Medicine Department, to confirm that the microspheres have gone to the intended areas.

Upon discharge, patients are given radiation protection advice by a Medical Physicist. Since the therapy agent is radioactive, some simple precautions may need to be followed.

More detailed information on this therapy can be found in the Patient Information Leaflet.

 

5. Strontium-89 (Metastron®) and Samarium-153 (Quadramet®) Therapies for Bone Metastases

Strontium-89 (Metastron®) and Samarium-153 (Quadramet®) therapies are used to relieve bone pain in patients with advanced prostate or breast cancer that has spread to the bone.

Metastron® and Quadramet® are both calcium analogues, and they accumulate in the bones, but mainly in the bone metastases which use a lot of calcium as they develop. The radiation released by the radionuclides destroys nearby cells. As the radiation is short range, it destroys the cancer cells whilst sparing the normal bone. In some cases, the bone marrow can be affected leading to a reduced blood cell count.  This is monitored by the doctors and can be treated if it happens.

Both therapies are carried out on an outpatient basis in the Nuclear Medicine Department of the Royal Surrey County Hospital. Patients are required to attend an appointment about a week before the planned therapy, where a Nuclear Medicine doctor will ensure that they are fit for therapy. At this appointment they will decide which therapy is most suitable for a particular patient, taking into account a range of factors. Both treatments are both given as a single injection.

The therapy appointment will last approximately 30 minutes, with a 30 minute delay before the appointment while the injection is being prepared. Patients are free to go home afterwards, but will be given radiation protection advice by a Medical Physicist. Some basic hygiene precautions need to be followed after the injection, because body fluids will be slightly radioactive during this time. In addition, patients may also be asked to restrict close contact with other people for a period of time.

More detailed information on this therapy can be found in the Patient Information Leaflet.