The London Gamma Knife Centre Kenton Lucas Building St Bartholomew’s Hospital West Smithfield London EC1A 7BE 020 3465 6006/7007 [email protected]www.thelondongammaknifecentre.com GILSPUR STREET HOLBORN VIADUCT HOSIER LN COCK LN CHARTERHOUSE STREET FARRINGDON STREET ST BRIDES ST FARRINGDON ST PAULS CITY THAMESLINK BARBICAN WEST SMITHFIELD G IL S P U R S TREE T WE WEST SMITHFIELD MRI GAMMA KNIFE THE LONDON GAMMA KNIFE CENTRE AT BARTS FARRINGDON R O A D OLD BAILEY NEWGATE STREET WEST SMITHFIELD LONG LN PUR STREET REE GILSPUR STREET WEST SMITHFIELD MAIN ENTRANCE FOUNTAIN
Transcript
The London Gamma Knife Centre Kenton Lucas Building
HCA Hospitals and Centres are regulated and inspected by the Care Quality Commission (CQC).
The CQC follow the Essential Standards of Quality and Safety in Healthcare as set out in the Health and Social
Care Act 2008.
The London Gamma Knife Centre is registered as a location of HCA International Ltd providing acute care
to adult service users under the regulated activities:
• Treatment of disease, disorder or injury
The registered manager is Aida Yousefi, Chief Executive Officer (The Harley Street Clinic).
A copy of the Centre’s most recent inspection report is available on request. If you wish to view this or would like to request a copy please contact the
Chief Executive Officer.
Copies of the report can also be obtained from the regulatory body website as indicated below.
Care Quality Commission www.cqc.org.uk
H ow t o g e t t o t H e g a m m a K n i f e C e n t r e at B a rt S
The Hospital is situated in the City of London, close to St Paul’s Cathedral.
Contact and addresses • St. Bartholomew’s Hospital Switchboard
www.bartsandthelondon.nhs.uk
T 020 7377 7000 (ask for the relevant department/extension)
• The Harley Street Clinic 35 Weymouth Street
London W1G 8BJ www.theharleystreetclinic.com
T 020 7935 7700 (ask for the relevant department extension)
F 020 7487 4415
• The London Gamma Knife Centre St Bartholomew’s Hospital
Kenton and Lucas Building, Basement West Smithfield
London EC1A 7BE T 020 3465 6006
Barbican and Farringdon are served by the Hammersmith and City, Metropolitan and Circle lines.
Blackfriars is served by the Circle and District lines and St Paul’s is served by the Central line.
BusThe following buses stop outside or close to the
hospital: 4, 8, 25, 56, 172 and 242. Low floor wheelchair access buses run on all routes serving
Barts Hospital.
For further information about public transports visit the Transport for London website www.tlf.gov.uk.
Taxi and CarBarts Health - NHS Trust is situated within the
congestion charging zone. All patients/visitors who drive to the hospital are therefore required to pay
the charge, although there are some exception and discounts, such as:
• Those with disabilities who hold a blue badge (formerly known as an orange badge)
• Residents living within the congestion charging zone
• Drivers of alternative fuel vehicles.
For further information visit the congestion charge website www.cclondon.com
The drop off/pick up point is in the Square, accessed via the King Henry VIII Gate on Giltspur Street. There is
no public parking at the Hospital itself, but there is an NCP car park close to the hospital on West Smithfield.
Disabled parking permits can be requested from The City of London Council if you are already
registered as a “disabled” in your local authority and have a “blue badge”. You will need to contact
the council for an application form on 0207 606 3030. They require confirmation of the number of hours you
will be in the hospital for treatment. You can get this information from your consultant’s secretary. Disabled
badges for councils outside the City of London Council are not recognised.
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• We suggest you bring with you an overnight bag
• It is advised not to bring any valuables with you
• Bring along any medication you may be on (take medication as normal on the morning
of your treatment).
C o m p l a i n t S
Please remember, we value all comments, as they help us to improve our service. Let us try and resolve any
issues that may be worrying you, before you go home.
In the event that any patient is dissatisfied with The London Gamma Knife Centre at St Bartholomew’s
services we encourage our staff to try to resolve the issue immediately and proactively.
Where this is not possible and you wish to make a formal complaint we have a three-stage complaints
process. On your request we will provide you detailed information about this.
Will the Gamma Knife procedure hurt?While the stereotactic frame is being fitted you will feel some discomfort. The actual Gamma Knife Treatment
is painless.
Will I be radioactive?No. All radiation stays within the treatment room.
The cobalt rays used in the Gamma Knife treatment do not remain in the body. The rays are relatively
harmless until they converge in the lesion or tumour.
Is Gamma Knife radiosurgery safe?The treatment plan will make the treatment as safe as
possible and most people will experience few if any side effects but there is a small risk of complications
documented earlier in this patients guide.
Is Gamma Knife radiosurgery effective?Results have proven to be superior or comparable to conventional neurosurgery, depending on the specific
condition treated.
Can Gamma Knife radiosurgery cause another tumour?
In the past 30 years of experience there has been no convincing evidence of radiosurgery causing new
tumours, although on rare occasions cancerous change in a treated tumour has been reported. Speak to your
consultant about this if you are worried. The number of cases followed over 20 to 30 years is relatively small
and future observations will be more informative. Based on the existing experience with radiation the incidence
of radiation induced tumour is highly unlikely.
f r e q u e n t ly a S K e d q u e S t i o n S
g r at u i t i e S
Our Code of Conduct states that staff can accept perishable goods such as flowers or fruits as gifts.
However they are not permitted to accept cash, cheques, stocks or any “financial instrument”. If a
patient, relative or friend insists on giving such gratuities the Radiotherapy Services Manager and
Registered Manager will be informed. Donations to charities are acceptable. If you would like more information on such donations please contact
the Gamma Knife Team.
Will the radiation burn my skin?The current radiation doses used are not sufficient
to cause permanent damage to the skin.
Following treatment when can I go back to work?As soon as you feel well enough. There is no reason
why you should not go back to work the following day.
Following treatment how soon can I travel (by car, bus, train, and plane)?
As soon as you feel well enough. There is no reason why you could not travel the following day.
When will I see an improvement or know if the treatment has worked?
Generally the effects of Gamma Knife radiosurgery take place over many months, or even years and this
is the reason for an annual review. Some lesions shrink gradually and eventually disappear while others simply
experience no further tumour growth. In a few cases when patients are being treated for Trigeminal
Neuralgia, some relief may occur in the hour following treatment, although often it requires weeks for pain
relief to occur.
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For patients who do not undergo an angiogram and if everything goes according to plan, patients are
discharged on the same day.
Patients who have had an angiogram need to stay in the hospital as a precaution due to the risk of bleeding from the wound in the groin. Neurological observations
should be performed as required. Patients may also spend the night in the hospital if there is any risk of
seizures following treatment or if they experience adverse side effects.
S i d e e f f e C t S
The usual short-term side effects are minimal. On the day of the treatment a post-treatment information
pamphlet will be given to you explaining in detail what to do should you experience any side effects.
Due to the four small skin wounds from the frame you may experience:
• Pin sites oozing and bleeding• Swelling at pin sites
• Pin site infection
The pins can compress on the nerves that supply sensation to the back of the head. As a result, you
may experience:
• Numbness and tingling on any area of the scalp
From supporting the weight of the frame and having your head manipulated into the treatment position.
You may feel:
• Shoulder muscle ache
From the release of pressure when the frame is removed, from anxiety and from the radiation you
may experience:
• Headache• Nausea and vomiting
p r a C t i C a l i S S u e S
NHS PatientsFor those patients who are eligible for NHS care,
The London Gamma Knife Centre at St Bartholomew’s will organize funding through your local Primary Care
Trust. This will be done in advance and approval must be gained before your treatment can be booked.
Private PatientsYou should check with your own insurer about cover
before undergoing any treatment. You are responsible for confirming your financial arrangements prior to
treatment. This will include obtaining pre-authorisation from your insurer, a letter of guarantee from your sponsor
(usually an embassy or a company) or a payment of a deposit in advance where you are settling your own
account. The deposit is likely to be a fairly substantial sum but any balance remaining after completion of
treatment would be reimbursed. Payment can be made by direct bank transfer, credit or debit card. A self-pay
package estimate is available on request.
Before treatment you will be asked to read and complete the HCA Registration Guide along with the Admission/Registration Form. These documents set out the contractual arrangements for your treatment,
and therefore form your contract with The London Gamma Knife Centre at Barts as part of The Harley Street Clinic. The services of your consultant(s) are
not normally included in your hospital charges. Their professional fees will be sent to you under
separate account.
At the end of the treatment, depending on how your account is being settled, there may be some extra charges to pay. For insured or embassy accounts
this will usually be extra costs not covered by contractual arrangements:
• Such as visitor meals, telephone calls or take-home medication
Due to the radiation that reaches the scalp when the lesion is superficial, you may experience:
• Local hair loss (not hair loss over the entire scalp)• The hair should grow back: but may be lighter in
colour and finer in texture.
A small number of patients experience long-term side effects from the Gamma Knife Treatment. During your outpatients’ appointment and also
during the consent process your consultant will have discussed with you specific side effects that you should be aware of: These may include seizures,
vision change and headaches.
f o l l ow u p
Following discharge either your treating or referring consultant’s secretary will contact you to arrange a follow-up appointment.Your treating consultant will
provide your general practitioner with a summary of your treatment.
On the day of your treatment you will receive a quality assurance questionnaire and shortly after your treatment there will be a follow up call from the
Gamma Knife Nurse.
We welcome your suggestions and comments as they are used to monitor the quality of the service provided
by the Gamma Knife Centre and wherever possible will be used to make further improvements.
For self-pay patients, in the unlikely event of the deposit not covering the cost of treatment, the
balance would need to be settled in full.
Please note that any tests required outside of the Gamma Knife package such as blood tests, will be
charged separately.
Due to the nature of patients undergoing treatment in the Gamma Knife Department, we ask that you only
bring one person with you. No children are permitted.
AccommodationA list of hotels and bed and breakfast accommodation
can be provided on request. Please telephone the Gamma Knife Centre for further information.
HospitalityTea, coffee, water and biscuits are available (free
of charge) to you and your nominated family/friend member in The London Gamma Knife Centre at
St Bartholomew’s waiting room. Some magazines are also provided.
Lunch will not be available. If you want you may bring something to eat (there is a microwave that you
can use) or food can be purchased. There are many cafes and coffee shops near Barts Health - NHS Trust. Having breakfast will not impact on your treatment. For patients who are undergoing an angiogram, breakfast
should be after you have had the procedure.
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PregnancyFemale patients should be aware of the importance of
not being pregnant on the day of treatment. This is because radiation can harm the baby. If you think you may be pregnant it is extremely important that you
discuss this with a member of the Gamma Knife team immediately.
Female patients between the age of 10 and 65 will be required to sign a declaration prior to treatment, of their
pregnancy status. You will be met by the multidisciplinary team.
t r e at m e n t p r o C e S S
On arrival at the Hospital you will report to the MRI Department at Kings George V Wing (follow the signs
pointing to imaging X-ray until the end).
The Treatment consists of four steps:
1. Stereotactic Frame fitting2. Diagnostic Imaging: CT, MRI or Angiography
3. Treatment planning4. Treatment
1. Stereotactic Frame fittingIn order to pinpoint the area that will be treated by the Gamma Knife, some measurements are taken of your
head and a guiding device called a Stereotactic Frame is fitted. This is a light weight aluminium frame which is
attached to your head with four surgical pins (two on the forehead and two on the back of the head). They
pierce the skin and rest on the skull, but do not pierce the skull. Four small injections of local anaesthetic will
be administered to numb the skin where the pins are to be placed. No hair will be shaved from your head. The
fitting of the frame takes approximately 10 minutes. You will experience a feeling of increasing pressure being applied to the head. However this feeling will
subside within 15 minutes.
Once the frame is fitted it remains in place for the duration of your treatment and is removed immediately
once treatment has been completed.
3. Treatment PlanningAfter the diagnostic imaging is performed you will
be taken to the Gamma Knife Centre. You will rest while the medical team plans the treatment. Both
you and your companion will wait in a small room, which includes comfortable seating and a selection
of magazines.
The images taken will be transferred to the Gamma Knife planning station, will be examined and the area
to be treated will be mapped out. The team will calculate the exact dose, treatment time and head
position(s) required.
4. TreatmentOnce the planning is completed you will be moved
to the treatment room and positioned on the Gamma Knife couch. The Stereotactic Frame will be fixed onto
the treatment couch. The Gamma Knife team will leave the room. As the team leaves you will hear a beeping
noise signifying treatment is about to begin.
The computerised program will begin your treatment session automatically.
The treatment is not painful and you will not feel or see anything.
The Gamma Knife team will monitor you by closed circuit television and an intercom system. You can talk to the team during treatment and you can request the
treatment to be stopped at any time.
We can play music to you whilst you are having your treatment. We can use either an Ipod, Iphone and
CD system for this. After treatment the Gamma Knife team will return.
2. Diagnostic ImagingAll patients require an MRI scan (or a CT scan if for any reason the patient can not have an MRI scan) which is
used to plan the treatment.
– You will be required to remove your jewellery and any metal objects whilst having the MRI scan
– In order to produce high quality pictures of your brain your head frame will be secured so it cannot move.
The imaging will take around 20 minutes
– Throughout the examination the staff will be able to see you and speak to you through an intercom
– A contrast agent will be administered into your vein
Angiography is only necessary for patients who are having treatment for a vascular abnormality such as
an arterio-venous malformation (AVM). You will be asked not to eat or drink for a minimum of 6 hours prior
to this. It will be necessary for you to wear a hospital gown for the duration of the treatment.
– The groin needs to be shaved. Please do it at home the day before treatment.
– A small skin incision will be made to allow the passage of a tube (catheter) through the femoral artery in the groin. A local anaesthetic will be injected into the
groin to numb the surrounding area. Contrast agent (dye) will be administered through the incision. There
may be a feeling of warmth or heat in the face or head during the injection, but this will pass quickly. During this
period of time there will be a series of x-ray images taken of the artery or arteries.
– When the procedure is finished, pressure will be exerted at the site of the skin incision until it has closed.
This will take a minimum of 10 minutes.
– Afterwards it is necessary to lie flat between 4 to 6 hours. this will coincide with your treatment time. Normal activities can usually resume the following day.
i m m e d i at e ly p o S t - t r e at m e n t
Immediately following treatment the Stereotactic Frame is removed and small dressings will be placed over the
forehead pin sites. If you are allergic to elastoplast please let us know.
Many patients feel very tired following the treatment. However, this is most likely due to the demands of the
day itself (early start, unfamiliar surroundings and procedures, and anxiety). After a good night of sleep
you should be feeling much better.
If you were on any restrictions prior to Gamma Knife treatment, they will continue.
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w e l C o m e t o t H e l o n d o n g a m m a K n i f e C e n t r e at
B a rt S H e a lt H .
Through a unique partnership between The Harley Street
Clinic and Barts Health “The London Gamma Knife
Centre at St Bartholomew’s ” offers a comprehensive
day case treatment facility that allows a team of specialist
consultants to treat brain lesions without open surgery.
We recognise all our patients as individuals. We aim to
meet your needs and those of your family and friends
according to your customs, spiritual beliefs, values and
dignity. Above all else we are committed to the care and
improvement of human life.
Many specialists work together as a team to
ensure you receive the best possible care.
The following booklet has been designed to provide you
with a general introduction to Gamma Knife® Treatment.
It will help you understand how the department operates
and what you can expect from us as a team.
g a m m a K n i f e r a d i o S u r g e ry
Gamma Knife Radiosurgery is a safe, effective and non-invasive procedure using radiation to treat
conditions and lesions of the brain. It can replace conventional surgery with the use of radiation or is
used in conjunction with it. The radiation is delivered with precision to the abnormal tissue within the brain
whilst sparing surrounding healthy tissue. It is not a “knife” at all.
• Gamma Knife treatment can usually be delivered as a day case
• Most patients experience minimal side effects and can return to their normal activities
almost immediately
• There is very little risk of infection, almost no risk of bleeding and no risk of spinal fluid leakage
• There is no need for general anaesthesia
• Unlike conventional radiotherapy Gamma Knife Radiosurgery is only directed at the target and spares
unnecessary treatment of adjacent, normal brain tissue
Gamma Knife Radiosurgery damages the DNA structure in the cells of the tumour or lesion being
treated so the cells no longer reproduce eventually rendering the lesion inert.
t H e m u lt i d i S C i p l i n a ry t e a m
The Clinician/Consultant is your treatment specialist. After discussion with you s/he will agree on and supervise your care and treatment. Specialities
involved include Neurosurgery, Clinical Oncology and Neuro-Radiology.
The Gamma Knife Radiographers are specially trained in Gamma Knife treatment and patient care. They work
closely with the consultant and medical physicists to plan your treatment.
The Gamma Knife Nurse will meet you on the morning
of your treatment day and work with the radiographers to provide support, education, advice and information to you and your family. If necessary, s/he will refer you
to other specialised professionals. The nurse will accompany you during your treatment day.
The Medical Physicists are radiation scientists. They work closely with your Consultant and Radiographer
to plan your treatment in detail. You will normally meet them during the frame fitting process.
Other Staff you may meet include the MRI and Angiography Radiographers, catering staff and porters.
You will meet male and female clinical staff in your team. If you have any concerns about this, please let us know.
B e f o r e t H e t r e at m e n t
ConsentIt is a legal requirement to have your signed consent to Gamma Knife treatment following a full discussion with
your Consultant. It is important that you understand what the proposed treatment involves so that you are fully informed before signing the consent form. Please
feel free to ask your specialist as many questions as you consider necessary.
PacemakerIf you have a pacemaker fitted please send any
relevant documentation to The Gamma Knife Centre. MRI scanning is normally required before planning
treatment and this is usually not possible with a pacemaker in place. Some modern pacemakers are MRI compatible but this would need to be confirmed
