Rob Chuter: collaborative sustainability in radiotherapy

Rob currently works as principal clinical scientist at The Christie, where he also leads on sustainability initiatives in radiotherapy for the trust. He is also a leading researcher in magnetic resonance linear accelerator (MR LINAC) technology an honorary senior lecturer position at the University of Manchester. 

It was an early love of science and physics that inspired Rob to undertake a degree in astrophysics at the University of Birmingham in 2022, which led in turn to a Master’s degree in medical physics and eventually a PhD. During those studies got the opportunity to travel to Hawaii’s Mauna Kea Observatories and use the UK infrared telescope located there. 

On completing his PhD in 2011, Rob undertook the NHS Scientist Training Programme (STP), which prepares medical physicists for work in hospitals, and was placed at St James’ University Hospital in Leeds, eventually leading to his first role as a Band 7 clinical scientist.

Then in 2015, a role came up at The Christie as a clinical scientist - an opportunity to work both as a researcher in MR Linac and in clinical science. 

During that time, he became involved in the Advanced Radiotherapy Technologies Network (ART-NET), a community of professionals spread across hospitals and research centres that was funded by a Cancer Research UK (CRUK) Network Accelerator Award of £4.3m. ART-NET sought to develop and spread national treatment protocols to improve and harmonise practice. 

Rob also began working with the Manchester Cancer Research Centre, where he focused on using the MR Linac to observe which tumours are oxygenated and which are not. His work at the MCRC is still funded by CRUK, and his research there continues to this day.

His passion for improving radiotherapy does not end, however, at improving treatment – he wants to make the entire operation more effective, more efficient and more sustainable.

At the age of 10, Rob’s fascination with nature led him to become an accidental bird watcher, after a kingfisher accidentally flew into the window of his childhood home. Rob says his parents were keen to encourage that interest, taking him on frequent rambles through the countryside.

While at the University of Birmingham, Rob became president of the student conservation society. Later, he became increasingly interested in climate change and began taking steps in his own lifestyle to be more environmentally conscious, including becoming a vegetarian and limiting his air travel. “I just did more and more in my personal life, and then I started thinking: ‘Well, I’ve probably done as much as I can personally – what about professionally?’” he explains. “I was working at The Christie, and I thought: ‘I wonder what I can do at work on this?’”

Rob applied for a grant from North West Greener NHS, a subdivision of the nationwide initiative to make the healthcare system net zero, to start looking at the carbon footprint of radiotherapy in 2021. His project found that patient travel contributes the most emissions in the field. That conclusion led him to apply for a grant from the National Institute for Health and Care Research to look at hypofractionation – dividing radiotherapy into fewer doses with increased radiation – for which he was awarded more than £440,000.

Usually, radiotherapy patients come in for upwards of 15, even 20, treatment appointments. But clinical trials have shown that, for prostate, lung and breast cancer, increasing each dose of radiation and reducing the total number of appointments to just five, has an equivalent impact to standard approaches. “Why can’t we do more of that?” Rob asks. “I want to look at the carbon footprint, but also the patient experience. There’s a general feeling that this is just universally beneficial to everybody. Technology has moved on – imaging makes us more confident in delivering doses.

“But you need to provide the evidence to funders and decision makers to show that it’s equivalent. If we can show that, then we can reduce the number of appointments.”

That research – titled Initial study to compare the carbon footPRINT, patient experience and resources of standard and hypofractionated radiotherapy (IMPRINT) – officially began in April 2024, and is set to run until September 2026.

Rob’s findings show that hypofractionation can lower carbon footprints, patients tend to prefer it, it reduces the resource burden on hospital trusts and the clinical outcomes are similar. All of which raises the question: why aren’t we doing more of this? “It almost always comes down to financing,” Rob explains. “How’s it being paid for? It needs money to get it implemented, especially in the smaller centres, and, if they’re already struggling, they just won’t go for it.”

In February 2020, he began discussions with the Radiotherapy Board, a UK-wide partnership established in 2013 by the SoR, the Royal College of Radiologists and the Institute of Physics and Engineering in Medicine, which provides guidance and support to help improve radiotherapy services. These discussions resulted in Rob helping to establish the Environmental Sustainability Working Group, a multidisciplinary team of the Radiotherapy Board that is tasked with supporting radiotherapy centres in reducing their carbon footprint. “It’s a team thing,” says Rob. “You can’t change anything with just physicists, with just clinicians – you need everybody involved. 

“We talked to them [the Radiotherapy Board] about creating a sustainability group with their involvement, and then we advertised to members, and that’s how the sustainability group was formed. [Their involvement] meant it was already connected to the relevant groups. That was where we came up with the idea of having a framework summarising all the evidence we’ve got, to say to departments ‘these are things you could do to lower your carbon footprint’.”

And across all of these projects and discussions, Rob has found himself with expertise to share.