An evaluation tool to embed assurance of delivery of best practice radiotherapy for lung cancer patients

Lung cancer is responsible for one in 7 new cases of cancer and approximately 4 out of 5 patients with lung cancer have non-small cell lung cancer (NSCLC). Of this group, 1 in 5 has early-stage disease which is associated with the best chance of cure. Lung cancer is more common in elderly patients and smokers, who have a higher incidence of other medical conditions. This means that in a proportion of patients with early stage NSCLC, surgery is too risky. Such patients are termed ‘medically inoperable’. Some other patients may be inoperable for technical reasons.

Stereotactic ablative body radiotherapy (SABR) refers to the use of highly targeted radiation therapy to structures outside the brain and skull - in this case in the thorax to the lungs.

NICE recommends the use of SABR for early stage NSCLC and this is recommended in the Royal College of Radiologists (RCR) lung cancer consensus guidelines.

NHS England had publicly committed to supporting the rollout of SABR across England for an expansion of access from 26 to 50 centres.

Situation

SABR involves precise irradiation of a lesion while sparing the surrounding normal tissues, and requires technically complex planning processes. It is crucial that this planning is performed to a consistently high standard, as any variation could impact on the quality of the treatment and consequently the patient outcome.

The UK Lung SABR consortium provides guidelines on best practice metrics to be achieved in this planning process. These metrics are for a range of different treatment regimen options resulting in a complex grid of requirements for providers to meet. While independent quality assurance can be used to assess providers’ initial adherence to these guidelines, it is challenging to easily demonstrate ongoing consistency across the full range of treatment regimens. An independent audit tool is therefore required to facilitate rapid collation of planning metrics for a range of patients for each regimen used and demonstrate guideline adherence.

Aspiration

Provide an easy way for providers to benchmark their lung planning metrics against UK best practice and support ongoing consistency and improvement. Utilise this tool to measure the quality of plans for any radiotherapy treatment site against best practice to ensure the best possible patient outcome.

Solution and impact

Elekta’s ProKnow DS is a cloud-based radiotherapy dose plan repository that includes dose analysis tools to support providers in demonstrating and improving quality of radiotherapy planning.

Treatment plan dose objectives tables (scorecards) can be designed to measure compliance with any set of metrics and to meet local needs or nationally set guidelines. The Northern Centre for Cancer Care in Newcastle has designed, and validated with other centres, a set of 20 Lung SABR guidelines scorecards. These allow individual providers to perform internal audit against the guidelines for any number of patients in all categories of the dose regimens.

ProKnow also allows easy sharing of the internal audit results and can facilitate national comparative audit for quality improvement purposes. ProKnow, in combination with modern planning system scripting, provides patient plan uploading methods that have minimal or no impact on the planning process. ProKnow facilitates both national and local audit through the creation of scorecards to improve the full range of providers’ external beam radiotherapy service.

Functionality

• ProKnow is a web tool that can store and analyse radiotherapy plans and associated patient metrics such as comorbidities and outcomes
• ProKnow provides a big data repository for national treatment planning data making it available for analysis, mining, learning and research purposes

Capabilities

• Fast, online and intuitive interface
• Creates scorecards to show plan dose against objectives
• Compares patient plans against objectives - individually or in any number
• Allows sharing of scorecard templates between providers
• Allows sharing of audit results using scorecards between providers
• Facilitates improvement of services through big data mining
• Allows sharing to be controlled by the provider which uploaded the patient’s treatment plan
• Allows control of visibility of patient details to comply with data protection requirements
• Potential to replace local data archives, with a resultant cost saving

Scope

• Web-based tool designed to be used by radiotherapy professionals
• Can be used anywhere with internet access through a browser
• Provides information governance (IG) compliance by allowing users to protect patient information display outside clinical settings

Key learning points

Easily achieved audit against national best practice for treatment planning metrics.

Find out more

More about ProKnow

Key contact

Chris Walker, head of radiotherapy physics, Northern Centre for Cancer Care, Newcastle upon Tyne

Christopher.Walker3@nhs.net

Elekta contact