The Radiotherapy Dataset (RTDS) NDRS Webinar - 18 th November 2020
Who’s presenting? Catherine Roe Project Lead, RTDS Michael Sharpe Project Manager and Technical Lead, RTDS Rebecca Girdler Lead Analyst, RTDS 2
Sections WHAT IS RADIOTHERAPY?.............................................................................4 THE DATASET……………………………………………………………………….12 SUBMISSION, RECEIPT AND PROCESSING THE DATA…………………….17 HISTORICAL DATA………………………………………………………...............29 APPLICATIONS FOR RTDS………………………………………………………..34 THE ORGANISATIONAL STRUCTURE OF RTDS………………………………52 HOW CAN THE RTDS BE ACCESSED?..........................................................63 3
What is Radiotherapy?
What is Radiotherapy? 1 of 3 Radiotherapy is high energy ionising radiation which causes damage to living tissue https://www.cancer.gov/about-cancer/treatment/types/radiation-therapy/external-beam 5
What is Radiotherapy? 2 of 3 The most common types of radiotherapy are: • External beam radiotherapy (teletherapy) • Radioactive sources (Brachytherapy) External beam radiotherapy is* 96% of all radiotherapy delivered *Approximately, based on 19/20 submissions 6
What is Radiotherapy? 3 of 3 Brachytherapy External Beam WHAT PRODUCES THE RADIOTHERAPY? WHAT PRODUCES THE RADIOTHERAPY? A machine (for example, A pure radioactive source a linear accelerator) that is always emitting radiation HOW IS THE RADIATION DELIVERED? HOW IS THE RADIATION DELIVERED? Deposits energy throughout the patient The source is placed inside the patient HOW IS SURROUNDING TISSUE IMPACTED? HOW IS SURROUNDING TISSUE IMPACTED? Radiation delivered from multiple angles Radiation is delivered to prevent accumulation of dose in directly where it is needed surrounding healthy tissue 7
Methods of External Beam Delivery Linac Tomotherapy Cyberknife Gammaknife 8
Brachytherapy in use (interstitial) Insertion of sources X-ray for verification MRI of needle placement 9
The Radiotherapy Treatment Pathway A clinician annotates the scans The patient is referred using a planning system, indicating: to the Radiotherapy • Where the individual beams of the Linac will go, department • What dose will be delivered per day, and • How many times the patient will have to attend. This is the Prescription. The patient attends. No radiotherapy is The patient attends delivered, instead the patient is scanned, the department for and if necessary moulds are taken one or more deliveries of radiotherapy. This is the Planning Appointment. This is an Attendance. 10
Proton Therapy 11
The Dataset
Purpose of the Radiotherapy Dataset …. Purpose of the standard is to collect consistent and comparable data across all ….. Providers… in order to provide intelligence for service planning, commissioning, clinical practice and research and the operational provision ….. Information Standard (SCCI 0111) 2009 Now DPA, NHS Digital 13
The Overall structure of the Dataset Patient Details unique to the patient, such as name, date of birth, etc Diagnosis Diagnosis of the disease being treated Episode The patients episode of care – normally a time period which may contain several types of treatment treating a singular disease Prescription Attendance A Prescription for a dose and fractionation The attendance by the patient to a radiotherapy of radiotherapy to be delivered to the patient. department for the delivery of one or more fractions of radiotherapy. Because the patient could be having more then one fraction delivered, Exposure this is not guaranteed to be unique per prescription An individual exposure of radiotherapy, delivering one of the fields of this fraction of the overall prescribed dose 14
Example of key fields in the data structure * n.b. some renamed for clarity The data includes information from a patient level down to an individual exposure, with 26 core items being defined Patient Local Patient Identifier Diagnosis NHS Number Diagnosis (ICD10) Date of Birth Tumour Laterality Postcode Episode Episode Start Date Decision To Treat date Prescription Earliest Clinical Appropriate Date Attendance Intent of Treatment Treatment region (if not primary) Attendance Dates Priority of Treatment Prescribed Dose OPCS Treatment codes Among other Prescribed Fractions noteworthy items, Actual Dose Every attendance every prescription Actual Fractions submitted includes includes both a treatment technique planned and Exposure in the form of delivered dose OPCS-4 X and Y National Machine Identifier codes Time of Exposure Isotope (if applicable) 15
Version 6 of the RTDS Currently in public consultation for Version 6 Consultation from the 16 th November to the 18 th December • • Several changes, mostly around getting better clinical data and improving provider readability at the point of export • After consultation and review, will need to go to national body for approval • Currently planned for go-live in 2022 Contact the RTDS Helpdesk to request a copy of the current schema RTDS.Helpdesk@nhs.net 16
Submission, receipt, and processing the data
Who is currently submitting to the dataset? • All English NHS Trusts delivering external beam radiotherapy (currently 51) • All Welsh NHS Hospitals delivering external beam radiotherapy • 3 of the 5 Scottish NHS Hospitals delivering external beam radiotherapy Last two expected to go live early next year 18
Systems involved in Radiotherapy Delivery (for external beam treatment) 1. The clinician creates 2. Elements of the plan 3. The Record and Verify the plan on the get transferred to the system is used to control the Treatment Planning Record and Verify treatment being delivered by System system the machines Record and Treatment Planning Verify System System 19
Systems involved in Radiotherapy Delivery (for external beam treatment) 2. A few centres have more than one Record 1. A lot of centres have and Verify system, more than one Treatment although it is less Planning System common Record and Treatment Verify System Planning 1 System 1 Treatment Record and Planning System 2 Verify System 2 3. Record and Verify systems will normally be attached to specific machines 20
Systems involved in Radiotherapy Delivery (for external beam treatment) Record and Verify System The majority of RTDS comes from Record and Verify systems 21
Further caveats • Not all treatments need a plan, so not all treatments go on a planning system • Not all radiotherapy delivering devices are connected to Record and Verify Systems • For non-device delivered radiotherapy, or machines used infrequently or for low volumes, Providers either enter data by hand on to the R+V, or submit the “other” format 22
Record and Verify Systems • Many suppliers but two currently in use in England, Scotland and Wales • Mosaiq, from Elekta, and Aria, from Varian • The different systems have different formats of extracts 23
Submissions – the Varian Aria format 1.csv - Demographics • Six files, produced with SQL created by Varian PAS 5.csv – Diagnosis/Course • Either in a tool called Infomaker or Aura – both SQL based extraction products running of the base system 2b.csv + 3.csv – • All Aria systems need a PAS Prescription and Plan extract – this is because it does not supply postcode 2a.csv - • The format of the six files is Attendances not consistent across Aria installations 4.csv - Exposures 24 Public Health England 24 Overview Public Health England
Submissions – the Elekta Mosaiq format • Only two files as designed to be as simple as possible to implement • Links directly in to back end of Fractions Mosaiq • Extracts using whatever tools PAS available - Access, Crystal Reports, Costings SQL Server • Implemented at all English and Welsh Mosaiq sites, either by Trust (optional, only if or by PHE The Trust w ant an OPCDS return) • No PAS file necessary unless Trusts wants OPCDS, as all data items from Mosaiq. • Dataset documented and available on request 25 Public Health England 25 Overview Public Health England
Submissions – the Other format • Only one file. Excel spreadsheet or CSV file • Designed by PHE PAS • Not captured live, captured after the fact (optional, only if The Trust want an • No PAS file necessary (unless OPCDS return) Trust wants OPCDS). • Used for molecular treatments of isotopes not recorded on the Record and Verify system 26 Public Health England 26 Overview Public Health England
Submissions – Combinations possible Aria Mosiaq NCRAS Portal Other PAS 27
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Historical data
Some Caveats • Different nations data is processed differently • Scottish granular-per-patient data is not held by NCRAS and is returned to Scottish authorities • Welsh data should be requested through Welsh authorities, however is held (with data protections) in a sister repository RTDS – Induction Presentation 30
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