The Radiotherapy Dataset (RTDS) NDRS Webinar - 18 th November 2020 - - PowerPoint PPT Presentation

The Radiotherapy Dataset (RTDS)

NDRS Webinar - 18th November 2020

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Who’s presenting? Catherine Roe

Project Lead, RTDS

Michael Sharpe

Project Manager and Technical Lead, RTDS

Rebecca Girdler

Lead Analyst, RTDS

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Sections

WHAT IS RADIOTHERAPY?.............................................................................4 THE DATASET……………………………………………………………………….12 SUBMISSION, RECEIPT AND PROCESSING THE DATA…………………….17 APPLICATIONS FOR RTDS………………………………………………………..34 THE ORGANISATIONAL STRUCTURE OF RTDS………………………………52 HISTORICAL DATA………………………………………………………...............29 HOW CAN THE RTDS BE ACCESSED?..........................................................63

What is Radiotherapy?

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https://www.cancer.gov/about-cancer/treatment/types/radiation-therapy/external-beam

Radiotherapy is

high energy ionising radiation which causes damage to living tissue What is Radiotherapy? 1 of 3

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The most common types of radiotherapy are:

• External beam radiotherapy (teletherapy)
• Radioactive sources (Brachytherapy)

What is Radiotherapy? 2 of 3 External beam radiotherapy is*

96%

• f all radiotherapy delivered

*Approximately, based on 19/20 submissions

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Radiation delivered from multiple angles to prevent accumulation of dose in surrounding healthy tissue

External Beam Brachytherapy

Radiation is delivered directly where it is needed A machine (for example, a linear accelerator) A pure radioactive source that is always emitting radiation Deposits energy throughout the patient The source is placed inside the patient

WHAT PRODUCES THE RADIOTHERAPY? WHAT PRODUCES THE RADIOTHERAPY? HOW IS THE RADIATION DELIVERED? HOW IS SURROUNDING TISSUE IMPACTED? HOW IS SURROUNDING TISSUE IMPACTED? HOW IS THE RADIATION DELIVERED?

What is Radiotherapy? 3 of 3

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Methods of External Beam Delivery

Linac Gammaknife Tomotherapy Cyberknife

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Brachytherapy in use (interstitial)

MRI of needle placement Insertion of sources X-ray for verification

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The patient attends. No radiotherapy is delivered, instead the patient is scanned, and if necessary moulds are taken

The Radiotherapy Treatment Pathway

The patient is referred to the Radiotherapy department This is the Prescription. A clinician annotates the scans using a planning system, indicating:

• Where the individual beams of the Linac will go,
• What dose will be delivered per day, and
• How many times the patient will have to attend.

The patient attends the department for

• ne or more deliveries
• f radiotherapy.

This is an Attendance. This is the Planning Appointment.

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Proton Therapy

The Dataset

….Purpose of the standard is to collect consistent

and comparable data across all ….. Providers… in

• rder to provide intelligence for service planning,

commissioning, clinical practice and research and the operational provision…..

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Information Standard (SCCI 0111) 2009 Now DPA, NHS Digital

Purpose of the Radiotherapy Dataset

Details unique to the patient, such as name, date of birth, etc

Patient

The patients episode of care – normally a time period which may contain several types of treatment treating a singular disease

Episode

The attendance by the patient to a radiotherapy department for the delivery of one or more fractions of radiotherapy. Because the patient could be having more then one fraction delivered, this is not guaranteed to be unique per prescription

Attendance

A Prescription for a dose and fractionation

• f radiotherapy to be delivered to the patient.

Prescription

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Diagnosis of the disease being treated

Diagnosis

An individual exposure of radiotherapy, delivering one of the fields of this fraction of the overall prescribed dose

Exposure

The Overall structure of the Dataset

Patient

Local Patient Identifier NHS Number Date of Birth Postcode Diagnosis (ICD10) Tumour Laterality

Diagnosis

Episode Start Date Decision To Treat date Earliest Clinical Appropriate Date Intent of Treatment Priority of Treatment

Episode

Attendance Dates OPCS Treatment codes

Attendance

Every attendance submitted includes treatment technique in the form of OPCS-4 X and Y codes The data includes information from a patient level down to an individual exposure, with 26 core items being defined

National Machine Identifier Time of Exposure Isotope (if applicable)

Exposure

Treatment region (if not primary) Prescribed Dose Prescribed Fractions Actual Dose Actual Fractions

Prescription

Among other noteworthy items, every prescription includes both a planned and delivered dose

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Example of key fields in the data structure *n.b. some renamed for clarity

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Version 6 of the RTDS

Currently in public consultation for Version 6

• After consultation and review, will need to go to national body for approval
• Several changes, mostly around getting better clinical data

and improving provider readability at the point of export

• Currently planned for go-live in 2022

Contact the RTDS Helpdesk to request a copy of the current schema

RTDS.Helpdesk@nhs.net

• Consultation from the 16th November to the 18th December

Submission, receipt, and processing the data

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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

• 2. Elements of the plan

get transferred to the Record and Verify system

• 1. The clinician creates

the plan on the Treatment Planning System

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Systems involved in Radiotherapy Delivery (for external beam treatment)

Treatment Planning System Record and Verify System

• 3. The Record and Verify

system is used to control the treatment being delivered by the machines

• 2. A few centres have

more than one Record and Verify system, although it is less common Record and Verify System 1

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Systems involved in Radiotherapy Delivery (for external beam treatment)

Treatment Planning System 1 Treatment Planning System 2 Record and Verify System 2

• 3. Record and Verify

systems will normally be attached to specific machines

• 1. A lot of centres have

more than one Treatment Planning System

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Systems involved in Radiotherapy Delivery (for external beam treatment)

Record and Verify System

The majority of RTDS comes from Record and Verify systems

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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

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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

PAS 1.csv - Demographics 5.csv – Diagnosis/Course 2b.csv + 3.csv – Prescription and Plan 2a.csv - Attendances 4.csv - Exposures

• Six files, produced with SQL

created by Varian

• Either in a tool called

Infomaker or Aura – both SQL based extraction products running of the base system

• All Aria systems need a PAS

extract – this is because it does not supply postcode

• The format of the six files is

not consistent across Aria installations

24 Overview

Public Health England 24

Public Health England

Submissions – the Varian Aria format

Fractions Costings

PAS

(optional, only if The Trust w ant an OPCDS return)

• Only two files as designed to be as

simple as possible to implement

• Links directly in to back end of

Mosaiq

• Extracts using whatever tools

available - Access, Crystal Reports, SQL Server

• Implemented at all English and

Welsh Mosaiq sites, either by Trust

• r by PHE
• No PAS file necessary unless Trusts

wants OPCDS, as all data items from Mosaiq.

• Dataset documented and available
• n request

25 Overview

Public Health England 25

Public Health England

Submissions – the Elekta Mosaiq format

Excel spreadsheet

• r CSV file

PAS

(optional, only if The Trust want an OPCDS return)

• Only one file.
• Designed by PHE
• Not captured live, captured after

the fact

• No PAS file necessary (unless

Trust wants OPCDS).

• Used for molecular treatments of

isotopes not recorded on the Record and Verify system

26 Overview

Public Health England 26

Public Health England

Submissions – the Other format

Aria PAS Mosiaq

Other

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Submissions – Combinations possible

NCRAS Portal

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Historical data

RTDS – Induction Presentation 30

• 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

Some Caveats

RTDS – Induction Presentation 31

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

England Wales Scotland English Historical data

• All NHS English Trusts currently submitting
• English data goes back to 2009
• 2009-2015 is legacy NATCANSAT data, 2016 onwards NCRAS
• Data completeness improves over time

RTDS – Induction Presentation 32

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

England Wales Scotland

• Welsh data goes back to 2018
• One site also has full 2017 submissions
• Some issues in submissions from one of the centres,

hoped to be resolved shortly

Welsh Historical data

RTDS – Induction Presentation 33

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

England Wales Scotland

• Scottish data only live recently
• Three centres have to-date 2020 uploaded
• Remaining two centres in progress, expected to follow shortly

Scottish Historical data

Applications for RTDS

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Types of Applications RTDS is currently used in a variety of ways.

• Immediate uses that change individual patient care
• Operational monitoring
• Research projects
• Processed and added to a patients cancer registration

These include:

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Immediate application (BARD) The RTDS is used to support BARD, Breast Screening After Radiotherapy Dataset

• Launched in 2018, BARD is a national database which records women who

have had radiotherapy to breast tissue before the age of 36.

• These patients are at increased risk of developing a second primary, and

BARD has been designed to ensuring screening is arranged at an appropriate time.

• At present BARD only records women with a lymphoma diagnosis

Further information here: https://w ww.christie.nhs.uk/patients-and-visitors/services/lymphoma/bard#!

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Operational Monitoring (CS2) The RTDS is used to provide operational reporting to all centres submitting.

Cancerstats 2 provides a variety of operational reporting, and is updated on a weekly basis

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Operational Monitoring (CS2), important caveats

• Only available on an HSCN connection (previously known as N3)
• Only to NHS users (providers, networks, commissioners, etc)
• Provides breakdown per Trust/Hospital of all sites submitting to the RTDS

Main reports available for all data uploaded since 2009, filterable by month

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Operational Monitoring (CS2) examples pt 1 of 2

Can see the use in Provides event reporting on

Event reporting

Attendances, Episodes and Prescriptions, which can be filtered by, among others, Hospital, Disease by ICD10, and month

Machine use

Machine attendances for any reported machine in England, Scotland or Wales

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Reports against the Provides the Working profile per day for any reported machine in England, Scotland or Wales

Quality, Innovation, Productivity and Prevention

measures relevant to radiotherapy for English sites

Working profile of Machine QIPP reporting

Operational Monitoring (CS2) examples pt 2 of 2

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New reporting recently launched includes

Operational Monitoring (CS2), Dose and Fractionation

Dose and Fractionation reporting

• Separate from main reports
• Back to April 2019, updated monthly
• Filterable for the main tumour types
• Currently only English and Welsh data
• Prepared to aid COVID response

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Cancerdata pt 1 of 3

Cancerdata is similar to Cancerstats 2, but reports in to the public domain

Cancerdata

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Cancerdata pt 2 of 3

Provides event reporting on Episodes and Attendances, which can be filtered by, among others, Cancer Alliance, Disease by tumour group, and year

Event reporting IMRT reporting

Provides Intensity Modulated Radiotherapy reporting Per Alliance, disease and year, among others, From 2009 to 2019 From 2014 to 2019

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Cancerdata pt 3 of 3 Available at

https://www.cancerdata.nhs.uk/radiotherapy

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Research projects RTDS has also been used in a variety of research projects

• In most of the cases we will be showing, analytical work was done in house,
• however requests for the data can be made via the Office of Data Release

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National Audits RTDS data has been used to compliment National Audits

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HERO pt 1 of 2 RTDS is contributing to HERO,

Health Economics in Radio-Oncology

• HERO is a project to benchmark costs for radiotherapy between different countries
• HERO is run by ESTRO, the European Society for Radiotherapy and Oncology

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HERO pt 2 of 2

Examples of HERO data capture form

• RTDS data is being used to calculate the volumes of treatments being performed
• The granular per Trust capture of RTDS should contribute to the accuracy of the figures
• The English participation is being supported by the Royal College of Radiologists, the RCR

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SABR Paper examples

England Netherlands

Damhuis, Senan, Harden et

• al. submitted

Comparison of Treatment Modalities Utilised

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For English patients, RTDS data is also processed by

• ur Cancer Registration Officers and added to the

cancer registrations made by the Registry. Cancer Registrations The patients cancer registration will be formed in part of the various datasets received by the registry.

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Simulacrum RTDS is also being simulated in the Simulacrum

• Health Data Insight (HDI), in partnership with AstraZeneca and IQVIA,

have developed a synthetic dataset (the Simulacrum) to imitate some

• f data held by NDRS, including the RTDS.
• As the data contains no real patient information, it can be used to analyse

cancer data without compromising patient confidentiality.

More information is available on the Cancerdata website (https://www.cancerdata.nhs.uk/simulacrum)

The organisational structure around RTDS

RTDS Helpdesk Data Liaison Team 53

Project Lead Project Manager T echnical Lead Lead Analyst

Analytical support

Full time RTDS Shared with other services

The RTDS Team

IT Development Data Loading Team Cancer Registration

Business Intelligence Team

RTDS Helpdesk Data Liaison Team 54

Project Lead Project Manager T echnical Lead Lead Analyst

Analytical support

Full time RTDS Shared with other services

The RTDS Team

IT Development Data Loading Team Cancer Registration

Business Intelligence Team

RTDS Management Team

RTDS Helpdesk Data Liaison Team 55

Project Lead Project Manager T echnical Lead Lead Analyst

Analytical support

Full time RTDS Shared with other services

The RTDS Team

IT Development Data Loading Team Cancer Registration

Business Intelligence Team

Provider support

RTDS Helpdesk Data Liaison Team 56

Project Lead Project Manager T echnical Lead Lead Analyst

Analytical support

Full time RTDS Shared with other services

The RTDS Team

IT Development Data Loading Team Cancer Registration

Business Intelligence Team

Analytical team

Project Lead Project Manager T echnical Lead Lead Analyst

RTDS Helpdesk Data Liaison Team 57

Analytical support

Full time RTDS Shared with other services

The RTDS Team

IT Development Data Loading Team Cancer Registration

Business Intelligence Team

Cancerstats 2 reporting

API Portal/Encore Dev RTDS Helpdesk Data Liaison Team 58

Project Lead Project Manager T echnical Lead Lead Analyst

Analytical support

Full time RTDS Shared with other services

The RTDS Team

IT Development Data Loading Team Cancer Registration

Business Intelligence Team

Waterfall loading RTDS Helpdesk Data Liaison Team 59

Project Lead Project Manager T echnical Lead Lead Analyst

Analytical support

Full time RTDS Shared with other services

The RTDS Team

IT Development Data Loading Team Cancer Registration

Business Intelligence Team

60 RTDS Helpdesk Data Liaison Team

Project Lead Project Manager T echnical Lead Lead Analyst

Analytical support

Full time RTDS Shared with other services

The RTDS Team

IT Development Data Loading Team Cancer Registration

Business Intelligence Team

RTDS processes for change and management

61 Overview

Radiotherapy Information Strategy Group

Public Health England 61

• RTDS advised by the RISG,
• Rotational membership
• Representative from many stakeholder fields and professional bodies
• Meets several times a year

RTDS processes for change and management

62 Overview

Radiotherapy User Group

Public Health England 62

• RTDS also host the RUG,
• Also rotational membership and meets several times a year
• Discuss issues raised through the membership or from other routes
• Sounding board for changes to RTDS and provider concerns

How can the RTDS be accessed?

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Access to the data

Operational Reporting for providers, updated weekly High level summaries available to the public

Cancerstats 2 Cancerdata ODR (Office of Data Release)

Individual requests for granular data

In addition it is possible pre-compiled data releases may be available, check the NCIN website: http://www.ncin.org.uk/home

Devolved nations data should be requested from the appropriate nation NCRASenquiries@phe.gov.uk

Questions about what is possible

RTDS.Helpdesk@nhs.net

Data Portals Analytical Queries and projects To contact us

Thank you

Catherine Roe

Project Lead, RTDS

Michael Sharpe

Project Manager and Technical Lead, RTDS

Rebecca Girdler

Lead Analyst, RTDS