V I NCENT K HOO Royal Marsden Hospital & Institute of Cancer - - PowerPoint PPT Presentation

V VI NCENT

I NCENT K

KHOO

HOO

Royal Marsden Hospital & Institute of Cancer Research St George’s Hospital & University of London

I CARO, Vienna : April 2009

Outline

• National Developments for RT in the UK
• Current general position for RT in the UK
• National Survey –

IMRT/IGRT in the UK

• Development Issues in the UK
• Summary

UK: National RT Advisory Group

• 6-2004 (Prof M Richards)
• Membership

– Clinicians, Radiographers, Med Physicists, relevant professional representatives, patients

• Terms of Reference

– Advise development and delivery of RT services incl. NHS Cancer Plan & NICE guidance – Advise RT policy programmes

• Demand and capacity for RT
• Requirements: Equipment, training, workforce
• Service delivery streamlining, quality
• Future developments
• Plan: Effect a world class RT service for UK

NRAG Report 1

• 2007
• 1.5m # / yr
• 30,000 # / 106
• 2016
• 2.9m # / yr
• 54,000 # / 106

Ministers DoH Report, 2007

• Should be
• 2.5m # / yr
• 48,000 # / 106
• Interim aim: 40,000 # / 106

by 2010/2011

• 2005: 8/39

RT centres are achieving this

Work I ncrease of 91%

NRAG Report 1

• 2007
• 8000 # / Linac
• 2016
• 8700 # / Linac

Ministers DoH Report, 2007

• 2010/2011
• 8300 # / Linac
• Each Linac

4-4.5 # (pat treatments) / hour

• Linacs

run 9.2 hrs/day with some at 11.5hrs/ day

• RT departments operate 239 days/ year

– Standard 5 day week – Close for only 3 bank holidays – Each linac with ≤ 19d QA/service during normal working hours

• Incorporate a service efficiency Linac

– Additional Linac in use 50-75% of time to cope with capacity peaks, other linac breakdown etc

• Operate services at 87% capacity so room for more

NRAG Report 2

• Maximum RT wait = 31 days
• Maximum patient journey time = 45 min
• Linac

replacement = 10 years

• Software & IT replacement = 3-5 years
• 4D methods (IGRT) as minimum

Ministers DoH Report, 2007

National Survey 2007: RT Planning & Delivery

• Questionnaire response: 48/58 (83%)

Jefferies et al Clin Onc 2009

• 46% use IMRT
• 27% use IMRT in routine management
• 19% use IMRT routinely in research
• 21% planning to initiate IMRT by 2008/2009
• 8% use IGRT in routine management
• 12% use IGRT in research setting
• 25% planning to initiate IGRT by 2008/2009

National Survey 2007: RT Planning & Delivery

Centres & Subsites: Usage

Jefferies et al Clin Onc 2009

I MRT Usage

Centres & Subsites: Technique

National Survey 2007: RT Planning & Delivery

Centres & Subsites: Usage

Jefferies et al Clin Onc 2009

I GRT Usage

National Survey 2007: RT Planning & Delivery

Jefferies et al Clin Onc 2009

Training I ssues

• Radiology input for TVD

– 13% had some input – 8% had occasional input – Average time for department 0.5-1.8 hrs/wk

• Structured training for image interpretation

– Oncology trainees: 4% (6% informal) – Radiographers: 16% (in-house), 8% (MSc module) – Physicists: 8% anatomy course, 2% (MSc module), 4% (informal)

National Survey 2007: RT Planning & Delivery

Jefferies et al Clin Onc 2009

Training I ssues

• Radiographer structured training

– 12 centres (25%)

• Physicist structured training

– 4 centres (8%)

National Survey 2007: RT Planning & Delivery

Cited Reasons for Lack of IMRT/IGRT Uptake

• Lacking Staff
• Lacking Equipment
• Lacking access to equipment
• Lacking Time
• Lacking Funding
• Lacking Training

The 5(6) L’s of Non-RT Development

Cancer Reform Strategy

DoH, 2008: www.cancer.nhs.uk

NRAG

Service delivery Governance

Wider world Commissioning

• Workforce
• Access
• Capacity
• equipment
• facilities
• Framework
• contracts/service
• tariffs
• toolkit
• Data set collection
• Provisions for progress
• Clinical Pathways
• Safety
• Tech assessment
• Peer review
• Survivorship
• Leadership
• Communication
• Collaboration
• Studies

Summary

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