The Implementa,on of Intensity Modulated Radiotherapy ... · PDF fileThe Implementation of...
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The Implementation of Intensity Modulated Radiotherapy Treatment (IMRT) for Prostate Cancer in Tayside Countermeasures Results • First patient started treatment November 2015. • All subsequent radical patients treated using IMRT (100%) • Minimal side effects • No Grade 2 toxicity • Reduction in prescriptions of ! Analgesia ! Fybogel ! Proctosedyl • No hospital admissions Reflections Background • IMRT improves cure rates by enabling higher doses of radiation to be delivered to the prostate gland. • Better sparing of surrounding normal tissue also results in fewer long term side effects and improved quality of life for patients. Problem UK 2014: 88% of all radical prostates were treated using IMRT. Tayside July 2015 = 0% • inability to escalate dose to the national standard. • unnecessary bowel and bladder toxicity. 95% of all radical prostate radiotherapy in NHS Tayside will be delivered using an IMRT plan by 31/12/15. The Implementa,on of Intensity Modulated Radiotherapy Treatment (IMRT) for Prostate Cancer in Tayside Dr Paddy Niblock, Department of Oncology, Ninewells Hospital and Medical School, Dundee Goal 100% 0% 95% 100% 0% Aberdeen Dundee Edinburgh Glasgow Inverness PROSTATE IMRT People Equipment Processes Environment No Time No Team No Training No Confidence No Fiducial Service No Protocols No Pathway Lack of US Probe & Covers No Fiducial Markers Lack of LINAC Time No QA Phantom No Money No Clinic No Water Lack of Planning Space Barriers • Change is challenging! • Clear goal and direction crucial • ‘Bite-size’ chunks essential • Regular communication • Persistence pays off • Ultimately it’s all about the team * Grateful thanks also to Professor Nabi and Dr Catherine Paterson BUSINESS CASE (Oncology and Urology Clinicians, Clinical Leads and Service Managers) RADIOTHERAPY STAFF (Medical, Nursing, Radiographers, Physicists, Secretarial) TRAINING Courses, Peer = Glasgow & Edinburgh, Dummy Planning (20 cases) ENVIRONMENT Clinic space (Urology) Planning space (Oncology) Water tap (Estates) UROLOGY STAFF Urologists, Clinical Nurse Specialist TRAINING Fiducial marker insertion Courses, Peer = Inverness Supervised insertion EQUIPMENT USS probe & covers (Urology) Fiducial markers (Oncology) QA Phantom (Oncology) Prostate IMRT Team Process and Pathway mapping 6 M O N T H S PROTOCOLS Clinical Management Guideline: Medical Fiducials insertion: Urology Prostate IMRT Document: All Bowel & Bladder Prep: Medical Patient Information Leaflets: Medical & Patient Liaison Group
Transcript of The Implementa,on of Intensity Modulated Radiotherapy ... · PDF fileThe Implementation of...
The Implementation of Intensity Modulated Radiotherapy Treatment
(IMRT) for Prostate Cancer in Tayside
Countermeasures
Results • First patient started treatment November 2015.
• All subsequent radical patients treated using IMRT (100%)
• Minimal side effects
• No Grade 2 toxicity
• Reduction in prescriptions of
! Analgesia
! Fybogel
! Proctosedyl
• No hospital admissions
Reflections
Background • IMRT improves cure rates by
enabling higher doses of radiation to be delivered to the prostate gland.
• Better sparing of surrounding normal tissue also results in fewer long term side effects and improved quality of life for patients.
Problem UK 2014: 88% of all radical prostates were treated using IMRT.
Tayside July 2015 = 0%
• inability to escalate dose to the national standard.
• unnecessary bowel and bladder toxicity.
95% of all radical prostate radiotherapy in NHS Tayside will be delivered using an IMRT plan by 31/12/15.
TheImplementa,onofIntensityModulatedRadiotherapyTreatment(IMRT)forProstateCancerinTayside
Dr Paddy Niblock, Department of Oncology, Ninewells Hospital and Medical School, Dundee
Goal
100%
0%
95%
100%
0%
Aberdeen
Dundee
Edinburgh
Glasgow
Inverness
PROSTATEIMRT
People
Equipment
Processes
Environment
No Time
No Team
No Training
No Confidence
No Fiducial Service
No Protocols
No Pathway
Lack of US Probe & Covers
No Fiducial Markers
Lack of LINAC Time
No QA Phantom
No Money No Clinic
No Water
Lack of Planning Space
Barriers
• Change is challenging! • Clear goal and direction crucial • ‘Bite-size’ chunks essential • Regular communication • Persistence pays off • Ultimately it’s all about the team * Grateful thanks also to Professor Nabi and Dr Catherine Paterson
BUSINESS CASE (Oncology and Urology Clinicians, Clinical Leads and Service Managers)
RADIOTHERAPY STAFF (Medical, Nursing, Radiographers, Physicists,
Secretarial)
TRAINING Courses,
Peer = Glasgow & Edinburgh, Dummy Planning (20 cases)
ENVIRONMENT Clinic space (Urology)
Planning space (Oncology) Water tap (Estates)
UROLOGY STAFF Urologists, Clinical Nurse Specialist
TRAINING Fiducial marker insertion
Courses, Peer = Inverness Supervised insertion
EQUIPMENT
USS probe & covers (Urology) Fiducial markers (Oncology)
QA Phantom (Oncology)
Prostate IMRT Team
Process and Pathway mapping
6 M O N T H S
PROTOCOLS Clinical Management Guideline: Medical
Fiducials insertion: Urology Prostate IMRT Document: All
Bowel & Bladder Prep: Medical Patient Information Leaflets: Medical & Patient Liaison Group
