The Radiotherapy Dataset · 2020. 11. 18. · Mosaiq. •Dataset documented and available on...
Transcript of The Radiotherapy Dataset · 2020. 11. 18. · Mosaiq. •Dataset documented and available on...
The Radiotherapy Dataset (RTDS)
NDRS Webinar - 18th November 2020
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Who’s presenting?
Catherine Roe
Project Lead, RTDS
Michael SharpeProject Manager and Technical Lead, RTDS
Rebecca GirdlerLead 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% of 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
one or more deliveries of 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
order 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
AttendanceA Prescription for a dose and fractionation of radiotherapy to be delivered to the patient.
Prescription
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Diagnosis of the diseasebeing treated
Diagnosis
An individual exposure of radiotherapy, delivering one of the fields of this fraction ofthe overall prescribed dose
Exposure
The Overall structure of the Dataset
PatientLocal Patient IdentifierNHS NumberDate of BirthPostcode
Diagnosis (ICD10)Tumour Laterality
Diagnosis
Episode Start DateDecision To Treat dateEarliest Clinical Appropriate DateIntent of TreatmentPriority of Treatment
Episode
Attendance DatesOPCS 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 IdentifierTime of ExposureIsotope (if applicable)
Exposure
Treatment region (if not primary)Prescribed DosePrescribed FractionsActual DoseActual 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
• 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 OverviewPublic Health England24 Public Health England
Submissions – the Varian Aria format
Fractions
CostingsPAS
(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
or by PHE
•No PAS file necessary unless Trusts
wants OPCDS, as all data items from
Mosaiq.
•Dataset documented and available
on request
25 OverviewPublic Health England25 Public Health England
Submissions – the Elekta Mosaiq format
Excel spreadsheet
or CSV filePAS
(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 OverviewPublic Health England26 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 Presentation30
• 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 Presentation31
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 Presentation32
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 Presentation33
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 onEvent 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 reportingProvides 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
our 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
of 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
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Project Lead
Project ManagerTechnical 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
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Project Lead
Project ManagerTechnical 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
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Project Lead
Project ManagerTechnical 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
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Project Lead
Project ManagerTechnical 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 ManagerTechnical Lead Lead AnalystRTDS Helpdesk
Data Liaison Team
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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
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Project Lead
Project ManagerTechnical 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
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Project Lead
Project ManagerTechnical 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
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RTDS Helpdesk
Data Liaison Team
Project Lead
Project ManagerTechnical 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 England61
• 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 England62
• 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 2Cancerdata
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
[email protected] Questions about what is possible
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