- Email: [email protected]
PO-1022: Implementation of a paperless workflow in radiotherapy; Reducing transcription
S563 ESTRO 36 _______________________________________________________________________________________________
app are available at aftercare check-ups, while 22.2% (24/108) are not convinced of a benefit of app-based patient documentation. Favorable of an alert function due to data input by patients with the need for further clarification are 64.8% (versus 35.2%), 94.3% are willing to contact the patient after notification. Of all, 93.5% support the idea to use collected data for scientific research and 75.0% believe it could be beneficial for the providing hospital. Conclusion The present work shows a great approval for telemedicine, mHealth and apps in oncology amongst HCPs. Assessing side effects can lead to quicker response and thus lower inconvenience of patients. Clinical data as life quality and treatment satisfaction could be used to evaluate and improve the therapy workflow. Regular input of patientreported outcome or side effects can be used to early detect and document the disease progression. Overall, this patient data can be used for scientific evaluations. Eventually, a mobile app would enhance the patient relation to his treating department as he has permanent contact using the mobile app - a trend also evolving in the medical field. PO-1020 Re-irradiation of Head and Neck Sarcomas: initial results of Protontherapy Center of Trento, Italy I. Giacomelli1, D. Scartoni1, M. Cianchetti1, F. Dionisi1, B. Rombi1, M. Amichetti1 1 Azienda Provinciale per i Servizi Sanitari APSS Trento, U.O. di Protonterapia, Trento, Italy Purpose or Objective Radiotherapy for head and neck (H&N) recurrent sarcomas is usually limited by the dose tolerance of critical structures mainly in the skull base. Re-irradiation of such cases is rarely performed in clinical practice. Numerous dosimetric studies have shown that proton therapy (PT) can spare more healthy tissue than conventional X-ray therapy and it can result in fewer side effects. We report the preliminary results in terms of feasibility and tolerance of re-irradiation with PT for recurrent previously irradiated H&N sarcomas . Material and Methods Between November 2015 and September 2016 four patients (pts) with five recurrent H&N Sarcomas were reirradiated with PT. Histology of the primary lesions were: pleomorphic sarcoma (1), alveolar rhabdomyosarcoma (2), sclerosing rhabdomyosarcoma (1), radiation-induced spindle cell sarcoma (1). Median age at re-irradiation was 30.0 years (range, 29.0-50.0 years). Karnofsky performance status was 90-100. Median interval time between previous radiotherapy and PT was 55.4 months; the median total dose received at the first radiotherapy course was 54.7 Gy (range, 50.4 – 60.0 Gy). Target definition was based on CT and MR imaging. Median CTV volume was 45.36 cc (range, 10.48-132.2 cc) and median PTV volume was 126.4 cc (range, 35.87-277.8 cc). Patients received a median total dose of 60.0 GyRBE (range, 50.060.0 GyRBE), 1.8–2.0 GyRBE per fraction; two pts received also sequential and one concomitant chemotherapy. All pts were treated with active beam scanning PT using 2-3 fields with single field optimization (SFO) technique. Acute and late toxicities were registered according to Common Terminology Criteria for Adverse Events version 4.0. Patients’ quality of life was assessed using the EORTCEORTC QLQ-C30 questionnaire. Results Treatment was well tolerated: all patients completed PT without breaks. Acute Grade 3 cutaneous erythema occurred in four pts . Registered G2 toxicities were fatigue (1) and soft tissue edema (1). Concerning late toxicities, one patient had persistent G1 pain at the site of previous irradiation and in one pt acute G3 skin erythema became G1 chronic dyschromia. At a median follow-up of 7.4
months (range, 1.4-12.7 months), all pts are alive with controlled local and distant disease Conclusion Our preliminary experience shows that PT re-irradiation of recurrent H&N sarcoma is feasible and safe. Longer followup and a larger number of patients are needed to definitively assess efficacy and late toxicity. Poster: RTT management
track:
Risk
management
/
quality
PO-1021 An electronically configurable checklist program for quality control of RT treatment planning K.H. Grosser1, A.C. Schulte1, W. Harms1 1 St. Claraspital, Radiooncology, Basel, Switzerland Purpose or Objective To asses efficacy of an adaptive checklist program to facilitate plan review for physicists. Material and Methods Pre-treatment plan review is fundamentally important to patient safety and treatment plan quality. A critical control point in this process is the ‘Planning Approval‘ process. To reduce the error rate we developed an adaptive electronical planning approval checklist as part of our quality assurance. We applied this program to more than 600 treatment plans produced with the Eclipse treatment planning system (VARIAN). Because we wanted to optimize the checklist continuously the program was set up to be adaptive with respect to the plan type and to allow the addition of new checklist items. All evaluated cases were documented in a database. The incidence rates of errors and their types are reported. Results The checklist program was introduced into clinical routine in October 2012 and was used in this version until the end of 2015. In total 638 plans were checked. With the help of this checklist program 303 errors in 190 treatment planes were detected. Most errors were classified as minor errors (i.e. incorrect target volume nomenclature). However, 29 dose-related errors have also been found. 13 new checklist items have been gradually added to the existing checklist to account for newly detected error possibilities. The average time to complete the checklist was approximately 3 minutes. The compliance rate was very high. As expected, the acceptance of the “Do-Confirm” strategy was higher than for the “Read-Do” practice. Conclusion A planning approval checklist is a valuable tool to reduce the error rate of treatment plan validation to almost zero. An automated or semi-automated checklist tool with direct access to the database of the treatment planning system would be desirable. PO-1022 Implementation of a paperless workflow in radiotherapy; Reducing transcription O. Shoffren1, Y. Tsang1, J. Kudhail1 1 Mount Vernon Cancer Centre, Radiotherapy Department, borehamwood, United Kingdom Purpose or Objective It is well recognised that due to the complexities of the radiotherapy pathway transcription errors are common. As such robust processes are in place throughout the treatment pathway to ensure checking processes are fit for purpose. With the importance on using source data to eliminate this potential for transcription errors to arise, our centre has adopted a paperless workflow allowing access to source data ; from referral to the last fraction of radiotherapy.
S564 ESTRO 36 _______________________________________________________________________________________________
The aim of the study was to evaluate the effectiveness of the new workflow in terms of reducing errors. Material and Methods Since April 2016, a paperless workflow has been introduced for each area of the pathway including; referral, data capture at CT, planning information and treatment information up to the last fraction. A focus group was formed to investigate the options available for recording the required information at all stages. These included using an electronic referral and booking form, dynamic documents for recording treatment setup details, electronic journals for recording actions and histories throughout the treatment and toxicity scoring. All checks required on before, during and after treatments were assigned as tasks or checklists and these were made into a standardised automated protocol.All errors at our centre are recorded electronically on a centralised incidence reporting system. The numbers of error occurrences that happened 3 months before and after the introduction of the process were analysed. Results In total, there were 51 and 49 radiotherapy related incidents recorded before and after the introduction of the paperless workflow respectively. The number of incidents related to transcription errors decreased from 29% (15/51) to 16% (8/49) since the paperless change. It’s noted that there was a small rise in reported incidences in other areas of the pathway due to a change in work procedure. Conclusion It’s suggested the number of transcription errors was minimised through the adoption of the paperless workflow. It’s also proved to be beneficial to have a centralised electronic incident reporting system to monitor and review incidents in a radiotherapy department, in order to streamline and optimise existing patient pathways. PO-1023 Reducing waiting room times - A 5 year review of an in-house KPI tool A. Wallis1, D. Moretti1 1 Liverpool Hospital, Radiation Oncology, Liverpool, Australia Purpose or Objective Patient waiting times has a significant impact in a patient’s overall satisfaction of their healthcare experience (1). The main contributors to patient waiting times are inadequate appointment duration, staff experience level, patient late arrival and machine breakdowns (1). Literature on radiation oncology productivity is dominated by variation and validation of the basic treatment equivalent (BTE) model (2). However, the technological advancements in imaging and treatment modalities such as intensity modulated radiation therapy (IMRT), image guided radiotherapy (IGRT), volumetric RT (VMAT) and Tomotherapy have changed the landscape of RT and its productivity measures (4). In 2011, the management team at Liverpool and Macarthur Cancer Therapy Centres (LMCTC) introduced an in-house key performance indicator (KPI) tool to measure the performance of the treatment machines. The catalyst for the design and implementation of the tool was the introduction of the New South Wales (NSW) Performance Measures report of 2010 (3). The main objective of the tool was to capture each individual patient's appointment time to ensure adequate and individualised patient appointment scheduling. It was hypothesised that the introduction of this tool would reduce the waiting room time for patients. Material and Methods In 2010, Mosaiq 2.0X was installed in LMCTC. This version allowed the extraction of time stamps in a reporting tool (Crystal reports version 11). Standardisation of the treatment processes improved the robustness of patient
data and allowed accurate extraction of time stamps in Mosaiq. This data were then imported into Microsoft Excel on a weekly basis for visual display of the KPIs. The tool was launched in October of 2010 for a trial period of two months and has been in use in the department since its introduction. Results During the period of October to December 2010, the department recorded that 56% of patients were treated on time. Since the tool was introduced and actioned in 2011, the department has recorded an average of 71.2% (range 69-76%) of patients treated on time. These results are encouraging considering the number of attendances to the department has increased over the 5 year period (Fig 1). The percentage of patients arriving late to their appointment is 8% (range 7.0-9.1) (Table 1). The average waiting room time for a patient is 3.5 minutes (range 2.3 – 4.5 minutes).
Conclusion The development of an in-house KPI tool has reduced waiting time for patients at LMCTC. Since the introduction of the tool we have increased the number of patients treated on time from 56% to 71.2% over the past 5 years. This is despite the increasing patient attendances and changes in technology and complexity. Interestingly, despite improvements from hospital management to improve parking and access to the departments, 8% of patients do not arrive on time for their appointment. PO-1024 Effectiveness of couch coordinate constraints to reduce error rates in radiation therapy delivery O. Nairz1, N. Breitkreutz1 1 MVZ InnMed, Strahlentherapie, Oberaudorf, Germany Purpose or Objective “Movement from reference marks” is one of the most error-prone steps in the radiation therapy process. The use of indexed immobilization devices and constrained absolute, patient specific couch coordinates is generally considered to be an efficient tool to reduce the risk of radiation therapy errors (RTE) during treatment delivery. In the light of implementing a quantitative risk assessment we analyzed table coordinates of patients treated in our department. We investigated the effectiveness of tolerance values to lower the incidence of both wrong movements from reference marks and irradiation of the wrong patient or isocenter. Material and Methods Actual table values of patients in treatment position during a period of 18 months were extracted from the records of the verification system. Patient setups were
app are available at aftercare check-ups, while 22.2% (24/108) are not convinced of a benefit of app-based patient documentation. Favorable of an alert function due to data input by patients with the need for further clarification are 64.8% (versus 35.2%), 94.3% are willing to contact the patient after notification. Of all, 93.5% support the idea to use collected data for scientific research and 75.0% believe it could be beneficial for the providing hospital. Conclusion The present work shows a great approval for telemedicine, mHealth and apps in oncology amongst HCPs. Assessing side effects can lead to quicker response and thus lower inconvenience of patients. Clinical data as life quality and treatment satisfaction could be used to evaluate and improve the therapy workflow. Regular input of patientreported outcome or side effects can be used to early detect and document the disease progression. Overall, this patient data can be used for scientific evaluations. Eventually, a mobile app would enhance the patient relation to his treating department as he has permanent contact using the mobile app - a trend also evolving in the medical field. PO-1020 Re-irradiation of Head and Neck Sarcomas: initial results of Protontherapy Center of Trento, Italy I. Giacomelli1, D. Scartoni1, M. Cianchetti1, F. Dionisi1, B. Rombi1, M. Amichetti1 1 Azienda Provinciale per i Servizi Sanitari APSS Trento, U.O. di Protonterapia, Trento, Italy Purpose or Objective Radiotherapy for head and neck (H&N) recurrent sarcomas is usually limited by the dose tolerance of critical structures mainly in the skull base. Re-irradiation of such cases is rarely performed in clinical practice. Numerous dosimetric studies have shown that proton therapy (PT) can spare more healthy tissue than conventional X-ray therapy and it can result in fewer side effects. We report the preliminary results in terms of feasibility and tolerance of re-irradiation with PT for recurrent previously irradiated H&N sarcomas . Material and Methods Between November 2015 and September 2016 four patients (pts) with five recurrent H&N Sarcomas were reirradiated with PT. Histology of the primary lesions were: pleomorphic sarcoma (1), alveolar rhabdomyosarcoma (2), sclerosing rhabdomyosarcoma (1), radiation-induced spindle cell sarcoma (1). Median age at re-irradiation was 30.0 years (range, 29.0-50.0 years). Karnofsky performance status was 90-100. Median interval time between previous radiotherapy and PT was 55.4 months; the median total dose received at the first radiotherapy course was 54.7 Gy (range, 50.4 – 60.0 Gy). Target definition was based on CT and MR imaging. Median CTV volume was 45.36 cc (range, 10.48-132.2 cc) and median PTV volume was 126.4 cc (range, 35.87-277.8 cc). Patients received a median total dose of 60.0 GyRBE (range, 50.060.0 GyRBE), 1.8–2.0 GyRBE per fraction; two pts received also sequential and one concomitant chemotherapy. All pts were treated with active beam scanning PT using 2-3 fields with single field optimization (SFO) technique. Acute and late toxicities were registered according to Common Terminology Criteria for Adverse Events version 4.0. Patients’ quality of life was assessed using the EORTCEORTC QLQ-C30 questionnaire. Results Treatment was well tolerated: all patients completed PT without breaks. Acute Grade 3 cutaneous erythema occurred in four pts . Registered G2 toxicities were fatigue (1) and soft tissue edema (1). Concerning late toxicities, one patient had persistent G1 pain at the site of previous irradiation and in one pt acute G3 skin erythema became G1 chronic dyschromia. At a median follow-up of 7.4
months (range, 1.4-12.7 months), all pts are alive with controlled local and distant disease Conclusion Our preliminary experience shows that PT re-irradiation of recurrent H&N sarcoma is feasible and safe. Longer followup and a larger number of patients are needed to definitively assess efficacy and late toxicity. Poster: RTT management
track:
Risk
management
/
quality
PO-1021 An electronically configurable checklist program for quality control of RT treatment planning K.H. Grosser1, A.C. Schulte1, W. Harms1 1 St. Claraspital, Radiooncology, Basel, Switzerland Purpose or Objective To asses efficacy of an adaptive checklist program to facilitate plan review for physicists. Material and Methods Pre-treatment plan review is fundamentally important to patient safety and treatment plan quality. A critical control point in this process is the ‘Planning Approval‘ process. To reduce the error rate we developed an adaptive electronical planning approval checklist as part of our quality assurance. We applied this program to more than 600 treatment plans produced with the Eclipse treatment planning system (VARIAN). Because we wanted to optimize the checklist continuously the program was set up to be adaptive with respect to the plan type and to allow the addition of new checklist items. All evaluated cases were documented in a database. The incidence rates of errors and their types are reported. Results The checklist program was introduced into clinical routine in October 2012 and was used in this version until the end of 2015. In total 638 plans were checked. With the help of this checklist program 303 errors in 190 treatment planes were detected. Most errors were classified as minor errors (i.e. incorrect target volume nomenclature). However, 29 dose-related errors have also been found. 13 new checklist items have been gradually added to the existing checklist to account for newly detected error possibilities. The average time to complete the checklist was approximately 3 minutes. The compliance rate was very high. As expected, the acceptance of the “Do-Confirm” strategy was higher than for the “Read-Do” practice. Conclusion A planning approval checklist is a valuable tool to reduce the error rate of treatment plan validation to almost zero. An automated or semi-automated checklist tool with direct access to the database of the treatment planning system would be desirable. PO-1022 Implementation of a paperless workflow in radiotherapy; Reducing transcription O. Shoffren1, Y. Tsang1, J. Kudhail1 1 Mount Vernon Cancer Centre, Radiotherapy Department, borehamwood, United Kingdom Purpose or Objective It is well recognised that due to the complexities of the radiotherapy pathway transcription errors are common. As such robust processes are in place throughout the treatment pathway to ensure checking processes are fit for purpose. With the importance on using source data to eliminate this potential for transcription errors to arise, our centre has adopted a paperless workflow allowing access to source data ; from referral to the last fraction of radiotherapy.
S564 ESTRO 36 _______________________________________________________________________________________________
The aim of the study was to evaluate the effectiveness of the new workflow in terms of reducing errors. Material and Methods Since April 2016, a paperless workflow has been introduced for each area of the pathway including; referral, data capture at CT, planning information and treatment information up to the last fraction. A focus group was formed to investigate the options available for recording the required information at all stages. These included using an electronic referral and booking form, dynamic documents for recording treatment setup details, electronic journals for recording actions and histories throughout the treatment and toxicity scoring. All checks required on before, during and after treatments were assigned as tasks or checklists and these were made into a standardised automated protocol.All errors at our centre are recorded electronically on a centralised incidence reporting system. The numbers of error occurrences that happened 3 months before and after the introduction of the process were analysed. Results In total, there were 51 and 49 radiotherapy related incidents recorded before and after the introduction of the paperless workflow respectively. The number of incidents related to transcription errors decreased from 29% (15/51) to 16% (8/49) since the paperless change. It’s noted that there was a small rise in reported incidences in other areas of the pathway due to a change in work procedure. Conclusion It’s suggested the number of transcription errors was minimised through the adoption of the paperless workflow. It’s also proved to be beneficial to have a centralised electronic incident reporting system to monitor and review incidents in a radiotherapy department, in order to streamline and optimise existing patient pathways. PO-1023 Reducing waiting room times - A 5 year review of an in-house KPI tool A. Wallis1, D. Moretti1 1 Liverpool Hospital, Radiation Oncology, Liverpool, Australia Purpose or Objective Patient waiting times has a significant impact in a patient’s overall satisfaction of their healthcare experience (1). The main contributors to patient waiting times are inadequate appointment duration, staff experience level, patient late arrival and machine breakdowns (1). Literature on radiation oncology productivity is dominated by variation and validation of the basic treatment equivalent (BTE) model (2). However, the technological advancements in imaging and treatment modalities such as intensity modulated radiation therapy (IMRT), image guided radiotherapy (IGRT), volumetric RT (VMAT) and Tomotherapy have changed the landscape of RT and its productivity measures (4). In 2011, the management team at Liverpool and Macarthur Cancer Therapy Centres (LMCTC) introduced an in-house key performance indicator (KPI) tool to measure the performance of the treatment machines. The catalyst for the design and implementation of the tool was the introduction of the New South Wales (NSW) Performance Measures report of 2010 (3). The main objective of the tool was to capture each individual patient's appointment time to ensure adequate and individualised patient appointment scheduling. It was hypothesised that the introduction of this tool would reduce the waiting room time for patients. Material and Methods In 2010, Mosaiq 2.0X was installed in LMCTC. This version allowed the extraction of time stamps in a reporting tool (Crystal reports version 11). Standardisation of the treatment processes improved the robustness of patient
data and allowed accurate extraction of time stamps in Mosaiq. This data were then imported into Microsoft Excel on a weekly basis for visual display of the KPIs. The tool was launched in October of 2010 for a trial period of two months and has been in use in the department since its introduction. Results During the period of October to December 2010, the department recorded that 56% of patients were treated on time. Since the tool was introduced and actioned in 2011, the department has recorded an average of 71.2% (range 69-76%) of patients treated on time. These results are encouraging considering the number of attendances to the department has increased over the 5 year period (Fig 1). The percentage of patients arriving late to their appointment is 8% (range 7.0-9.1) (Table 1). The average waiting room time for a patient is 3.5 minutes (range 2.3 – 4.5 minutes).
Conclusion The development of an in-house KPI tool has reduced waiting time for patients at LMCTC. Since the introduction of the tool we have increased the number of patients treated on time from 56% to 71.2% over the past 5 years. This is despite the increasing patient attendances and changes in technology and complexity. Interestingly, despite improvements from hospital management to improve parking and access to the departments, 8% of patients do not arrive on time for their appointment. PO-1024 Effectiveness of couch coordinate constraints to reduce error rates in radiation therapy delivery O. Nairz1, N. Breitkreutz1 1 MVZ InnMed, Strahlentherapie, Oberaudorf, Germany Purpose or Objective “Movement from reference marks” is one of the most error-prone steps in the radiation therapy process. The use of indexed immobilization devices and constrained absolute, patient specific couch coordinates is generally considered to be an efficient tool to reduce the risk of radiation therapy errors (RTE) during treatment delivery. In the light of implementing a quantitative risk assessment we analyzed table coordinates of patients treated in our department. We investigated the effectiveness of tolerance values to lower the incidence of both wrong movements from reference marks and irradiation of the wrong patient or isocenter. Material and Methods Actual table values of patients in treatment position during a period of 18 months were extracted from the records of the verification system. Patient setups were