ESTRO 2024 - Abstract Book

S5891

RTT - Service evaluation, quality assurance and risk management

ESTRO 2024

1090

Digital Poster

A service evaluation of the clinical contingencies implemented during a Linac Replacement Programme.

Chloe A Wells 1,2 , Mike Kirby 2

1 The Christie NHS Foundation Trust, The Christie at Oldham, Manchester, United Kingdom. 2 University of Liverpool, Faculty of Health Sciences, Liverpool, United Kingdom

Purpose/Objective:

A Linac Replacement Programme (LRP) was recently completed to install 2 Versa HD linear accelerators ensuring patients continue to receive gold standard care [1,2] . Clinical contingencies were devised to mitigate the impact of unscheduled interruptions during the LRP. The clinical contingencies implemented during the LRP were the diversion of Category 1 patients and the use orthogonal 2D MV images in the event of Conebeam CT (CBCT) breakdown. This project aimed to appraise the degree to which clinical contingencies devised by the multidisciplinary team (MDT) decreased the impact on treatment delivery. To answer this, three primary objectives were evaluated. Firstly, how effectively the contingency protocols put in place minimised unscheduled breaks. Further, how the LRP data compared with cancellations in a year when both machines were fully functioning (2019-2020). Finally, evaluating whether treatment delivery for Category 1 patients could have continued during the LRP and its feasibility for application in future LRPs.

Material/Methods:

During the LRP, 855 patients received treatment. The oncology management system MOSAIQ was used to generate reports to identify all incidents of treatment adjustment. The same detailed reports were generated for Linac service history in the 2019-2020 financial year and were used for comparative analysis. In the 2019-2020 financial year 132 patients were either delayed or cancelled for Linac services. The LRP population was then subdivided into two groups; those for whom treatment delivery was not impacted, and those for whom treatment was adjusted. Anomalous results were identified and removed from the analysis. Causative factors in Linac breakdowns and adjustments to treatment were analysed for each patient. Patients who had multiple adjustments were identified to ascertain changes in overall treatment time (OTT).

Results:

671 of the 855 patients who received treatment during the LRP, experienced no increase in OTT (78.5%). 38.5% of the 184 patients impacted by linac breakdowns during the LRP experienced no increase in OTT, through deployment of clinical contingencies. Throughout the LRP, Linac breakdowns were a leading factor of treatment adjustments. Moreover, CBCT faults were the primary cause for machine closure, resulting in 52% of treatment adjustments. Due to the prevalence of CBCT faults, breast patients remained on treatment at a higher rate than prostate patients who required 3D geometric verification, CBCTs, prior to treatment. The comparison the LRP and 2019-2020 data demonstrated the patient disease groups affected by machine downtime were comparable. However, there was a