ESTRO 2024 - Abstract Book

S5892

RTT - Service evaluation, quality assurance and risk management

ESTRO 2024

predominance of prostate patients in the LRP data, with 58.7% of affected patients receiving treatment for prostate cancer in comparison with 39.3% in 2019-2020 data. Increases in OTT could not be eliminated completely however the implementation of clinical contingencies did reduce the incidence of increase in OTT during the LRP. The single Category 1 patient who experienced an unscheduled break evidences the importance of the relocation of service delivery for these patients.

Conclusion:

This assessment of the clinical contingencies implemented during the LRP was imperative to ensure quality patient care and inform future decision making. This project highlighted the importance of preparation for CBCT faults and patient categorisation in the development of future clinical contingencies. The extended Dose and fractionation 60Gy in 20# presented increased opportunities for cancellation in prostate patients when compared with breast patient’s prescriptions of 40Gy in 15# or 26Gy in 5#. It must be accepted that treatment cancellations cannot be eliminated entirely within a two Linac centre, without additional matched machines, the transfer of patients was not possible. Therefore, the priority was minimising the impact of unscheduled breaks, with compensation or deployment of clinical contingencies. The use of MV imaging to produce orthogonal 3D assessment of patient set-up enabled continuation of treatment delivery. The diversion of Category 1 patients protected them from LRP related unscheduled breaks. For the 21.5% of patients for whom treatment adjustment was employed the clinical contingencies effectively prevented them exceeding the RCR guidance of 2-day extension in OTT. Imaging contingencies effectively minimised the number of patients who experienced a 2-day break. LRPs are a component of the lifespan of Linacs. Individual hospitals and trusts have undertaken LRPs, developing clinical contingencies with national guidelines and department protocols. However there remains little documented evidence on the outcomes in terms of contingency planning or impact of the LRP on treatment delivery. While further examination is required to validate the initial findings, this project provides a foundation for the future production of standardized clinical contingencies in LRPs.

Keywords: Contingency, Unscheduled Breaks

References:

1. Lievens Y, Borras JM, Grau C. Provision and use of radiotherapy in Europe. Molecular Oncology. (2020) 14(7):1461 1469

2. The Royal College of Radiologists. Policy Priorities for clinical oncology 2021-2026. London. The Royal College of Radiologists, 2021. 1-9

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