a survey of radiotherapy services in 2007canceruk.net/rtservices/rtequip2007/uk rt survey...

A Survey of Radiotherapy Services In The UK @ 14.05.2007

A Multidisciplinary Survey of Radiotherapy Services in the UK at 14.05.2007

Commentary on Data Tables in Excel File<Activity from RT Equip Survey 2007 v 5.8.xls>

1 Contents

1 Contents.......................................................................................................................................12 Background.................................................................................................................................23 Data Collection............................................................................................................................24 Index............................................................................................................................................25 Summary.....................................................................................................................................36 Linear Accelerator and Cobalt Machine Inventory.....................................................................47 Fractions per machine.................................................................................................................78 Average Fractions per machine...................................................................................................89 Activity per million population...................................................................................................910 Definitions.................................................................................................................................1311 References.................................................................................................................................15

Helen Forbes of 15 22/01/2008


2 Background

This survey is intended to build on the work already done during the previous Surveys of Radiotherapy Services in England carried out by the National Cancer Services Analysis Team (NATCANSAT) in 1999, 2001, 2002 and 2005. It includes updated and extended analysis of the data collected as part of the previous work.

3 Data Collection

Data collection was carried out during May – October 2007. All radiotherapy facilities were asked on 9th May 2007 to complete the census to reflect the position in their department as of 14th May 2007 (the Survey Date).

Data was collected as previously by means of an electronic data collection toolkit. Each radiotherapy facility was supplied with a unique password which allowed them to access the data entered for the 2005 survey, and update it using a web based data collection toolkit.

Data entered on the website was also fed back to each Centre in Excel for validation prior to analysis.

Data was requested and received from all NHS radiotherapy facilities in the UK. Two facilities (Derby, and the Hammersmith Hospitals) were unable to provide activity data; these facilities submitted inventory data alone.

Please Note: The remaining sections each refer to tables in the accompanying spreadsheet

4 Index

The Index sheet includes links to all of the other sheets in the spreadsheet.



5 Summary

5.1 Output per head of population

These data represent the 46 facilities in England which were able to submit radiotherapy activity data, and include only radiotherapy given using a megavoltage machine (a linear accelerator or cobalt). The sum of each RT Centre’s population (48,344,311) is less than the total population of England (50,088,625) and represents the sum of the catchment populations of the centres for which activity data was available.

Figures are given for the number of radiotherapy courses, fractions and exposures given per million of the population for three financial years.

5.2 Output per Linac

These data represent the overall radiotherapy activity given on linear accelerators which were in regular clinical use.

Figures are given for the total number of radiotherapy courses, fractions and exposures given, and the maximum, minimum, mean and standard deviation for three financial years.

Cobalt machines, machines which were not in regular clinical use in the relevant year and machines with very low activity (less than 100 courses) were excluded from this group.



6 Linear Accelerator and Cobalt Machine Inventory

Lists all Linear Accelerators and Cobalt Units reported by each radiotherapy facility in any of the surveys. This includes machines that have been decommissioned.

6.1 Trust Code:

The NHS Code for each Radiotherapy Provider.

6.2 NHS Trust Name:

The Trust where the machine is located.

6.3 Network Code:

The cancer network in which the radiotherapy facility is located. It should be noted that radiotherapy activity will be carried out at each facility for patients from outside of the cancer network.

6.4 Unique ID:

A reference number for each record.

6.5 Local Equipment Name:

Is the name by which the machine is known in the radiotherapy facility.

6.6 Equipment Reference Number:

The NHS Code for each radiotherapy machine.

6.7 Machine Type:

Indicates whether this is a linear accelerator or a cobalt machine.

6.8 Manufacturer:

The manufacturer of the equipment.

6.9 Model:

The model name/number of the equipment.

6.10Max Energy:

The maximum energy in MeV of the radiation beam (photons or electrons) which the equipment will produce for treatment.

6.11MLC:



Indicates whether the machine is fitted with a multi-leaf collimator.

6.12Portal image:

Indicates whether the machine is fitted with on-line portal imaging.

6.13V+R:

Indicates whether the machine is fitted with computerised verification of treatment parameters, and recording of doses given.

6.14Electrons:

Indicates whether the machine is used for electron treatments.

6.15Year Installed:

Gives the year when the machine was first used for clinical treatments

6.16Year Closed:

Gives the date when the machine was, or is planned to be last regularly used for clinical treatments.

6.17Usage:

Indicates if a machine is in regular (daily) use for clinical treatments, used as a backup machine (i.e. to cover for planned or unplanned maintenance), whether it is still present or has been removed, and has not yet been installed or is being commissioned.

6.18Number of Hours per day in use

Indicates the number of hours the equipment is planned to operate each weekday for clinical treatments on the census date of 14th May 2007.

6.19WTE Staff

The number of WTE staff normally rostered to operate the equipment on the census date.

6.20Backup number of hours per week

Indicates the number of hours machines used for backup purposes only are normally used per week.

6.21Additional or Replacement Machine

For machines installed since 2000 only. Indicates whether this machine was a replacement for a decommissioned machine, or an additional machine to increase the capacity of a facility.

6.22Activity Data



Multiple fields for Courses, Fractions and Exposures give the activity of this machine for each financial year (1st April – 31st March) from 1998/99 to 2006/07.

6.23In clinical use

‘Y’ indicates the equipment was in regular clinical use on the survey date.

6.24Full Year of Activity Data 06/07

Indicates the machine was in regular clinical use for the whole of the financial year 06/07, and therefore was includes for the method 2 activity per machine calculations.



7 Fractions per machineShown on the spreadsheet “Chart No of # per machine”

This chart shows the number of fractions treated by each megavoltage machine in clinical use during the financial year 2006/07. Note that some machines may have been in clinical use for only part of 2006/07. The insert table comes from the National Radiotherapy Advisory Group Report2 (NRAG). The red line shows the required number of fractions per linear accelerator for 2006 from the NRAG report.

Shown on the spreadsheet “Chart No of # per machine (2)”

This chart shows the number of fractions treated by each megavoltage machine in clinical use throughout the financial year 2006/07. Note that some machines may have been in use for only part of the working day (3 or 4 hours per day). The insert table comes from the National Radiotherapy Advisory Group Report2 (NRAG). The red line shows the required number of fractions per linear accelerator for 2006 from the NRAG report.



8 Average Fractions per machineShown on the spreadsheets “Chart Av # per RT site” / “Chart Av # per RT site (2)” / “Chart Av # per RT centre” / “Chart Av # per RT centre (2)” These sheets give an indication of the average number of radiotherapy fractions treated per machine in each radiotherapy facility. It is important to remember that, especially in larger facilities, individual machines may be used for different types of treatment resulting in uneven number of fractions on each machine. The average figure for each facility however will be comparable.

8.1 The first two charts are presented by radiotherapy site. Some radiotherapy facilities are based on two hospital sites (Guys and St Thomas’, Hammersmith and Charing Cross, The Royal Marsden at Fulham Road and Sutton, and The Mid Kent Oncology Centre in Maidstone and Canterbury.) On the ‘radiotherapy site’ charts each site for these facilities is shown separately. The third and fourth charts are presented by radiotherapy centre, in these the data from both sites is considered together.

8.2 The first and third charts calculate the average activity using the same methodology as previous surveys. This takes the total number of fractions given during a year (including activity given on machines which closed or opened during the year) and divides it by the number of machines in clinical use on the survey date.

8.3 As the survey date (14th May 2007) was after the end of the financial year (2006/07), this can under-represent the activity for sites which have expanded during the year, where the denominator will include machines which were not in use at the beginning of the year. It can also over-represent the activity for sites which are undergoing a replacement program on the census date, and are operating on less that their normal complement of machines, the denominator will include the smaller number of machines, and the numerator will include machines which have subsequently been removed from service.

8.4 The second and fourth charts (suffix ‘2’) use a revised methodology. These only include machines which were in clinical use throughout the whole the year (2006/07).

8.5 This second figure will give a fair representation of the average use of machines for the year in question, and may be a better measure for facilities which fall into the two categories identified as anomalies with the ‘old’ methodology. This activity may still be abnormally high if the centre was operating on less than its normal complement of machines during the year (2006/07) because machines were out of commission for replacement.



9 Activity per million population

This sheet gives the numbers of courses, fractions and exposures delivered per million of population.

9.1 Radiotherapy Site:

Two site centres are listed separately.

9.2 Catchment Population:

Gives the Radiotherapy Catchment Population for each facility.

For the analyses of previous equipment surveys, Radiotherapy Catchment Populations calculated for the 1999 survey1 were used. The 1999 Radiotherapy Catchment Populations were based on a geographical analysis of post coded patient data from the period 1993-1998. As these populations are now out of date, new Radiotherapy Catchment Populations were calculated using methodology routinely used by NATCANSAT for other projects.

A data extract was taken from the Hospital Episodes Statistics Database (HES) for all admissions or out-patient attendances under the care of a clinical or medical oncologist (at a RT Centre) during the period 1997/8 – 2006/7 for admitted patient care, and 2003/4 – 2006/7 for out-patients. These data were then grouped to generate one record per patient. The patients were then aggregated using the postcode of their home address into a 2001 census ward. The population of each census ward was then shared on a pro-rata basis between the radiotherapy centres attended by its residents (Method B).

This methodology has resulted in some significant changes to the 1999 Radiotherapy Catchment Populations. These changes particularly apply to an increase in calculated catchment population for radiotherapy facilities which provide a significant service to patients outside of their natural catchment area.

Please see the Excel file “HES England 1997-2006 Radiotherapy Populations (Method A+B) V1.0.xls” for an explanation of the methodology, tables of RT catchment populations and some maps of RT Centre Dominant Catchment Areas.



Figure 1: Radiotherapy Centre Provider Dominant Catchment Areas: calculated using HES Data (1997-2006).



9.3 Sum of activity:

The following fields give the total activity (courses, fractions and exposures) delivered at each facility in each year.

9.4 Courses per Million Population Served

Gives the number of courses of radiotherapy started at the facility during each year (for definitions see section 10.1.) divided by the calculated catchment population for the facility.

Courses per million population served is a good indicator for the adequacy of service provision to the underlying population. It ignores differences in clinical practice between Centres, which result in patients receiving different numbers of fractions and exposures per course of radiotherapy.

9.5 Fractions per Million Population Served

Gives the number of fractions of radiotherapy given at the facility during each year (for definitions see section 10.2.) divided by the calculated catchment population for the facility.

Fractions per million population served is a good indicator for the equipment requirement for the underlying population. It takes into account local clinical practices.

The chart “Chart # per million” presents data from this column. The insert table is taken from the NRAG report2.

9.6 Exposures per Million Population Served

Gives the number of exposures of radiotherapy given at the facility during each year (for definitions see section 10.3.) divided by the calculated catchment population for the facility.

Like fractions per million population, exposures per million population served is a good indicator for the equipment requirement for the underlying population. It takes into account local clinical practices.

The chart “Chart exps per million” presents data from this column.

9.7 No of LAs:

The number of linear accelerators in routine clinical use at the facility on the census date.

9.8 No of Cobalts:

The number of cobalt units in routine clinical use at the facility on the census date.

9.9 Number of machines per million population:



The number of linear accelerators, plus half of the number of cobalt units (cobalts operate more slowly than linear accelerators, so this factor is normally used) divided by the calculated catchment population.

The chart “Chart Equivalent Number of Machines per Million” presents data from this column. The insert table is from the NRAG report2. The red line indicates the 2006 target from the table.



10 Definitions

The definitions listed below were those used for the purposes of the survey.

10.1Course:

A course is defined as a pre-planned set of attendances for radiotherapy given to a body-site. A course may consist of one or more phases.

Examples:

Treatment given concurrently to two or more separate anatomical sites was counted as two or more separate courses (e.g.: whole head for brain metastases, and hip for bone metastases).

Except treatment given concurrently to two or more separate anatomical sites as part of the same treatment, which was counted as one course. (e.g.: breast and axilla for breast primary, or face and anterior split neck for head & neck primary).

Treatment given in several phases, as planned at the beginning of the course was counted as one course (e.g.: bladder and pelvic nodes for first 20 fractions, followed by bladder alone for 12 fractions for bladder primary, or shrinking fields for splenomegaly in chronic lymphocytic leukaemia).

Re-treatments to a previously treated anatomical site were counted as new courses, unless they were already planned at the beginning of the first course.

10.2Fraction:

A fraction is defined as one attendance for radiotherapy. A course may be made up of between one and thirty five fractions radiotherapy given to an anatomical site.

Examples:

Treatment given concurrently to two or more separate anatomical sites was counted as two or more separate fractions, even if the treatments are given on the same machine (e.g.: whole head for brain metastases, and hip for bone metastases).

Treatment given concurrently to two or more separate anatomical sites as part of the same treatment on the same treatment machine, was counted as one fraction. (e.g.: breast and axilla for breast primary, or face and anterior split neck for head & neck primary).

Treatment given concurrently to two or more separate anatomical sites as part of the same treatment on two or more machines was counted as two or more fractions. (e.g.: breast and electron boost to tumour bed on another linac for breast primary, or face and anterior split neck with electron boost to enlarged lymph node on another machine for head & neck primary).

10.3Exposure:

An exposure is defined as each time the radiation beam is turned on, to treat the patient from a new direction. A fraction may be made up of one to four or more exposures.



Examples:

Each treatment field represents one exposure ‘Double’ exposures associated with the use of a universal wedge count as one exposure. ‘Double’ exposures requiring some intervention from the radiographer (e.g.: to place or

remove some form of beam modification) will count as two (or more) exposures. Non-treatment exposures (e.g.: portal films) are not counted. Non-patient exposures (e.g.: test beams for energy changes, patient dosimeter standards) are

not counted.



11 References

1A Survey of Radiotherapy Services in England 1999DOH 2000www.canceruk.net/natcansat/radiotherapy.htm

2NRAG Report


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