Oncology Central

End-to-End Treatment Verification for Advanced Radiotherapy

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This piece highlights how the UK’s National Physical Laboratory (NPL) is enabling greater confidence in radiotherapy, leading to accelerated implementation of the most advanced techniques and helping to ensure patients receive the same standard of treatment irrespective of where they receive their treatment.

The cancer statistics for the UK are somewhat sobering, one in two people born after 1960 will be diagnosed with some form of cancer during their lifetime [1] and there are currently approximately 330,000 new diagnoses every year, a number which has been growing by around 2% per annum [2]. All of us will be affected by this disease in some way at some point in our lives and when it happens we need the reassurance that we will have access to the best care possible. Despite the significant improvements that have been made in the treatment of cancer over the last 40 years, the UK survival rate has continued to lag behind that in countries of similar wealth [3]. This is manifested in the UK having amongst the lowest age-standardized incidence rates of rich countries, but amongst the highest mortality rates, meaning that fewer people in the UK survive a diagnosis of cancer than should.

The UK has a deserved reputation for creativity and excellence in the design and development of new interventions that have the potential to deliver significant improvements in outcomes. However, one potential cause for the UK’s high mortality rates is the fact that other than in a few leading centres, internationally we are viewed as being slower to adopt new innovations, across all treatment modalities, than other countries, even where those innovations are clearly cost-effective and/or were developed within the UK health system. One of the critical enablers for rapid and widespread adoption of new innovations is ensuring their performance, safety and effectiveness can be measured and optimized in what is necessarily a conservative community.

“It is sobering to note that the value of good radiotherapy is substantially greater than the incremental gains that have been achieved with new drugs and/or biologicals. These results strongly reinforce the importance of doing well what we already know.”  Peters et al Clin. Oncol. 2010 [4]

Ground-breaking metrology research supports the NHS England principles

In October last year NHS England initiated a consultation process: Modernizing Radiotherapy Services in England – developing proposals for future service models, which sets out a number of principles to guide the modernization of radiotherapy services and the development of future clinical commissioning products. The National Physical Laboratory (NPL) has played a key role in supporting the UK medical physics community from the beginning of the twentieth century, initially through the design, construction and calibration of specialized equipment alongside the development of world leading codes of practice in collaboration with the medical physicists professional institute to ensure rigorous and consistent dissemination of dose quantification into the clinic. A recent review of data collected by NPL over the last 20 years has shown how the combination of these factors have assisted in considerably reducing the variability of the dose delivered across the nation.

In more recent times, ground-breaking metrology research has been undertaken to support innovative treatments where these complex systems require novel approaches to measurement to ensure continued consistency of the dose delivered to the patient. NPL continues to broaden this role to further enable the rapid, efficient and widespread adoption of advanced radiotherapy technologies thus supporting the NHS England principles to be delivered that will support improvements in patient outcomes.

A focus on the quality of radiotherapy treatment throughout the whole pathway

Towards Safer Radiotherapy states, “comparative audits can provide valuable opportunities to ensure safe delivery of radiotherapy and consistency of patient outcomes”, citing the NPL audit scheme as an example [5].

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