Cloud software for helping build quality assurance in radiotherapy

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Published: 23 Nov 2022
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Prof Richard Sullivan, Dr Philippa Lewis and Dr Thea Johnson

Prof Richard Sullivan (King's College London, London, UK ), Dr Philippa Lewis (Guy's and St Thomas' Hospital, London, UK) and Dr Thea Johnson (Guy's and St Thomas' Hospital, London, UK) discuss software in the cloud for helping build quality assurance in radiotherapy.

Dr Lewis initially explains the background of this study. The goal of this project was to see if a cloud-based system could be introduced in LMICs for helping build quality assurance in radiotherapy.

She explains that cloud software helps a radiologist send radiology scans anonymously to peer-reviewers anywhere in the world. The remote reviewer can then give feedback on the plans that have been sent across. This system helps create a more global and standardised approach towards treating cancer.

Dr Johnson concludes by discussing the future plans for this project.

RS: Ladies and gentlemen, welcome to ecancer. I’m Richard Sullivan from King’s College London, here at the World Cancer Congress. It’s absolutely marvellous to welcome two colleagues to talk about something absolutely fascinating, some new work they’ve been doing looking at software in the cloud for helping build quality assurance for radiotherapy. A great pleasure to welcome Dr Pippa Lewis, who is a consultant clinical oncologist at Bath, Pippa, welcome.

PL: Thank you.

RS: And Dr Thea Hope Johnson who is a clinical Fellow at Guy’s and St Thomas, so just down the road from me. So a very warm welcome. Please tell ecancer a little bit about the initial work you started doing on this, because this sounds really exciting - a huge problem ensuring quality in radiotherapy planning. Obviously core for you, you’ve worked all over the world in global oncology. Tell us a little bit about the original project.  

PL: We know that peer review in radiotherapy planning is really important and we know that quality assurance at all points in the radiotherapy planning pathway helps give really good outcomes for patients. In well-established and well-resourced radiotherapy centres peer review is already part of the pathway but in low- and middle-income countries there are lots of barriers to introducing peer review in radiotherapy. So what we did, we did a feasibility study – three countries in Africa, four radiotherapy centres – and we looked to see whether we could introduce cloud-based technology or cloud-based software to help peer review in radiotherapy. We worked in Tanzania, Botswana and Ghana and we looked at installing cloud-based software for radiotherapy peer review.

RS: How does that work? Just explain to people a little bit about what do you mean by cloud-based software?

PL: It’s a software which allows a radiotherapy planner to upload CT scans and radiotherapy contours and send them across anonymously to a reviewer anywhere in the world using the cloud. That remote reviewer can then give feedback on the radiotherapy plans that have been sent across. So it’s a way of doing peer review, quality assurance, but also a learning tool and an educational tool, particularly for isolated centres or single practitioner centres.

RS: Okay, it sounds absolutely fantastic. Tell us what happened in the first iteration.

PL: The first study we did unfortunately didn’t work. What we found was that actually there were lots of problems trying to install this software in these countries – technical issues, mostly internet coverage problems. So we wanted to move on from that and then take from our experience what we’d learned about what those barriers were and create our own bespoke platform. So we wanted to create a web-based platform which meant that it would be much easier to use where there were those technical issues.

RS: Fantastic. So you’re obviously into phase 2 now, a lot of learning from this early piece of work. Thea, moving over to you, tell us a little bit about phase 2 and how things are going, what are the plans?

TJ: We are now looking to test out the new platform, called Ace-RT and we’re looking now at both how it can be done feasibly but also how it is as an educational tool. So we are looking for pairs of trainees, or people seeking feedback on their contours and their planning, and trainers who are remotely reviewing these and providing the feedback. So we’re looking to test it in a range of different resource settings, so we’re looking to test it in London, in the UK, but also across the world so we’re looking for centres in lots of different continents and countries to just try it out. Then what we really want to know is not only does it work in these settings but also how it is as an education tool. One of the functions of Ace-RT is that it makes a portfolio for the users so they can look back over time at the different scans that they’ve had reviewed and just have a portfolio saved, all anonymised patient information so there’s nothing there that they can be identified by. But it’s just a really nice way of evidencing their development over time.

RS: So tell us a little bit more, firstly where’s the funding coming from for this because this sounds quite a big endeavour? And when do you think you’re going to have some results to know whether or not this is effective for quality assurance, for education? Again, it sounds superb but these are complicated things to put into effect.

PL: Yes, so the funding has come from the Science and Technology Facilities Council and also from Guy’s Cancer Charity. They funded our original feasibility study and that’s ongoing with the Ace-RT platform. We’re still developing the platform so we’re working with colleagues in Ghana and Zambia at the moment and what we’re looking to do is expand the pilot project that we’re doing - up to ten countries we’re hoping. So that’s going to take a lot longer, so in the next twelve months we’ll be looking to roll that larger pilot out. Hopefully beyond that we will start to get some really good information and feedback.

RS: The question people will be asking, listening to this, if they’re clinical oncologists in other countries is can they get involved. Is there a way of doing it? Are you interested in opening it up? Do you want more partners?

PL: Absolutely. What we really want is to get people who are enthusiastic and interested and think that this might benefit them in their centres. We’d love to hear from you and if there is anybody who wants to participate in that larger pilot programme it would be really great to hear from them.

RS: That’s absolutely fantastic. An amazing global oncology programme here being talked about at the World Cancer Congress. Dr Pippa Lewis, Dr Thea Hope Johnson, thank you so much for joining ecancer.

PL: Thank you.