Cloud-based Electronic Infrastructure in Support of Linac-based Radiotherapy in Challenging Environments

Lead Research Organisation: King's College London
Department Name: Cancer Studies

Abstract

This study aims to adapt an existing Cloud-based Electronic Platform (CEP) to facilitate remote treatment planning, research, education and multidisciplinary training partnerships between radiotherapy teams working in high-income countries and those in low and middle-income countries (LMICs) which operate in challenging environments. As part of the proposed 3-month work package, four radiotherapy centre visits will be planned in Nigeria and Ghana as part of this feasibility study.

Planned Impact

This proposal forms part of an initiative to design a linear accelerator for radiotherapy (cancer treatment) that is reliable, cost effective and appropriate for use in developing countries. However, the planned integration of novel linac designs require concomitant investments in training, research, data collection and manpower capacity to ensure the delivery of high quality radiotherapy and up-scaling of existing resources.

By evolving and adapting a cloud-based medical informatics infrastructure to support the delivery of radiotherapy based cancer treatment it is expected that the Cloud based electronic platform (CEP) will begin to address these needs. Currently, health records, diagnostic images, and radiotherapy data are located in disparate locations in a clinic and are not readily accessible. A CEP can facilitate the aggregation of these data and provide access to a wider range of services such as on-demand remote linac-based treatment planning, training and knowledge sharing in newer radiation modalities, and research trial participation. It will also facilitate the implementation of standard operating procedures for treatment planning, quality assurance and quality control (QA/QC). Cloud-based peer review allows radiation oncologists serving disparate populations in LMICs and in remote sites elsewhere to get expert advice from their clinical peers for linac-based treatments within each country (as part of a "hub and spoke system") or between international partners. A CEP can also obviate the need for local software modules such as treatment planning software and backup of data. The CEP infrastructure also links in with the linac service training and fault learning project.

Going forward this feasibility project will enable us to design a CEP that meets the unique needs of LMICs, which will subsequently be piloted to demonstrate its potential to support high quality linac-based radiotherapy in challenging environments. In addition it will be expected to develop new sustainable international partnerships between organisations to develop expertise and capacity for radiotherapy delivery in LMICs.

The work is of global importance, and by assessing the feasibility of adapting an existing CEP in Ghana and Nigeria it will undoubtedly provide insights that will be applicable beyond these countries to other LMICs across Africa and Asia. The results of our feasibility study will be published in at least one high income journal and we would expect to present the findings at one or more high impact international cancer conference. E.g. International Union for Cancer Control (UICC) and the American Society for Radiation Oncology (ASTRO).
 
Description Collaboration with Cancer Diseases Hospital (Lusaka) 
Organisation University Teaching Hospital
Country Zambia 
Sector Hospitals 
PI Contribution Radiotherapy team at the Cancer Diseases Hospital approached as site partner for cloud project. They will be willing to participate following planned software updates. We undertook a needs assessment to understand better the specific requirements and uses for a Cloud Electronic Platform in the clinical setting in each country. We assessed the local informatics infrastructure that is currently available to support Cloud Electronic Platforms. We developed the framework for adapting the Cloud Electronic Platform given local infrastructure and environmental conditions.
Collaborator Contribution Intellectual input into design of pilot study encompassing the Cancer Diseases Hospital as a site partner.
Impact Mutlidisciplinary involving several members of cancer team - medical physics, radiation therapists, radiation oncologists.
Start Year 2019
 
Description Collaboration with Komfo Anokye Teaching Hospital, Accra 
Organisation Komfo Anokye Teaching Hospital (KATH)
Country Ghana 
Sector Hospitals 
PI Contribution Engagement with respect to the development of a radiotherapy peer review protocol. This has involved a site visits by the research team to Ocean Road Cancer Centre: 1. To undertake a needs assessment to understand better the specific requirements and uses for a Cloud Electronic Platform in the clinical setting in each country. 2. To assess the local informatics infrastructure that is currently available to support Cloud Electronic Platforms. 3. To develop the framework for adapting the Cloud Electronic Platform given local infrastructure and environmental conditions.
Collaborator Contribution Acting as partners in support of the development of a radiotherapy peer review program to improve the quality of treatment delivery. They will participate in the pilot of the radiotherapy peer review tool
Impact Multidisciplinary involving medical physics, radiation oncologists and radiographers Research paper submitted with partners: Implementation of a Novel Cloud-based Platform for Facilitating Remote Radiotherapy Peer Review and Training in Resource-Limited Settings: Results of Feasibility Assessments in Four Centres in Sub-Saharan Africa
Start Year 2018
 
Description Collaboration with Life Gaborone Hospital 
Organisation Life Gaborone Private Hospital
Country Botswana 
Sector Hospitals 
PI Contribution The Life Gaborone Private Hospital, although a private hospital, provides publicly funded radiotherapy services in Botswana. wWe created a collaboration which sought to test the cloud based software. This involved direct collaboration with two radiation oncologists at the centre and a medical physicist. This has involved a site visits by the research team to Life Gaborone Private Hospital: 1. To undertake a needs assessment to understand better the specific requirements and uses for a Cloud Electronic Platform in the clinical setting in each country. 2. To assess the local informatics infrastructure that is currently available to support Cloud Electronic Platforms. 3. To develop the framework for adapting the Cloud Electronic Platform given local infrastructure and environmental conditions.
Collaborator Contribution Radiotherapy workforce were engaged in the pilot study. Helping to obtain ethics to undertake the study, identification of relevant clinical cases for upload, installation and use of software.
Impact Peer review paper submitted for publication - Implementation of a Novel Cloud-based Platform for Facilitating Remote Radiotherapy Peer Review and Training in Resource-Limited Settings: Results of Feasibility Assessments in Four Centres in Sub-Saharan Africa
Start Year 2019
 
Description Collaboration with Ocean Road Cancer Centre, Tanzania 
Organisation Ocean Road Cancer Centre
Country Tanzania, United Republic of 
Sector Hospitals 
PI Contribution Engagement with respect to the development of a radiotherapy peer review protocol. This has involved a site visits by the research team to Ocean Road Cancer Centre: 1. To undertake a needs assessment to understand better the specific requirements and uses for a Cloud Electronic Platform in the clinical setting in each country. 2. To assess the local informatics infrastructure that is currently available to support Cloud Electronic Platforms. 3. To develop the framework for adapting the Cloud Electronic Platform given local infrastructure and environmental conditions.
Collaborator Contribution Acting as partners in support of the development of a radiotherapy peer review program to improve the quality of treatment delivery. They will participate in the pilot of the radiotherapy peer review tool
Impact Multidisciplinary - medical physicists, radiographers and radiation oncologists involved Journal submission - Implementation of a Novel Cloud-based Platform for Facilitating Remote Radiotherapy Peer Review and Training in Resource-Limited Settings: Results of Feasibility Assessments in Four Centres in Sub-Saharan Africa
Start Year 2018
 
Description Collaboration with Virginia Commonwealth University, USA 
Organisation Virginia Commonwealth University
Country United States 
Sector Academic/University 
PI Contribution Research team piloting radiotherapy peer review cloud computing software developed by Virginia Commonwealth University
Collaborator Contribution Involved in site visits to test cloud computing tool in Ghana and Tanzania
Impact No outputs currently. multidisciplinary collaboration involving medical physicists and radiation oncologists.
Start Year 2018