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).
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).
Organisations
- King's College London (Lead Research Organisation)
- Ocean Road Cancer Centre (Collaboration)
- Life Gaborone Private Hospital (Collaboration)
- Virginia Commonwealth University (Collaboration)
- Komfo Anokye Teaching Hospital (KATH) (Collaboration)
- University Teaching Hospital (Collaboration)
- Dr. National Center General Hospital Cipto Mangunkusumo (Collaboration)
Publications
Mutebi M
(2022)
Cancer research across Africa: a comparative bibliometric analysis.
in BMJ global health
Dosanjh M
(2019)
Developing Innovative, Robust and Affordable Medical Linear Accelerators for Challenging Environments.
in Clinical oncology (Royal College of Radiologists (Great Britain))
Lewis PJ
(2021)
Structure and Processes of Existing Practice in Radiotherapy Peer Review: A Systematic Review of the Literature.
in Clinical oncology (Royal College of Radiologists (Great Britain))
Wells JC
(2022)
Randomized Controlled Trials in Lung, Gastrointestinal, and Breast Cancers: An Overview of Global Research Activity.
in Current oncology (Toronto, Ont.)
Lewison G
(2020)
Cancer research in the 57 Organisation of Islamic Cooperation (OIC) countries, 2008-17.
in Ecancermedicalscience
Dodkins J
(2022)
Is Clinical Research Serving the Needs of the Global Cancer Burden? An Analysis of Contemporary Global Radiation Therapy Randomized Controlled Trials.
in International journal of radiation oncology, biology, physics
Gouveia AG
(2022)
System-Level Capacity of High-Dose Rate (HDR) Brachytherapy for Management of Cervical Cancer in an Upper-Middle Income Country: A Case Study From Brazil.
in International journal of radiation oncology, biology, physics
Aggarwal A
(2018)
Radiation Therapy Research: A Global Analysis 2001-2015.
in International journal of radiation oncology, biology, physics
Rubagumya F
(2022)
Participation of Lower and Upper Middle-Income Countries in Clinical Trials Led by High-Income Countries.
in JAMA network open
Description | The work has sought to understand the translational impact of new information communication technologies to support training and quality assurance in the low and middle income setting. We undertook needs assessments in four radiotherapy centres, across east, west and southern Africa, in both public and private settings. This included evaluating the IT infrastructure and radiotherapy workflow to understand whether cloud-based technology had a role in facilitating radiotherapy peer review and education. We then undertook a pilot study, in which we attempted to install and use the cloud software in each centre, to facilitate remote, external peer review of radiotherapy contouring. Technological constraints precluded installation and full functioning of the cloud software in three of the four centres during this pilot study, and further technical issues prevent its ongoing use in the centre where installation was completed. The four centres involved in the study do not yet have formal peer review processes in place for radiotherapy planning, and could benefit from the educational and quality assurance aspects of cloud-based technology if it is tailored to the needs and capabilities of low-resource settings. The current software needs to be updated to enable greater compatibility across different countries (particularly the issue of low bandwidth internet access) and radiotherapy planning systems. This is currently underway and is expected to be delivered in the next few months. In addition contact has been made with radiotherapy research groups nationally and internationally regarding similar software which has different functionality and could potentially be used for this peer review and training project to support quality improvement. Collaborations have been initiated. In 2022 - the work has progressed well and been presented to the International Atomic Energy Agency to be considered as an educational tool. As a result the tool is being tested in Indonesia and South Africa. |
Exploitation Route | The learning points include the following: The need to co-develop technological innovations in the low and middle income setting with country partners and not assume technology that is functional in the high income setting will either work or have the same impact. A needs assessment should be the first priority before trialling a technology to understand the specifications required and to make technical changes prior to a pilot study. Ensure any feasibility/pilot study of the technology is done in different country settings and region. There is no pan "continental" or income group solution. Consider further larger scale prospective evaluation of the technology to support widespread implementation with a particular focus on: effectiveness, affordability and scalability. |
Sectors | Healthcare |
URL | https://pubmed.ncbi.nlm.nih.gov/33405955/ |
Description | The findings of the work have been presented to the International Atomic Energy Association. This has led to agreements with teams in Indonesia and South Africa to trial the work. In addition, discussions are going on to develop a business case to ensure the sustainability of the cloud service with Amazon Web Server. |
Sector | Healthcare |
Guideline Title | Radiotherapy target volume definition and peer review, second edition - RCR guidance |
Description | Support for professional guidelines for peer review in radiation oncology |
Geographic Reach | National |
Policy Influence Type | Citation in clinical guidelines |
Impact | The practice guidelines have been informed by a systematic review I undertook. This has informed practice patterns for peer review in radiotherapy which is critical for quality assurance and patient outcomes. https://pubmed.ncbi.nlm.nih.gov/33160791/ |
URL | https://www.rcr.ac.uk/publication/radiotherapy-target-volume-definition-and-peer-review-second-editi... |
Description | ARCHERY: Artificial Intelligence based Radiotherapy treatment planning |
Amount | $399,935 (USD) |
Funding ID | CCR-21-300 |
Organisation | Rising Tide Foundation |
Sector | Charity/Non Profit |
Country | Switzerland |
Start | 06/2022 |
End | 08/2026 |
Description | ARCHERY: Artificial Intelligence based Radiotherapy treatment planning for Cervical and Head and Neck cancer |
Amount | $2,012,108 (USD) |
Funding ID | 1U01CA269143-01 |
Organisation | National Institutes of Health (NIH) |
Department | National Cancer Institute (NCI) |
Sector | Public |
Country | United States |
Start | 08/2022 |
End | 08/2026 |
Description | African Prostate Cancer - Disparities in Outcomes Study |
Amount | £49,889 (GBP) |
Organisation | Wellcome Trust |
Sector | Charity/Non Profit |
Country | United Kingdom |
Start | 02/2021 |
End | 01/2022 |
Description | Artificial intelligence to automate the use of radiotherapy to treat acute oncological conditions such as severe pain, bleeding and neurological symptoms in patients with advanced cancers |
Amount | £913,386 (GBP) |
Funding ID | 215706/Z/19/Z |
Organisation | Wellcome Trust |
Sector | Charity/Non Profit |
Country | United Kingdom |
Start | 05/2020 |
End | 05/2024 |
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 Department of Radiotherapy, Cipto Mangunkusumo General Hospital, Faculty of Medicine University of Indonesia, Jakarta, Indonesia |
Organisation | Dr. National Center General Hospital Cipto Mangunkusumo |
Country | Indonesia |
Sector | Hospitals |
PI Contribution | Research Partner with the radiotherapy faculty of this institution who are collaborating on the Cloud project to build capacity in radiotherapy. |
Collaborator Contribution | They have piloted and evaluated the cloud based tool as a method of supporting training in technical radiotherapy |
Impact | Paper in development |
Start Year | 2023 |
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 |
Title | Artificial intelligence for radiotherapy contouring and planning |
Description | As part of a Wellcome award I have led a team at Guys Hospitals that have developed algorithms for the contouring and planning of lung cancer radiotherapy, spinal metastases and whole brain radiotherapy. It now awaits late stage clinical evaluation. |
Type | Therapeutic Intervention - Radiotherapy |
Current Stage Of Development | Early clinical assessment |
Year Development Stage Completed | 2023 |
Development Status | Under active development/distribution |
Impact | The development process also included creating algorithms for the automation of bladder radiotherapy. |
Title | ACE-RT |
Description | ACE-RT is a software platform used to supporting training of radiation oncologists. Through this grant award we have developed it further to enable use as a training portfolio and to receive feedback on clinical cases. The platform is designed as an educational tool to promote learning. ? It can allow for review to be conducted remotely- both in place and time. ? It can be used aid oncologists in training by allowing their supervising consultants to review their work and provide tailored, qualitative feedback. ? It can be used as a 'peer-review' tool for consultant oncologists to seek and provide feedback to their peers. ? A portfolio of the trainee's work is formed, evidencing their development over time ? The cloud-based programme can be accessed worldwide when internet coverage is available |
Type Of Technology | Webtool/Application |
Year Produced | 2022 |
Impact | The software is being tested in the UK and internationally as part of a pilot. This will be coordinated in collaboration with the IAEA. |
URL | https://www.ace-rt.com/learn/ |
Description | Podcast on the ARCHERY trial |
Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | ? The ARCHERY Study - can AI transform the way we plan radiotherapy. Podcast of the new muticentre international study assessing AI in radiotherapy. https://www.mrcctu.ucl.ac.uk/our-research/other-research-policy/our-podcast/ |
Year(s) Of Engagement Activity | 2022 |
URL | https://www.mrcctu.ucl.ac.uk/our-research/other-research-policy/our-podcast/ |