The Ottawa Hospital Cancer Centre

A Large Multi-Site Paperless Clinic

  • 10 Linacs, 2 Tomo, Cyberknife, 3 CT Sims, Brachy Suite, Ortho etc
  • Two campuses
  • Staff
    • 18 Medical Physicists
    • 2 Physics Associates
    • 4 Physics Techs
    • 4 Medical Physics Residents
    • 7 Electronics/Machine Shop
    • 10 Treatment Planners
    • ~125 Therapists
  • 4000 patients/year — 75 000 individual treatments
  • Paperless since ~2006
  • Lots of time spent on quality control activity
    • How can we make QC more efficient?

Operational Challenges

Machine QC

  • Lots of QC data generated
  • Users & roles
  • Daily QC program review
  • Data access
  • Long term data storage
What should we do with all this data?

First Solution

When confronted with a problem, people often say:
‘I know...I'll use Excel!’
Now they have two problems.
 – with apologies to Jamie Zawinski

Second attempt

What we had

  • 150+ spreadsheets
  • Fragmented data entry interfaces
  • Painful to review and approve
  • Painful to generate plots
  • Painful to add new tests
  • Multiple versions of same spreadsheet in the wild

What we wanted

  • Single point of access
  • Consistent data entry interface
  • Straightforward review and approval
  • Easy to look at data trends
  • Quick test additions & modifications

Let’s Buy Something

No need to reinvent the wheel

  • Atlas comes closest to what we wanted
  • Not straightforward for therapists
  • Test frequencies hard wired (Daily, Monthly, Annual)
  • Not web based
  • Not extendable
  • Cost?

Let’s Build Something!

Perils of an in-house system

  • Previous attempts
  • We are not in the business of writing software!
  • Risky — Is this even going to work?
  • Very low “bus factor”
http://adamprescott.net/2012/12/04/lean-development-teams/

Mitigating the Risk

  • Develop prototype
    • See what works & what doesn't
    • What haven't you considered yet?
    • Allowed for time estimate
    • Proof of concept
  • Open Source
    • Give it away for free
    • Build a community of users
    • Mutual benefit for TOHCC & Medical Physics community
    • (Hopefully) increases the projects bus factor
  • Go for it!

QATrack+

QATrack+ at TOHCC

From Development to the Clinic

Dec 2011
Prototype
Jan 2012
Started full scale development
Jul 2012
Gather feedback from Therapy focus group
Aug 2012
First clinical pilot: Tomotherapy Morning QA
Sep 2012
Train Therapists: two 20min sessions
Oct 2012
Begin clinical rollout of daily QA
Dec 2012
Monthly QA rolled out as time permitted
Jan 2013
Start publicizing

QATrack+ Demo

First year of QATrack+

  • In Ottawa
    • 140+ users (use Active Directory!) spread over 2 campuses
    • 150+ test lists made up of 1400 tests
    • 10 000+ QA sessions completed
    • 200 000 test results
  • In use (or will be soon)
    • Durham Regional Cancer Centre
    • PEI Cancer Centre
    • Odette Cancer Centre (Sunnybrook)
    • Others? Interest from Australia, The Netherlands, UK & France

The Future

  • Equipment Inventory
  • Event Log
  • Plugin System
  • Custom reports (e.g. compliance)
  • Data Archiving
  • Improved Plots (scatter plots etc)
  • ...

More clinics!

Treatment Planning

Patient Treatment Process

1) Patient consult with physician

2) Rad onc assigns care plan (treatment objectives) — prescription

3) Treatment planner creates plan

4) Plan approval by physician : GOTO 3 if rev's required

5) Plan QC by second planner : GOTO 3 if rev's required

6) Plan QC by physicist + pt-spec. QA : GOTO 3 if rev's required

7) Patient treatment

Operational Challenges

Treatment Planning

  • 400+ plans generated per month that need to be QA'd
  • No easy way for planners to check if Careplan objectives being met
  • No formalized record of why compromises were made
  • Hard to answer questions like:
    • "How often are we hitting all of our careplan objectives for prostate IMRT plans?"
    • "What is the mean dose being delivered to the heart across all Tomotherapy breast plans?"

How can we make this process better?

Software!

  • We want a simple means of tracking whether or not radiotherapy treatment plans are meeting clinical objectives
  • Requirements:
    • Quickly check whether careplan objectives are being met (initial + QC)
    • Simple/accessible web based user interface
    • Has to easily handle multiple TPS
    • Keep historical record of careplans/objectives and results
    • Allow us to easily gather aggregate stats on plan quality

QAPlan+

Software we hope will have a new name soon ;)

QAPlan+

Simple Plan Checking Software

  • Follow the QATrack+ model
  • Web app written in Python/Django
  • Free & Open Source
  • A work in progress
  • Clinical in 2014?

QAPlan+ Demo

Final Remarks

  • Lots of tasks in your day could benefit from better software
  • You have a perspective that people in industry often lack
    • Internal dev may produce better results than commercial
    • Consider hiring someone else to write the software!
    • Don't forget about the bus factor
  • Learn how to program
    • Automate an annoying task
    • it will change the way you see problems
  • Keep your ears open
    • Ideas often come from listening to other people complain
  • Clinical software should be about improving quality of life!

Thank You!

email: rataylor@toh.on.ca

Acknowlegements:

D. La Russa, C. Angers, R. Studinski, D. Mason