Development and evaluation of an automated system designed to significantly reduce the resource requirements of Intensity Modulated Radiotherapy (IMRT) treatment plan

Radiotherapy aims to cure people of cancer by using x-rays to kill tumour cells. It is effective, with half of all patients cured of cancer receiving radiotherapy. X-rays however also kill normal cells and a key aim of radiotherapy is targeting cancer cells whilst avoiding healthy tissue. This is difficult and for most treatments crucial organs, such as the rectum or bladder, receive a dose of x-rays which result in unpleasant side effects. Examples of these side effects are diarrhoea and rectal bleeding. They can be both short lived or permanent and can significantly affect a patient's quality of life.

Intensity Modulated Radiotherapy (IMRT) is an advanced form of radiotherapy. This technique enables a more targeted treatment, resulting in lower doses to normal tissue. This in turn reduces side effects. The planning of this treatment is however complex and requires many hours of expert staff?s time. IMRT is therefore more expensive than standard radiotherapy and is only offered to 35% of patients. This means not all patients who would benefit from IMRT are able to receive it. It is estimated at least 50% of patients would benefit from IMRT and it is likely in the future IMRT will become the standard treatment technique. Research into improving IMRT efficiency is therefore crucial to reduce costs and open up patient access to the advanced technique in financially difficult times.

With this research we aim to do just that by using computer programs to automate the process of IMRT planning, a process which is currently manual and very time consuming. We will evaluate this technique by recreating the treatment plans for 35 previously treated prostate and head and neck cancer treatments using the automated method. These sites account for approximately 29% of all curative radiotherapy patients. When recreating these plans we will time how long the process takes.

Alongside this plan regeneration we will measure the time it takes to plan current clinical patients using standard techniques. This will be done for 15 prostate and 15 head & neck patients. We will look at the results and compare the staff and computer time requirements for treatment planning using the two techniques. We will also compare the total time required from starting the plan to it being finished, the plan turnaround time. This comparison will show us how efficient the automated techniques are compared to current manual techniques. We will also compare the treatment quality of the two techniques by looking at how well the x-rays miss the critical organs. This comparison is based on computer simulations and is a guide to how toxic the treatment will be for the patient.

The results are expected to show that the automated technique eliminates staff interaction in the planning process and reduces the machine time required for plan generation by half. The automated technique is also expected to give the same or better treatment quality than manual methods and significantly reduce the plan turnaround time. These automated techniques will be applicable to the majority of cancers and if implemented will reduce the costs associated with IMRT provision by at least 1/3. This will mean greater patient access to IMRT at the same cost to the NHS, resulting in more patients receiving a less toxic treatment. Throughout this project we will have active patient representative involvement, ensuring this project is patient focused from launch to completion. We believe patients will give a unique perspective on technological advancements and service improvements, which are beneficial for all parties.

The results of this work are expected to be significant in improving patient treatments. We aim to widely spread key findings locally, nationally and internationally with the intention of being the driving force behind improvements in IMRT service delivery. Improvements which should mean more patients receive this world class treatment.