Improving innovation in radiotherapy to tackle cancer backlog
Dr Anna Britten is consultant clinical oncologist at the Sussex Cancer Centre and director of medical affairs at Elekta, offers her thoughts on the role AI can play in reducing the cancer backlog.
The UK is facing its worst cancer crisis in 40 years. A combination of the COVID-19 pandemic and decades of an under-funded NHS have resulted in the creation of a monumental healthcare crisis.
In order to gain control over this crisis, the NHS must keep up the excellent vaccination campaign, meet the needs of COVID-19 victims (both acute and long term), as well as continue treating, in a timely manner, all the cancer cases that have arisen before, during and after the multiple pandemic lockdowns.
A recent report by the All Party Parliamentary Group for Radiotherapy has devised a six point COVID-19 recovery plan to save lives and money. Among its recommendations, the group calls for a ring-fenced investment fund for cutting-edge IT technology including software solutions, AI and machine learning products.
With human supervision, AI can be used to take over a fair proportion of the radiation therapy workflows, ensuring greater capacity, improving access, enabling a reduction in COVID-19 cancer backlogs, and more importantly, allowing staff to spend more time face-to-face with patients.
Speeding up diagnosis and treatment by expanding use of tech and AI
Most radiation therapy departments were able to continue to deliver a reasonable service throughout the multiple lockdowns. During this time of unprecedented conflicts, the need to adapt resulted in a move away from long-engrained radiation therapy protocols to more hypofractionation (and ultra-hypofractionation) aimed at compensating for a reduction in surgery and systemic cancer therapy delivery.
Radiation therapy technology has come a long way thanks to research and development. It is this constant innovation, which is the reason why we have today accurate, fast and increasingly automated workflows for a treatment that is highly effective and very safe. Amongst Elekta’s product, there are software tools developed for automatic contouring, essential for adaptive radiotherapy workflows. Contouring is a step in the radiation therapy process that is most subjective and therefore prone to weakness in standardisation. It entails drawing around the targets needing to be treated accurately, and around the anatomy which needs to be avoided, thereby increasing the accuracy and reducing the side effects.
Elekta’s research team has been curating thousands of MR image data sets provided by the MR-linac consortium and using them to train auto-contouring models. These algorithms will become an integral part of an adaptive radiotherapy workflow where a patient’s radiotherapy plan is adapted daily to the anatomy, pathology and biology of that day.
With human supervision, there is no reason why AI cannot significantly contribute to creating a faster, safer, and ever more precise process. Right the way through from diagnostic investigations to treatment planning, adaptation and delivery, AI can help improve cancer outcomes, tackle waiting lists, and offset workforce shortages.
Innovation must happen in conjunction with focussed training
Technology can make a huge difference to cancer care, particularly at a time when services are under significant pressure. However, there is little point in having highly sophisticated radiotherapy technology if the expert cannot use it effectively. Hence why developing the users must happen in tandem with innovation.
Focussed training and upskilling radiographers to take on extra responsibilities – such as contouring - will assist in accelerating implementation of advanced technologies like Stereotactic Ablative Radiation Therapy (SABR). Consequently, in addition to creating a modern radiotherapy service, we will be developing therapy radiographer career progression, leading to a happier more content workforce. Education and training is therefore key to creating sustainability in a service that has been historically underfunded and often overlooked with just 5% of the NHS budget, something that was recently acknowledged at an online cancer summit, where APPG for Radiotherapy chair Tim Farron MP recognised that the NHS workforce possessed the expertise needed to tackle the COVID-19 cancer backlog, but could only address it if ministers admitted to the existence of a cancer healthcare crisis, delivered vital investment in cancer services, and acted quickly.
Elekta is focussed on supporting and providing training for radiographers and radiation oncologists. Our cloud-based contouring and planning academies (ECA and EPA) provide the training needed to a global workforce dedicated to providing the best cancer care.