Updated: Aug 26, 1998
This is the most recent structured information on this project. Complementary data can be found on previous documents
TARGET Telematics application in radiation and general oncology treatment

Overview

• Rationalisation of investments in new equipment (high-end medical imaging devices, laboratory equipment, expensive processing software, etc.) based upon individual institutional specialties, and
• Access to skills and knowledge to increase the quality level of diagnosis and treatment.

This may lead to clear benefits and costs savings. Targeted purchasing of specialty technologies reflects the need of systems to avoid duplication and rationalisation in their mix of available services. Both features rely heavily on the integration of intra-system management teams and the centralisation of the technology specification, assessment and approval process.

Radiation therapy is a notable example of how the above model can impact on current routine. In radiation therapy, the scientific community has made relevant progresses in making the treatment-planning process faster and more precise and, in general, in improving treatment conditions. However, only few radiation therapy centres (usually, large university hospitals) are provided with the most modern facilities for studying complex treatment plans (e.g., 3D treatment-planning for proton beams, multileaf collimators, stereotaxic treatment, conformal therapy, etc.). At the same time, there are a lot of small peripheral hospitals where specific radiotherapical background is not available. This means that patients that must undergo radiation therapy have often to rely only upon specialised centres, even for simple problems related to their treatment.

Yet, some of the technologies are still not mature enough to be transferred into the clinical practice. Every expert perceives a significant gap between the available technologies demonstrated in congresses and trade shows and the level of usage of high-tech applications in the clinical practice. A fundamental reason is that the validation of medical applications is affected by a kind of logic short-circuit. In fact to be widely adopted a medical application must be proven effective. However, effectiveness is proven only through clinical trials, which means to have groups of health professionals using the application in the clinical practice. In other words this means to convince many professionals to use an application (which is not validated yet) just because is "promising".

This is the background against which TARGET was initiated. The main thrust of the project is aimed at establishing a framework for implementation of Health Professionals collaboration, accompanied by a thorough validation and clinical trials. TARGET is currently validating its concepts in Radiation Oncology, but the model shows a very high replication potential in fields different from the one considered.

Purpose and objectives

The main purpose of the project is the creation of a Demonstrator for an advanced telematic radiation therapy environment. The demonstrator will aim at linking specialised centres to remote facilities in order to ensure a better distribution of resources and the usage of both subsidiary technologies in Radiation Oncology and expertise in state-of-the-art diagnostic and radiotherapeutic oncology, and to favour future developments. In addition, there is a need for image-transmission and multimedia systems for the purpose of creating historical archives useful in studying compression and data processing in general, with particular regard for the specific objectives of radiation therapy (e.g., 3D reconstruction for target volume outline, etc.).

The goals of the project can be summarised as follows:

• ? To make latest developments in 3D advanced image analysis available to support and expedite current practice in Radiation Oncology centres;
• ? To share and distribute resources and expertise between specialists and subsidiary centres via an advanced telematic network in the field of Radiation Oncology. This will lead to improved treatment planning and follow-up for a better quality of radiotherapy service delivered to tumour patients.
• ? To provide the Health Authorities involved in the health care organisation with a method for an exact monitoring of the situation of cancer in the regions associated with the project;

In the context of the first and the second goal, it will be possible to use modular treatment-planning systems in large specialised hospitals, connected with low-cost workstations to peripheral hospitals and health-care centres, where only selected part of the complete software are present. This would allow a two-direction relation, in the sense that the peripheral centre could contact the main centre for consultation or development of a complex treatment plan for a patient to be treated locally. At the same time, the peripheral centre would be able to use the central resources to study the plan, if specialised personnel are available, and to make plans locally for which the available software is enough. The images and the information present at peripheral centres should also be available (on request) to the central institution for remote consultation.

This approach could also bypass the need for providing every radiation therapy centre with modern treatment-planning system; the complete software should be available only in few central institutions. Informative tools could be accessed by small peripheral hospitals, using even very low-cost workstations (like PCs). Such tools would be used by non-specialised personnel working in small hospitals to solve small problems affecting patients who are undergoing radiation therapy treatment, or during their follow-ups. Above all, this is important in regions where specialised centres for cancer treatment are not present or are very few.

The users involved in the project (apart from the patient end-user), are health-care providers in a given territory, including regional authorities, specialised centres and remote hospitals. Local health-care structures acquire epidemiological data and information for correct planning; they simplify the quality control of radiation therapy treatment planning and reduce the costs and difficulties for patients. Specialised centres facilitate radiation therapy treatment in remote hospitals, by providing the necessary support also for high- level treatment planning. They receive information about patients during the disease and follow-up, thus allowing a constant and correct updating of medical records. Radiation therapy research is being developed through connections and comparisons among European specialised centres. Moreover connections among specialised centres with different technological resources and different facilities improve both the use of available instruments and international co-operation. Radiation therapy activity at remote centres is simplified through connections with specialised centres for treatment-planning and 3D reconstruction, using high-level communication protocols. Remote experts are consulted for diagnostic and therapeutical problems. The health authorities should have a role in the definition of standards of high-quality treatment plannings elaborated by main radiation therapy centres. The aim of the quality control is to eliminate deviations from the accepted standards for each step of the clinical management of patients that undergo radiation therapy.

Results

• Advanced 3D image analysis tools to support and expedite current practice;
• Better and more complete utilisation of the treatment facilities and current technologies;
• Reduction of patient travelling that often burden Public Administration;
• Rationalisation of investments for treatment facilities;
• Improvement of standardisation of high quality treatment planning facilities elaborated by main European radiation therapy centres.

List of deliverables

Year 1

Year 2

List of participants

	Copyright 1998 © EHTO All rights reserved This server is the only official EHTO WWW knowledge repository. Mail suggestions to: webmaster@ehto.org