Specialty
Radiation Oncology
A linear accelerator serves a district, sometimes a state. A course of radiotherapy is a run of daily appointments over weeks against that one machine, so a day lost to a breakdown, a power cut or a missing plan moves every patient behind it.
Impact and action
The course.
- The fraction schedule is a paper chart on the console, so the plan, the appointments and the record of what was delivered are three separate accounts of the same treatment.The course runs as a recurring schedule of due tasks, each one marked delivered, missed or skipped, with the history kept.Quest
- A gap in the course matters clinically and is visible only to whoever is holding the chart.A missed fraction is a state on the record rather than an absence from it, and a rule can be set to raise it.Sentinel
The machine.
- Machine downtime is absorbed by the front desk, which rings patients in whatever order it can remember.The accelerator is a resource in the digital twin of the hospital, with its own schedule and its own maintenance record, so the queue behind it is visible as a queue.Vigil
The on treatment review.
- Weekly reviews and toxicity scoring are written on the chart, and the chart is filed at the end of the course.Reviews are forms with their own validation and their own version history, attached to the course rather than to the week.Glyph
The record of what was actually delivered.
- Planning images and treatment records stay on the planning system, and the oncology note describes them from memory.The study returns to the order that requested it and is read in the record beside the plan.ForgeAtlas
The queue
A waiting list is an operating fact, and it can be read.
Where the delay actually is.
Falcon reads from every tool without owning or changing any of it, and names the source of each figure it shows. A department that can see whether its delay is simulation, planning, machine time or transport can act on the one that matters.
And who is waiting.
Each patient on the list is a record with a state and a due date, so a rescheduled week is a change to the schedule rather than an afternoon of phone calls.
A machine a district shares is an infrastructure question before it is a clinical one.
Radiotherapy capacity is the largest single piece of arithmetic in cancer care in this part of the world.
Where the modelling has been done, the return on adding capacity is counted in millions of life years, and every scenario turns on utilisation. A morning in which an accelerator stands idle is capacity a region has already paid for.
Move past the treatment day reconstructed afterwards from the console log. Quest runs the course as a schedule of due tasks, each marked delivered, missed or skipped, and Falcon reads utilisation and delay out of the same records without owning or altering any of them.
What a shared accelerator adds
Quality control is a process with a cost.
- Plan checks, chart checks and machine checks are recorded in separate books, and nobody can say which of them is catching anything.Each check is a step in a repeatable procedure with an owner and a due time, and a late step is flagged as overdue on a live board.Cadence
The queue is the clinical problem.
- A breakdown or a power cut moves every patient behind it, and the front desk reconstructs the new order from memory.Each patient on the list is a record with a state and a due date, so a lost day is a change to a schedule rather than an afternoon of calls.Quest
- Machine downtime is absorbed as an inconvenience and never counted against the queue it created.The accelerator is a resource in the digital twin of the hospital, with its own schedule and its own maintenance record.
A course is billed as a package.
- Weeks of daily treatment are billed against a scheme package rate, a state variant of it and sometimes a corporate credit book at once.One course produces every one of them, on one tariff engine, with a tamper-proof trail behind each transaction.Vault
The inspection.
- Calibration records, maintenance schedules and the risk register are reconstructed before an inspection rather than kept for one.They stand as they are produced, alongside the incidents, the committees and the training and competency records.Vigil
Published research
What the literature measured, and who measured it.
Findings about radiotherapy departments elsewhere, cited to show the problem is measured. Nothing below is a result at a hospital running Pensieve.
- The Global Task Force on Radiotherapy for Cancer Control estimated that scaling up radiotherapy capacity in low and middle income countries by 2035 would save 26.9 million life years over the lifetimes of the patients treated.Atun R, Jaffray DA, Barton MB, et al. Expanding global access to radiotherapy. The Lancet Oncology, 2015;16(10):1153-1186.
- A study that quantified individual quality control checks in radiation oncology found wide variation in how many errors each check caught, with physics review of the plan and the chart among the most effective.Ford EC, Terezakis S, Souranis A, et al. Quality control quantification (QCQ): a tool to measure the value of quality control checks in radiation oncology. International Journal of Radiation Oncology, Biology, Physics, 2012;84(3):e263-e269.
- WHO guidance on medical equipment maintenance treats a current and complete inventory as the precondition for the programme, because inspection, preventive maintenance, staffing and budget are all sized from it.World Health Organization. Medical equipment maintenance programme overview. WHO Medical device technical series, Geneva, 2011.