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Radiotherapy planning and organization in The Netherlands

Radiotherapy planning and organization in The Netherlands. Ben Slotman Professor and Chair, Radiation Oncology VU University medical center Amsterdam, The Netherlands. At the end of the ‘90s. Waiting for new Government decision on capacity Long waiting times

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Radiotherapy planning and organization in The Netherlands

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  1. Radiotherapy planning and organization in The Netherlands Ben Slotman Professor and Chair, Radiation Oncology VU University medical center Amsterdam, The Netherlands

  2. At the end of the ‘90s Waiting for new Government decision on capacity Long waiting times Suboptimal fractionation schemes Impossibility to implement new techniques No extra reimbursement for intensive therapy …etc……. …...etc….. ………etc..

  3. Re-imbursement “Treatment series” ?! A complete treatment consisting of x fractions New series for extra electron fields, boost, or even every change in field sizes, etc. Sometimes 3 series for one treatment Insurance companies agreed (or not) No comparison between and within centers possible No parameter which incorporates relative workload

  4. New reimbursement parameters Limited number of categories Should reflect workload Should be fool-proof Should be used for comparison of production between and within institutes Should be used for planning future needs for staffing and infrastructure

  5. T and B categories • Teletherapy • T1: simple, patient already known to the dept. • T2: standard • T3: intensive (CRT) • T4: special (SRT, IMRT) • Brachytherapy • B1: simple (plaque) • B2: standard (breast) • B3: intensive (Fletcher) • B4: special (stereotactic, Prostate seeds)

  6. Costs of Teletherapy (in €)

  7. Costs of Brachytherapy (in €)

  8. Costs of T and B categories Relativecosts • Teletherapy • T1: simple 0.3 • T2: standard 1.0 • T3: intensive 1.7 • T4: special 2.3 • Brachytherapy • B1: simple 0.6 • B2: standard 1.0 • B3: intensive 2.3 • B4: special 8.1

  9. Costs of T and B categories RelativecostsTtotal T2eq Similar for Brachytherapy • Teletherapy • T1: simple 0.3 100 30 • T2: standard 1.0 100 100 • T3: intensive 1.7 100 170 • T4: special 2.3 100 230 Total 400 530

  10. Prognosis 2000 – 2010: Patients

  11. Prognosis 2000 – 2010: T-distribution 40% 60%

  12. Prognosis 2000 – 2010: B-distribution

  13. Linacs and personnel Excluding Brachytherapy For 250 B2eq. : 0.5-1.0 radiation oncologists 0.5 physicist 0.5 physics assistants 1.0-2.0 technologists

  14. Size of 21 centers Number of centers

  15. Size of 21 centers Number of centers

  16. Size of 21 centers Number of centers

  17. Teleytherapy 1996-2008

  18. T-total and T-equivalent

  19. Linacs 1996-2008

  20. Radiationoncologists 1996-2008 fte Registered In training Needed based on T2-eq

  21. Physicists 1996-2008 fte Registered In training Needed based on T2-eq

  22. Technologists 1996-2008 fte Registered Needed based on T2-eq

  23. 2005: Evaluation

  24. 2005: Evaluation and new Prognosis • New cancer incidence data (2004): 2015 + 43% increase compared to2005 • T2equivalent overestimates the needs (inflation) More efficient delivery of complex treatments For future calculations complexity (T2eq/T) and efficiency-factor New T2eq = 0,86 x T2-equivalent • No evidence for increase in number of retreatments 1,30 in stead of 1,35 • Some underconsumption: Utilisation 43% in 2005, 44% in 2010 and 45% in 2015

  25. Prognosis

  26. Prognosis

  27. Number of linacs

  28. Newlydefinedactivities

  29. Teletherapy: T0-T6

  30. Satellites • Hospital prestige • Patient comfort/travel • Multidisciplinary treatment • Is there maximum center size?

  31. Satellites • Satellite at least 2 linacs • No treatment planning • Mother institute at least 4 linacs • Mother institute at least 10-12 ROs • Same quality system • At least 90% of treatments • Personnel paid by mother institute

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