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  • Measure Summary
  • NQMC:011097
  • Jan 2016

Brain and central nervous system (CNS) cancer: proportion of patients with brain/CNS cancer undergoing radical radiotherapy for whom the radiotherapy planning process includes MRI fusion.

NHS Scotland, Scottish Cancer Taskforce. Brain and central nervous system cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jan. 39 p. [24 references]

View the original measure documentation External Web Site Policy

This is the current release of the measure.

Measure Hierarchy

Cancer Quality Performance Indicators (QPIs) > Brain and Central Nervous System Cancer

Age Group

UMLS Concepts (what is this?)

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the proportion of patients with brain/central nervous system (CNS) cancer undergoing radical radiotherapy for whom the radiotherapy planning process includes magnetic resonance imaging (MRI) fusion.

Note from the National Quality Measures Clearinghouse: This measure is part of the Cancer Quality Performance Indicators (QPIs) collection. For more information, including a complete list of QPI measure sets, please visit the Healthcare Improvement Scotland Web site External Web Site Policy.

Rationale

Determining the gross target volume is a critical process in the radiotherapy planning of patients with primary brain/central nervous system (CNS) cancer. Radiotherapy planning computed tomography (CT) scans provide very limited information on the extent of the primary tumour, and attempts to utilise anatomical magnetic resonance imaging (MRI) information by 'side-by-side' visual assessment are usually inaccurate (Cattaneo et al., 2005).

MRI fusion enables the superior anatomical and physiological information provided by MRI to be accurately combined with planning CT data sets in order to optimise gross tumour volume (GTV) delineation. MRI fusion has been shown to reduce inter-observer variation in target delineation of high grade gliomas (Cattaneo et al., 2005) and a number of studies have shown that target volumes determined by CT alone frequently underestimate tumour extent (Jansen et al., 2000).

Evidence for Rationale

Cattaneo G, Dell'Oca I, Broggi S, Molinelli S, Di Muzio NG, Messa C, Fazio F, Calandrino R. Treatment planning comparison between conformal radiotherapy and helical tomotherapy in case of stage III NSCLC. Radiother Oncol. 2005 Sep;76:S222.

Jansen EP, Dewit LG, van Herk M, Bartelink H. Target volumes in radiotherapy for high-grade malignant glioma of the brain. Radiother Oncol. 2000 Aug;56(2):151-6. PubMed External Web Site Policy

NHS Scotland, Scottish Cancer Taskforce. Brain and central nervous system cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jan. 39 p. [24 references]

Primary Health Components

Brain/central nervous system (CNS) cancer; radical radiotherapy; magnetic resonance imaging (MRI) fusion

Denominator Description

All patients with brain/central nervous system (CNS) cancer undergoing radical radiotherapy (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Number of patients with brain/central nervous system (CNS) cancer undergoing radical radiotherapy for whom radiotherapy planning includes magnetic resonance imaging (MRI) fusion (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

The collection of data is piloted on a small number of patient records using a paper data collection form produced by the Information Services Division (ISD). The aim is to identify any anomalies or difficulties with data collection prior to full implementation. At least one NHS board in each Regional Cancer Network participates in the pilot.

Evidence for Extent of Measure Testing

NHS Scotland. National cancer quality performance indicators: overview of development process. Edinburgh (Scotland): NHS Scotland; 2012 Dec. 7 p.

State of Use

Current routine use

Current Use

Internal quality improvement

National reporting

Public reporting

Measurement Setting

Ambulatory/Office-based Care

Ambulatory Procedure/Imaging Center

Hospital Inpatient

Hospital Outpatient

Professionals Involved in Delivery of Health Services

Physicians

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Unspecified

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

Living with Illness

IOM Domain

Effectiveness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Therapeutic Intervention

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
All patients with brain/central nervous system (CNS) cancer undergoing radical radiotherapy

Exclusions

  • Patients unable to undergo a magnetic resonance imaging (MRI) scan, e.g.:
    • Pacemaker or other MRI incompatible implanted device
    • Cerebral aneurysm clip
    • Contraindication to intravenous contrast medium
  • Patients who refuse MRI

Exclusions/Exceptions

Medical factors addressed

Patient factors addressed

Numerator Inclusions/Exclusions

Inclusions
Number of patients with brain/central nervous system (CNS) cancer undergoing radical radiotherapy for whom radiotherapy planning includes magnetic resonance imaging (MRI) fusion

Exclusions

  • Patients unable to undergo a MRI scan, e.g.:
    • Pacemaker or other MRI incompatible implanted device
    • Cerebral aneurysm clip
    • Contraindication to intravenous contrast medium
  • Patients who refuse MRI

Numerator Search Strategy

Fixed time period or point in time

Data Source

Electronic health/medical record

Paper medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

External comparison at a point in, or interval of, time

External comparison of time trends

Internal time comparison

Prescriptive standard

Prescriptive Standard

Target: 95%

The tolerance within this target is designed to account for factors of patient choice.

Evidence for Prescriptive Standard

NHS Scotland, Scottish Cancer Taskforce. Brain and central nervous system cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jan. 39 p. [24 references]

Original Title

QPI 10 – radical radiotherapy planning process.

Measure Collection Name

Cancer Quality Performance Indicators (QPIs)

Measure Set Name

Brain and Central Nervous System Cancer

Submitter

NHS Scotland - National Government Agency [Non-U.S.]

Scottish Cancer Taskforce - National Government Agency [Non-U.S.]

Developer

NHS Scotland - National Government Agency [Non-U.S.]

Scottish Cancer Taskforce - National Government Agency [Non-U.S.]

Funding Source(s)

Scottish Government

Composition of the Group that Developed the Measure

Brain/Central Nervous System (CNS) Cancer QPI Development Group

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2016 Jan

Measure Maintenance

The Cancer Quality Performance Indicators (QPIs) will be kept under regular review and be responsive to changes in clinical practice and emerging evidence.

Date of Next Anticipated Revision

2017 Aug

Measure Status

This is the current release of the measure.

Source(s)

NHS Scotland, Scottish Cancer Taskforce. Brain and central nervous system cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jan. 39 p. [24 references]

Measure Availability

Source document available from the Healthcare Improvement Scotland Web site External Web Site Policy.

For more information, contact the Healthcare Improvement Scotland at Gyle Square, 1 South Gyle Crescent, Edinburgh, Scotland EH12 9EB; Phone: 0131 623 4300; E-mail: comments.his@nhs.net; Web site: www.healthcareimprovementscotland.org/ External Web Site Policy.

Companion Documents

The following is available:

  • NHS Scotland. National cancer quality performance indicators: overview of development process. Edinburgh (Scotland): NHS Scotland; 2012 Dec. 7 p. This document is available from the Healthcare Improvement Scotland Web site External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on May 4, 2017. The information was verified by the measure developer on May 23, 2017.

Copyright Statement

No copyright restrictions apply.

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