Digitalization in radiotherapy now and in the future
I have been in the nursing field for almost 20 years, and during that time I have seen tremendous development in digitalization. In my work as a radiotherapist in the Radiotherapy Unit, new forms of digitalization have been in use for a long time.
We call ourselves a “paperless unit”, which means that everything works electronically: patient information systems, patient call system, radiation treatment plans, etc. For example, the fingerprint identification for patients register and identify themselves for treatment has been in use for twenty years. About 7 years ago, patients also had a mobile application in the experiment, which allowed the patient’s treatment times and self-care instructions to be given to the phone. At the moment, only the patient’s instructions are given on paper, but hopefully I will be able to change that in the near future. In a few years, the development has been revolutionary -radiation therapy is even more precise, efficient and safe. The biggest changes have been made in dose planning and treatment machines.
Dose planning includes planning scans (CT, MRI, PET), whose image quality and various reconstructions have become more and more accurate. Modern dose planning software enhanced with AI (artificial intelligence) and machine learning accelerate treatment planning. We also use programs that assist in drawing critical organs, which can be used to delineate treatment areas even more precisely.
The treatment machine uses imaging-guided radiation therapy (IGRT) and real-time monitoring, which enable the treatment to be targeted very precisely. Patients’ treatment history and data are stored digitally, which enables more efficient transmission of information and reduces the risk of errors. Robotics is used in the CyberKnife treatment device, which is the only one in Finland. It is an advanced radiotherapy equipment that uses robotics and real-time imaging. The treatment head is attached to a robot familiar from the automotive industry. The treatment table also has a robot arm, which enables precise X, Y and Z direction movements of the table, as well as rotation of the table.
The digitalization of healthcare, and especially the development of digital technologies, has brought both opportunities and needs for development to the operations of healthcare organizations. Wellbeing services country of North Savo (PSHVA) has also set a goal of expanding the use of digital services among both professionals and residents. In the future, the subject of development will be the introduction of digital control methods for radiotherapy patients. For example, an online guidance environment would be able to supplement the oral guidance given in research and treatment situations and thus improve both patient and radiation safety. With the help of the virtual environment, the patient and their relatives could familiarize themselves with the treatment path online before coming to the hospital. In the environment, it would be possible to get to know e.g. to the facilities and equipment of the radiotherapy unit virtually. In addition, different instructions can be created there, such as dietary and bladder filling instructions for those receiving treatment for the pelvic area. The benefit of the virtual environment is its uniformity, easy usability and comprehensibility of the program.
GDPR
Data protection is extremely important in the social and health sector. Finland and the EU have strict data protection laws, such as the EU’s General Data Protection Regulation (GDPR). It defines how personal data should be processed and protected. The new data protection reform has improved and strengthened patients’ rights, which creates trust in the social and health sector. Protection of patient data, informing and consent to the collection of data, as well as high-quality recording of patient data are the biggest areas affected by the regulation in Radiotherapy.
Our patients mainly come from the Northern and Southern Savo welfare regions, but also from other parts of Finland. That is why it is very important to have all patient data, radiological examinations and previous radiotherapy information seamlessly available to us. However, the implementation is laborious and requires a lot of resources in the already very busy patient work. Several complex information systems are used in the industry, so integrating them is challenging. As a rule, our customers are elderly people who are not aware of all their rights, so information and consent requests and records take time. Recording patient data has turned into complex structured recording, which takes even more time.
In personal life, the data protection regulation can be seen online every day. Pop-up windows asking for permission to process data are already on the websites of almost all parties. Their purpose is to ensure that my personal data is processed safely, legally and transparently. Frustrating, but certainly necessary. As a customer in healthcare, the new regulation gives you security and rights to manage your own data. However, this requires different consents to be given to different entities (private, primary health care, specialist care, coil and insurance companies).
ChatGPT
For example, robotics is already in use in surgery and radiotherapy. However, the human still controls the robot. ChatGBT suggests the use of robotics e.g. for diagnostics, treatment and rehabilitation tasks and prevention. The idea of “Diagnostic robots” is very realistic. For example, in X-rays and radiotherapy where there is radiation exposure, could the robot be in the examination/treatment room to hold/guide the patient? Robotics intended for care and rehabilitation also sounds like a good idea. Companionship and discussion group for the lonely, helping with daily activities and taking care of medication for the elderly, assisting and guiding in rehabilitation processes. But is this humane? On the other hand, a better robot to help when there is no one?
In the future, we need to focus even more on prevention, because the population is getting older and the staff shortage will be worse than today. Utilizing people’s self-recorded well-being and health data for healthcare use is one enabling factor for prevention. ChatGBT proposes the transfer of continuous monitoring of smart devices, and even chips placed under the skin, directly to healthcare. At the same time, the devices would guide people’s lifestyles, offer individual recommendations for maintaining a healthy lifestyle, and give warnings about possible health risks. It is also true from my own experience that various mobile applications and smart watches encourage, for example, to move and drink liquids. But would I want a skin implant? Why not, if it is used to monitor blood pressure or blood sugar? Or the chip would even tell you the macros and nutrients of the food you ate. And people have already been implanted with microchips in Finland. However, this raises ethical and privacy-related issues.
Self-assessment
I have always had an interest in digital methods both in my personal life and in my professional life. I have always been the first to train, e.g. for the introduction of electronic patient information systems and the development of digital control methods.
Digitization is developing in big steps, whether we like it or not. Digitization offers the care sector opportunities to improve access to care (mobile applications, remote receptions, chats), efficiency and thus cost-effectiveness. New technologies, such as artificial intelligence and mobile applications, are changing the way healthcare works. But where is the line of ethics? Which one do you choose if you have to have an operation: a robot or a doctor? At the same time, it is important to ensure data protection and data security in order to maintain patients’ trust and meet the requirements of the law. Cyber security threats are precisely one of the biggest risks in the digital society.
I also learned how to blog.
I have commented on https://blogi.savonia.fi/hannabjorklof/digi-society/ and https://blogi.savonia.fi/maijanblogi/digi-society/