Safety and quality are cornerstones of the SABR service delivered at GenesisCare. We are incredibly proud of the robust governance that underpins our service, supported by a collaborative, multi-disciplinary team with patient care & experience at the heart of every decision we make. The culture of safety around our stereotactic service has evolved through dedicated review and audit of each referral. We continually review and improve our service to ensure that we can provide safe and effective treatments to patients across the UK.
The GenesisCare SABR service adopted the UK SABR consortium guidance from the outset and based much of our clinical and technical quality measures on this well-recognised publication. We continue to support and contribute to national discussions on SABR techniques and continually review international guidance alongside that of the UK.
The MR-Linac team at the Cromwell at work; an example of the collaborative approach needed across all staff groups to make the delivery of stereotactic radiotherapy a success.
The UK SABR service is supported by a team of expert stereotactic specialist staff who oversee training, patient pathway & audit, as well as the daily operation of the service:
A physicist since 2005, Paul has a plethora of experience in a wide range of stereotactic techniques & modalities. He has been a key figure in the expansion & oversight of the GenesisCare SABR service since 2015 and has been either directly or indirectly involved in the treatment of over 500 SABR patients in that time. He has also planned over 1000 Gamma Knife cases of a variety of pathologies, having spent 3 years under the guidance of a globally recognised expert in Stereotactic Radiosurgery.
Principal Stereotactic Radiographer, UK
With 9 years’ experience in radiotherapy, Kyle joined GenesisCare in 2018 from Cambridge University Hospitals NHS Foundation Trust. Kyle had regular involvement in all aspects of CUH’s busy SABR service and was on the team that opened the Varian Novalis TrueBeam SRS service there in 2017. Prior to joining the stereotactic team in January 2021, he was the Lead Therapy Radiographer at the GenesisCare Cambridge centre & oversaw the operation of the complex SABR service delivered there, treating some of the most complex linac SABR cases delivered in GenesisCare.
Key Aspects of Clinical Governance behind the UK SABR Service:
- To maximise consistency across the network GenesisCare staff follow a controlled set of protocols covering all aspects of treatment from referral, imaging, planning, image guidance and treatment. The protocols are regularly reviewed by all members of the stereotactic team and have been written in line with SABR Consortium Guidance as well as the most up-to-date peer reviewed research. The stereotactic treatment protocols are all available on request should you have any questions about the service or wish to know more about certain technical aspects.
- All referrals pass through the SABR Advisory Team (SAT) MDT where the suitability of SABR treatment discussed. GenesisCare’s rapidly expanding network of advanced treatment modalities such as the MR-Linac can be leveraged to provide patients with the access to the best possible care, and the SAT MDT will give any recommendations for specific modalities to referring clinicians.
- Once discussed at MDT, all SABR cases pass through additional ‘SABR Huddle’ meeting prior to the planning scans to discuss the best planning & treatment strategy for each patient, with each case benefiting from the wealth of experience provided by attendees from the stereotactic team, physics team, local treating teams & rotating SAT consultants. Referring clinicians are also always welcome to join these calls to discuss their case.
- On-site & remote support is provided where needed during training and on an ad hoc case for any SABR case. Imaging support is provided either on-site or remotely using IT systems by physics or the stereotactic radiographer.
Education & Training:
- We have a robust education framework for all staff groups across the 14 centres in the GenesisCare UK network. This is supported by standardised competency frameworks & entitlement registers.
- We employ a 4-step training programme with a mix of contact and self-directed learning. This includes focus on GenesisCare SABR policies, case studies, specialist IGRT training & on-set supervision.
- We have a continuing education programme for all staff with regular refresher training delivered as required, as well as CPD sessions & courses.
Incident Reporting, Risk Management & Audit:
- We are proud of our honest and open reporting culture. All incidents are reviewed jointly by local teams, the stereotactic team & the central physics team. More serious incidents are discussed at the weekly Risk & Safety committee, and discussions fed back to all relevant parties. Any subsequent actions are owned by the whole team.
- We employ a significant risk assessment & management process when launching new SABR techniques, in line with national guidance.
- Changes in practice are based on national guidance, high quality peer-reviewed research, or audits of data captured across all 14 UK centres.
Living our Genesis Care Values – A Case Study
In 2018 we treated a 51-year-old lady with well controlled primary breast cancer but with an isolated metastasis in L1. The patient was unfortunately unable to undergo treatment in her local NHS trust due to concerns about the titanium hardware within vertebra causing uncertainty in the dose delivery and subsequently increasing the risk to the spinal cord. The GenesisCare team worked closely with the Clinical Oncologist to quantify the uncertainty introduced by the titanium hardware and we were able to tailor our treatment planning approach to safely deliver an ablative dose to the vertebra. The patient is now 3 years post treatment and enjoying a good quality of life with her family with no disease progression or associated treatment side effects. This successful outcome is not in isolation and is mirrored across out network. In part this reflects the values that we always strive to deliver in GenesisCare: Partnership, Empathy, Bravery, Integrity, and Innovation.
If you have any questions about the SABR service provided at GenesisCare, please feel free to reach out to us any time on SABR@genesiscare.co.uk.
Principal Stereotactic Physicist, UK
Principal Stereotactic Radiographer, UK