has been one of the biggest contributors to meeting these expectations as of exactly how the research will lead to this outcome is, sadly, nowhere near as
new processes, physical resources and generally reducing unit costs have been common. Research programmes that fall into the category of fundamental research
delivered by the technological industries. Arguably, the greatest manifestation are often accompanied by a defence of ‘increased knowledge’ in the belief that
of this in recent years has been the development of knowledge management this alone is sufficient justification for the programme.
and data processing – both utterly dependent on, and driven by, the pace of
development of the disciplines loosely referred to as the computer sciences. The Here, then, is the nub of the problem. Underpinning technology is moving on at
rate of change in this sector was characterised by Gordon Moore in 1965. He a rate that out-strips the validation processes. This has given rise to a number of
observed that the number of transistors that could be placed inexpensively on research initiatives within the NHS that are ‘scatter-gun’ in their scope. In turn,
a silicon die would double approximately every two years. This observation has this has stemmed from the fact that there is no general understanding of the
proved remarkably accurate and is now a ‘law’ named after the Intel co-founder. overall technology strategy. This combination of circumstances raises the real risk
The significance of this law is that it defines the rate of growth of the underlying that radiotherapy will fall short in its duty of care to deliver the most effective
processing power of the micro-processors that have become so ubiquitous and, and practicable treatment technology and processes that may be available to its
hence, the rate of development of many current technologies. supporting taxpayers.
Countering the pressure for rapid process change is a natural (and wholly proper) Sanctioning research programmes that do not have robust linkages between
conservatism – after all, no-one wants to deploy technologies or practices that may the output of the work and improved patient care, exacerbates this risk. If the
have unexpected and unwelcome side effects. Adherence to the need for RCTs argument above is accepted, it is clear that a much greater understanding of
has been the defence against rapid process change on the basis that this robust the technology road-map must be developed, and the approach to technology
It cannot risk
scientific process ’guarantees’ that a new process delivers the expected benefits validation must be modified so that the validation process has a time-cycle better
without undue or unexpected adverse side effects. matched to the underlying technology development cycles.
adopting
Here then, lies the first clue as to why radiotherapy may be struggling to get to Viewing things differently
technology that
grips with deploying new technologies: the goalposts are always moving; the rate Useful insights can be gleaned from considering others that have faced similar
of technological development is high, but validation processes are such that by the problems; what have they done to address the problem, and can their approach
proves to be
time there is certainty that a new technique or process is robust, so much time has read across to radiotherapy to a greater or lesser extent?
elapsed (up to 20 years in extreme cases) that many interim developments have
fundamentally
been missed. There is also the risk of ‘paralysis by analysis’: a new development The ‘problem’ radiotherapy faces could be characterised as the need to speed up
is identified, trials are undertaken, then the decision to deploy is made. By that the adoption of relevant, new technologies while avoiding dreadful technology
flawed
point, the technological base has moved on so far that the technology deemed selection mistakes. The current system is very ‘safe’ but it is too slow. It also has
‘safe’ to deploy is out-of-date or, worse, obsolete. The pressures to start again and a second order effect in that it drives a fragmented research effort that is poorly
assess the newest, latest technology without deploying the now out-of-date option co-ordinated with industry and academia.
are often irresistible (in particular, if this point in time coincides with a low point
in the capital expenditure cycle). The end result can be a near endless assessment One organisation that has faced a very similar problem is the UK Ministry of
and validation cycle that fails to provide general access to the ‘better treatment Defence (MoD). This entity is under clear pressure to adopt new technology early if
facilities’ expected by weary taxpayers. it offers material benefit over that in use by opposing forces. Equally, it cannot risk
adopting new technology that proves to be fundamentally flawed.
The second clue that radiotherapy is struggling to deploy new technologies may
be found by considering the spread of radiotherapy research work undertaken The MoD’s approach to the problem has been to formalise the common steps
by various centres in the UK. This ranges from fundamental research into new through which any new technology evolves – from the first spark of intuition
technologies and processes such as carbon ion therapy, to applied research that from an inventor, through to the state when it is fully proven, understood, and
is focussed strongly on the development of efficient delivery methodologies, for in general use. This model is referred to as the ’technology readiness levels‘
9

example, how best to use IGRT. Undoubtedly, all are very well-intentioned research (TRL), and reduces the problem to a set of nine non-dimensional numbers that
studies aspiring to improve the lot of the patients. However, a clear understanding refer to the readiness state: One is at the ‘spark of genius’ stage, while nine is
14
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IMAGING & ONCOLOGY
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2009
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