allocated to a technology that has been properly proven. The thinking is that risk of A quantitative method for assessing the risk/benefit of introducing new
deployment is highest at TRL 1, and lowest at TRL 9. The formal definitions are in technology earlier than would be the case currently; Prime
Figure 1. A framework against which requests for research programme funding can
be assessed to understand where in the technology development cycle the expectation
TRL 1 Basic principles observed and reported.
programme would fit.
TRL 2 Technology concept and/or application formulated.
is addressing
TRL 3 Analytical and experimental critical function and/or characteristic proof-
Summary
of-concept. Development of an evaluation methodology similar to that used by the MoD cancer problems
TRL 4 Technology component and/or basic technology subsystem validation in
would, without doubt, consume some resource in the near-term. Nevertheless,
a laboratory environment.
it would be money well spent as a robust framework would become available quickly and
TRL 5 Technology component and/or basic technology subsystem validation in
against which the risks associated with the adoption of new technology could be
a relevant environment.
assessed, together with the benefits promised. It would also provide a framework effectively
against which research activity can be positioned, and to properly co-ordinate this
TRL 6 Technology system/subsystem model or prototype demonstration in a
with academia and industry.
relevant environment.
TRL 7 Technology system prototype demonstration in an operational
In the final count, if radiotherapy succeeds in co-ordinating its efforts in this
environment.
manner, it will have taken a great step forward in ensuring that it discharges
TRL 8 Actual Technology system completed and qualified through test and
its responsibilities to its ‘owners’. Patients can be assured that they are being
demonstration.
offered the best available technology at an acceptable level of risk. Effectively,
TRL 9 Actual Technology system qualified through successful mission the radiotherapy professions will be in control of the deployment of new
operations. technology, and the current problem of being controlled by, or overtaken by, new
Figure 1.
developments will become a thing of the past.
There are formal processes to assess the TRL of any given technology to ensure a Donna Routsis is lead research radiographer in the oncology
degree of uniformity in the categorisation of quite diverse subject technologies.
centre at Addenbrooke’s NHS Trust, Cambridge
The result of these categorisations, apart from formalising risk, drives both
procurement decisions and decisions as to the type of organisation that should
References
undertake the assessment work. While there are, of course, always some
1. Crump H. Cancer patients missing out on best treatment because of cost. Health
exceptions, TRL 1 to TRL 4 are generally delegated to academia, TRL 5 to 7 sit with
Service Journal, 2009: London.
key suppliers, and TRL 8 and 9 is where it gets to the ‘sharp end’.
2. Rad magazine. Urgent need for linac upgrades. Rad magazine, 2009.
3. Darzi A. High Quality Care for All. 2008, Department of Health: London.
This approach allows informed decisions about the risks of early deployment
4. Department of Health. Cancer Reform Strategy. 2007, Department of Health.
to be taken without the need to validate all technologies before deployment.
5. NHS Technology Adoption Centres, 2009, http://www.technologyadoptionhub.nhs.uk/
If a technology has significant operational benefits and has reached TRL 6 (for
6. National Radiotherapy Advisory Group. Back to the Future. 3rd Annual National NRAG
example) a deployment decision may be taken in advance of the completion of
Meeting, 2008. London.
steps 7 to 9.
7. Department of Health. Cancer Reform Strategy. 2007: London.
8. National Radiotherapy Advisory Group. Radiotherapy: developing a world class
service for England, Department of Health, 2007.
Radiotherapy would be well advised to take this basic model and develop and
9. Ministry of Defence. Policy: information and guidance on the technology
refine it to suit its own purposes. The benefits that could flow from such an
management aspects of UK MOD Defence Acquisition. Technology Management,
approach would be:
2008.
A formalised methodology to assess the relative risk of purchasing technology
10. Brown I Smale A Wong M. Management of Medical Technology & Implementation
offerings from competing vendors (who will always present their goods in the Issues. Engineering in Medicine and Biology Society, 2006. Proceedings of 27th
best possible light);
Annual International Conference of the IEEE-EMBS, 2005: pp 5672 - 5675.
2009
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