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					                                       Radiotherapy Dataset version 3.7 Manual



Radiotherapy Dataset v3.7

Manual



Version 3.7
Date 16th September 2008




Document Management
Prepared by: Helen Forbes (Helen.Forbes@ccotrust.nhs.uk)

Contributors
Role                Name                   Title
Owner               Helen Forbes           Clinical Information Manager
Contributor         Brian Cottier          Head of NATCANSAT
Contributor         Chris Ball             Senior Data Analyst


Version Control
 Version     Date             Author                 Change Description
 V3.63       21/05/2008       Chris Ball             Description amendment to 5.1.12 and 7.3
 V3.64       12/06/2008       Helen Forbes           Minor amendments from ISB appraisal panel
                                                     4/6/08
 V3.65       04/07/08         Helen Forbes           Further amendments from ISB disposition of
                                                     issues, and detailed disposition.
 V3.66       15/09/08         Chris Ball             Data item name changes in accordance with NHS
                                                     data dictionary additional user instructions
 V3.7        18/09/08         Chris Ball             Further data item name changes in accordance with
                                                     NHS data dictionary additional user instructions




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Contents:
1  Introduction .................................................................................................................................................4
2  Background..................................................................................................................................................5
3  Who will use the standard?..........................................................................................................................6
4  Impact Assessment ......................................................................................................................................7
 4.1     Data Collection .................................................................................................................................. 7
    4.1.1     Items not collected:.................................................................................................................... 7
    4.1.2     Items not coded or coded using different coding systems:........................................................ 7
    4.1.3     Differences in currencies between sites:.................................................................................... 8
 4.2     Data Extraction .................................................................................................................................. 8
 4.3     Impact Summary:............................................................................................................................. 10
    4.3.1     Initial setup time ...................................................................................................................... 10
    4.3.2     Ongoing time requirement....................................................................................................... 10
5 Implementation and training guidance ......................................................................................................11
 5.1     Data items and issues are recorded below: ...................................................................................... 11
    5.1.1     PATIENT PATHWAY: version 6........................................................................................... 11
    5.1.2     PATIENT IDENTITY ............................................................................................................. 12
    5.1.3     PATIENT CHARACTERISTICS ........................................................................................... 12
    5.1.4     CARE EPISODE - Person Group (Consultant)....................................................................... 12
    5.1.5     CARE EPISODE - CLINICAL DIAGNOSIS (ICD): ............................................................. 13
    5.1.6     CARE EPISODE - CLINICAL DIAGNOSIS (READ) .......................................................... 13
    5.1.7     ATTENDANCE OCCURRENCE - Activity Characteristics: ................................................ 13
    5.1.8     ATTENDANCE OCCURRENCE - Service Agreement Details: ........................................... 14
    5.1.9     ATTENDANCE OCCURRENCE - Clinical Activity Group (OPCS): .................................. 14
    5.1.10    ATTENDANCE OCCURRENCE - Clinical Activity Group (READ):.................................. 14
    5.1.11    ATTENDANCE OCCURRENCE -Location Group of Care Attendance:.............................. 14
    5.1.12    GP REGISTRATION .............................................................................................................. 15
    5.1.13    REFERRAL - Activity Characteristics:................................................................................... 15
    5.1.14    REFERRAL - Person Group (Referrer): ................................................................................. 15
    5.1.15    MISSED APPOINTMENT - Occurrence................................................................................ 15
    5.1.16    HEALTHCARE RESOURCE GROUP - Activity Characteristics:........................................ 15
    5.1.17    HEALTHCARE RESOURCE GROUP - Clinical Activity Group:........................................ 15
    5.1.18    RADIOTHERAPY TAIL IDENTIFIER ................................................................................. 16
    5.1.19    RADIOTHERAPY EPISODE................................................................................................. 16
    5.1.20    RADIOTHERAPY PRESCRIPTION ..................................................................................... 16
    5.1.21    RADIOTHERAPY EXPOSURE............................................................................................. 17
 5.2     Training............................................................................................................................................ 17
6 Oncology Management (OMS)/ Verify and Record (V&R) Systems Guidance ......................................18
 6.1     Patient Demographics...................................................................................................................... 18
 6.2     Attendance Occurrence.................................................................................................................... 19
 6.3     Radiotherapy Episode...................................................................................................................... 20
 6.4     Radiotherapy Prescription ............................................................................................................... 20
 6.5     Radiotherapy Exposure.................................................................................................................... 21
7 Patient Administration Systems (PAS) Guidance .....................................................................................21
 7.1     18 week wait Data Items.................................................................................................................. 21
 7.2     Patient Demographics...................................................................................................................... 22



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  7.3     Service Agreement details ............................................................................................................... 22
  7.4     Linkage of PAS to OMS Data ......................................................................................................... 23
8 Quality assurance.......................................................................................................................................24
9 Risk Assessment ........................................................................................................................................25
  9.1     Changes in data collection ............................................................................................................... 25
  9.2     Data Extraction ................................................................................................................................ 25
  9.3     Detection of unsafe practice ............................................................................................................ 25
  9.4     Output quality .................................................................................................................................. 26
10 Appendix 1 - Care Dataset for Radiotherapy ............................................................................................27
11 Appendix 2 – ICD10 codes for Primary Diagnosis...................................................................................35
12 Appendix 3 – OPCS4 codes for anatomical site treated coding................................................................37
13 Appendix 4 Software Specific Guidance...................................................................................................39
  13.1 Visir / Oncentra................................................................................................................................ 39
  13.2 Varis / Aria ...................................................................................................................................... 46
  13.3 Impac / Mosaiq ................................................................................................................................ 53
14 Appendix 5 – OPCS4.4 codes for Radiotherapy .......................................................................................63
15 Appendix 6 - Specification for Extract from PAS for RTDS v3.6............................................................64
16 Appendix 7 - Specification of Extract from OMS for RTDS v3.6............................................................66
17 Appendix 8 – User instructions for the Visir Toolkit................................................................................69
  17.1 Installation ....................................................................................................................................... 69
  17.2 Running the extracts from Visir ...................................................................................................... 73
     Instructions for using the VISIR Export files .......................................................................................... 73
  17.3 Creating the extract from PAS......................................................................................................... 74
     Step 1 – Copy Extract files ...................................................................................................................... 75
     Step 2 – Centre Information & Dates ...................................................................................................... 76
     Step 3 – Obtain List of Patients for PAS Data Extract ............................................................................ 77
     Step 4 - Reference and Integrity Checks ................................................................................................. 77
     1) PAS System Extract......................................................................................................................... 78
     2) Consultant Oncologist ..................................................................................................................... 80
     3) Primary Diagnosis ........................................................................................................................... 82
     4) Treatment Machine.......................................................................................................................... 85
     5) Beam Energy and Type ................................................................................................................... 89
     6) Not Linked to Requisition ............................................................................................................... 93
     7) Linked to Old Requisition ............................................................................................................... 96
     8) Unsummarised Treatment................................................................................................................ 99
     Completing the housekeeping checks.................................................................................................... 101
  17.4 Running the extract........................................................................................................................ 102
  Appendix 1................................................................................................................................................. 103
18 Appendix 9 - User instructions for the Impac Toolkit.............................................................................105
19 Appendix 10 - User instructions for the Varis Toolkit............................................................................105
20 Appendix 11 – Quality Assurance Process..............................................................................................105




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1 Introduction
There is no current requirement to report radiotherapy activity in the UK.

Paradoxically, as most radiotherapy is carried out using linear accelerators, which are run by
databases which store every detail of every treatment given, there is a huge volume of very high
quality data available.

The objective of the radiotherapy dataset is to collect a standard dataset regarding every patient
treated with radiotherapy in the NHS in the UK.

This document lists the dataset which is to be collected, and identifies changes which will need to
be made in some centres in order to implement collection of the dataset.




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2 Background
Since the disbandment of the radiotherapy Körner return in 1995, there has been no central
collection of radiotherapy activity in the UK.

In 1998 the team which eventually became the National Cancer Services Analysis Team was
established to carry out work which would be used to allocate the New Opportunities Fund money
for new radiotherapy equipment in England. In order to complete this work, the team had to
approach each radiotherapy facility in the UK to collect data.

As a result of this work, it became clear that excellent data were available in radiotherapy facilities
and that if these data could be collected centrally, that a useful resource could be developed.

In 2003 a first version of a standard radiotherapy dataset was developed and circulated to centres.
 All were encouraged to identify which data items they were able to extract from existing systems.

Two major issues arose from this. The first was that many centres had never extracted data from
their systems before, and that systems contained ‘dummy’ data on non-patient treatments, and
other data anomalies, which had been previously relevant. It became clear that the data entry
processes would need to be validated if data was to be used for these purposes. The second
issue was that there was a great deal of variation in the expertise of centres to extract data from
their systems. Some centres were unable to produce extracts. Work with expert centres and the
manufacturers has produced extraction toolkits which enable data to be extracted with less
expertise and system knowledge.

A large database (~500,000 treatments) has been assembled using data which are readily
available, and these data have proved useful for comparative work. The next step in the process
will involve standardisation of data collection methodologies so that standard returns can be
submitted.




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3 Who will use the standard?
Data for the standard will continue to be collected by radiotherapy radiographers and practitioners
treating patients with radiotherapy, and clerical staff supporting them.

The majority of items in the data standard are already collected in radiotherapy facilities, with some
centres collecting the whole standard. Data will be extracted directly from radiotherapy equipment
software (verify and record systems, or radiotherapy management systems) for production of the
standard.

The data will initially be collated by the National Cancer Services Analysis Team, who will prepare
standard analyses of the information. Once the data standard is established and there is
confidence within the service in the data collected, the collation of data will be negotiated with the
Secondary Uses Service.

Primary users of the output data will be the organisations responsible for radiotherapy in the NHS
(Providers, Purchasers and Cancer Networks), who will use the data for service planning and
benchmarking.

Secondary users of the output data will include organisations who collect data for epidemiological,
clinical audit and research purposes (eg: Cancer Registries, National Clinical Audit Support
Program, and The National Clinical Research Network). All of these organisations currently collect
data on radiotherapy using parallel paper based systems.

Subject to adequate data quality and information governance, data will finally be shared with other
organisations with an interest in radiotherapy (eg: Royal Colleges, Independent researchers,
Patient Groups, Public).




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4 Impact Assessment

   4.1 Data Collection
The majority of data items are already collected in radiotherapy centres.

The impact in individual centres varies depending on the number of items in the proposed data
standard already collected, and local variations in the coding systems used (if any) and differences
in the currencies used in each centre.


       4.1.1 Items not collected:
A small number of items (eg: NHS number, Decision to treat date, Earliest Clinically Appropriate
Date, Priority) are not routinely collected on the system from which the extract is produced at most
sites. These data items are readily available from patient casenotes, and are usually recorded on
other systems.

There are two major approaches to resolving this issue:

   •   To begin collecting the item using the verify and record/radiotherapy management system.
       This will generally involve additional effort if the item has previously been recorded only in
       casenotes, but will normally be done as part of a new clinical record entry process adding a
       few seconds to a process which will take several (3-5) minutes. Guidance is provided at
       Appendix 4 to indicate which fields should be used for each item in the commonly used
       software packages.

   •   To extract the data item from an alternative system where it is already recorded, and join it
       to the extract taken from the verify and record/radiotherapy management system to
       complete the extract. This approach will also require additional effort to develop a tool
       which will facilitate the join, and the quality assure the joined data to ensure that no errors
       arise. This is likely to take 2-3 days of development time (probably from the local IT
       department, or medical physics department) as a one off process. Followed by minimal
       additional time to extract the data from more than one system, and join the data each month
       prior to submission.


       4.1.2 Items not coded or coded using different coding systems:
A small number of items (consultant, diagnosis, anatomical site treated) are coded in the data
standard. Historically verify and record systems have had local codes included, or have had these
items entered as free text. Many sites have now updated their systems to include the proposed
codes.

The approaches to resolving this issue are as follows:




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   •   To recode a coded item after the extract has been run. This might be applicable where the
       relevant data item is already well coded, and can be effectively mapped to the required
       codes. An example might be consultant code, where most systems record this item under a
       local personnel code, or using the consultant’s initials. These local codes could be mapped
       to the GMC numbers, and the data extraction tool could be modified to replace the local
       codes in the extract with the required code. This would require minimal effort to generate a
       file mapping the local codes to the standard codes.
   •   To modify the software to facilitate the entry of data using the correct codes. This is
       applicable where the data was previously recorded using free text or using a set of codes
       which cannot easily be mapped to the standard codes. An example might be diagnosis,
       where if data is coded it is often using a set of codes devised locally, which will not easily
       map to the proposed set of ICD10 codes. Software patches are undergoing development
       with the support of the system manufacturers to facilitate updating of the code lists in the
       systems. Additional work may be required where free text was previously used. The
       training implications of adopting new coding systems are addressed later in the document.


       4.1.3 Differences in currencies between sites:
The data standard clearly defines a ‘patient’, ‘episode, ‘prescription’ and ‘exposure’. In general
these equate to records stored in certain tables in each of the software packages. As the
databases are relational, there is the capacity to create new records onto which new records will
be attached at different times in the patient’s progress through the process. For example, the
definition of a tumour states that all treatment given relating to each primary tumour should be
related back to one tumour record. In some centres it is practice to create a new tumour record
each time a patient is referred for further treatment, or to create a new tumour record if a patient
develops secondary tumours.

The two solutions are as follows:

   •   To modify local practice to ensure that records are created in line with the definitions. This
       is unlikely to have any significant time impact on the data entry time (in most cases it is
       likely to save time). The training implications are covered later in this document.

   •   In certain circumstances it might be possible to extract data so that additional records
       created in this way are ignored. Any extract derived in this way would require careful quality
       assurance.



   4.2 Data Extraction

To date data extraction has been using extraction tools developed by the National Cancer
Services Analysis Team in collaboration with experts on each of the software packages from
radiotherapy facilities in the UK, and from the software manufacturers.

Prior to extraction, a number of quality reports on the data might be run. For example, at the end
of each treatment, a summary is entered manually on the system which flags the treatment as



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complete. The extract uses this flag to identify treatments which have finished during the relevant
time period. It is possible to leave the summary uncompleted, and therefore the treatment still
flagged as ongoing, a report could identify treatments which appear to have no activity since the
end of the relevant period and therefore which are likely to be complete. A manual exercise would
then need to be undertaken to identify the missing summaries. It seems likely that data quality
would improve after several cycles.

The extraction is generally a two stage process, where the initial stage is to run a series of extracts
from the database tables, using the proprietary executive information software recommended by
the supplier, along with a series of extract files provided as part of the extraction tool.

This initial process has to be run on a backup server, as these systems are mission critical for the
treatment of patients, and a failure while treatments are being undertaken could be disastrous.
Some sites do not have backup servers. In this case the extracts are run at the end of the day
after treatment is finished.

The second stage of the process is to run the extracts from the database through an Access
Database tool. The tool generates the table structure required for the data standard, and formats
each data item correctly. It would be during this process that certain fields could be recoded if
appropriate.

Data will then need to be quality assured before it is submitted. The National Cancer Services
Analysis Team are preparing a series of quality reports which could be run prior to submission (eg:
number of records, completeness of fields, validation of field formats), centres might wish to also
develop their own protocols for data quality assurance. NATCANSAT are encouraging discussion
on this and other areas via a listserver. The current proposed quality assurance process is
outlined in Appendix 11.

The pre-report quality assurance and the initial extraction process is likely to be run by the team
responsible for the database, this will usually be a specialist radiographer, physicist or clinical
technologist. If there is no backup server, this person will need to stay behind at the end of the
working day (many departments operate extended working hours) in order to see the process
complete to ensure that the database has not crashed as a result. This may take anything up to
one hour (although only a few minutes of this time would be required to start the process and
remove the completed extracts at the end).

Pre-report quality assurance may initially take some time to complete (perhaps 2-3 days) if data
quality is poor in a centre and has not been tested in this way previously. It would be expected
that data quality would quickly improve with appropriate training, and that this process would take
no more than 30 minutes to 1 hour to complete under normal circumstances.

The second stage of extraction, and the post-report quality assurance might be run by the same
radiotherapy team, or might be taken over by a Trust’s information team. In either case, the time
taken to run the second stage is minimal (10 minutes per extract). The time taken to do quality
assurance will vary, depending on the numbers of errors identified by the reports, and the volume
of additional reports run by a centre. This process may take some time (perhaps 2-3 days) for the
first extract when Trusts will check that both overall numbers are correct, and audit a small number
of individual cases to ensure that each data item has been correctly transferred to the extract, so



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that Trusts can satisfy themselves that reports have run successfully. After this it might take
anything from 30 minutes to a day depending on the extent of quality assurance carried out, and
the quality of the input data.


   4.3 Impact Summary:


       4.3.1 Initial setup time

Data Input:
Two days – two weeks of clinical scientist/clinical technologist/specialist radiographer time to
modify look-up tables and/or generate mapping tables.
Training of data entry staff – One hour for clinical staff, three hours for non-clinical staff.

Extraction:
One week of clinical scientist/clinical technologist/specialist radiographer/information officer to run
initial quality assurance and to ensure that data is correctly extracted.


       4.3.2 Ongoing time requirement

Data Input:
Minimal additional time from staff (radiographers or clerical staff) entering new cases on the
system.

Extraction:
Thirty minutes to one hour of clinical scientist/clinical technologist/specialist radiographer to run the
extract (may need to be run out of hours if there is no backup server) – may require additional time
to wait for the report to run out-of hours (up to one hour).
Thirty minutes to three hours of scientist/clinical technologist/specialist radiographer/information
officer for quality assurance.




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5 Implementation and training guidance
The Cancer Action Team has proposed that each cancer network/radiotherapy facility establishes
an implementation group. This group will lead the process for the implementation of changes
required for each radiotherapy facility.

The dataset and extraction tools have been tested at the majority of radiotherapy facilities in the
UK. The main thrust of implementation will therefore to be to make the changes to data collection
processes as indicated in the impact section.

Considerable work has been done to identify the data items which are not collected (if any) at each
centre, and any other areas where modifications will need to be undertaken. Centres and
Networks should refer to the documentation which has been sent to them by the National Cancer
Services Analysis Team

NATCANSAT have tools which are approved by the manufacturers, which will facilitate updating of
coded lists within the common software packages (Visir/Oncentra, Varis/Aria, Lantis and Impac).


   5.1 Data items and issues are recorded below:

Each Radiotherapy Attendance will be reported using the Dataset below, see Appendix 1 which
consists of the Standard CDS plus an Additional Radiotherapy Tail. Attendance specific
information will be taken from the Oncology Management Systems (OMS) at each Radiotherapy
Facility, and combined with demographic and other non-‘attendance specific’ information taken
from PAS to generate the required file. This will avoid duplication of entry of Radiotherapy
Attendances into PAS and OMS.


       5.1.1 PATIENT PATHWAY: version 6

       Unique Booking Reference Number (Converted) The unique booking reference number
       assigned by the NHS Connecting for Health Choose and Book system when a patient
       accepts an appointment date offered of an appointment offer where the offer was made via
       the NHS Connecting for Health Choose and Book system
       Patient Pathway Identifier - An identifier, which together with the Organisation Code of the
       issuer, uniquely identifies a patient pathway. This is an existing data item which should be
       available from PAS.
       Organisation Code (Patient Pathway Identifier Issuer) - This is the Organisation Code of
       the organisation issuing the patient pathway identifier.
       Referral To Treatment Status - The status of an activity (or anticipated activity) for the 18
       Week referral to treatment period decided by the lead care professional. This is an existing
       data item which should be available from PAS.
       Referral To Treatment Period Start Date will be the date that request for radiotherapy is
       received, where radiotherapy is the appropriate treatment for the 18 week wait. (See the
       dataset definitions in Appendix 1 for specific guidance).



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       Referral To Treatment Period End Date will be the date that first fraction of radiotherapy is
       given, where radiotherapy is the appropriate treatment for the 18 week wait.

       5.1.2 PATIENT IDENTITY
       For reasons of confidentiality, the patient's preferred name and address (not including
       postcode of usual address must not be carried where a valid NHS Number is present. For
       patients with sensitive conditions (as defined in DSCN 41/98/P26), all patient identifiable
       information must be removed from Commissioning Data Set records. This includes local
       patient identifier, organisation code (local patient identifier), NHS number, patient name,
       patient usual address, postcode of usual address, organisation code (PCT of residence),
       and person birth date (in Patient Characteristics data group below).

       Local Patient Identifier – this number is normally a local casesheet number, or an internal
       database sequence number.
       Organisation Code (Local Patient Identifier) is the standard NHS organisational code
       issued by NACS
       NHS Number – is used to identify a person uniquely within the NHS in England and Wales.
       If NHS number is recorded in the non-standard field this can be handled by the extraction
       toolkit. NHS number must be consistently recorded in the same field, which should
       preferably be equipped to validate the number on save. Where NHS number is currently
       not recorded (~30% of facilities) steps should be taken to ensure that it is entered on the
       system, or that it can be joined from another source when data is extracted.
       NHS Number Status Indicator indicates the status of the above record of the NHS number
       regarding validation.
       Patient Name is the preferred name of the patient, forename followed by surname.
       Patient Usual Address is the usual address nominated by the patient.
       Postcode Of Usual Address - is the post code of the patient’s usual address. It is
       consistently recorded in PAS systems.
       Organisation Code (PCT of Residence) is the standard NHS organisational code issued
       by NACS.


       5.1.3 PATIENT CHARACTERISTICS

       Person Birth Date is consistently recorded by all centres in a standard field in all databases
       Person Gender Current is consistently recorded by all centres in a standard field in all
       databases. (data from some databases will need to be recoded)
       Carer Support Indicator is not required.


       5.1.4 CARE EPISODE - Person Group (Consultant)
       Consultant Code records the person responsible for this care episode. In the case of
       radiotherapy care episodes a therapy radiographer will be responsible so the default code
       for an “other Health Care Professional” will be used. The radiographer's own code is not
       used.




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       Main Specialty Code is the specialty in which the other Health Care Professional is
       contracted or recognised. In the case of radiotherapy care episodes will be recorded with an
       “Allied Health Care Professional code.
       Treatment Function Code is the specialty under which the patient is treated. In the case of
       radiotherapy, the clinical oncology code will be used.


       5.1.5 CARE EPISODE - CLINICAL DIAGNOSIS (ICD):

       Diagnosis Scheme In Use This denotes the Coding Scheme basis of the Diagnosis i.e
       ICD10
       Primary Diagnosis (ICD) This is the ICD10 code for the primary tumour which is
       undergoing therapy, taken from the list in Appendix 2. Non-clinical staff will require training
       in coding this field. Visir users must code each target for the same tumour with the same
       code so that these can be aggregated to generate one tumour record for each tumour.
       Patients presenting with secondary tumours from an unknown primary site should be coded
       as C80 (Unknown primary site)
       Secondary Diagnosis (ICD) – as primary diagnosis. This is not required for radiotherapy
       records.


       5.1.6 CARE EPISODE - CLINICAL DIAGNOSIS (READ)
       Diagnosis Scheme In Use This is not required as ICD10 is used.
       Primary Diagnosis (Read) This is not required as ICD10 is used.
       Secondary Diagnosis (Read) This is not required as ICD10 is used.


       5.1.7 ATTENDANCE OCCURRENCE - Activity Characteristics:

       Attendance Identifier A sequential number or time of day used to enable an attendance to
       be uniquely identified. With RTDS the patient identifier and treatment date will be used and
       this will link OPCDS with the radiotherapy attendance record.
       Administrative Category This records the category of treatment for this episode e.g. NHS
       or private health care. This is an existing data item which should be available from PAS.
       Attended Or Did Not Attend This indicates whether or not an appointment took place.
       Where data is extracted from treatment systems, and the administration of a radiotherapy
       exposure is the trigger for the generation of an attendance record the value will always be
       attended.
       First Attendance This indicates whether this is the first attendance of this radiotherapy
       episode (first attendance or follow up attendance or making contact.) This will be derived
       from the episode data in the Oncology Management System.
       Medical Staff Type Seeing Patient A classification of the type of medical staff seeing the
       patient. For radiotherapy the code for Care Professional team will be recorded.
       Operation Status (Per Attendance) is used once for each record to record states of
       knowledge regarding the operative procedure. For radiotherapy the code for treated will be
       used.




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       Outcome of Attendance is records the outcome of the attendance, and whether the patient
       has been given a further appointment or discharged. This will be derived from the episode
       data in the Oncology Management System.
       Appointment Date Mandatory date which will be extracted from the Oncology Management
       system using the extraction tool.
       Age at CDS Activity Date This is calculated from the appointment date minus the patient’s
       date of birth.
       Earliest Reasonable Offer Date – This is not required.


       5.1.8 ATTENDANCE OCCURRENCE - Service Agreement Details:

       Commissioning Serial Number is used to identify patients treated under Out of Area
       Treatments (OATs). This is an existing data item which should be available from PAS.
       NHS Service Agreement Line Number may be used to identify a specific service
       agreement reference where the main identifier refers to a general omnibus agreement. This
       should be an existing data item which should be available from PAS.
       Provider Reference Number A convention agreed locally between a provider and
       Commissioner for use within a CDS message. This is an existing data item which should be
       available from PAS
       Commissioner Reference Number A number (alphanumeric) allocated by the
       commissioner to a referral request. This is an existing data item which should be available
       from PAS
       Organisation Code (Code of Provider) is the standard NHS organisational code issued by
       NACS
       Organisation Code (Code of Commissioner) is the standard NHS organisational code
       issued by NACS

       5.1.9 ATTENDANCE OCCURRENCE - Clinical Activity Group (OPCS):

       Procedure Scheme In Use used to denote the scheme basis of an Intervention, Operation
       or A&E Treatment. For radiotherapy care procedures OPCS-4 will be used.
       Primary Procedure (OPCS) Procedure Date (of Primary Procedure) The OPCS code for
       radiotherapy procedure will be recorded in the Oncology Management System.
       Procedure (OPCS) Procedure Date (of Secondary Procedure) The OPCS code for
       radiotherapy procedure will be recorded in the Oncology Management System.

       5.1.10 ATTENDANCE OCCURRENCE - Clinical Activity Group (READ):

       Procedure Scheme In Use - This is not required. OPCS is to be used. Please see above.
       Primary Procedure (Read) Procedure Date (Of Primary Procedure) - This is not
       required. OPCS is to be used. Please see above.
       Procedure (Read) Procedure Date (Of Secondary Procedure) - This is not required.

       5.1.11 ATTENDANCE OCCURRENCE -Location Group of Care Attendance:
       Location Class for use within CDS messages of the physical location within which the
       recorded patient event occurs



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       Site Code (Of Treatment) is the standard NHS organisational code issued by NACS.
       Location Type – This is not required.


       5.1.12 GP REGISTRATION

       GMP (Code of Registered or Referring GMP) should be the GMC code of the General
       Medical Practitioner with whom the patient is registered. This is an existing data item which
       should be available from PAS.
       Code of GP Practice (Registered GMP) is the standard NHS organisational code issued
       by NACS. This is an existing data item which should be available from PAS.


       5.1.13 REFERRAL - Activity Characteristics:

       Priority Type this item is recorded in the Oncology Management System by the majority of
       centres, but the coding systems used are frequently not able to be mapped to the NHS
       codes. Centres will need to review the impact of modifying codes to the NHS codes.
       Service Type Requested is the terms of reference for this referral. In the case of
       radiotherapy, the specific procedure code will be used in all cases.
       Source of Referral for Out-Patients is used to identify the source of referral. In the case of
       radiotherapy, the specific procedure code will be used in all cases.
       Referral Request Received Date is the date of which the radiotherapy radiographer
       receives the referral request from clinical oncologist.



       5.1.14 REFERRAL - Person Group (Referrer):

       Referrer Code is the Consultant Clinical Oncologist’s GMC number.
       Referring Organisation Code is the standard NHS organisational code issued by NACS.


       5.1.15 MISSED APPOINTMENT - Occurrence
       Last DNA or Patient Cancelled Date This is not required.


       5.1.16 HEALTHCARE RESOURCE GROUP - Activity Characteristics:
       Healthcare Resource Group Code - This item is under discussion pending the
       implementation of new HRG codes.
       Healthcare Resource Group Code-Version Number


       5.1.17 HEALTHCARE RESOURCE GROUP - Clinical Activity Group:

       Procedure Scheme In Use - This is not required.
       HRG Dominant Grouping Variable-Procedure - This is not required.



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       5.1.18 RADIOTHERAPY TAIL IDENTIFIER

       Attendance Identifier A sequential number or time of day used to enable an attendance to
       be uniquely identified. With RTDS the patient identifier and treatment date will be used and
       this will link OPCDS with the radiotherapy attendance record. This item will not require data
       input.
       Organisation Code (Code of Provider) is the standard NHS organisational code of the
       provider of radiotherapy, issued by NACS.
       Appointment Date The mandatory date for this radiotherapy attendance.


       5.1.19 RADIOTHERAPY EPISODE

       Radiotherapy Episode Identifier is an internal database sequence number from the table
       (see Appendix 4). This item will not require data input. This item will not require data input.
       Decision to Treat Date (Teletherapy /Brachytherapy) (DDT) is the date when the clinician
       and the patient agreed that this course of radiotherapy needs to be administered. The date
       is recorded in the majority of centres, but is sometimes recorded in alternate systems.
       Earliest Clinically Appropriate Date This is the first date that the patient is available to
       start radiotherapy. It is the same date as the Decision to Treat date, above unless there
       was an elective delay for clinical reasons e.g patient needs to recover from surgery,
       treatment protocol advises hormone therapy required before radiotherapy. This item is not
       recorded by all centres, and is sometimes recorded in alternate systems.
       Radiotherapy Priority - this item is recorded in a standard location by the majority of
       centres in OMS. The coding systems used are mapped to the NHS priority codes. Centres
       will need to review the impact of modifying codes to the new Radiotherapy Priority codes as
       recommended by the Royal College of Radiologists.
       http://www.rcr.ac.uk/docs/oncology/pdf/gaps.pdf E= Emergency, U=Urgent, R=Routine and
       D=Elective Delay.
       Treatment Start Date (Radiotherapy Treatment Course) – The date of first fraction of
       radiotherapy in this episode. The date is derived from individual treatment data recorded
       consistently in a standard location in all facilities.


       5.1.20 RADIOTHERAPY PRESCRIPTION

       Prescription Identifier- time of day used to enable an attendance to be uniquely identified.
       With RTDS the patient identifier and treatment date will be used. This item will not require
       data input.
       Radiotherapy Treatment Region – this item is not recorded by most centres. The code will
       determine the intention of the radiotherapy to treat either the primary tumour = P, regional
       lymph nodes = R, primary and regional nodes = PR, non - anatomically specific primary site
       =A, prophylaxis to non-primary site = O or metastatic disease=M.
       The recommended field for this data item is identified in Appendix 4. Centres will need to
       begin to collect this data item. It will not be possible for non-clinical staff to identify the code
       for this field unless it is explicitly defined on the case record.




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       Radiotherapy Anatomical Treatment Site This field needs completion ONLY when the
       site treated cannot be derived from the diagnosis and ‘radiotherapy treatment region’ fields.
        (ie: when the entry in the radiotherapy treatment region: field is A, O or M.) The site treated
       needs to be coded using the OPCS4 site code (See appendix 3). Non-clinical staff will
       require training in order to be able to code anatomical sites.
       Number of Teletherapy Fields- this item is derived from individual treatment data recorded
       consistently in a standard location in all facilities. This item will not require data input.
       Radiotherapy Prescribed Dose – as defined in the ICRU50 report. The total prescribed
       absorbed dose, in Grays, at ICRU reference point, for the prescription. This item is
       consistently recorded in a standard format in all centres. Some centres still use non-SI
       units, but these can easily be converted in the access database tool, if appropriate. See
       www.icru.org/n_992_4.htm for further information.
       Prescribed Fractions - The total number of fractions or hyperfractions of radiotherapy to be
       given with this prescription. This item is consistently recorded in a standard format in all
       centres.
       Radiotherapy Actual Dose – as defined in the ICRU50 report. The total absorbed dose, in
       Grays, at ICRU reference point, given for this prescription of radiotherapy. This item is
       consistently recorded in a standard format in all centres.
       See www.icru.org/n_992_4.htm for further information.
       Actual Fractions -The total actual number of fractions or hyperfractions the patient
       received for this prescription of radiotherapy. This item is consistently recorded in a
       standard format in all centres.
       Radiotherapy Treatment Modality is either teletherapy =T or brachytherapy= B. This field
       is derived from the equipment code, which is entered consistently in a standard location at
       all sites. This item will not require data input.


       5.1.21 RADIOTHERAPY EXPOSURE

       Field Identifier - internal database sequence number from the table used for the
       prescription record (see Appendix 4). This item will not require data input.
       Machine Identifier - this item is consistently recorded by all centres in a standard location.
       Most centres use local codes for machine names, which will need to be mapped to the
       standard codes. This can be done using the extraction tool.
       Teletherapy Beam Type – this item is consistently recorded in a standard format in all
       centres. Most centres use local codes for beam type (usually combined with beam energy),
       which will need to be mapped to the standard codes of T1= Photons, T2 = Electrons and T3
       = Other. This can be done using the extraction tool.
       Teletherapy Beam Energy – This data only required for multi-modality machines. The
       beam energy is recorded as MeV/MV/MVp. For kVp machines the energies should be
       recorded as decimals (e.g. 250kV = 0.25MV). This item is consistently recorded in a
       standard format in all centres. This item will not require data input.
       Time of Exposure - The time when radiotherapy exposure commences. This item is
       recorded automatically and consistently in the OMS.

5.2      Training




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The data items where specific training is likely to be required (especially where data is being
entered by non-clinical staff) will be the coded diagnosis and anatomical site treated fields, and the
new field of treatment to, and also any specific fields which are new at a particular centre.

Training & Support will be provided in three main ways:

1: Data entry and coding: training materials will be prepared (presentations, trainers and trainees
notes) and made available to all facilities via the project website. Individual implementation groups
will adopt the most appropriate training format for their staff.

2: Data Extraction/QA and submission: Clear instructions are provided as a readme file with the
extraction toolkits. As QA protocols develop it might be appropriate to provide training for non-
radiotherapy staff who are carrying out QA.

3: Dataset helpdesk: The National Cancer Services Analysis Team runs a helpdesk for all their
projects. The helpdesk is staffed by two junior analysts (AfC grade 4), who will deal with
straightforward queries immediately and pass complex ones onto the project team for a response
within 24 hours. This helpdesk will continue to provide telephone support to users of the data
standard as required.

4: On-site help/training: The National Cancer Services Analysis Team has retained the services of
two experienced staff (a recently retired principal physicist, and a recently retired superintendent
radiographer), who will be available to visit centres and assist with resolving problems and training
on-site.

6 Oncology Management (OMS)/ Verify and Record (V&R) Systems
  Guidance
A series of reports from the OMS and /or V&R database tables need to be extracted using the
proprietary executive information software recommended by the supplier to populate the data
items listed below. Appendix 7 gives a list of the specific data items to be taken from OMS in order
to generate the required file. Extraction reports approved by the manufacturers are provided for
each OMS.

The second stage of the reporting will import the reports into an Access database. A Visual Basic
tool then generates the table structure required for the data standard, and formats each data item
correctly.

         6.1 Patient Demographics

      Local Patient Identifier This identifier is routinely a local casesheet number, or an internal
      database sequence number created in the OMS. It will be used to link records from the
      Oncology Management System (OMS) to the PAS records.
      NHS Number is increasingly being recorded in Oncology Management System (OMS) and
      being the primary patient identifier. It will be used to link records from the Oncology
      Management System (OMS) to the PAS records.




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      Postcode of Usual Address is consistently recorded by most centres in a standard field in
      all databases. In facilities where postcode is not recorded, steps should be taken to ensure
      that it is entered on the system, or that it can be joined from another source when data is
      extracted.
      Person Birth Date is consistently recorded by most centres in a standard field in all
      databases. In facilities where date of birth is not recorded or default date used, steps should
      be taken to ensure that it is entered on the system, or that it can be joined from another
      source when data is extracted.
      Person Gender Current is consistently recorded by most centres in a standard field in the
      OMS database. This may need to be recoded or mapped to reflect dataset requirements.
      Primary Diagnosis (ICD) is now being used to record diagnosis. In centres were ICD10 is
      not the coding scheme used, there will be direct mapping to the local used codes. The code
      describes the primary tumour which is undergoing radiotherapy. Non clinical staff will require
      training in coding this field. Visir users must code each target for the same tumour with the
      same code so that these can be aggregated to generate one tumour record for each tumour.
       Patients presenting with secondary tumours from an unknown primary site should be coded
      as C80 (Unknown primary site).

         6.2 Attendance Occurrence
      Attendance Identifier is a sequential number or date and time stamp taken from the OMS
      and used to uniquely identify a radiotherapy attendance.
      Administrative Category has not previously recorded in OMS although appropriate
      datafields have been identified. Steps should be taken to ensure that it is entered on the
      system.
      Attended or did not attend defaults to an attended record where the event triggering an
      attendance record is a radiotherapy exposure and unless DNA information is available in the
      OMS.
      First Attendance The first attendance of the radiotherapy episode is registered by the
      Access database tool.
      Outcome of Attendance will be completed in OMS for the last treatment of the radiotherapy
      episode (discharged).
      Appointment Date is will automatically created with date and time stamp in the OMS.
      Primary Procedure will be taken from the appointment scheduler or activity capture software
      module of the OMS. The list of OPCS4 radiotherapy procedures codes Appendix 5 will need
      to be imported into the module or directly mapped using the Access database tool.
      Please note that a radiotherapy attendance may have as many as six procedures related to
      that attendance. Equally the same radiotherapy prescription may have different procedures
      codes associated with it.
      Primary Date (of Primary Procedure) see above.
      Referral Request Received Date - the date in which the radiotherapy radiographer receives
      the referral for treatment from the clinical oncologist is recorded in OMS.
      Referrer Code – the name or initials of the consultant responsible for the planning and / or
      prescribing the radiotherapy is recorded in the OMS. The Access database tool registers the
      General Medical Council number for that individual doctor.




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         6.3 Radiotherapy Episode

      Radiotherapy Episode ID Number is an internal database primary key taken from the OMS
      to uniquely identify a radiotherapy episode.
      Decision to treat date -This item is recorded in the majority of centres, but is sometimes
      recorded in alternate systems. The recommended field for this data item is identified in
      Appendix 4. If centres wish to continue to record this item elsewhere, they need to ensure
      that it can be joined to the extract adequately.
      Earliest Clinically Appropriate Date. The date is recorded in the majority of centres, but is
      sometimes recorded in alternate systems. The recommended field for this data item is
      identified in Appendix 4. If centres wish to continue to record this item elsewhere, they need
      to ensure that it can be joined to the extract adequately.
      Radiotherapy Priority - this item is recorded in OMS but the coding systems used are
      frequently not able to be mapped to the NHS codes. The recommended field for this data
      item is identified in Appendix 4.
      Start Date (Radiotherapy Treatment Course) – this date is derived from individual
      treatment data recorded consistently in the OMS.


         6.4 Radiotherapy Prescription

      Prescription ID Number is an internal database primary key taken from the OMS to uniquely
      identify a radiotherapy prescription.
      Radiotherapy Treatment Region – This item is not recorded by most centres. The
      recommended field for this data item is identified in Appendix 4. Centres will need to begin to
      collect this data item. In the case of the Elekta OMS, as only one appropriate datafield has
      been identified the data items, Radiotherapy Treatment Region and Anatomical Treatment
      Site, below will be recorded together.
      Ra\diotherapy Anatomical Treatment Site – This item is recorded in OMS but the coding
      systems used are frequently not able to be mapped to the NHS codes. The recommended
      field for this data item is identified in Appendix 4. The anatomical treatment site needs to be
      coded using the OPCS4 site code (see appendix 3). Non-clinical staff will require training in
      order to be able to code anatomical sites.
      Number of Teletherapy Fields – This item is derived from individual treatment data
      recorded consistently in the OMS.
      Radiotherapy Prescribed Dose – This item is consistently recorded in a standard field in
      the OMS. Some centres still use non-SI units, but these can easily be converted in the
      extraction tool, if appropriate.
      Prescribed Fractions – This item is consistently recorded in a standard field in the OMS.
      Most centres use local codes for beam type (usually combined with beam energy), which will
      need to be mapped to the standard codes. This can be done using the extraction tool.
      Radiotherapy Actual Dose – The accumulative given dose is calculated from individual
      treatment data which are recorded automatically and consistently in the OMS. Some centres
      still use non-SI units, but these can easily be converted in the extraction tool, if appropriate.
      Teletherapy/Brachytherapy Actual Fractions - The total number of actual fractions given is
      calculated from individual treatment data which are recorded automatically and consistently
      in the OMS.



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      Radiotherapy Treatment Modality – This field is derived from the equipment code, which is
      entered consistently in a standard location at all sites. The extraction tool will populate this
      item.


         6.5 Radiotherapy Exposure
      Radiotherapy Field Identifier – is an internal database sequence number taken from the
      OMS to uniquely identify a radiotherapy exposure.
      Machine Identifier - This item is consistently recorded by all centres in a standard location.
      Most centres use local codes for machine names, which will need to be mapped to the
      standard codes. This can be done using the extraction tool.
      Teletherapy Beam Type – This item is consistently recorded in a standard format in all
      centres. Most centres use local codes for beam type (usually combined with beam energy),
      which will need to be mapped to the standard codes of T1= Photons, T2 = Electrons and T3
      = Other. This can be done using the extraction tool.
      Teletherapy Beam Energy – This data only required for multi-modality machines. The
      beam energy is recorded as MeV/MV/MVp. For kVp machines the energies should be
      recorded as decimals (e.g. 250kV = 0.25MV). This item is consistently recorded in a
      standard format in all centres. This item will not require data input.
      Time of Exposure - The time when radiotherapy exposure commences is recorded
      automatically and consistently in the OMS. The format for time in the Elekta OMS
      (HH:MM:SS:SSS) will be reformatted into the standard code in the extraction tool.


7 Patient Administration Systems (PAS) Guidance
Demographic and other non-‘attendance specific’ information from the Standard CDS specification
will be taken from Patient Administration Systems (PAS) and joined to the ‘attendance specific’
Radiotherapy Data items to avoid duplication of entry of Radiotherapy Attendances. Appendix 6
gives a list of the specific data items to be taken from PAS in order to generate the required file.
The file should be a comma delimited file with quotes (“”) as the text identifier.

The data items intended for monitoring the 18 week waits are recorded as optional in this dataset
as, to date, most Trusts are not yet recording this items.

The extract of PAS data will be taken on a monthly basis to include information for all patients
attending for radiotherapy during the month. If radiotherapy attendances are not recorded on the
PAS systems it may not be possible to identify the correct cohort of patients. In which case the
data can be produced for all patients on the Master Patient Index MPI current for the month and
the relevant cases will be joined using the radiotherapy data.


         7.1 18 week wait Data Items
      Unique Booking Reference Number (Converted) This is a new field to monitor 18 week
      waits. It is an optional data item which will start to be recorded in PAS systems. If available it
      should be taken.
      Patient Pathway Identifier The identifier is often generated locally in the PAS system. At
      present, they may not be unique.



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      Organisation Code (Patient Pathway Identifier Issuer) Together with the Patient
      Pathway Identifier allows the identifier to become unique.
      Referral To Treatment Status
      The status of an activity (or anticipated activity) for the 18 Week referral to treatment period
      decided by the lead care professional. This is an existing data item which should be available
      from PAS.
      Referral To Treatment Period Start Date will be the date that request for radiotherapy is
      received, where radiotherapy is the appropriate treatment for the 18 week wait. (See the
      dataset definitions in Appendix 1 for specific guidance).
      Referral To Treatment Period End Date
      Is the date that first fraction of radiotherapy is given. This is recorded in PAS.

         7.2 Patient Demographics

      Local Patient Identifier This identifier is routinely a local casesheet number, or an internal
      database sequence number from PAS. It will be used to link records from PAS to the
      Radiotherapy Attendances records taken from the Oncology Management System (OMS).
      NHS Number Is recorded and verified in PAS. It will be used to link records from PAS to the
      Radiotherapy Attendances records taken from the Oncology Management System (OMS).
      NHS Number Status Indicator indicates the status of the above record of the NHS number
      regarding validation.
      Patient Name to be used only if NHS number is not validated. See NHS number status
      indicator.
      Patient Usual Address Only to be used if NHS number is not validated. See NHS number
      status indicator.
      Postcode Of Usual Address is consistently recorded by most centres in a standard format
      in PAS. In facilities where postcode is not recorded, steps should be taken to ensure that it is
      entered on the system, or that it can be joined from another source when data is extracted
      Organisation Code (PCT of Residence) Can be derived from the postcode above. It is the
      standard NHS organisational code issued by NACS.
      Person Birth Date is consistently recorded in a standard field in PAS.
      Person Gender Current is consistently recorded by all centres in a standard field in all
      databases. (data from some databases will need to be recoded)

         7.3 Service Agreement details

      Commissioning Serial Number is used to identify patients treated under Out of Area
      Treatments (OATs). This is an existing data item which should be available from PAS.
      NHS Service Agreement Line Number may be used to identify a specific service
      agreement reference where the main identifier refers to a general omnibus agreement. This
      should be an existing data item which should be available from PAS.
      Provider Reference Number A convention agreed locally between a provider and
      Commissioner for use within a CDS message. This is an existing data item which should be
      available from PAS.
      Commissioning Serial Number is used to identify patients treated under Out of Area
      Treatments (OATs). This is an existing data item which should be available from PAS.




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      Organisation Code (Code of Commissioner) The organisation which has commissioned
      this episode of radiotherapy and is recorded routinely in PAS.
        GMP (Code of Registered or Referring GMP) is consistently recorded in a standard field
        in PAS.
        Code of GP Practice (Registered GMP) is consistently recorded in a standard field in
        PAS.

         7.4 Linkage of PAS to OMS Data

    This area is important and requires careful consideration.

    The toolkits provided by NATCANSAT link the PAS and OMS data on the basis of the PAS
    number OR the NHS number alone. The toolkit can be modified to link on the basis of more
    fields if this is appropriate.

    If one number alone is to be used as the linking field it must be a validated secondary source
    of the reference number in the Oncology Management System. You will need to consider how
    the reference number (the PAS or NHS number) is entered onto the OMS, and how it is
    subsequently validated. If the number is transcribed directly from a validated primary source
    (eg: directly from the PAS system, or from the casesheet), it is a secondary source of data.
    This secondary source might then be validated by an interface with the PAS system, which
    returns other patient demographics (eg: the patient’s name) which are verified to ensure that
    the correct PAS number has been recorded in the OMS. Alternatively the number might be
    validated because the casesheet is used to identify the patient for each attendance for
    treatment, and the number from the casesheet is entered into the system to search for the
    patient records each day, and then the patient details are verified against the casesheet to
    ensure that the correct patient record has been retrieved.

    In these and similar examples a match between the PAS and OMS by this one validated
    reference number will be adequate.

    An example of an inadequately validated number might be one entered from the radiotherapy
    prescription sheet, where the number had been transcribed from the casesheet. If there is no
    PAS interface, an incorrectly transcribed number might be entered into the OMS, and there
    would be no cross-validation to identify that it was not the correct number. When the patient
    returned for further radiotherapy, if the incorrect number from the radiotherapy prescription
    was used to retrieve the patient record from the OMS, it might be possible for a whole course
    of radiotherapy to be recorded with the wrong reference number.

    Centres should give careful consideration to their systems for transcribing a validating the
    number used to identify patients on their OMS. If these are not adequate for this purpose,
    then more extensive matching can be undertaken to ensure that the same patient is recorded
    against the same number in both systems (using name, date of birth and/or postcode as
    appropriate), or procedures could be changed to ensure that numbers are validated.

    Contact the helpdesk to discuss specific examples in this area.




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8 Quality assurance
Data will be quality assured by radiotherapy centres prior to being submitted as described in the
Appendix 11.

Routine quality assurance:
Upon receipt quality assurance will be carried out in the following areas:

   •   File format – to ensure that each of the files contains the correct number of fields of the
       correct length.
   •   Referential integrity – to ensure that there is a patient record for each tumour etc.
   •   Number of records – the number of each type of records will be compared between tables
       and with previous submissions.
   •   Field format checks – eg: to check that NHS numbers and postcodes are in valid formats
   •   Cross validation checks – to check that dates are in a logical sequence, and that diagnoses
       are associated with patients of an appropriate age/sex profile
   •   Clinical checks – to ensure that the casemix is consistent with other similar sites and other
       submissions from the same sites.

Data which fails quality assurance tolerances will be reviewed by a senior analyst, who may be
able to resolve the problem, or may need to refer back to the centre to fix problems in the source
data or the extraction process.

Data which passes the QA tolerances will be uploaded to the master database, and the standard
reports will be uploaded to the project website as soon as possible. (Expected to be within three
days of receipt of data). Submitting sites will be encouraged to review the output reports to ensure
that they are satisfied that the output looks correct.

Ad-hoc quality assurance:
A rolling program of quality audits will be established. External auditors (from NATCANSAT or
from a peer organisation) will review submissions against alternative data sources for:

   •   Completeness (all treatments carried out on a machine are correctly transferred to the
       extract)
   •   Accuracy (data appears on the system as it appears on the extract)
   •   Precision (data entered on the system is as it appears in the clinical case record)




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9 Risk Assessment
The risks associated with the implementation of this data standard fall into four main areas:
   • changes in data collection
   • data extraction
   • detection of unsafe practice
   • output quality

The systems which are being used to collect data for the standard were designed to verify and
record radiotherapy treatments, in order to minimise risk of staff errors when treating patients.
These systems are mission critical to the administration of treatments, where errors can be
catastrophic. It is essential that these services are not disrupted by implementation of the
standard.

   9.1 Changes in data collection

Centres will need to implement changes to the way in which they collect data. Some will need to
make significant changes to the currencies they use to count patients.

Provided adequate checking procedures are in place, there will be no reason why these changes
should have any impact on patients directly.

The changes in data collection practice will need to be carefully managed to ensure that all staff
have time to adapt to the new practices and are not distracted from their primary purpose of
treating patients correctly.


   9.2 Data Extraction

The data extraction process, if run on a live database might have the impact of slowing down, or
even crashing the database. This might affect patient treatments, increasing overall time taken to
treat patients, and reducing accuracy and causing delays.

Data extraction tools are run under protocols to ensure that there will be no impact on patient
treatments.


   9.3 Detection of unsafe practice

Data submitted using the data standard might include information which indicates that a particular
clinician is undertaking unsafe practices, or an individual patient has undergone an erroneous
treatment which might be deemed to be unsafe.

The policy for identifying and dealing with unusual practices is laid out in ‘Policy Guidance on the
Detection of Unusual Practice.doc’.



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   9.4 Output quality

The data output from the data standard is intended to be used for a wide range of purposes.
Some these will have a higher threshold for data quality than others. For example analysis of the
activity undertaken using a treatment machine, will require only a certainty that all of the activity on
the machine has been correctly included in data submission. Data passed to the cancer registry to
facilitate the recording of radiotherapy against the registry record for an individual to be used for
epidemiological purposes will need to be quality assured in that all of the patient identifiers are
correct, so that the treatment information is attached to the correct patient record.

If the output data was not of adequate quality for the purpose for which it is being used, there will
be a risk that decisions are taken based on the wrong information.

Output quality will be assessed by an information governance committee. This committee will
identify the appropriateness of the available data to be used for each purpose.




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10 Appendix 1 - Care Dataset for Radiotherapy
Version History:


V1.0 Jan-03 Initial draft
V1.1 Jan-03 Modified after internal consultation
V1.2 May-03 Modified after consultation with the cancer action team, and other interested parties
V1.3 Aug-03 Aligned with National Cancer Dataset
V1.4 Aug-03 Version used for initial consultation with radiotherapy departments.
V1.5 Jan-04 Dataset used for the majority of first extracts (small modifications made in the light of consultation)
V2.0 Feb-06 Admission section removed, Exposure section added. Other fields removed. Feedback from first round of data collection.
V2.1 Jun-06 'Treatment to' field split to place anatomical site in a separate field
V2.2 Feb-07 Modified to align field names and formats with the Data Dictionary. No changes to dataset.
V3.0 July-07 Modified to facilitate the collection of OPCDS alongside RTDS
V3.1 Sep-07 Data items in prescription data group moved to exposure data group in response to predicted practice
V3.2 Jan-08 Course redefined as Episode of radiotherapy to encompass all radiotherapy in a pre-planned period of care
V3.3 Mar-08 Treatment modality to move from Episode to Prescription data group to take into account mixed modality for a course of radiotherapy
V3.4 Mar-08 Field “Date decided to start treatment” reintroduced to Radiotherapy Episode group.
V3.5 Mar-08 Field “Radiotherapy prescribed duration” omitted due to data item not being routinely recorded electronically.
V3.6 Apr-08    Modified to align field names and formats with the Data Dictionary. No changes to dataset
V3.7 Sep-08 Modified to align field names and formats with the Data Dictionary. No changes to dataset



Author
Helen Forbes
Clinical Information Manager
National Cancer Services Analysis Team
Clatterbridge Centre for Oncology NHS Trust
Clatterbridge Road
Bebington
Wirral
CH63 4JY
Phone:        0151 482 7739
Fax:          0151 482 7674
E-mail:       helen.forbes@ccotrust.nhs.uk



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CDS DATA GROUP: ATTENDANCE OCCURRENCE - Location Group of Care Attendance: To carry the details of the location and Site
Code of Treatment.
One occurrence of this Group is permitted
No Name                                           Format      Size   Definition                            Codes Values New or Source Notes
                                                                                                                        Existing Dataset

LO1                                               Alphanumeric 2     for use within CDS messages of the    01          Existing CDS
                                                                     physical location within which the    02
                                                                                                                                      Record 01 – Health Site
      LOCATION CLASS                                                 recorded patient event occurs.        03
                                                                                                                                      (General Occurrence)
                                                                                                           04
                                                                                                           05
LO2                                               Alphanumeric 5     ORGANISATION SITE where the           R           Existing CDS
                                                                     PATIENT was treated.                  A-9
      SITE CODE (OF TREATMENT)                                                                             A-9
                                                                                                           1-9
                                                                                                           1-9
LO3                                               Alphanumeric 6     A physical LOCATION where                         Existing CDS
      LOCATION TYPE
                                                                     PATIENTS are seen or where services
      Definition and value list currently under                                                                                       Omit
                                                                     exist or from which requests for
      review
                                                                     ACTIVITIES are sent

CDS DATA GROUP: GP REGISTRATION:
To carry the details of the Patient's Registered GMP.
One occurrence of this Group is permitted.
No Name                                           Format      Size   Definition                            Codes Values New or Source Notes
                                                                                                                        Existing Dataset

GP1                                               Alphanumeric 8     GMC Code of the GENERAL MEDICAL                   Existing CDS
      GENERAL MEDICAL PRACTITIONER
                                                                     PRACTITIONER (GMP) with whom the
      (SPECIFIED)
                                                                     PATIENT is registered.
GP2                                               Alphanumeric 6     Code of the practice of the GENERAL A-H,          Existing CDS
                                                                     MEDICAL PRACTITIONER (GMP)           J-N,
                                                                     with whom the PATIENT is registered. P,W
                                                                                                          or
      GENERAL MEDICAL PRACTICE                                                                            Y
      CODE (PATIENT REGISTRATION)                                                                         1-9
                                                                                                          1-9
                                                                                                          1-9
                                                                                                          1-9
                                                                                                          1-9

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CDS DATA GROUP: REFERRAL - Activity Characteristics:
To carry the details of the referral.
One occurrence of this Group is permitted.

No Name                              Format      Size    Definition                                  Codes Values New or Source Notes
                                                                                                                  Existing Dataset

RF1                                  Numeric     1       This is the priority of a request for       1            Existing CDS
      PRIORITY TYPE                                      services                                    2                             1=routine 2=urgent

RF2                                  Numeric     1       The terms of reference for the          1   Advice/consult Existing CDS
                                                         REFERRAL REQUEST                            ation
                                                                                                 2   Specific
      SERVICE TYPE REQUESTED                                                                                                       Record 2 – Specific Procedure
                                                                                                     procedure
                                                                                                 3   Other

RF3                                  Alphanumeric 2    A CLASSIFICATION which is used to                          Existing CDS     Record 05 – referral from a
      SOURCE OF REFERRAL FOR OUT-
                                                       identify the source of referral of each                                     consultant, other than in A&E
      PATIENTS
                                                       Consultant Out-Patient Episode.                                             Dept
RF4                                  Date        ccyy- This records the date the REFERRAL                          Existing CDS    Date of referral request from
      REFERRAL REQUEST RECEIVED
                                                 mm-dd REQUEST was received by the Health                                          clinical oncologist to
      DATE
                                                       Care Provider.                                                              radiotherapy radiographer


CDS DATA GROUP: REFERRAL - Person Group (Referrer):
To carry the details of the referrer.
One occurrence of this Group is permitted.

No Name                              Format      Size    Definition                                  Codes Values New or Source Notes
                                                                                                                  Existing Dataset

RG1                                  Alphanumeric 8      Code of the PERSON making the referral                   Existing CDS
                                                                                                                                   Consultant Clinical
      REFERRER CODE
                                                                                                                                   Oncologist’s GMC number
RG2                                  Alphanumeric 5      ORGANISATION from which the                 R            Existing CDS
                                                                                                                                   Record Clinical Oncologist’s
      REFERRING ORGANISATION CODE                        referral is made, such as GP Practice or    A-9
                                                                                                                                   Organisation
                                                         NHS Trust                                   A-9



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CDS DATA GROUP: MISSED APPOINTMENT - Occurrence:
To carry the details of a missed appointment.
One occurrence of this Group is permitted.

No Name                               Format      Size   Definition                                   Codes Values New or Source Notes
                                                                                                                   Existing Dataset

DN1                                   Date        ccyy- This date is derived from OFFERED                         Existing CDS   Omit (unless DNA
      LAST DNA OR PATIENT CANCELLED
                                                  mm-dd FOR ADMISSION DATE and                                                   information is available from
      DATE
                                                        ADMISSION OFFER OUTCOME                                                  PAS)

CDS DATA GROUP: HEALTHCARE RESOURCE GROUP - Activity Characteristics:
To carry the details of the Healthcare Resource Group.
One occurrence of this Group is permitted.

No Name                               Format      Size   Definition                                   Codes Values New or Source Notes
                                                                                                                   Existing Dataset

HR1                                   Alphanumeric 3     The basis for costing inpatient and                      Existing CDS   Omit (will be defined from
      HEALTHCARE RESOURCE GROUP
                                                         daycase services                                                        OPCS-4 codes by HRG 4
      CODE
                                                                                                                                 grouper)
HR2                                   Alphanumeric 3                                                  1           Existing CDS
      HEALTHCARE RESOURCE GROUP
                                                                                                                                 Omit
      CODE-VERSION NUMBER


CDS DATA GROUP: HEALTHCARE RESOURCE GROUP - Clinical Activity Group:

No Name                               Format      Size   Definition                                   Codes Values New or Source Notes
                                                                                                                   Existing Dataset

HR3                                   Alphanumeric 3                                              01
                                                         used in the Clinical Activity Group of the        A&E Existing CDS
                                                         CDS to denote the scheme basis of an     02       OPCS-4                Omit (will be defined from
                                                         Intervention, Operation or A&E           03       READ4                 OPCS-4 codes by HRG 4
                                                         Treatment.                               04       READ5                 grouper)
      PROCEDURE SCHEME IN USE                                                                     05       Read3
HR4                                   Alphanumeric 3     field derived by the Healthcare Resource 1               Existing CDS
      HRG DOMINANT GROUPING                              Group Acute Inpatient Grouper                                           Omit
      VARIABLE-PROCEDURE




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         RADIOTHERAPY CARE DATASET – to form a tail for each radiotherapy attendance record
CDS DATA GROUP: RADIOTHERAPY TAIL IDENTIFIER
To carry the details of the out-patient CDS to which this radiotherapy tail relates
No Name                                Format       Size    Definition                                    Codes Values New or Source Notes
                                                                                                                       Existing Dataset

RT1                                    Alphanumeric 12      Sequential number or time of day used to                  Existing CDS
      ATTENDANCE IDENTIFIER                                 enable an attendance to be uniquely
                                                            identified.
RT2                                    Alphanumeric 3       A code which identifies an               R                Existing CDS
                                                            ORGANISATION uniquely.                   A-9
      ORGANISATION CODE (OPCDS)
                                                                                                     A-9

RT3                                    Date         ccyy- An arrangement for a PATIENT to be                          Existing CDS
                                                                                                                                        Date of patient’s attendance for
      APPOINTMENT DATE                              mm-dd seen by or be in contact with one or more
                                                                                                                                        radiotherapy
                                                          CARE PROFESSIONALS.


CDS DATA GROUP: RADIOTHERAPY EPISODE
To carry the details of the Episode of radiotherapy being given at this attendance.

No Name                                Format       Size    Definition                                    Codes Values New or Source Notes
                                                                                                                       Existing Dataset

RE1 RADIOTHERAPY EPISODE               Alphanumeric 50      Any identifier that is unique for each                    New
    IDENTIFIER                                              radiotherapy episode.

RE2 DECISION TO TREAT DATE             Date         ccyy- The date on which it was decided that the                   Existing National
    (RADIOTHERAPY TREATMENT                         mm-dd PATIENT required a specific Planned                                  Cancer This is the date the clinician
    COURSE)                                               Cancer Treatment. This is the date that                              Dataset and patient agrees that this
                                                          the consultation between the PATIENT                                          course of radiotherapy needs to
                                                          and the clinician took place and a Planned                                    be given.
                                                          Cancer Treatment was agreed
RE3 EARLIEST CLINICALLY                Date         ccyy- This is the first date that the patient would               New               Same as the Date Decided to
    APPROPRIATE DATE                                mm-dd have been available to start radiotherapy                                     Treat unless there was an
                                                                                                                                        elective delay for clinical or
                                                                                                                                        social reasons. Also known as
                                                                                                                                        “Ready to Start”date


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RE4 RADIOTHERAPY PRIORITY              Alphanumeric 1    The priority for this course of therapy as E                New
                                                         classified by the requesting clinician     U                                  http://www.rcr.ac.uk/docs/onco
                                                                                                    R                                  logy/pdf/gaps.pdf
                                                                                                    D
RE5 TREATMENT START DATE               Date        ccyy- The start of a stay, an episode, period                     Existing National
    (RADIOTHERAPY TREATMENT                        mm-dd covered by a plan or other time period.                              Cancer
                                                                                                                                       Date of First Fraction of
    COURSE)                                              This may be used to calculate the length                             Dataset
                                                                                                                                       Radiotherapy in this episode.
                                                         of the period, or to classify by financial
                                                         year or other time-based criterion.

CDS DATA GROUP: RADIOTHERAPY PRESCRIPTION
To carry the details of each Prescription of radiotherapy being given at this attendance.
Multiple Occurrences of this group are allowed
No Name                                Format      Size    Definition                          Codes        Values New or Source           Notes
                                                                                                                   Existing Dataset
RP1 PRESCRIPTION IDENTIFIER            Alphanumeric 50     Any identifier that is unique for                         New
                                                           each radiotherapy prescription.

RP2 RADIOTHERAPY TREATMENT             Alphanumeric 2      The specific area to be P         Primary                 New
    REGION                                                 treated with            PR        Primary & Regional
                                                           radiotherapy.                     Nodes
                                                                                   R         Regional Nodes
                                                                                   A         Non-anatomically
                                                                                             specific primary site
                                                                                    O        Prophylactic (to non-
                                                                                             primary site)
                                                                                    M        Metastasis
RC3 RADIOTHERAPY ANATOMICAL                                The part of the body to which the OPCS4 'Z'               Existing Cancer
    TREATMENT SITE                                         RADIOTHERAPY ACTUAL code for                                       Registratio
                                                           DOSE is administered.             anatomical site                  n Dataset Only to be complete for
                                                                                             taken from the                               entries A, O or M in
                                                                                             list in                                      ‘Treatment to’field
                                                                                             Appendix 3

RP4 NUMBER OF TELETHERAPY FIELDS Numeric           2       The prescribed number of fields                           Derived   National    The number of fields
                                                           of a Teletherapy Treatment                                          Cancer      prescribed in this
                                                           Course.                                                             Dataset     prescription.
                                                                                                                               (Can be
                                                                                                                               derived
                                                                                                                               from this
                                                                                                                               field)

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RP5 RADIOTHERAPY PRESCRIBED DOSE Numeric           5 (inc. 2 The total prescribed absorbed                    Existing National       ICRU50 ref pt -prescribed
                                                   d.p.)     radiation dose in Gray                                    Cancer         dose in Gy for the whole
                                                                                                                       Dataset        prescription.
                                                                                                                                      www.icru.org/n_992_4.htm
RP6 PRESCRIBED FRACTIONS              Numeric      3         The prescribed number of                         Existing National
                                                             Fractions or hyperfractionation                           Cancer
                                                             of a Teletherapy Treatment                                Dataset
                                                             Course
RP7 RADIOTHERAPY ACTUAL DOSE          Numeric      5 (inc. 2 The total actual absorbed                        Existing National       ICRU50 ref pt – the total
                                                   d.p.)     radiation dose given in Grays.                            Cancer         actual adsorbed dose in Gy
                                                                                                                       Dataset        for the whole prescription.
                                                                                                                                      www.icru.org/n_992_4.htm
                                                                                                                                      This item may be omitted
                                                                                                                                      from all but the ultimate
                                                                                                                                      fraction for this
                                                                                                                                      prescription.
RP8 ACTUAL FRACTIONS                  Numeric      2        The total number of Fractions or                  Existing National       The total number of
                                                            hyperfractionation of a                                    Cancer         fractions or hyperfractions
                                                            Teletherapy Treatment Course                               Dataset        for the whole prescription.
                                                            administered                                                              This item may be omitted
                                                                                                                                      from all but the ultimate
                                                                                                                                      fraction for this
                                                                                                                                      prescription.
RP9 RADIOTHERAPY TREATMENT            Alphanumeric 1        Identifies each record as a      T         Tele    New     identifies
    MODALITY                                                'Teletherapy' or 'Brachytherapy'           therapy         prescription
                                                            record                           B         Brachy          as a
                                                                                                       therapy         Teletherapy
                                                                                                                       or
                                                                                                                       Brachyther
                                                                                                                       apy dataset


CDS DATA GROUP: RADIOTHERAPY EXPOSURE
To carry the details of each radiotherapy exposure delivered at this attendance.
Multiple Occurrences of this group are allowed
No Name                               Format       Size     Definition                         Codes   Values New or Source Notes
                                                                                                              Existing Dataset

RX1 RADIOTHERAPY FIELD IDENTIFIER Alphanumeric 50                                                             New                 An identifier that is unique for
                                                                                                                                  each radiotherapy exposure.


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RX2 MACHINE IDENTIFIER        Alphanumeric 12        A unique code ascribed to the    R                   Existing   National
                                                     radiotherapy equipment used to A-9                              Cancer
                                                     treat this exposure.             A-9                            Dataset
                                                                                      0-1                                       Five character site code & two
                                                                                      0-1                                       character equipment type code
                                                                                      LA/CO/KV/O                                & sequence number for this
                                                                                      T                                         machine issued by
                                                                                      1-9                                       NATCANSAT.
                                                                                      1-9
                                                                                      1-9
                                                                                      1-9
RX3 TELETHERAPY BEAM TYPE     Alphanumeric 2         The prescribed type of beam of a T1         Photons Existing    National
                                                     Teletherapy Treatment Course. T2            Electron            Cancer
                                                                                                 s                   Dataset
                                                                                      T3         Other
RX4 TELETHERAPY BEAM ENERGY   Numeric      6 (inc. 3 The prescribed energy of a                           Derived    Nationa    Beam energy in
                                           d.p.)     Teletherapy Treatment Course.                                   l          MeV/MV/MVp. Please record
                                                                                                                     Cancer     kVp energies as decimals (e.g.
                                                                                                                     Dataset    250kV = 0.25MV). Only for
                                                                                                                                multi-modality machines.
                                                                                                                     (Can be
                                                                                                                     derived
                                                                                                                     from
                                                                                                                     this
                                                                                                                     field)
RX5 TIME OF EXPOSURE          Time          Hh:mm: Time when the exposure was                             New
                                            ss (8) initiated




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11 Appendix 2 – ICD10 codes for Primary Diagnosis
ICD10 code   Descriptor
C00          Malignant neoplasm of lip
C01          Malignant neoplasm of base of tongue
C02          Malignant neoplasm of other and unspecified parts of tongue
C03          Malignant neoplasm of gum
C04          Malignant neoplasm of floor of mouth
C05          Malignant neoplasm of palate
C06          Malignant neoplasm of other and unspecified parts of mouth
C07          Malignant neoplasm of parotid gland
C08          Malignant neoplasm of other and unspecified major salivary glands
C09          Malignant neoplasm of tonsil
C10          Malignant neoplasm of oropharynx
C11          Malignant neoplasm of nasopharynx
C12          Malignant neoplasm of piriform sinus
C13          Malignant neoplasm of hypopharynx
C14          Malignant neoplasm of other and ill-defined sites in the lip, oral cavity and pharynx
C15          Malignant neoplasm of oesophagus
C16          Malignant neoplasm of stomach
C17          Malignant neoplasm of small intestine
C18          Malignant neoplasm of colon
C19          Malignant neoplasm of rectosigmoid junction
C20          Malignant neoplasm of rectum
C21          Malignant neoplasm of anus and anal canal
C22          Malignant neoplasm of liver and intrahepatic bile ducts
C23          Malignant neoplasm of gallbladder
C24          Malignant neoplasm of other and unspecified parts of biliary tract
C25          Malignant neoplasm of pancreas
C26          Malignant neoplasm of other and ill-defined digestive organs
C30          Malignant neoplasm of nasal cavity and middle ear
C31          Malignant neoplasm of accessory sinuses
C32          Malignant neoplasm of larynx
C33          Malignant neoplasm of trachea
C34          Malignant neoplasm of bronchus and lung
C37          Malignant neoplasm of thymus
C38          Malignant neoplasm of heart, mediastinum and pleura
C39          Malignant neoplasm of other and ill-defined sites in the respiratory system and intrathoracic organs
C40          Malignant neoplasm of bone and articular cartilage of limbs
C41          Malignant neoplasm of bone and articular cartilage of other and unspecified sites
C43          Malignant melanoma of skin
C44          Other malignant neoplasms of skin
C45          Mesothelioma
C46          Kaposi's sarcoma
C47          Malignant neoplasm of peripheral nerves and autonomic nervous system
C48          Malignant neoplasm of retroperitoneum and peritoneum
C49          Malignant neoplasm of other connective and soft tissue

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C50          Malignant neoplasm of breast
C51          Malignant neoplasm of vulva
C52          Malignant neoplasm of vagina
C53          Malignant neoplasm of cervix uteri
C54          Malignant neoplasm of corpus uteri
C55          Malignant neoplasm of uterus, part unspecified
C56          Malignant neoplasm of ovary
C57          Malignant neoplasm of other and unspecified female genital organs
C58          Malignant neoplasm of placenta
C60          Malignant neoplasm of penis
C61          Malignant neoplasm of prostate
C62          Malignant neoplasm of testis
C63          Malignant neoplasm of other and unspecified male genital organs
C64          Malignant neoplasm of kidney, except renal pelvis
C65          Malignant neoplasm of renal pelvis
C66          Malignant neoplasm of ureter
C67          Malignant neoplasm of bladder
C68          Malignant neoplasm of other and unspecified urinary organs
C69          Malignant neoplasm of eye and adnexa
C70          Malignant neoplasm of meninges
C71          Malignant neoplasm of brain
C72          Malignant neoplasm of spinal cord, cranial nerves and other parts of central nervous system
C73          Malignant neoplasm of thyroid gland
C74          Malignant neoplasm of adrenal gland
C75          Malignant neoplasm of other endocrine glands and related structures
C76          Malignant neoplasm of other and ill-defined sites
C77          Secondary and unspecified malignant neoplasm of lymph nodes
C78          Secondary malignant neoplasm of respiratory and digestive organs
C79          Secondary malignant neoplasm of other sites
C80          Malignant neoplasm without specification of site
C81          Hodgkin's disease
C82          Follicular [nodular] non-Hodgkin's lymphoma
C83          Diffuse non-Hodgkin's lymphoma
C84          Peripheral and cutaneous T-cell lymphomas
C85          Other and unspecified types of non-Hodgkin's lymphoma
C88          Malignant immunoproliferative diseases
C90          Multiple myeloma and malignant plasma cell neoplasms
C91          Lymphoid leukaemia
C92          Myeloid leukaemia
C93          Monocytic leukaemia
C94          Other leukaemias of specified cell type
C95          Leukaemia of unspecified cell type
C96          Other and unspecified malignant neoplasms of lymphoid, haematopoietic and related tissue
C97          Malignant neoplasms of independent (primary) multiple sites




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12 Appendix 3 – OPCS4 codes for anatomical site treated coding
OPCS4 Code   Description
Z01          Tissue Of Brain
Z246         Lung
Z247         Mediastinum
Z301         Liver
Z313         Spleen
Z47          Skin Of Face
Z48          Skin Of Other Part Of Head Or Neck
Z491         Skin Of Breast
Z492         Skin Of Axilla
Z493         Skin Of Anterior Trunk
Z494         Skin Of Back
Z495         Skin Of Buttock
Z498         Specified Skin Of Trunk Nec
Z499         Skin Of Trunk Nec
Z501         Skin Of Arm
Z502         Skin Of Hand
Z503         Skin Of Finger
Z504         Skin Of Leg
Z505         Skin Of Foot
Z506         Skin Of Toe
Z508         Skin Of Specified Site Nec
Z509         Skin Nec
Z534         Peritoneal Cavity
Z611         Cervical Lymph Node
Z612         Scalene Lymph Node
Z613         Axillary Lymph Node
Z614         Mediastinal Lymph Node
Z615         Paraaortic Lymph Node
Z616         Inguinal Lymph Node
Z618         Specified Lymph Node Nec
Z619         Lymph Node Nec
Z63          Bone Of Cranium
Z64          Bone Of Face
Z65          Jaw
Z661         Atlas
Z662         Axis Bone
Z663         Cervical Vertebra
Z664         Thoracic Vertebra
Z665         Lumbar Vertebra
Z668         Specified Vertebra Nec
Z669         Vertebra Nec
Z68          Bone Of Shoulder Girdle
Z69          Humerus
Z74          Rib Cage

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Z75          Bone Of Pelvis
Z76          Femur
Z87          Other Part Of Musculoskeletal System




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13 Appendix 4 Software Specific Guidance

     13.1 Visir / Oncentra
CARE DATASET FOR RADIOTHERAPY
EACH RADIOTHERAPY ATTENDANCE TO BE REPORTED USING THE DATASET BELOW,
WHICH CONSISTS OF THE STANDARD CDS PLUS AN ADDITIONAL RADIOTHERAPY TAIL.
ATTENDANCE SPECIFIC INFORMATION WILL BE TAKEN FROM ONCOLOGY MANAGEMENT
SYSTEMS (OMS) AT EACH RADIOTHERAPY FACILITY, AND COMBINED WITH
DEMOGRAPHIC AND OTHER NON-‘ATTENDANCE SPECIFIC’ INFORMATION TAKEN FROM
PAS TO GENERATE THE REQUIRED FILE. THIS WILL AVOID DUPLICATION OF ENTRY OF
RADIOTHERAPY ATTENDANCES INTO PAS AND OMS.

CDS DATA GROUP: PATIENT PATHWAY: version 6
To carry the details of the Patient Pathway.
One optional occurrence of this Group is permitted.
Opt                          CDS Data Element                               Table                         Field
 O UNIQUE BOOKING REFERENCE NUMBER (CONVERTED)                                        NOT REQUIRED FROM VISIR
 O PATIENT PATHWAY IDENTIFIER                                                         NOT REQUIRED FROM VISIR
 O ORGANISATION CODE (PATIENT PATHWAY IDENTIFIER ISSUER)                              NOT REQUIRED FROM VISIR
 O REFERRAL TO TREATMENT STATUS                                                       NOT REQUIRED FROM VISIR
 O REFERRAL TO TREATMENT PERIOD START DATE                                            NOT REQUIRED FROM VISIR
 O REFERRAL TO TREATMENT PERIOD END DATE                                              NOT REQUIRED FROM VISIR
      LEAD CARE ACTIVITY INDICATOR (Not defined or approved by the
 *
      Information Standards Board)
CDS DATA GROUP: PATIENT IDENTITY:
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To carry the identity of the Patient.
One occurrence of this Group is permitted.
Opt                           CDS Data Element                                 Table                                  Notes
 M LOCAL PATIENT IDENTIFIER                                                    Patient   PersNo (although flexible with other IDs)
 M ORGANISATION CODE (LOCAL PATIENT IDENTIFIER)                                          NOT REQUIRED FROM VISIR
 M NHS NUMBER                                                                  Patient   PatID2 (although flexible with other IDs)
 M NHS NUMBER STATUS INDICATOR                                                           NOT REQUIRED FROM VISIR
 O PATIENT NAME                                                                          NOT REQUIRED FROM VISIR
 O PATIENT USUAL ADDRESS                                                                 NOT REQUIRED FROM VISIR
 M POSTCODE OF USUAL ADDRESS                                                   Patient   Zip
 M ORGANISATION CODE (PCT OF RESIDENCE)                                                  NOT REQUIRED FROM VISIR
Note: For reasons of confidentiality, the patient's preferred name and address (not including POSTCODE OF USUAL ADDRESS) must not be
     carried where a valid NHS Number is present. For patients with sensitive conditions (as defined in DSCN 41/98/P26), all patient
     identifiable information must be removed from Commissioning Data Set records. This includes LOCAL PATIENT IDENTIFIER,
     ORGANISATION CODE (LOCAL PATIENT IDENTIFIER), NHS NUMBER, PATIENT NAME, PATIENT USUAL ADDRESS,
     POSTCODE OF USUAL ADDRESS, ORGANISATION CODE (PCT OF RESIDENCE), and PERSON BIRTH DATE (in Patient
     Characteristics data group below).

CDS DATA GROUP: PATIENT CHARACTERISTICS:
To carry the characteristics of the Patient.
One occurrence of this Group is permitted.
Opt                           CDS Data Element                                 OMS                                    Notes
 M PERSON BIRTH DATE                                                          Patient    BirthDate
 M PERSON GENDER CURRENT                                                      Patient    Sex
 O CARER SUPPORT INDICATOR                                                               NOT REQUIRED FROM VISIR
CDS DATA GROUP: CARE EPISODE - Person Group (Consultant):
To carry the details of the responsible Consultant.
One occurrence of this Group is permitted.
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 M CONSULTANT CODE                                                                        NOT REQUIRED FROM VISIR
 M MAIN SPECIALTY CODE                                                                    NOT REQUIRED FROM VISIR
 M TREATMENT FUNCTION CODE                                                                NOT REQUIRED FROM VISIR
CDS DATA GROUP: CARE EPISODE - CLINICAL DIAGNOSIS (ICD):
To carry the details of the ICD Diagnosis Scheme and the Diagnoses.
 O DIAGNOSIS SCHEME IN USE                                                                NOT REQUIRED FROM VISIR
 O PRIMARY DIAGNOSIS (ICD)                                                   TargetVol Diag (mapped through toolkit from local codes if necessary)
     SECONDARY DIAGNOSIS (ICD)
 O                                                                                        NOT REQUIRED FROM VISIR
     Multiple Secondary Diagnoses may be recorded.
CDS DATA GROUP: CARE EPISODE - CLINICAL DIAGNOSIS (READ):
To carry the details of the READ Diagnosis Scheme and the Diagnoses.
 O    DIAGNOSIS SCHEME IN USE                                                             NOT REQUIRED FROM VISIR
 O    PRIMARY DIAGNOSIS (READ)                                                            NOT REQUIRED FROM VISIR
      SECONDARY DIAGNOSIS (READ)
 O                                                                                        NOT REQUIRED FROM VISIR
      Multiple Secondary Diagnoses may be recorded.
CDS DATA GROUP: ATTENDANCE OCCURRENCE - Activity Characteristics:
To carry the details of the Care Attendance or cancelled appointment.
 M ATTENDANCE IDENTIFIER                                                      Multiple    PIDNo &”.”& SessNo
 M ADMINISTRATIVE CATEGORY                                                     Patient    ChargeCategory
 M ATTENDED OR DID NOT ATTEND                                                             NOT REQUIRED FROM VISIR
 M FIRST ATTENDANCE                                                           FieldExp Taken from minoftimestart for this reqno
 M MEDICAL STAFF TYPE SEEING PATIENT                                                      NOT REQUIRED FROM VISIR
 M OPERATION STATUS (per attendance)                                                      NOT REQUIRED FROM VISIR
 M OUTCOME OF ATTENDANCE                                                      FieldExp Taken from minoftimestart for this reqno where treatstat is AVSL
   APPOINTMENT DATE
 M (This is the mandatory date used to derive the mandatory CDS ACTIVITY      FieldExp Timestart
   DATE)
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 M AGE AT CDS ACTIVITY DATE                                                         NOT REQUIRED FROM VISIR
 O    EARLIEST REASONABLE OFFER DATE                                                NOT REQUIRED FROM VISIR
CDS DATA GROUP: ATTENDANCE OCCURRENCE - Service Agreement Details:
To carry the details of the Service Agreement for the Care Attendance.
 M    COMMISSIONING SERIAL NUMBER                                                   NOT REQUIRED FROM VISIR
 O    NHS SERVICE AGREEMENT LINE NUMBER                                             NOT REQUIRED FROM VISIR
 O    PROVIDER REFERENCE NUMBER                                                     NOT REQUIRED FROM VISIR
 M    COMMISSIONER REFERENCE NUMBER                                                 NOT REQUIRED FROM VISIR
 M    ORGANISATION CODE (CODE OF PROVIDER)                                          NOT REQUIRED FROM VISIR
 M    ORGANISATION CODE (CODE OF COMMISSIONER)                                      NOT REQUIRED FROM VISIR
CDS DATA GROUP: ATTENDANCE OCCURRENCE - Clinical Activity Group (OPCS):
To carry the details of the OPCS coded Clinical Activities undertaken.
O PROCEDURE SCHEME IN USE                                                 NOT REQUIRED FROM VISIR
O PRIMARY PROCEDURE (OPCS)                                                New Field HRG Code (delivery)
                                                                 Series
O PROCEDURE DATE (of Primary Procedure)                                   Date as appointment date
  (Multiple Procedures may be recorded)
                                                                          New Field HRG Code (preparation)
O PROCEDURE (OPCS)                                               Series
                                                                          Date as appointment date
O PROCEDURE DATE (of Secondary Procedure)
CDS DATA GROUP: ATTENDANCE OCCURRENCE - Clinical Activity Group (READ):
To carry the details of the READ coded Clinical Activities undertaken.
  O    PROCEDURE SCHEME IN USE                                                      NOT REQUIRED FROM VISIR
  O    PRIMARY PROCEDURE (READ)
                                                                                    NOT REQUIRED FROM VISIR
  O    PROCEDURE DATE (of Primary Procedure)
       (Multiple Procedures may be recorded)
  O    PROCEDURE (READ)                                                             NOT REQUIRED FROM VISIR
  O    PROCEDURE DATE (of Secondary Procedure)
CDS DATA GROUP: ATTENDANCE OCCURRENCE - Location Group of Care Attendance: To carry the details of the location and Site Code of

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Treatment.
One occurrence of this Group is permitted.
 M LOCATION CLASS                                                                  NOT REQUIRED FROM VISIR
 M SITE CODE (OF TREATMENT)                                                        NOT REQUIRED FROM VISIR
     LOCATION TYPE
 *                                                                                 NOT REQUIRED FROM VISIR
     Definition and value list currently under review
CDS DATA GROUP: GP REGISTRATION:
To carry the details of the Patient's Registered GMP.
One occurrence of this Group is permitted.
 M    GMP (CODE OF REGISTERED OR REFERRING GMP)                                              NOT REQUIRED FROM VISIR
 O    CODE OF GP PRACTICE (REGISTERED GMP)                                                   NOT REQUIRED FROM VISIR
CDS DATA GROUP: REFERRAL - Activity Characteristics:
To carry the details of the referral.
One occurrence of this Group is permitted.
 M PRIORITY TYPE                                                                 Requisition PatCat (mapped through toolkit from local codes)
 M SERVICE TYPE REQUESTED                                                                    NOT REQUIRED FROM VISIR
 M SOURCE OF REFERRAL FOR OUT-PATIENTS                                                       NOT REQUIRED FROM VISIR
 M REFERRAL REQUEST RECEIVED DATE                                               Requisition Requisition Date
CDS DATA GROUP: REFERRAL - Person Group (Referrer):
To carry the details of the referrer.
One occurrence of this Group is permitted.
                                                                                             ReqDoctor (mapped through toolkit from local codes to GMC
 M REFERRER CODE                                                                 TargetVol
                                                                                             no)
 M REFERRING ORGANISATION CODE                                                               NOT REQUIRED FROM VISIR
CDS DATA GROUP: MISSED APPOINTMENT - Occurrence:
To carry the details of a missed appointment.
One occurrence of this Group is permitted.
 M LAST DNA OR PATIENT CANCELLED DATE                                                        NOT REQUIRED FROM VISIR
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CDS DATA GROUP: HEALTHCARE RESOURCE GROUP - Activity Characteristics:
To carry the details of the Healthcare Resource Group.
One occurrence of this Group is permitted.
 O    HEALTHCARE RESOURCE GROUP CODE                                                      NOT REQUIRED FROM VISIR
 O    HEALTHCARE RESOURCE GROUP CODE-VERSION NUMBER                                       NOT REQUIRED FROM VISIR
CDS DATA GROUP: HEALTHCARE RESOURCE GROUP - Clinical Activity Group:
To carry the details of the HRG Dominant Grouping Variable - Procedure.
 O    PROCEDURE SCHEME IN USE                                                             NOT REQUIRED FROM VISIR
 O    HRG DOMINANT GROUPING VARIABLE-PROCEDURE                                            NOT REQUIRED FROM VISIR




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RADIOTHERAPY CARE DATASET – to form a tail for each radiotherapy attendance record
CDS DATA GROUP: RADIOTHERAPY TAIL IDENTIFIER
To carry the details of the out-patient CDS to which this radiotherapy tail relates
 M ATTENDANCE IDENTIFIER                                                         Multiple PIDNo &”.”& SessNo
 M ORGANISATION CODE (OPCDS)                                                                NOT REQUIRED FROM VISIR
 M APPOINTMENT DATE                                                              Fieldexp timestart
CDS DATA GROUP: RADIOTHERAPY EPISODE
To carry the details of the Episode of radiotherapy being given at this attendance.
Multiple Occurrences of this group are allowed
 M RADIOTHERAPY EPISODE ID NUMBER                                                Multiple   PIDNo &”.”& SessNo &”.”& RequisitionNo
      DECISION TO TREAT DATE (RADIOTHERAPY TREATMENT
 M                                                                              Requisition Reqdate
      COURSE)
 M EARLIEST CLINICALLY APPROPRIATE DATE                                         Requisition MinStartDate
 M RADIOTHERAPY PRIORITY                                                        Requisition PatCat
 M START DATE (RADIOTHERAPY TREATMENT COURSE)                                    FieldExp Minoftimestart for this reqno
CDS DATA GROUP: RADIOTHERAPY PRESCRIPTION
To carry the details of the Prescription of radiotherapy being given at this attendance.
Multiple Occurrences of this group are allowed
      PRESCRIPTION IDENTIFIER                                                               PIDNo &”.”& SessNo &”.”& RequisitionNo &”.”&
 M                                                                                Series
                                                                                            TargetVolNo &”.”& SeriNo
 M RADIOTHERAPY TREATMENT REGION                                                Requisition New Field “Treatment to” codes P,PR,R,A,O or M
 M RADIOTHERAPY ANATOMICAL TREATMENT SITE                                       Requisition New Field Anatomical Site treated
 M NUMBER OF TELETHERAPY FIELDS                                                   Series    NoFields
 M RADIOTHERAPY PRESCRIBED DOSE                                                   Series    TDSeri
 M PRESCRIBED FRACTIONS                                                           Series    FracSeri
 M ACTUAL FRACTIONS                                                               Series    TDAccReal (only completed when treatstat = AVSL)
 M TELETHERAPY/BRACHYTHERAPY ACTUAL FRACTIONS                                     Series    FracGiven (only completed when treatstat = AVSL)

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 M RADIOTHERAPY TREATMENT MODALITY                                                             NOT REQUIRED FROM VISIR (T or B)
CDS DATA GROUP: RADIOTHERAPY EXPOSURE
To carry the details of each radiotherapy exposure delivered at this attendance.
Multiple Occurrences of this group are allowed
      RADIOTHERAPY FIELD IDENTIFIER                                                            PIDNo &”.”& SessNo &”.”& RequisitionNo &”.”&
 M                                                                                 Multiple
                                                                                               TargetVolNo &”.”& SeriNo &”.”& FieldNo
      MACHINE IDENTIFIER                                                                       ExpUnit (mapped through toolkit from local codes to national
 M                                                                             FieldExp
                                                                                               reference number)
 M TELETHERAPY/BRACHYTHERAPY BEAM TYPE                                              Series     RadQual (mapped through toolkit from local codes)
 M TELETHERAPY BEAM ENERGY                                                          Series     RadQual (mapped through toolkit from local codes)
 M TIME OF EXPOSURE                                                            FieldExp TimeStart



   13.2 Varis / Aria
CARE DATASET FOR RADIOTHERAPY

EACH RADIOTHERAPY ATTENDANCE TO BE REPORTED USING THE DATASET BELOW, WHICH CONSISTS OF THE
STANDARD CDS PLUS AN ADDITIONAL RADIOTHERAPY TAIL. ATTENDANCE SPECIFIC INFORMATION WILL BE TAKEN
FROM ONCOLOGY MANAGEMENT SYSTEMS (OMS) AT EACH RADIOTHERAPY FACILITY, AND COMBINED WITH
DEMOGRAPHIC AND OTHER NON-‘ATTENDANCE SPECIFIC’ INFORMATION TAKEN FROM PAS TO GENERATE THE
REQUIRED FILE. THIS WILL AVOID DUPLICATION OF ENTRY OF RADIOTHERAPY ATTENDANCES INTO PAS AND OMS.


CDS DATA GROUP: PATIENT PATHWAY: version 6
To carry the details of the Patient Pathway.
One optional occurrence of this Group is permitted.
Opt                             CDS Data Element                                   Table                                   Field
 O UNIQUE BOOKING REFERENCE NUMBER (CONVERTED)                                                NOT REQUIRED FROM VARIS
 O PATIENT PATHWAY IDENTIFIER                                                                 NOT REQUIRED FROM VARIS
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 O ORGANISATION CODE (PATIENT PATHWAY IDENTIFIER ISSUER)                  NOT REQUIRED FROM VARIS
 O REFERRAL TO TREATMENT STATUS                                                        NOT REQUIRED FROM VARIS
 O REFERRAL TO TREATMENT PERIOD START DATE                                             NOT REQUIRED FROM VARIS
 O REFERRAL TO TREATMENT PERIOD END DATE                                               NOT REQUIRED FROM VARIS
      LEAD CARE ACTIVITY INDICATOR (Not defined or approved by the
 *
      Information Standards Board)
CDS DATA GROUP: PATIENT IDENTITY:
To carry the identity of the Patient.
One occurrence of this Group is permitted.
Opt                            CDS Data Element                               Table                                   Field
                                                                             Patient PatientId (all possible IDs like PatientId1, PatientId2,
 M LOCAL PATIENT IDENTIFIER
                                                                                     UniversalPatientID, SSN should be exported)
 M ORGANISATION CODE (LOCAL PATIENT IDENTIFIER)                                       NOT REQUIRED FROM VARIS
 M NHS NUMBER                                                                Patient PatientId2
 M NHS NUMBER STATUS INDICATOR                                                        NOT REQUIRED FROM VARIS
 O PATIENT NAME                                                                       NOT REQUIRED FROM VARIS
 O PATIENT USUAL ADDRESS                                                              NOT REQUIRED FROM VARIS
 M POSTCODE OF USUAL ADDRESS                                                          NOT REQUIRED FROM VARIS
 M ORGANISATION CODE (PCT OF RESIDENCE)                                               NOT REQUIRED FROM VARIS
Note: For reasons of confidentiality, the patient's preferred name and address (not including POSTCODE OF USUAL ADDRESS) must not be
     carried where a valid NHS Number is present. For patients with sensitive conditions (as defined in DSCN 41/98/P26), all patient
     identifiable information must be removed from Commissioning Data Set records. This includes LOCAL PATIENT IDENTIFIER,
     ORGANISATION CODE (LOCAL PATIENT IDENTIFIER), NHS NUMBER, PATIENT NAME, PATIENT USUAL ADDRESS,
     POSTCODE OF USUAL ADDRESS, ORGANISATION CODE (PCT OF RESIDENCE), and PERSON BIRTH DATE (in Patient
     Characteristics data group below).

CDS DATA GROUP: PATIENT CHARACTERISTICS:
To carry the characteristics of the Patient.
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One occurrence of this Group is permitted.
Opt                             CDS Data Element                               Table                              Field
 M PERSON BIRTH DATE                                                          Patient DateOfBirth
 M PERSON GENDER CURRENT                                                      Patient Sex
 O CARER SUPPORT INDICATOR                                                             NOT REQUIRED FROM VARIS
CDS DATA GROUP: CARE EPISODE - Person Group (Consultant):
To carry the details of the responsible Consultant.
One occurrence of this Group is permitted.
 M CONSULTANT CODE                                                                     NOT REQUIRED FROM VARIS
 M MAIN SPECIALTY CODE                                                                 NOT REQUIRED FROM VARIS
 M TREATMENT FUNCTION CODE                                                             NOT REQUIRED FROM VARIS
CDS DATA GROUP: CARE EPISODE - CLINICAL DIAGNOSIS (ICD):
To carry the details of the ICD Diagnosis Scheme and the Diagnoses.
 O DIAGNOSIS SCHEME IN USE                                                                NOT REQUIRED FROM VARIS
 O PRIMARY DIAGNOSIS (ICD)                                                   Diagnosis DiagnosisCode
      SECONDARY DIAGNOSIS (ICD)
 O                                                                                        NOT REQUIRED FROM VARIS
      Multiple Secondary Diagnoses may be recorded.
CDS DATA GROUP: CARE EPISODE - CLINICAL DIAGNOSIS (READ):
To carry the details of the READ Diagnosis Scheme and the Diagnoses.
 O    DIAGNOSIS SCHEME IN USE                                                          NOT REQUIRED FROM VARIS
 O    PRIMARY DIAGNOSIS (READ)                                                         NOT REQUIRED FROM VARIS
      SECONDARY DIAGNOSIS (READ)
 O                                                                                     NOT REQUIRED FROM VARIS
      Multiple Secondary Diagnoses may be recorded.
CDS DATA GROUP: ATTENDANCE OCCURRENCE - Activity Characteristics:
To carry the details of the Care Attendance or cancelled appointment.
 M ATTENDANCE IDENTIFIER                                                      ScheduledActivity ScheduledAcivitySer

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                                                                                                UserDefinedActivityAttribute (01=NHS, 02=PP,
 M ADMINISTRATIVE CATEGORY                                                   Activity Capture
                                                                                                03=Amenity, 04=Cat II)
 M ATTENDED OR DID NOT ATTEND                                                                   NOT REQUIRED FROM VARIS
 M FIRST ATTENDANCE                                                                             NOT REQUIRED FROM VARIS
 M MEDICAL STAFF TYPE SEEING PATIENT                                                            NOT REQUIRED FROM VARIS
 M OPERATION STATUS (per attendance)                                                            NOT REQUIRED FROM VARIS
 M OUTCOME OF ATTENDANCE                                                                        NOT REQUIRED FROM VARIS
   APPOINTMENT DATE                                                      ScheduledActivity ScheduledActivityStartDateTime
 M (This is the mandatory date used to derive the mandatory CDS ACTIVITY
   DATE)
 M AGE AT CDS ACTIVITY DATE                                                                     NOT REQUIRED FROM VARIS
 O EARLIEST REASONABLE OFFER DATE                                                               NOT REQUIRED FROM VARIS
CDS DATA GROUP: ATTENDANCE OCCURRENCE - Service Agreement Details:
To carry the details of the Service Agreement for the Care Attendance.
 M    COMMISSIONING SERIAL NUMBER                                                     NOT REQUIRED FROM VARIS
 O    NHS SERVICE AGREEMENT LINE NUMBER                                               NOT REQUIRED FROM VARIS
 O    PROVIDER REFERENCE NUMBER                                                       NOT REQUIRED FROM VARIS
 M    COMMISSIONER REFERENCE NUMBER                                                   NOT REQUIRED FROM VARIS
 M    ORGANISATION CODE (CODE OF PROVIDER)                                            NOT REQUIRED FROM VARIS
 M    ORGANISATION CODE (CODE OF COMMISSIONER)                                        NOT REQUIRED FROM VARIS
CDS DATA GROUP: ATTENDANCE OCCURRENCE - Clinical Activity Group (OPCS):
To carry the details of the OPCS coded Clinical Activities undertaken.
 O PROCEDURE SCHEME IN USE                                                          NOT REQUIRED FROM VARIS
 O PRIMARY PROCEDURE (OPCS)                                       Activity
                                                                                    OPCS4.4 codes
 O PROCEDURE DATE (of Primary Procedure)                          Capture
   (Multiple Procedures may be recorded)                          Activity
                                                                                    OPCS4.4 codes
 O PROCEDURE (OPCS)                                               Capture
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 O PROCEDURE DATE (of Secondary Procedure)
CDS DATA GROUP: ATTENDANCE OCCURRENCE - Clinical Activity Group (READ):
To carry the details of the READ coded Clinical Activities undertaken.
  O    PROCEDURE SCHEME IN USE                                                NOT REQUIRED FROM VARIS
  O    PRIMARY PROCEDURE (READ)
                                                                              NOT REQUIRED FROM VARIS
  O    PROCEDURE DATE (of Primary Procedure)
       (Multiple Procedures may be recorded)
  O    PROCEDURE (READ)                                                       NOT REQUIRED FROM VARIS
  O    PROCEDURE DATE (of Secondary Procedure)
CDS DATA GROUP: ATTENDANCE OCCURRENCE - Location Group of Care Attendance: To carry the details of the location and
Site Code of Treatment.
One occurrence of this Group is permitted.
 M LOCATION CLASS                                                     NOT REQUIRED FROM VARIS
 M SITE CODE (OF TREATMENT)                                           NOT REQUIRED FROM VARIS
      LOCATION TYPE
 *                                                                    NOT REQUIRED FROM VARIS
      Definition and value list currently under review
CDS DATA GROUP: GP REGISTRATION:
To carry the details of the Patient's Registered GMP.
One occurrence of this Group is permitted.
 M    GMP (CODE OF REGISTERED OR REFERRING GMP)                               NOT REQUIRED FROM VARIS
 O    CODE OF GP PRACTICE (REGISTERED GMP)                                    NOT REQUIRED FROM VARIS
CDS DATA GROUP: REFERRAL - Activity Characteristics:
To carry the details of the referral.
One occurrence of this Group is permitted.
 M PRIORITY TYPE                                                     Course   Intent (see RADIOTHERAPY EPISODE - Priority type also)
 M SERVICE TYPE REQUESTED                                                     NOT REQUIRED FROM VARIS
 M SOURCE OF REFERRAL FOR OUT-PATIENTS                                        NOT REQUIRED FROM VARIS
 M REFERRAL REQUEST RECEIVED DATE                                    Course   StartDateTime
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                                                                                        Date of referral request from clinical oncologist to radiotherapy
                                                                                        radiographer (Action Sheet received) see Earliest Clinically
                                                                                        Appropriate date below
CDS DATA GROUP: REFERRAL - Person Group (Referrer):
To carry the details of the referrer.
One occurrence of this Group is permitted.
 M REFERRER CODE                                                                Doctor    DoctorId ( Consultant Oncologist to map to GMC number)
 M REFERRING ORGANISATION CODE                                                            NOT REQUIRED FROM VARIS
CDS DATA GROUP: MISSED APPOINTMENT - Occurrence:
To carry the details of a missed appointment.
One occurrence of this Group is permitted.
 M LAST DNA OR PATIENT CANCELLED DATE                                                     NOT REQUIRED FROM VARIS
CDS DATA GROUP: HEALTHCARE RESOURCE GROUP - Activity Characteristics:
To carry the details of the Healthcare Resource Group.
One occurrence of this Group is permitted.
 O    HEALTHCARE RESOURCE GROUP CODE                                                      NOT REQUIRED FROM VARIS
 O    HEALTHCARE RESOURCE GROUP CODE-VERSION NUMBER                                       NOT REQUIRED FROM VARIS
CDS DATA GROUP: HEALTHCARE RESOURCE GROUP - Clinical Activity Group:
To carry the details of the HRG Dominant Grouping Variable - Procedure.
 O    PROCEDURE SCHEME IN USE                                                             NOT REQUIRED FROM VARIS
 O    HRG DOMINANT GROUPING VARIABLE-PROCEDURE                                            NOT REQUIRED FROM VARIS

RADIOTHERAPY CARE DATASET – to form a tail for each radiotherapy attendance record
CDS DATA GROUP: RADIOTHERAPY TAIL IDENTIFIER
To carry the details of the out-patient CDS to which this radiotherapy tail relates
M    ATTENDANCE IDENTIFIER                                                     ScheduledActivity     SceduledAcivitySer
M    ORGANISATION CODE (OPCDS)                                                                       NOT REQUIRED FROM VARIS


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M    APPOINTMENT DATE                                                             ScheduledActivity       ScheduledActivityStartDateTime
CDS DATA GROUP: RADIOTHERAPY EPISODE
To carry the details of the Episode of radiotherapy being given at this attendance.
     RADIOTHERAPY EPISODE ID NUMBER                                                 Course      CourseSer (of first course if there are more than one) (need a
                                                                                                sequence number which is the same for all courses in an episode)
M


     EARLIEST CLINICALLY APPROPRIATE DATE If only one date field                    Course      StartDateTime Previously “Ready to start date” when the patient
     available then earliest clinically appropriate date should be recorded Is it               would have first been clinically available for treatment (the same
M
     possible make to available fields for all of the date?                                     as the referral request received date, unless there is a clinical
                                                                                                reason for starting treatment later).
M    RADIOTHERAPY PRIORITY                                                          Course      Intent (see Referral - Priority type also)
     START DATE (TELETHERAPY/BRACHYTHERAPY TREATMENT                                TreatmentFieldHstry       TreatmentDateTime (first treated field on episode
     COURSE)                                                                                                  level)
                                                                                                              This is the date of the first exposure in the episode.
M                                                                                                             Previously calculated this date by aggregating all of
                                                                                                              the exposures which make up the episode, and
                                                                                                              reporting the minimum date. Will the proposed field
                                                                                                              be completed before the end of treatment?
CDS DATA GROUP: RADIOTHERAPY PRESCRIPTION
To carry the details of each Prescription of radiotherapy being given at this attendance.
Multiple Occurrences of this group are allowed
 M PRESCRIPTION ID NUMBER                                                           PlanSetup      PlanSetupSer
     RADIOTHERAPY TREATMENT REGION                                                  Activity       Captured during planning task
                                                                                    Capture        (Previously “Treatment to” P= Primary
                                                                                                   PR=Primary & Regional Nodes
 M                                                                                                 R=Regional Nodes
                                                                                                   A=Non-anatomically specific primary site
                                                                                                   O=Prophylactic to non-primary site
                                                                                                   M=Metastasis)
 M ANATOMICAL TREATMENT SITE (RADIOTHERAPY)                                         Activity       Captured during planning task
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                                                                              Capture       OPCS4 “Z” codes - Only to be complete for entries A, O or M
                                                                                           in ‘Treatment to’field
 M NUMBER OF TELETHERAPY FIELDS                                              Field         count FieldSer (only treatment fields to be counted)
     RADIOTHERAPY PRESCRIBED DOSE                                                          calculate Dosecontribution.DosePerFraction *
 M
                                                                                           Fractionation.NoFractions
 M TELETHERAPY/BRACHYTHERAPY PRESCRIBED FRACTIONS                             Fractionation NoFractions
     RADIOTHERAPY ACTUAL DOSE                                                                           TotDoseDelivered (final fraction) - the total dose
                                                                                                        delivered for the whole prescription. These need
                                                                                                        only be completed on the final attendance for each
 M                                                                            RefPointDeliveredDose     prescription but can be completed on other
                                                                                                        attendances which are reported after the
                                                                                                        prescription is complete if this is easier).

 M TELETHERAPY/BRACHYTHERAPY ACTUAL FRACTIONS                                 Session      SessionNum (count session for PlanSetup)
 M TREATMENT MODALITY                                                         PlanSetup    TreatmentType
CDS DATA GROUP: RADIOTHERAPY EXPOSURE
To carry the details of each radiotherapy exposure delivered at this attendance.
Multiple Occurrences of this group are allowed
 M FIELD ID NUMBER                                                            TreatmentFieldHstry     RadiationSer
 M MACHINE IDENTIFIER                                                         Machine                 MachineId Previously Equipment name
 M TELETHERAPY/BRACHYTHERAPY BEAM TYPE                                        Machine                 MachineId will mapped to beam type
 M TELETHERAPY BEAM ENERGY                                                    TreatmentFieldHstry     EnergyMode T1: Photons T2: Electrons T3: Other
 M TIME OF EXPOSURE                                                           TreatmentFieldHstry     TreatmentDateTime



   13.3 Impac / Mosaiq
CARE DATASET FOR RADIOTHERAPY

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EACH RADIOTHERAPY ATTENDANCE TO BE REPORTED USING THE DATASET BELOW,
WHICH CONSISTS OF THE STANDARD CDS PLUS AN ADDITIONAL RADIOTHERAPY TAIL.
ATTENDANCE SPECIFIC INFORMATION WILL BE TAKEN FROM ONCOLOGY MANAGEMENT
SYSTEMS (OMS) AT EACH RADIOTHERAPY FACILITY, AND COMBINED WITH
DEMOGRAPHIC AND OTHER NON-‘ATTENDANCE SPECIFIC’ INFORMATION TAKEN FROM
PAS TO GENERATE THE REQUIRED FILE. THIS WILL AVOID DUPLICATION OF ENTRY OF
RADIOTHERAPY ATTENDANCES INTO PAS AND OMS.

CDS DATA GROUP: PATIENT PATHWAY: version 6
To carry the details of the Patient Pathway.
One optional occurrence of this Group is permitted.
Opt                          CDS Data Element                               Table                          Field
 O UNIQUE BOOKING REFERENCE NUMBER (CONVERTED)                                         NOT REQUIRED FROM IMPAC
 O PATIENT PATHWAY IDENTIFIER                                                          NOT REQUIRED FROM IMPAC
 O ORGANISATION CODE (PATIENT PATHWAY IDENTIFIER ISSUER)                               NOT REQUIRED FROM IMPAC
 O REFERRAL TO TREATMENT STATUS                                                        NOT REQUIRED FROM IMPAC
 O REFERRAL TO TREATMENT PERIOD START DATE                                             NOT REQUIRED FROM IMPAC
 O REFERRAL TO TREATMENT PERIOD END DATE                                               NOT REQUIRED FROM IMPAC
      LEAD CARE ACTIVITY INDICATOR (Not defined or approved by the
 *
      Information Standards Board)
CDS DATA GROUP: PATIENT IDENTITY:
To carry the identity of the Patient.
One occurrence of this Group is permitted.
Opt                          CDS Data Element                               Table                          Field
 M LOCAL PATIENT IDENTIFIER                                                Ident    IDA
 M ORGANISATION CODE (LOCAL PATIENT IDENTIFIER)                                     NOT REQUIRED FROM IMPAC
 M NHS NUMBER                                                              Ident    IDB
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                                                                              Or      Or
                                                                              Patient SS_Number
                                                                                      Some sites have NHS No in both tables, some in only one.
 M NHS NUMBER STATUS INDICATOR                                                        NOT REQUIRED FROM IMPAC
 O PATIENT NAME                                                                       NOT REQUIRED FROM IMPAC
 O PATIENT USUAL ADDRESS                                                              NOT REQUIRED FROM IMPAC
 M POSTCODE OF USUAL ADDRESS                                                          NOT REQUIRED FROM IMPAC
 M ORGANISATION CODE (PCT OF RESIDENCE)                                               NOT REQUIRED FROM IMPAC
Note: For reasons of confidentiality, the patient's preferred name and address (not including POSTCODE OF USUAL ADDRESS) must not be
     carried where a valid NHS Number is present. For patients with sensitive conditions (as defined in DSCN 41/98/P26), all patient
     identifiable information must be removed from Commissioning Data Set records. This includes LOCAL PATIENT IDENTIFIER,
     ORGANISATION CODE (LOCAL PATIENT IDENTIFIER), NHS NUMBER, PATIENT NAME, PATIENT USUAL ADDRESS,
     POSTCODE OF USUAL ADDRESS, ORGANISATION CODE (PCT OF RESIDENCE), and PERSON BIRTH DATE (in Patient
     Characteristics data group below).

CDS DATA GROUP: PATIENT CHARACTERISTICS:
To carry the characteristics of the Patient.
One occurrence of this Group is permitted.
Opt                            CDS Data Element                               Table                                  Field
 M PERSON BIRTH DATE                                                          Patient Birth Date
 M PERSON GENDER CURRENT                                                      Admin Gender
 O CARER SUPPORT INDICATOR                                                            NOT REQUIRED FROM IMPAC
CDS DATA GROUP: CARE EPISODE - Person Group (Consultant):
To carry the details of the responsible Consultant.
One occurrence of this Group is permitted.
 M CONSULTANT CODE                                                                    NOT REQUIRED FROM IMPAC
 M MAIN SPECIALTY CODE                                                                NOT REQUIRED FROM IMPAC
 M TREATMENT FUNCTION CODE                                                            NOT REQUIRED FROM IMPAC

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CDS DATA GROUP: CARE EPISODE - CLINICAL DIAGNOSIS (ICD):
To carry the details of the ICD Diagnosis Scheme and the Diagnoses.
 O DIAGNOSIS SCHEME IN USE                                                            NOT REQUIRED FROM IMPAC
 O PRIMARY DIAGNOSIS (ICD)                                                   Medical Topography
      SECONDARY DIAGNOSIS (ICD)
 O                                                                                    NOT REQUIRED FROM IMPAC
      Multiple Secondary Diagnoses may be recorded.
CDS DATA GROUP: CARE EPISODE - CLINICAL DIAGNOSIS (READ):
To carry the details of the READ Diagnosis Scheme and the Diagnoses.
 O    DIAGNOSIS SCHEME IN USE                                                         NOT REQUIRED FROM IMPAC
 O    PRIMARY DIAGNOSIS (READ)                                                        NOT REQUIRED FROM IMPAC
      SECONDARY DIAGNOSIS (READ)
 O                                                                                    NOT REQUIRED FROM IMPAC
      Multiple Secondary Diagnoses may be recorded.
CDS DATA GROUP: ATTENDANCE OCCURRENCE - Activity Characteristics:
To carry the details of the Care Attendance or cancelled appointment.
 M ATTENDANCE IDENTIFIER                                                     Multiple Patient Seqno &”.”& Date/time of first exposure for this attendance
 M ADMINISTRATIVE CATEGORY                                                      ?        01=NHS, 02=PP, 03=Amenity, 04=Cat II
 M ATTENDED OR DID NOT ATTEND                                                            NOT REQUIRED FROM IMPAC
 M FIRST ATTENDANCE                                                                      NOT REQUIRED FROM IMPAC
 M MEDICAL STAFF TYPE SEEING PATIENT                                                     NOT REQUIRED FROM IMPAC
 M OPERATION STATUS (per attendance)                                                     NOT REQUIRED FROM IMPAC
 M OUTCOME OF ATTENDANCE                                                                 NOT REQUIRED FROM IMPAC
   APPOINTMENT DATE
 M (This is the mandatory date used to derive the mandatory CDS ACTIVITY DoseHst Tx_Date
   DATE)
 M AGE AT CDS ACTIVITY DATE                                                              NOT REQUIRED FROM IMPAC
 O    EARLIEST REASONABLE OFFER DATE                                                     NOT REQUIRED FROM IMPAC
CDS DATA GROUP: ATTENDANCE OCCURRENCE - Service Agreement Details:
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To carry the details of the Service Agreement for the Care Attendance.
 M    COMMISSIONING SERIAL NUMBER                                                      NOT REQUIRED FROM IMPAC
 O    NHS SERVICE AGREEMENT LINE NUMBER                                                NOT REQUIRED FROM IMPAC
 O    PROVIDER REFERENCE NUMBER                                                        NOT REQUIRED FROM IMPAC
 M    COMMISSIONER REFERENCE NUMBER                                                    NOT REQUIRED FROM IMPAC
 M    ORGANISATION CODE (CODE OF PROVIDER)                                             NOT REQUIRED FROM IMPAC
 M    ORGANISATION CODE (CODE OF COMMISSIONER)                                         NOT REQUIRED FROM IMPAC
CDS DATA GROUP: ATTENDANCE OCCURRENCE - Clinical Activity Group (OPCS):
To carry the details of the OPCS coded Clinical Activities undertaken.
 O PROCEDURE SCHEME IN USE                                                    NOT REQUIRED FROM IMPAC
                                                                     Schedule Activity / Hsp_Code_2
                                                                      /CPT Put treatment HRG in one Hosp Code, and planning HRG in
 O PRIMARY PROCEDURE (OPCS)                                                   another. For first fraction, pull both HRGs. Link the
 O PROCEDURE DATE (of Primary Procedure)                                      appointment (with activity code) by date/time (i.e. linking
                                                                              Schedule table with Dose_Hst). Note – means that scheduled
                                                                              machine MUST be the treatment machine.
   (Multiple Procedures may be recorded)
                                                                     Schedule
 O PROCEDURE (OPCS)                                                           Activity/ Hsp_Code_3
                                                                      /CPT
 O PROCEDURE DATE (of Secondary Procedure)
CDS DATA GROUP: ATTENDANCE OCCURRENCE - Clinical Activity Group (READ):
To carry the details of the READ coded Clinical Activities undertaken.
  O    PROCEDURE SCHEME IN USE                                                         NOT REQUIRED FROM IMPAC
  O    PRIMARY PROCEDURE (READ)
                                                                                       NOT REQUIRED FROM IMPAC
  O    PROCEDURE DATE (of Primary Procedure)
       (Multiple Procedures may be recorded)
  O    PROCEDURE (READ)                                                                NOT REQUIRED FROM IMPAC
  O    PROCEDURE DATE (of Secondary Procedure)
CDS DATA GROUP: ATTENDANCE OCCURRENCE - Location Group of Care Attendance: To carry the details of the location and
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Site Code of Treatment.
One occurrence of this Group is permitted.
 M LOCATION CLASS                                                                 NOT REQUIRED FROM IMPAC
 M SITE CODE (OF TREATMENT)                                                       NOT REQUIRED FROM IMPAC
      LOCATION TYPE
 *                                                                                NOT REQUIRED FROM IMPAC
      Definition and value list currently under review
CDS DATA GROUP: GP REGISTRATION:
To carry the details of the Patient's Registered GMP.
One occurrence of this Group is permitted.
 M    GMP (CODE OF REGISTERED OR REFERRING GMP)                                           NOT REQUIRED FROM IMPAC
 O    CODE OF GP PRACTICE (REGISTERED GMP)                                                NOT REQUIRED FROM IMPAC
CDS DATA GROUP: REFERRAL - Activity Characteristics:
To carry the details of the referral.
One occurrence of this Group is permitted.
 M PRIORITY TYPE                                                                 Medical Waittime_Pro_Id
 M SERVICE TYPE REQUESTED                                                                 NOT REQUIRED FROM IMPAC
 M SOURCE OF REFERRAL FOR OUT-PATIENTS                                                    NOT REQUIRED FROM IMPAC
                                                                                 Medical UrgentGPRef_Dt_Tm
 M REFERRAL REQUEST RECEIVED DATE                                                        In MOSAIQ V1.3, have GP Referral date. Rename the label as
                                                                                         ‘Referral Request Date’ in UK translation file ?
CDS DATA GROUP: REFERRAL - Person Group (Referrer):
To carry the details of the referrer.
One occurrence of this Group is permitted.
 M REFERRER CODE                                                                  PatCPlan MD_ID
 M REFERRING ORGANISATION CODE                                                                NOT REQUIRED FROM IMPAC
CDS DATA GROUP: MISSED APPOINTMENT - Occurrence:
To carry the details of a missed appointment.
One occurrence of this Group is permitted.
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 M LAST DNA OR PATIENT CANCELLED DATE                                    NOT REQUIRED FROM IMPAC
CDS DATA GROUP: HEALTHCARE RESOURCE GROUP - Activity Characteristics:
To carry the details of the Healthcare Resource Group.
One occurrence of this Group is permitted.
 O    HEALTHCARE RESOURCE GROUP CODE                                  NOT REQUIRED FROM IMPAC
 O    HEALTHCARE RESOURCE GROUP CODE-VERSION NUMBER                   NOT REQUIRED FROM IMPAC
CDS DATA GROUP: HEALTHCARE RESOURCE GROUP - Clinical Activity Group:
To carry the details of the HRG Dominant Grouping Variable - Procedure.
 O    PROCEDURE SCHEME IN USE                                         NOT REQUIRED FROM IMPAC
 O    HRG DOMINANT GROUPING VARIABLE-PROCEDURE                        NOT REQUIRED FROM IMPAC




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RADIOTHERAPY CARE DATASET – to form a tail for each radiotherapy attendance record
CDS DATA GROUP: RADIOTHERAPY TAIL IDENTIFIER
To carry the details of the out-patient CDS to which this radiotherapy tail relates
 M ATTENDANCE IDENTIFIER                                                         Multiple Patient Seqno &”.”& Date/time of first exposure for this attendance
 M ORGANISATION CODE (OPCDS)                                                                 NOT REQUIRED FROM IMPAC
 M APPOINTMENT DATE                                                              DoseHst Tx_Date
CDS DATA GROUP: RADIOTHERAPY EPISODE
To carry the details of the Episode of radiotherapy being given at this attendance.
 M RADIOTHERAPY EPISODE ID NUMBER                                               PatCPlan Course
      DECISION TO TREAT DATE (TELETHERAPY/BRACHYTHERAPY                         PatCPlan
 M                                                                                           Eff_Date Screen label says “start date”
      COURSE)
      EARLIEST CLINICALLY APPROPRIATE DATE                                      Medical LastFollow_DtTm
 M                                                                                      ‘Last Follow up date’. Rename the label as ‘Ready to Start in UK
                                                                                        translation file ?
 M RADIOTHERAPY PRIORITY                                                         Medical Waittime_Pro_Id
   START DATE (TELETHERAPY/BRACHYTHERAPY TREATMENT                              DoseHst Tx_Date
 M COURSE)                                                                              Min of tx_date where PatCPlan joins to Site by PCP_ID, and Site
                                                                                        joins to Dosehst by SIT_ID
CDS DATA GROUP: RADIOTHERAPY PRESCRIPTION
To carry the details of each Prescription of radiotherapy being given at this attendance.
Multiple Occurrences of this group are allowed
 M PRESCRIPTION ID NUMBER                                                             Site   Sit_ID
 M RADIOTHERAPY TREATMENT REGION                                                      Site   Site_Name
 M ANATOMICAL TREATMENT SITE (RADIOTHERAPY)                                           Site   Site_Name
      NUMBER OF TELETHERAPY FIELDS                                                       Count of FLD_ID
 M                                                                               DoseHst Number of unique entries in the FLD_ID field in the DoseHst table
                                                                                         with the same Sit_ID excluding fields with ‘no dose’ imaging.
 M RADIOTHERAPY PRESCRIBED DOSE                                                       Site   Dose_ttl

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 M TELETHERAPY/BRACHYTHERAPY PRESCRIBED FRACTIONS                 Site  Fractions
 M RADIOTHERAPY ACTUAL DOSE                                                    DoseHst Mu_Cgray
      TELETHERAPY/BRACHYTHERAPY ACTUAL FRACTIONS                               DoseHst Count of Tx_Date
 M                                                                                     Number of unique entries in the Tx_Date field in the DoseHst table
                                                                                       for the same Sit_ID
 M TREATMENT MODALITY                                                          DoseHst Machine_ID
CDS DATA GROUP: RADIOTHERAPY EXPOSURE
To carry the details of each radiotherapy exposure delivered at this attendance.
Multiple Occurrences of this group are allowed
 M FIELD ID NUMBER                                                             DoseHst FLD_ID
 M MACHINE IDENTIFIER                                                          DoseHst Machine_ID
 M TELETHERAPY BEAM TYPE                                                       DoseHst Modality
 M TELETHERAPY BEAM ENERGY                                                     DoseHst Energy
 M TIME OF EXPOSURE                                                            DoseHst Tx_Time




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14 Appendix 5 – OPCS4.4 codes for Radiotherapy
 OPCS4
 Code        Name                             Description

 X631        Radiotherapy Volume Definition   Vol. Definition For Radiotherapy With Imaging/Dosimetry
 X632        Radiotherapy Volume Definition   Vol. Definition For Radiotherapy With Imaging/Dosim/Tech Sup
 X633        Radiotherapy Volume Definition   Vol. Definition For Mult. Phases of Complex Radio./Dosimetry
 X634        Radiotherapy Volume Definition   Vol. Definition For Simple Radiotherapy/Imaging/Dosimetry
 X635        Radiotherapy Volume Definition   Vol. Definition For Simple Radiotherapy/Imaging/Simp.Calc.
 X636        Radiotherapy Volume Definition   Vol. Definition For X-Ray/Electron/Megavoltage/Simp. Calc,
 X638        Radiotherapy Volume Definition   Other Specified
 X639        Radiotherapy Volume Definition   Unspecified
 X641        Radiotherapy Preparation         Preparation For Total Body Irradiation
 X642        Radiotherapy Preparation         Preparation For Intracavitary Radiotherapy
 X643        Radiotherapy Preparation         Preparation For Interstitial Radiotherapy
 X648        Radiotherapy Preparation         Other Specified
 X649        Radiotherapy Preparation         Unspecified
 X651        Radiotherapy Delivery            Delivery of A Fraction of Total Body Irradiation
 X652        Radiotherapy Delivery            Delivery of A Fraction of Intracavitary Radiotherapy
 X653        Radiotherapy Delivery            Delivery of A Fraction of Interstitial Radiotherapy
 X654        Radiotherapy Delivery            Delivery of A Fraction of External Beam Radiotherapy
 X655        Radiotherapy Delivery            Oral Delivery of Radiotherapy For Thyroid Ablation
 X658        Radiotherapy Delivery            Other Specified
 X659        Radiotherapy Delivery            Unspecified
 Y911        External Beam Radiotherapy       Delivery of A Fraction of Complex Radiotherapy on A Megavolt
 Y912        External Beam Radiotherapy       Delivery of A Fraction of Simple Radiotherapy on A Megavoltage
 Y913        External Beam Radiotherapy       Delivery of A Fraction of Radiotherapy on A Superficial Orthovoltage
 Y918        External Beam Radiotherapy       Other Specified
 Y919        External Beam Radiotherapy       Unspecified




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15 Appendix 6 - Specification for Extract from PAS for RTDS v3.6

Please note that data items are based on OPCDS version 6, which includes some items intended for
monitoring 18 week waits which are not yet recorded by most Trusts (these items are identified as 18 week
wait items in the notes column, and are all recorded as optional in this dataset.)
It is intended that all attendance specific information will be retrieved from Oncology Management
Systems, and joined to these data from PAS to produce the OPCDS for radiotherapy.
The extract will be required at the end of each month (in time for the submission to be made on the tenth of
the following month) to include information for all patients attending for radiotherapy during the month.
AS radiotherapy is not recorded on most PAS systems it may not be possible to identify the correct cohort
of patients, in which case the data can be produced for all patients on the MPI current for the month, and
the relevant cases will be joined using the radiotherapy data.

Data to be produced as a comma delimited file with quotes as the text identifier.

Opt                         CDS Data Element                                               Notes
                                               (new field to monitor 18 week waits –
 O UNIQUE BOOKING REFERENCE NUMBER (CONVERTED) may start to be recorded in PAS
                                               systems)
 O PATIENT PATHWAY IDENTIFIER                                            (18 week waits)
      ORGANISATION CODE (PATIENT PATHWAY IDENTIFIER
 O                                                  (18 week waits)
      ISSUER)
 O REFERRAL TO TREATMENT STATUS                                          (18 week waits)
 O REFERRAL TO TREATMENT PERIOD START DATE                               (18 week waits)
 O REFERRAL TO TREATMENT PERIOD END DATE                                 (18 week waits)
                                                                         Data item can be used to link records
 M LOCAL PATIENT IDENTIFIER
                                                                         from PAS and OMS
                                                                         Data item can be used to link records
 M NHS NUMBER
                                                                         from PAS and OMS
 M NHS NUMBER STATUS INDICATOR
                                                                         Omit if validated NHS number is
 O PATIENT NAME
                                                                         present
                                                                         Omit if validated NHS number is
 O PATIENT USUAL ADDRESS
                                                                         present
 M POSTCODE OF USUAL ADDRESS
 M ORGANISATION CODE (PCT OF RESIDENCE)
                                                                         Data item can be used to link records
 M PERSON BIRTH DATE
                                                                         from PAS and OMS
                                                                         Data item can be used to link records
 M PERSON GENDER CURRENT
                                                                         from PAS and OMS

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 M COMMISSIONING SERIAL NUMBER                             (e.g. OAT123(=))
 O NHS SERVICE AGREEMENT LINE NUMBER
 O PROVIDER REFERENCE NUMBER
 M COMMISSIONER REFERENCE NUMBER
 M ORGANISATION CODE (CODE OF COMMISSIONER)
 M GMP (CODE OF REGISTERED OR REFERRING GMP)
 O CODE OF GP PRACTICE (REGISTERED GMP)




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16 Appendix 7 - Specification of Extract from OMS for RTDS v3.6
Please note that data items are based on OPCDS version 6. It is intended that the following data items for
each Radiotherapy attendances will be extracted from Oncology Management Systems, and joined to the
PAS extract (see Specification for Extract from PAS for RTDS v3.6) to produce the OPCDS for
Radiotherapy.

The extract will be required at the end of each month (in time for the submission to be made on the tenth of
the following month) to include information for all patients attending for radiotherapy during the month.

Data to be produced as a comma delimited text file with quotes (“”) as the text identifier.
                 CDS Data Element                                Codes                            Notes
                                                          Alphanumeric (10)        Data item can be used to link
LOCAL PATIENT IDENTIFIER                                                           records from PAS and OMS
NHS NUMBER                                                Numeric (10)

POSTCODE OF USUAL ADDRESS                                 Alphanumeric 8(max)
                                                          ccyy-mm-dd               Data item can be used to link
PERSON BIRTH DATE                                                                  records from PAS and OMS
                                                         0                         NK
                                                         1                         Male
PERSON GENDER CURRENT                                    2                         Female
                                                         9                         Not specific
PRIMARY DIAGNOSIS (ICD)                                                            ICD10 codes
ATTENDANCE OCCURRENCE
                                                         Alphanumeric (12)         A sequential number or time of
ATTENDANCE IDENTIFIER                                                              day used to enable an attendance
                                                                                   to be uniquely identified
                                                         01                        NHS
ADMINISTRATIVE CATEGORY                                  02                        PP
                                                         5                         Default to 5 – Attended (unless
ATTENDED OR DID NOT ATTEND                                                         DNA information is available
                                                                                   from OMS)
                                                         1                         First visit
FIRST ATTENDANCE                                         2                         Subsequent visits
                                                         1                         Last treatment (discharged)
OUTCOME OF ATTENDANCE                                    2
APPOINTMENT DATE                                         ccyy-mm-dd
                                                          Z                        OPCS4 Procedure codes
                                                          1-9                      A radiotherapy attendance may
PRIMARY PROCEDURE (OPCS)                                  1-9                      have as many as six procedures
                                                          1-9                      related to that attendance. Equally
PROCEDURE DATE (of Primary Procedure)                     ccyy-mm-dd               the same radiotherapy prescription
                                                                                   may have different procedures
                                                                                   codes associated with it.
(Multiple Procedures may be recorded)                     Z
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PROCEDURE (OPCS)                                1-9
                                                1-9
                                                1-9
PROCEDURE DATE (of Secondary Procedure)         ccyy-mm-dd
                                                ccyy-mm-dd          When radiotherapy radiographer
                                                                    receives the radiotherapy request
REFERRAL REQUEST RECEIVED DATE                                      (action sheet) from the clinical
                                                                    oncologist.
REFERRER CODE                                   GMC number          Consultant Clinical Oncologist
RADIOTHERAPY EPISODE
RADIOTHERAPY EPISODE NUMBER                     Alphanumeric (50)   Any identifier that is unique for
                                                                    each radiotherapy episode
DECISION TO TREAT DATE                          ccyy-mm-dd          Previously “Date Decided to
                                                                    Treat” (DDT)
EARLIEST CLINICALLY APPROPRIATE DATE            ccyy-mm-dd          Previously “Ready to Start” date
RADIOTHERAPY PRIORITY                           E                   Emergency
                                                U                   Urgent
                                                R                   Routine
                                                D                   Elective Delay (N/A)
START DATE                                      ccyy-mm-dd          Date of First Fraction of
(TELETHERAPY/BRACHYTHERAPY                                          Radiotherapy in this
TREATMENT COURSE)                                                   episode.
RADIOTHERAPY PRESCRIPTION
PRESCRIPTION IDENTIFIER                         Alphanumeric (50)   Any identifier that is unique for
                                                                    each radiotherapy prescription
RADIOTHERAPY TREATMENT REGION                   P                   Primary
                                                PR                  Primary & Regional Nodes
                                                R                   Regional Nodes
                                                A                   Non-anatomically specific
                                                                    primary site
                                                O                   Prophylaxis (to non-primary site)
                                                M                   Metastasis
ANATOMICAL TREATMENT SITE                       Z
                                                0-1
                                                0-1
NUMBER OF TELETHERAPY FIELDS                    Numeric (2)         Will be derived from individual
                                                                    exposure records.
RADIOTHERAPY PRESCRIBED DOSE                    5 (inc. 2 d.p.)     ICRU50 ref pt -prescribed dose in
                                                                    Gy for this prescription.
                                                                    www.icru.org/n_992_4.htm
TELETHERAPY/BRACHYTHERAPY                       Numeric (3)         The total number of fractions or
PRESCRIBED FRACTIONS                                                hyperfractions prescribed for this
                                                                    prescription.
RADIOTHERAPY ACTUAL DOSE                        5 (inc. 2 d.p.)     ICRU50 ref pt – the total actual
                                                                    adsorbed dose in Gy for this
                                                                    prescription.
                                                                    www.icru.org/n_992_4.htm
TELETHERAPY/BRACHYTHERAPY ACTUAL                Numeric (3)         The actual number of fractions or
                                                                    hyperfractions given for this
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FRACTIONS                                                      prescription.

TREATMENT MODALITY                         T                   Teletherapy
                                           B                   Brachytherapy
RADIOTHERAPY EXPOSURE
FIELD IDENTIFIER                           Numeric (50)        Any identifier that is unique for
                                                               each radiotherapy exposure
MACHINE IDENTIFIER                         A-Z
                                           A-9
                                           A-9
                                                               Previously “Equipment name”
                                           0-1
                                                               Five character site code & two
                                           0-1
                                                               character equipment type code &
                                           LA/CO/KV/OT
                                                               sequence number for this machine
                                           1-9
                                                               issued by NATCANSAT
                                           1-9
                                           1-9
                                           1-9
TELETHERAPY/BRACHYTHERAPY BEAM TYPE T1                         T1 Photons
                                           T2                  T2 Electrons
                                           T3                  T3 Other
TELETHERAPY BEAM ENERGY                    6 (inc. 3 d.p.)     Beam energy in MeV/MV/MVp.
                                                               Please record kVp energies as
                                                               decimals (e.g. 250kV = 0.25MV).
                                                                Only for multi-modality
                                                               machines
TIME OF EXPOSURE                           Hh:mm:ss(8)         Time only is required.




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17 Appendix 8 – User instructions for the Visir Toolkit

User instructions for the Visir v3 / Oncentra Toolkit to extract the National
Radiotherapy Dataset (RTDS v3.6)


   17.1 Installation
The installation package “setup.exe” can be downloaded as a zipped file from the RTDS website
www.canceruk.net. Make a directory on your C Drive named RES. Run the executable file to
install the toolkit in the c:\res directory of your PC and follow the instructions with the Set up
Wizard.




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When the installation is complete, the toolkit will consist of 2 elements:

   •   a series of .SQL queries and batch files to extract data from the Visir database.
   •   a Visual Basic tool which links to the “Visir RTDSv3.mdb” database and converts the
       extracts from Visir and PAS into the OPCDS and RTDS for radiotherapy.

Please note: If you have already installed a previous version of the RTDS Visir Tool you will
need to remove the software by opening the control panel and selecting “add or remove
programs” to uninstall the RTDS VISIR Setup before installing a newer version.

The error message shown below will appear if there is a previous version of the toolkit installed.




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   17.2 Running the extracts from Visir

VERY IMPORTANT: Do NOT run the extracts on a live database while patients are being
treated. Use a backup server, or run them at a time when the database is not being used for
patient treatments. There is a small risk that the database may slow or crash while the reports
are being run.

The purpose of the batch file and queries is to copy the appropriate tables and fields from your
VISIR system in order to create the 8 data and 5 lookup tables in the reports folder.

Please note: The extracts must be run a minimum of 10 days after the end of the time period to
be extracted. This is to ensure data integrity, see unsummarised records in section 4 below.

Instructions for using the VISIR Export files

The use of these extract files has been approved by Nucletron.

   •   Create 2 folders named SQL ad REPORTS in the VISIR base directory.

   •   The series of sql queries and batch files will be found in the folder “c:\res\extract”. You will
       need to copy these to the SQL folder in the VISIR base directory which you have just
       created.

   •   Open natsatextract.bat and enter 'base path', 'username' and 'password' and if necessary
       modify sql files etc accordingly.

   •   Run the natsatextract.bat files. This should take approximately 30-60 minutes depending
       on amount of data and processor power.

   •   The required output files will be returned to the reports folder which will rename itself with
       today's date when completed i.e. 13-03-2007 NCS

   •   The Fileclean.bat will run automatically as part of this process. It is used to tidy up the data
       text files i.e. removing leading and trailing ','. You may decide not to use this.

   •   The csv files present in the reports folder are.

                            CODEDIAG
                            CODEINTENTION
                            CODEPRIOCAT
                            CODEREGION
                            CODETREATTYPE
                            FIELD
                            FIELDEXP
                            FIELDSERI
                            FRACTION
                            PATIENT
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                              SERIES
                              TARGETVOL
    •   Copy the .csv files from the reports folder extract files from Visir into the c:\res directory on
        your PC (where the toolkit is installed).
.

Please Note: The exported csv file should be left ‘as is’ once exported. Don’t attempt to open the
file in any other package such as Microsoft Excel as this can cause corruption of the data.


    17.3 Creating the extract from PAS
A critical phase of the RTDS extraction is the production of an extract from your PAS
system for all patients treated during the period specified.
To assist in creating the PAS data extract, a text file can be generated containing a list of
patient identifiers that appear in the VISIR extract between the dates specified. For further
information please go to Step 3 of Section 4 - Running the VISIR tool.
The format of the PAS Extract is a CSV file with the columns listed in the document
‘OPCDS for radiotherapy PAS Extract Specification.doc’. It is important to note that
although some fields are marked as optional they must still be represented in the csv file
by using a comma. Column names do not have to match the RTDS field headings. They
do, however, have to be included and they MUST appear in the order specified.

The extract will be required at the end of each month (in time for the submission to be made on
the tenth of the following month) to include information for all patients attending for radiotherapy
during the month.

See PAS Extract Specification for Extract for OPCDS and RTDS v3.62 for further information.

Create the output file as a comma delimited file with quotes as the text identifier.
Name the file “PASData.csv”
Copy ‘PASData.csv’ into c:\res directory on your PC (where the toolkit is installed).




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Running the VISIR tool
To open the VISIR tool, use the shortcut on the desktop or find the RTDS_VISIR_v1.04.exe file in
C\RES. The Main Application Screen will appear as below:




Step 1 – Copy Extract files

The tool will not run unless all the VISIR csv files are present.

If you have correctly placed all of the extract tables in the C:\RES directory, step 1 will be
disabled, as shown here. Skip step 1.

If the button “Browse for CSV File” is active and the message “CSV Files is missing. Please
locate” appears as below, then you need to check that the Visir extract csv files are in the c:\res
directory on your PC and named correctly. If the extract files are in a different location, you can
direct the tool to them by using the “browse” button to locate the missing file.

Please note the browse option will copy the CSV files from the different location into C:\RES. If
you then amend the original CSV files (for example when running a new month’s extract) the tool
will not take account of these changes. It will still use the “old” copy in C\:RES. This time you will
not be able to redirect it back to the original files or browse. The copy in C:\RES must be
changed and the Refresh Data button clicked.

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Step 2 – Centre Information & Dates
Information specific to your Centre needs to be recorded. This can be done by via following the
instructions on the screens:-

   1. Select your organisation name from the drop down menu. If it is not listed, you can enter it
      in the table named “RES_Centres” in the Visir RTDS v3 database in C:\RES or telephone
      the RTDS Helpdesk on 0870 840 8033.

   2. Select from the option of “NHS Number” or “Local Patient Identifier” to identify which field
      in the PAS Extract will be used to link the PAS and VISIR data.


   3. Select from the option of “PersNo”, “PatID2” or “PatID3” to identify which patient identifier
      field in the VISIR system will be used in the tool to link the PAS and VISIR data.

   4. Enter the inclusive time period for which the extract is to be run. (This is normally one
      complete calendar month).

Please note: When you have completed the 4 steps listed here, have created the Output
database and the procedure is finished, the settings above can be saved by choosing “Save and
Close” option when you close the tool.
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Step 3 – Obtain List of Patients for PAS Data Extract
To assist in creating the PAS data extract a text file can be generated containing a list of patient
identifiers that appear in the VISIR extract between the dates specified in Step 2. Simply click
the ‘Patient List’ button. Please make sure that all of Step 2 has been accurately completed prior
to producing this text file otherwise the list will not be correct and the PAS extract will have to be
repeated.
A critical phase of this process is the production of an extract from your PAS system for all
patients seen during the period specified. The format of this extract is a CSV file with the
columns listed in the document ‘OPCDS for radiotherapy PAS Extract Specification.doc’. It is
important to note that although some fields are marked as optional they must still be represented
in the csv file by using a comma. Due to the problems of changing system column names to
exactly match the specification it has been decided that column names do not have to match.
They do, however, have to be included and they MUST appear in the order specified.

Step 4 - Reference and Integrity Checks

This step carries out a number of housekeeping and data integrity checks. There are 5 lookup
tables contained in the database “Visir RTDS v3” to be found in C:\RES which will be populated
with data defined by the user. The user should consider an independent check when entering
data into the tables or subsequently by opening the database (when the tool is closed) and
verifying the data in the tables below.

   •    UserPopTblCommissioningSerialNumber
   •    UserPoptblConsultantGMCNumbers
   •    UserPoptblDiagnosisCodeMapping
   •    UserPoptblDummyPatients
   •    UserPoptblMachines
   •    UserPoptblRadQual

To enter data into the tables, follow the instructions on screen in Step 4. Select the “check button”
for each check in turn. Ensure that the tick boxes are empty before you begin your checks. This
can be done if necessary, by selecting the “untick all boxes”. Once you have completed a check,
put a tick next to the relevant check.

There are 8 checks.

   1.   PAS Extract
   2.   Consultant Oncologist
   3.   Primary Diagnosis
   4.   Treatment Machine
   5.   Beam Energy and Type
   6.   Linked to Requisition
   7.   Not Linked to Requisition
   8.   Unsummarised Treatment



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Each check will give on screen instructions which you will need to follow. If data is missing or
erroneous you will need to deal with this data and in some cases rerun the extracts and then
rerun the tool, starting at step 1 again.

   1) PAS System Extract

A CSV file “PASdata” needs to be located in the C\RES directory for this procedure to run. If the
“check data” button is disabled then the tool cannot find the PAS extract. You need to check the
file PASdata.csv is in C:\RES and named correctly.

By selecting the “check data” button for PAS System Extract, the database runs a query linking
PAS records to Visir Patient records but omitting records included in the table
“userPoptblDummyPatients” in the database. You may wish to populate this table before running
the tool. Run an update query in the Visir RTDS v3 database to populate the lookup table
“userPoptblDummyPatients with Visir PID No and PersNo which are known test or non patient
records. (This does not need to be done but will save you time).
Alternatively use the on screen instructions.

The screen will either be shown as below with the message “PAS Extract complete”.




The check is completed. You should return to the main screen and place a tick in “PAS System
Extract” box.

OR a list of Visir patient records will appear, as the example shows below.


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There are two possible explanations for the omission of records in the PAS extract:

1. Record in Visir refers to a non patient or test – eg: verification, calibration, blood irradiation etc
2. Record in Visir where the record in PAS is missing or has a different number (and therefore
   cannot be linked).

You need to review the patient records shown, and identify the reason for each omission.

If the record is as described in 1 – a non patient, add the record to the test or “dummy patients”
lookup table. This can be done by placing a tick in the “Dummy” column next to the record.
Select the “Save” button when all relevant records have been ticked. This will record the PIDNo
and PersNo in the lookup table. Once this has been done, the record will no longer appear in the
report.

Records as described in 2, with a different number on Visir and PAS, or omitted from PAS will
need to be modified and the extracts run again. Use the ‘Print’ or ‘To Excel’ buttons to obtain the
details of these patients to ensure that they are correctly updated.


Please Note: Any patient not included in the PAS extract will be omitted from the RTDS export
produced by the tool


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   2) Consultant Oncologist




By selecting the “check data” button for Consultant GMC Number Lookup, the database runs a
query to check that all General Medical Council Numbers are complete for consultants listed for
patients treated in the time period specified. The records are held in the lookup table
“UserPoptblConsultantGMCNumbers” in the database.

The first time the tool is used, all GMC numbers will need to be entered. These can be found
from the Trust information department, or via the TRUD service, or from the GMC website
www.gmc-uk.org .

You may wish to populate this table before running the tool. Run an update query in the Visir
RTDS v3 database to populate the lookup table “UserPoptblConsultantGMCNumbers” with the
corresponding GMC Numbers for the Visir “ReqDoc” field entry (This does not need to be done
but will save you time).

The GMC code should be entered as a “C” prefix followed by a 7 digit number

Alternatively use the on screen instructions as below.




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             .

The screen shows a list of Consultant records as entered into Visir which have no corresponding
GMC Numbers in the lookup table. To manually type GMC numbers into the table, select the “To
type GMC Numbers into table, CLICK here” button. This will take you to the screen below.




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This is a complete list of Consultants entered in the ‘ReqDoc’ field in the requisition table of Visir.
 If the GMC Number column is blank, type the GMC number for the consultant then save. The
GMC code should be entered as a “C” prefix followed by a 7 digit number. If you then return to
the previous screen and rerun the check, the record(s) will disappear and the message “GMC
Number complete” appears. If the record is still there the GMC Number has been entered
incorrectly.

It is important that these numbers are transcribed correctly and we recommend an
independent check.

If a GMC Number is missing from the lookup table, the record will still appear in the extract but
the consultant field will be blank.

Once the list has been populated, it will only need to be updated when there is a change in the
consultants at your Trust. The screen will show the message below “GMC Number complete”
when the check is complete and no changes need to be made.

The check is completed. You should return to the main screen and tick the check box.


   3) Primary Diagnosis

The Primary Diagnosis check operates in the same way as the Clinical Oncologist lookup query
as above.




By selecting the “check data” button for Diagnosis Code Lookup, the database runs a query to
check that all ICD 10 Codes are complete for primary diagnosis records held in Visir for the time
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period specified. The ICD codes and diagnosis look up records are held in the table
“UserPoptblDiagnosisCodeMapping” in the database.

The first time the tool is used, all ICD10 Codes will need to be entered. The codes can be found
in Appendix1 or on the NATCATSAT website www.canceruk.net . You may wish to populate this
table before running the tool. Run an update query in the Visir RTDS v3 database to populate the
lookup table ““UserPoptblDiagnosisCodeMapping with the corresponding ICD 10 codes for the
Visir “Diag” field entry. (This does not need to be done but will save you time). The ICD 10 code
should be entered as a “C” prefix followed by a 2 digit number.


Alternatively use the on screen instructions as below




The screen shows a list of diagnosis codes as entered into Visir which have no corresponding
ICD10 codes in the lookup table. To manually type ICD 10 codes into the table, select the “To
type Codes into table, click here” button. This will take you to the screen below.

See Appendix 1 for a list of approved ICD 10 codes.




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This is a complete list of Diagnosis Codes and Description as entered in the ‘Diag’ field the
Target Vol table in Visir. If the ICD10 code is blank, type the ICD 10 code for each local diagnosis
code and description then save. . If you then return to the previous screen and rerun the check,
the record(s) will disappear and the message “ICD 10 complete” appears. If the record is still
there the ICD 10 code has been entered incorrectly.
The ICD code should be entered as a “C” prefix followed by a 2 digit number.

Please note: Refer to the notes in section 4.1.2 of the RTDS dataset manual to ensure that any
codes currently in use can be adequately mapped to ICD10 codes. If necessary, review and
update the diag code list in Visir.

If the ICD 10 code is missing from the lookup table, the record will still appear in the extract but
the diagnosis field will be blank.

Once the list has been populated, it will only need to be updated when there is an addition or
change to local diagnosis code.

The screen will show the message below “ICD10 Complete” when the check is complete and no
changes need to be made.




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The check is completed. You should return to the main screen and tick the check box.


   4) Treatment Machine

The Treatment Machine check operates in the same way as the Primary Diagnosis lookup.




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By selecting the “check data” button for Treatment Machine, the database runs a query to check
that the National Machine ID and Treatment Modality for each machine is complete, for the time
period specified. The records are held in the lookup table “UserPoptblMachines” in the database.

The first time the tool is used, the Machine ID code (from the National Radiotherapy Equipment
Survey, see below) and the Treatment Modality Code will need to be entered. The National
Machine ID will be sent to you from NATCANSAT, or from the National Radiotherapy Equipment
Survey 2007.
http://www.canceruk.net/rtservices/rtequip2007/UK%20RT%20Equipment%20Survey%202007%20Engla
nd%20v1%2033.xls. You may wish to populate this table before running the tool. Run an update
query in the Visir RTDS v3 database to populate the lookup table “UserPoptblMachines” with the
corresponding machine information for the Visir “ExpUnit” field entry. The Treatment Modality is
either “T” for teletherapy or “B” for brachytherapy. (This does not need to be done but will save
you time).

Alternatively use the on screen instructions as below.




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The screen shows a list of machine codes entered into Visir which have no corresponding
Machine ID code. To manually type the National Machine ID Code into the table, select the “To
type codes into table, click here” button. This will take you to the screen below.

Use the ‘To type codes into table, click button” to open the lookup table, then type in the national
code for each machine listed. See the National Radiotherapy Equipment Survey for National
Machine ID Numbers
http://www.canceruk.net/rtservices/rtequip2007/UK%20RT%20Equipment%20Survey%202007%20Engla
nd%20v1%2033.xls or call the NATCANSAT helpdesk on 0870 840 8033




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This is a complete list of machines as entered in the ‘ExpUnit’ field of the Field Exp table in Visir.
In the Machine ID column, type the national code and modality for each machine then save. The
National Machine code is a 6 or 7 digit code prefixed by the Provider ( NHS Trust) organisation
code. In the Modality column enter either “T” for teletherapy or “B” for brachytherapy. If you then
return to the previous screen and rerun the check, the record(s) will disappear and the message
“There are no missing records”” appears.

If the ExpUnit is missing from the lookup table, the record will still appear in the extract but the
machine ID field will be blank.

Once the list has been populated, it will only need to be updated when there is an addition or
change to the local machine code.

The screen will show the message below “There are no missing records” when the check is
complete and no changes need to be made.




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The check is completed. You should return to the main screen and tick the check box.

   5) Beam Energy and Type

The Beam Energy and Type lookup operates in the same way as the Treatment machine lookup.




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By selecting the “check data” button for Beam Energy and Type, the database runs a query to
check that the accepted beam energy and beam type for each treatment machine is complete for
the time period specified. The records are held in the lookup table “UserPoptblRadQual” in the
database.

Please note: for Cobalt Teletherapy machines please leave beam energy and type blank.

The first time the tool is used, the beam type and energy for each machine will need to be
entered. You may wish to populate this table before running the tool. Run an update query in
the Visir RTDS v3 database to populate the lookup table “UserPoptblRadQual” with the
corresponding beam energy ( MeV / MVp) and beam type (T1= Photons; T2= Electrons; T3=
Other) for the Visir “RadQual” field entry.
(This does not need to be done but will save you time).

The screen shows a list of codes entered into Visir which have no corresponding beam or type.




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Use the “To type codes into table, click button” to open the look up table and then type in the
beam energy (in MeV/MVp) and radiation type code for each “radqual” listed.




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This is a complete list of the beam Beam (radiation) type codes are as follows:

T1     Photons
T2     Electrons
T3     Other

If a Radqual code is missing from the lookup table, the record will still appear in the extract but
the beam type and energy will be blank.

Once the list has been populated, it will only need to be updated when there is an addition or
change to the local machine code.

The screen will show the message below “Beam Energy and Type complete” when the check is
complete and no changes need to be made.




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The check is completed. You should return to the main screen and tick the check box.


   6) Not Linked to Requisition

The “Not Linked to Requisition” check operates in the same way as the PAS extract check above.




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By selecting the “check data” button for “Not Linked to Requisition”, the database runs a query
linking the target volume records within the specified dates to a corresponding requisition table
record.

The screen will either be shown as below with the message “All records are linked to a
requisition”.




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The check is completed. You should return to the main screen and place a tick in “Not Linked to
Requisition” box.

OR

A list of records copied from the Targetvol table in Visir will appear, as the example below shows




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If a record is shown here then the corresponding record cannot be found in the requisition table
of Visir. In other words there is no request for the treatment recorded.

You need to review the records shown, and identify the reason for each omission. The reason is
probably that the identifier is different in Target Volume table than in the Requisition table. If this
is the case, the records will need to be amended at source and the extract run again.

Use the ‘Print’ or ‘To Excel’ buttons to obtain the details of these patients to ensure that they are
correctly updated. Remember to refresh data in the tool when new data is available.


Please note :If the target volume records are not attached to a requisition, the records will be
excluded from the extract.



   7) Linked to Old Requisition

The “Linked to Old Requisition” check operates in the same way as the PAS extract check.




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By selecting the “check data” button for “Linked to Old Requisition, the database runs a subquery
linking the target volume records within the specified dates to a requisition table record. If
another target volume record is linked to the same requisition and the first radiotherapy exposure
is more than 60 days earlier than the first exposure for this target volume, it will appear in the list
below.

The screen will either be shown as below with the message “No records linked to Old
Requisition”.




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The check is completed. You should return to the main screen and place a tick in “Linked to Old
Requisition” box.

OR

The list below shows attendance records for the target volume which appears to be linked to the
wrong requisition as there appears to be another target volume linked to the same requisition and
the first radiotherapy exposure is more than 60 days earlier than the first exposure for the first
target volume.

There are two possible explanations

   1. The target volume record has been linked to the wrong requisition record, perhaps an
      early requisition record for the same patient. If necessary, attach target volume record to
      the correct requisition, and re-run the extracts.

   2. This is a true record and the start date for is more than 60 days before the first fraction of
      radiotherapy for this target volume.




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   8) Unsummarised Treatment
The “Unsummarised Treatment” check operates in the same way as the PAS extract check.




By selecting the “check data” button for Unsummarised Treatment, the database runs a query to
identify patient records where the “TreatStat” field is not set to finished (code AVSL) and the
patient has not received any radiotherapy exposures between the end of the time period
specified and the time when the report was run (minimum 10 days).

The screen will either be shown as below with the message “No Unsummarised Treatment”.




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The check is completed. You should return to the main screen and place a tick in “Unsummarised
Treatment” box.

OR

A list of records from the Patient table in Visir where the treatment status has not been set to
finished and the patient has not received any radiotherapy exposures between the end of the
time period specified and the time when the report was run (minimum 10 days).

There are two possible explanations

   1. The patient has had the treatment suspended and has not received any radiotherapy
      between the end of the time period specified and the date of data extract.
   2. The patient has completed the radiotherapy but the status has not been set to “finished”.
      In this case the record will need to be amended at source and the extract run again.
      Remember to refresh data in the tool when new data is available.

Please note: If finished treatments are unsummarised, they will still be included in the extract but
the finished date and total dose will not be completed.




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Completing the housekeeping checks

Once all the housekeeping and data integrity checks above have been completed and there is a
tick in each of the boxes, you can proceed to creating the RTDS.

The program will not be run if any of the tick boxes are left unticked




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   17.4 Running the extract

To create the RTDS output files, select the “Run” button



The tool will create an Access database named Visir RTDS v3 Output.mdb. This should be
submitted in accordance with your Trust policy for Information Governance on the transfer of
potentially identifiable patient data. If necessary, please refer this to your Caldicott Guardian.

NATCANSAT accept data submissions by the following routes

   •   Email to and from NHSnet addresses
   •   Email with AES 256 encryption to and from NHSTrust.uk addresses
   •   FTP via nww server with AES 256 encryption
   •   Special Delivery or courier service with AES 256 encryption




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Appendix 1
RTDS v3.5 – ICD10 codes for Primary Diagnosis
ICD10 code   Descriptor
C00          Malignant neoplasm of lip
C01          Malignant neoplasm of base of tongue
C02          Malignant neoplasm of other and unspecified parts of tongue
C03          Malignant neoplasm of gum
C04          Malignant neoplasm of floor of mouth
C05          Malignant neoplasm of palate
C06          Malignant neoplasm of other and unspecified parts of mouth
C07          Malignant neoplasm of parotid gland
C08          Malignant neoplasm of other and unspecified major salivary glands
C09          Malignant neoplasm of tonsil
C10          Malignant neoplasm of oropharynx
C11          Malignant neoplasm of nasopharynx
C12          Malignant neoplasm of piriform sinus
C13          Malignant neoplasm of hypopharynx
C14          Malignant neoplasm of other and ill-defined sites in the lip, oral cavity and pharynx
C15          Malignant neoplasm of oesophagus
C16          Malignant neoplasm of stomach
C17          Malignant neoplasm of small intestine
C18          Malignant neoplasm of colon
C19          Malignant neoplasm of rectosigmoid junction
C20          Malignant neoplasm of rectum
C21          Malignant neoplasm of anus and anal canal
C22          Malignant neoplasm of liver and intrahepatic bile ducts
C23          Malignant neoplasm of gallbladder
C24          Malignant neoplasm of other and unspecified parts of biliary tract
C25          Malignant neoplasm of pancreas
C26          Malignant neoplasm of other and ill-defined digestive organs
C30          Malignant neoplasm of nasal cavity and middle ear
C31          Malignant neoplasm of accessory sinuses
C32          Malignant neoplasm of larynx
C33          Malignant neoplasm of trachea
C34          Malignant neoplasm of bronchus and lung
C37          Malignant neoplasm of thymus
C38          Malignant neoplasm of heart, mediastinum and pleura
C39          Malignant neoplasm of other and ill-defined sites in the respiratory system and intrathoracic organs
C40          Malignant neoplasm of bone and articular cartilage of limbs
C41          Malignant neoplasm of bone and articular cartilage of other and unspecified sites
C43          Malignant melanoma of skin
C44          Other malignant neoplasms of skin
C45          Mesothelioma
C46          Kaposi's sarcoma
C47          Malignant neoplasm of peripheral nerves and autonomic nervous system
C48          Malignant neoplasm of retroperitoneum and peritoneum
C49          Malignant neoplasm of other connective and soft tissue
C50          Malignant neoplasm of breast
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C51          Malignant neoplasm of vulva
C52          Malignant neoplasm of vagina
C53          Malignant neoplasm of cervix uteri
C54          Malignant neoplasm of corpus uteri
C55          Malignant neoplasm of uterus, part unspecified
C56          Malignant neoplasm of ovary
C57          Malignant neoplasm of other and unspecified female genital organs
C58          Malignant neoplasm of placenta
C60          Malignant neoplasm of penis
C61          Malignant neoplasm of prostate
C62          Malignant neoplasm of testis
C63          Malignant neoplasm of other and unspecified male genital organs
C64          Malignant neoplasm of kidney, except renal pelvis
C65          Malignant neoplasm of renal pelvis
C66          Malignant neoplasm of ureter
C67          Malignant neoplasm of bladder
C68          Malignant neoplasm of other and unspecified urinary organs
C69          Malignant neoplasm of eye and adnexa
C70          Malignant neoplasm of meninges
C71          Malignant neoplasm of brain
C72          Malignant neoplasm of spinal cord, cranial nerves and other parts of central nervous system
C73          Malignant neoplasm of thyroid gland
C74          Malignant neoplasm of adrenal gland
C75          Malignant neoplasm of other endocrine glands and related structures
C76          Malignant neoplasm of other and ill-defined sites
C77          Secondary and unspecified malignant neoplasm of lymph nodes
C78          Secondary malignant neoplasm of respiratory and digestive organs
C79          Secondary malignant neoplasm of other sites
C80          Malignant neoplasm without specification of site
C81          Hodgkin's disease
C82          Follicular [nodular] non-Hodgkin's lymphoma
C83          Diffuse non-Hodgkin's lymphoma
C84          Peripheral and cutaneous T-cell lymphomas
C85          Other and unspecified types of non-Hodgkin's lymphoma
C88          Malignant immunoproliferative diseases
C90          Multiple myeloma and malignant plasma cell neoplasms
C91          Lymphoid leukaemia
C92          Myeloid leukaemia
C93          Monocytic leukaemia
C94          Other leukaemias of specified cell type
C95          Leukaemia of unspecified cell type
C96          Other and unspecified malignant neoplasms of lymphoid, haematopoietic and related tissue
C97          Malignant neoplasms of independent (primary) multiple sites




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18 Appendix 9 - User instructions for the Impac Toolkit

19 Appendix 10 - User instructions for the Varis Toolkit

20 Appendix 11 – Quality Assurance Process
The Quality Assurance process for RTDS falls into four broad phases:

Phase 1: QA of Extracted Data
Phase 2: QA of Output files before submission
Phase 3: QA of Output files upon receipt
Phase 4: Data Quality Audits

Phase 1: QA of extracted data
These processes are be run on data which has been extracted from Oncology Management
Systems and PAS in order to identify problems with data which might result in omissions from or
errors in the .xml files produced.

They are currently well developed only for one package (Visir/Oncentra), and although the issues
will be similar for other packages they will not be identical.

The processes are documented in detail in the RTDS Data Manual v3.6.

They are intended to check for data integrity. (ie: that related tables have the appropriate records
in each of the tables), and for code mapping (ie: that the records exist in lookup tables for codes
for all of the entries in the extracted data.)

Some of the checks identify records which are certainly errors (eg: there is an entry against a
consultant who is not in the lookup table for GMC number). These will require correction before
the extract is run.

Other checks identify potential errors (eg: treatment entered against a requisition from more than
sixty days before treatment started), which are suspicious of a data entry error, but may be
correct. These will require further investigation.




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             PAS              Extract from
                                  PAS                      QA
                                                          Checks
             VISIR            Extract from
                                  Visir                              No Errors

                                                           Errors


                                Investigate                          Ready to
                                and correct                             run
                                   errors                             output
                                                                       files




Errors identified by the Phase 1 QA checks will require investigation, and will need to be
corrected in the source database (as indicated in the diagram above). Once these corrections
have been made the extracts will need to be re-run, and the QA checks will be performed again.
If further errors have been introduced by the correction of previous errors these will be identified
by the QA checks. This loop will be repeated until no errors are identified by the QA checks, and
any potential errors identified are confirmed as correct. Then the process can be carried out to
produce the .xml files for submission.

Phase 2: Phase 2: QA of Output files before submission
Once the .xml files are produced, Trusts will carry out further quality assurance before the files
are submitted. For this purpose the .xml files are re-imported into an Access Database.

The following logic checks are carried out:
   • Completeness
          o Percentage of records with each field completed
          o List of records with empty fields
   • Code validation
          o Percentage of records with invalid entries in any field
          o List of records with invalid entries in any field
   • Cross validation
          o Person birth date before all other dates
          o First attendance – only one entry with a value of 01, with an appointment date
             earlier than all other appointment dates for each Radiotherapy Episode Identifier
          o Outcome of attendance – only one entry with a value of 01, with an appointment
             date greater than all other appointment dates for each Radiotherapy Episode
             Identifier
          o Referral Request Received date is earlier than or equal to the appointment date
          o Decision to treat date is earlier than or equal to the appointment date
          o Decision to treat date is earlier than or equal to the Referral Request Received date

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          o Decision to treat date is earlier than or equal to the Earliest Clinically Appropriate
              Date
          o Earliest Clinically Appropriate date is earlier than or equal to the appointment date
          o Where Radiotherapy Priority = E, Decision to treat date is earlier than earliest
              clinically appropriate date
          o Where Radiotherapy Priority does not equal E, Decision to treat date is equal to
              earliest clinically appropriate date
          o Radiotherapy Start date is later than or equal to Decision to treat date, Referral
              request received date, Earliest Clinically appropriate date.
          o Radiotherapy Start date is earlier than or equal to appointment date
          o Anatomical treatment site is completed if there is an entry of A, O or M in
              radiotherapy treatment region.
          o Number of teletherapy fields is greater than or equal to the number of exposures
              associated with the same prescription.
The logic checks will identify any records which contain data entry errors. These errors will need
to be corrected in the source database, and the extracts will need to be run again and the QA
checks repeated.

The following reports are produced:
   • Minimum and Maximum Appointment Dates
   • Number of attendances
   • Number of unique attendance identifiers recorded against each radiotherapy machine ID
       on each date
   • Number of unique attendance identifiers recorded against each radiotherapy machine ID
   • Number of unique radiotherapy episode identifiers recorded against each radiotherapy
       machine ID
   • Number of unique radiotherapy prescription identifiers recorded against each radiotherapy
       machine ID
   • Number of radiotherapy exposures recorded against each radiotherapy machine ID

The reports will help providers to assess the completeness of data, and to identify any areas
where data has not been collected or extracted. The figures can be used to compare with data
collected from other sources, or other time periods in order to identify any possible omissions.

Phase 3: QA of Output files upon receipt
Upon receipt by NATCANSAT all of the QA checks listed in Phase 2 will be repeated, and the
reports produced will be compared with totals for other extracts submitted by the same centre.

Initially, invalid field entries will be removed from the extract, then a QA report will be produced
including the output of the phase 2 queries on the updated dataset, along with any values which
fall outside of tolerances (either absolute: eg: 100% of appointment dates are completed, or
comparative eg: the number of attendances reported for machine x is <90% of the value reported
last month, or for this month last year.)

The QA report will be sent to the submitting centre within 3 working days of receipt of the
submission.

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If data received is within tolerances, data will be uploaded to a central database, and used to
populate the secondary reports on the RES analysis website. The centre will then have 5
working days to review the secondary reports before data is used to populate the primary reports
on the RES analysis website.

If data received is outside of tolerances, the centre will be asked to resubmit data or explain
variations before analysis is carried out.

Upon receipt of the very first extract, NATCANSAT will also review any code mapping tables, and
feedback any issues directly to the submitting centre.




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Phase 4: Data Quality Audits

The Cancer Action Team (NCAT) have offered the services of a team who have considerable experience of
collecting cancer data in two cancer networks. This team will be used to carry out a program of data
quality audits at individual centres, which will result in each centre being audited a minimum of once
every three years. Centres will not be audited until they are able to reliably (minimum of three months)
submit data which meets the QA requirements, unless NATCANSAT believe that a data quality audit may
help to resolve this issue.

Data quality audits will consist of two separate elements:
    • Correctness – correctness will be audited against the original source data (this might be a paper
       record filed in the casesheet, where this exists, or the computer record for electronic health records.
        A small sample of radiotherapy courses will be selected at random from the submitted data, and
       will be manually checked against the source data.
    • Completeness – completeness will be audited against electronic or paper diary records for at least
       one whole day on each of the treatment machines. A manual check will be carried out to ensure
       that all patients recorded as treated in the diary have been included in the submitted data, and that
       there are no records submitted which are not recorded in the diary.
For both elements, any discrepancies will be investigated, and a report will be produced indicating the
proportion of errors detected, and whether these appeared to be systematic or sporadic. Centres will then
be required to produce an action plan to explain how data quality will be improved.




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