CLINICAL Engineering MDT is about modifying clinical envoironment

Modifying clinical environment

1. Clinical Engineering MDT Revisiting our Goals & our Concept document Engr. Hoor Abdul Ghani Dr. Sehrish Abrar Dr. Ahmed Nadeem Abbasi 17 th August 2021

2. CONCEPT DOCUMENT CLINICAL ENGINEERING M.D.T BOARD Dr SEHRISH ABRAR Chair, C.E. MDT Faculty, Radiation Oncology, AKU Clinical Facilitator : Dr. Fatima Shaukat Engineering Facilitator : Engr. Hoor Abdul Ghani

3. SCOPE: MULTI-DISCIPLINARY TEAM BUILDING FOR RADIATION ONCOLOGY SERVICE DEVELOPMENT UNDER HEADING OF: Comprehensive Cancer Service Development FOCUS: RADIATION ONCOLOGY FACILITY OBJECTIVES: PRIMARY: Round Table Deliberations in a Multi Disciplinary Team in order: To achieve Comprehensive Solutions of problems evolving from all relevant aspects of RADIATION ONCOLOGY facility Service Development To develop and inculcate multi-disciplinary culture via bringing experts from concerned engineering and medical fraternity To achieve high quality standards via mutual sharing of ideas leading to patient centred solutions

4. FOR RADIATION ONCOLOGY Concerned Related Faculty from: Biomedical Engineers (CE) Civil Engineers Architects Occupational Health & Safety Radiation Oncology Clinicians Clinical Medical Physicists RT Technologists Clinical Engineering MDT concept can be applied to other clinical services as well, but this document only covers the Discipline of RADIATION ONCOLOGY

5. KARACHI EDUCATIONAL INSTITUTES INVOLVED IN THE TRAINING OF: A)Biomedical Engineers B)Civil Engineers C) Architects D) Occupational Health & Safety Engineers E)Radiation Oncology Doctors F)Clinical Medical Physicists G)RT Technologists

6. A) Biomedical Engineering A-1)Faculty of Biomedical Engineering, Sir Syed University of Engineering & Technology A-2)Faculty of Biomedical Engineering, NED University, LEJ Campus A-3) Faculty of Biomedical Engineering, Hamdard University A-4) Faculty of Biomedical Engineering, Ziauddin University, ZUFEST

7. B) Civil Engineering B-1)NED C) Architecture C-1) ARCOP D) Occupational Health & Safety Engineers Name: Shahid Lutfi Designation: Environment Consultant Engineer Email: [email protected] Dr. Sarosh Hashmat Lodi Vice Chancellor, NED University PA: Mr Omer 1. S.A. Pasha   Senior Project Architect arcopassociates.com Contact: 021-35894895

8. E) Radiation Oncologists E-1) Existing RT facilities ATOMIC ENERGY MEDICAL CENTER AGA KHAN UNIVERSITY JPMC KIRAN NEUROSPINAL AND CANCER CARE INSTITUTE SIUT ZIAUDDIN MEDICAL UNIVERSITY E-2) Institutes intending to start RT Service CANCER FOUNDATION HOSPITAL CHK INDUS HOSPITAL LIAQUAT NATIONAL HOSPITAL NIBD PNS SHIFA PAKISTAN ONCO CARE SHAUKAT KHANUM MEMORIAL HOSPITAL

9. STEERING COMMITEE TEAM Contact Persons  Engr. Hoor Abdul Ghani Biomedical Engineer, coordinator Email: [email protected] Dr Sehrish Abrar Radiation Oncologist, AKU Email: [email protected] Dr Fatima Shaukat Radiation Oncologist, AKU Email: fatima.shaukat@aku .edu Engr. Shahid Lutfi Environment Consultant Email: [email protected] Dr Ahmed Nadeem Abbasi Radiation Oncologist, AKU Email: [email protected]

10. REVIEW OF CONTEMPORARY PUBLISHED MANUSCRIPTS Dr BILAL MAZHAR QURESHI SECTION HEAD RADIATION ONCOLOGY. AKU

11. In LMICs severe shortfall in RT capacity, especially in Sub-Sahara Africa. RT staff includes biomedical engineering support from a formalized service contract Improvements machine downtime & patient waiting times,

12. Reflect different service contracts countries: Oxford centre had full parts contract with the manufacturer, Gaborone centre had a full parts and service contract with manufacturer Nigerian centres did not have either a parts or a service contract .

13. Number of engineering clinical technologists required depend on extent to which maintenance is carried out in-house. Even with fully externally resourced service contract, the facility for first line repair and quality control is provided inhouse

14. In order to overcome problems of maintenance and support, all acquired equipment comes with a maintenance contract and that the “contract is set up with a company with well established service centres close to where the radiotherapy unit will be housed” It would also be beneficial if, in areas that do not have immediate access to a radiotherapy producer, adequate local maintenance staff is trained by the supplier of the radiotherapy units and employed by the cancer centre , helping to drive down the costs associated with long-distance travel between a user and a producer.

15. CONCLUSION The current situation in most LMIC with an average of less than 30% of all cancer patients having access to any services is totally unacceptable. There is a lot that the international community can do by supporting global partnerships and joint programmes among the various active key players. To meet the needs of the growing number of cancer patients a complete solution will need to be developed that can address all facets of radiotherapy acquisition and use, assisting the ever growing number of patients in LMIC to access the radiotherapy treatment that they require. More affordable solutions to the cancer epidemic are urgently required as with each passing day the number of those afflicted with the disease climbs and the global impact of cancer continues to grow. Radiation therapy is an essential component of cancer treatment and must be made available to all who need it. The encouraging news is the high level resolution adopted in September 2011 by the United Nations’ General Assembly on Prevention and Control of Noncommunicable Diseases (NCDs) following the leadership and extensive efforts of WHO, supported by other UN agencies and a significant number of NGOs. This is the first time that the global community has recognized at the highest international forum, with strong support of all countries, the burden of NCDs, including cancer, and their serious social and economic impact in LMIC. The implementation of this resolution, as requested by the General Assembly, will open the way for the donor community to look at successful programmes and interventions that can offer suitable and sustainable solutions for developing countries. In this context, to ensure the development of effective and sustainable treatment capacity in LMIC, radiotherapy and palliative care services should be planned at the national level as an integrated component of a national cancer control programme with careful long-term infrastructure and workforce planning within the scope of targets defined to implement the resolution on NCDs. The relative success of recent international efforts such as IAEA’s PACT partnership, its AGaRT and VUCCnet initiatives, and the Joint Programme with WHO are encouraging. No doubt such collective efforts, if maintained and strengthened with support from the industry, can play a major role in making radiotherapy technology accessible and affordable to cancer patients all over the world, regardless of their location or financial means. l

16. Repair of equipment Decommisioning of machine Spare parts etc

17. CONCLUSION Obstacles to the effectiveness and efficiency of radiotherapy services at country level include: (1) the lack of a network type organizationalstructure that would link radiotherapy centers in such a way that it ensures access to a wide range of radiotherapy techniques available, (2) a limited quality management culture with services oriented to the professionals more than to the patients, (3) work organization oriented to the day-to-day practice rather than a medium or long-term strategic planning, and (4) lack of a system of self-evaluation based on carefully recorded clinical outcomes. Observation and analysis of radiotherapy services planning around the world show that the optimal provision and outcomes are reached when (1) radiotherapy services are centrally planned and monitored through the continued use of validated indicators over time, (2) radiotherapy services are integrated into national cancer control plans, (3) local problems of access to radiotherapy services are systematically identified and addressed, (4) radiotherapy services are given the necessary attention through a combination of political will tapping into resources from government, international organizations and NGOs.

18. EXPERT INPUT FROM N.E.D. FACULTY COLLEAGUES

19. SUGGESTED FUTURE AGENDA MORE COMBINED EDUCATIONAL EVENTS A TALK ON ‘’SERVICE CONTRACT ISSUES’’ CLINICAL ATTACHMENT 2-4 WEEKS OF A SENIOR INTERESTED STUDENT OF BIO-MED ENGG. DEPT. NED AIM= DEVELOPMENT OF A MODULE FOR TRAINING [ DIDACTIC] OF CLINICAL ENGINEERS & DOCTORS [ TRANS-DISCIPLINARY] A.O.B.