Cancer Care Ontario
Metric Methods - ALR Radiation Methods
DRAFT
ACTIVITY LEVEL REPORTING
METRIC METHODS
ALR Metrics for Radiation Therapy
DRAFT
May 2014
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Cancer Care Ontario
Metric Methods - ALR Radiation Methods
DRAFT
Table of Contents
...................................................................................................................................................................... 1
Background ............................................................................................................................................... 4
1. Purpose of this Document ........................................................................................................... 4
2. Data submitted to CCO and how it is used to calculate metrics .................................. 5
3. The ALR process ............................................................................................................................. 9
ALR Metrics - Clinic Visit Entity ................................................................................................... 10
C1R Metric - New Radiation Case .......................................................................................... 10
C2R Metric – Radiation Follow up Visits .............................................................................. 10
R5 Metric - Radiation Review Visits....................................................................................... 10
ALR Metrics - Radiation Entity ..................................................................................................... 11

Radiation Planning Visits ....................................................................................................... 11
R1 Metric - Radiation Planning Visits - Mould Room ...................................................... 11
R2 Metric - Radiation Planning Visits – Simulation ......................................................... 13
R3 Metric - Radiation Planning Visits – Clinical Mark-up .............................................. 14
R4 Metric - Radiation Planning Visits – Planning and Dosimetry ............................... 14
R6 Metric - Total Radiation Planning & Review Visits..................................................... 15
R40 Metric - Total Radiation Planning .................................................................................. 15

Radiation Treatment Visits ................................................................................................... 17
R23 Metric - Radiation Treatment Visits - Cobalt ............................................................ 17
R24 Metric - Radiation Treatment Visits – Linear Accelerator .................................... 18
R25 Metric - Radiation Treatment Visits – Megavoltage ............................................... 19
R26 Metric - Radiation Treatment Visits – Superficial & Orthovoltage ................... 19
R14 Metric - Radiation Treatment Visits – Brachytherapy ........................................... 19
R15 Metric - Total Radiation Treatment Visits .................................................................. 20
R16 Metric - Total Radiation Treatment & Planning Visits ........................................... 21

Radiation Fraction Activities ................................................................................................. 21
R7 Metric - Radiation Fractions – Cobalt ............................................................................. 21
R8 Metric - Radiation Fractions – Linear Accelerator ..................................................... 22
R9 Metric - Radiation Fractions – High-Energy (Cobalt & Linac) ............................... 22
R10 Metric - High Energy NHPIP Minutes ........................................................................... 23
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Cancer Care Ontario
Metric Methods - ALR Radiation Methods
DRAFT
R11 Metric - Radiation Fractions – Superficial & Orthovoltage .................................. 23
RLE Metric - Radiation Low Energy NHPIP Minutes – Superficial & Orthovoltage
............................................................................................................................................................ 23
BRACHY FRACTIONS Metric - Radiation Fractions – Brachytherapy ........................ 24
R12 Metric - Total Radiation Fractions ................................................................................. 24
R13 Metric - Total Treatments NHPIP Minutes ................................................................. 25

Radiation Treated Cases ........................................................................................................ 25
R17 Metric - Radiation Treated Cases – Cobalt ................................................................ 25
R18 Metric - Radiation Treated Cases – Linear Accelerator ........................................ 26
R19 Metric - Radiation Treated Cases – Superficial & Orthovoltage ........................ 27
R20 Metric - Radiation Treated Cases – Brachytherapy ............................................... 28
R21 Metric - Total Radiation Treated Cases....................................................................... 29
R30 Metric - New Radiation Treated Cases ........................................................................ 29
R31 Metric - Previously Treated Radiation Cases ............................................................ 29
Possible data quality issues that may have an impact on the ALR metrics .......... 30
Appendix 1 – NHPIP Codes (including inactive codes) .......................................................... 31
Appendix 2: Health Care Provider (HCP) Specialty Codes.................................................. 47
Appendix 3 – NHPIP Codes submitted to DataBook in 2013-2014 and used to
calculate ALR metrics for Radiation Therapy ............................................................................. 51
Version
Author
Date
Notes
V0.9
V0.9.1
Cristian Preda
Cristian Preda
April 28, 2014
April 29, 2014
V.0.9.2
V.0.9.3
Cristian Preda
Cristian Preda
May 2, 2014
May 8, 2014
V.0.9.4
Cristian Preda
May 13, 2014
Initial draft
Changes made based on feedback from Sukanya
Gopinath
Modified Appendix 1 to flag inactive NHPIP codes
Modified based on feedback from Eric Gutierrez: new
column indicating if the NHPIP code is active or not
Modified based on feedback from Eric Gutierrez:
correction for NHPIP codes included in R1 and R4
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Cancer Care Ontario
Metric Methods - ALR Radiation Methods
DRAFT
Background
Cancer Care Ontario (CCO) developed the Activity Level Reporting (ALR) data set in 1992 to collect data
about patient-care activities that occur in the cancer centres (Integrated Cancer Programs). Over time,
this reporting was also expanded to other facilities outside of the cancer centres. This data is used by
CCO to determine volume-based funding, to assess performance, to inform quality improvement
initiatives and to populate the Ontario Cancer Registry. It is also a rich data set for cancer-related
research conducted by CCO and external researchers.
The primary scope of ALR data elements collected is systemic and radiation therapy services (for
facilities where this is applicable) and outpatient oncology clinic visits. Each record conveys a key
activity or event performed, as well as related dates and details. Records submitted are at a patient
level (including personal health information), but are activity/event-centric rather than patient-centric.
Facilities submit a month-long batch of ALR records to CCO every month. There is a one month lag
between the month of submission and the month described in the data. For instance, July data is
submitted in September and September data is submitted in November.
The data is submitted in a *.csv file format. The data is uploaded by the centre to a web based
application that performs submission logging and error checking. If the file passes several stages of
sequential error checking (at the file and record levels) it is retained by CCO for further processing.
Otherwise, the centres are automatically notified that the file needs to be corrected and resubmitted.
1. Purpose of this Document
The purpose of this document is to explain how CCO processes ALR data submissions to prepare the
data for reporting and analysis. The first section below will provide details on key metrics that CCO
utilizes for reporting volume-based and performance metrics. An explanation of the logic flow and
business rules applied by CCO to each record to determine whether it should be included in these
metrics is provided in section two.
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Cancer Care Ontario
Metric Methods - ALR Radiation Methods
DRAFT
2. Data submitted to CCO and how it is used to calculate metrics
CCO conducts regular reporting as well as ad-hoc analyses to manage and guide the cancer system’s
performance. Business rules are automatically applied to the monthly ALR updates to calculate metrics
for radiation volumes and wait times.
Radiation planning and treatment begins when a patient visits a hospital in preparation for radiation.
Planning visits include preparations done in the Mould Room and for Simulation, Clinical Mark-up, and
Dosimetry. Treatment visits include the type of radiation used, (i.e. Brachytherapy, Megavoltage,
Superficial and Orthovoltage), including associated radiation fractions for each treatment. Radiation
case level metrics include New, Total and previously treated patient case volumes.
The table below lists the key metrics generated and the table/entity they are based on. (Note: Following
sections will explain how additional data elements submitted are used as criteria to determine which
records should be included or excluded in performance metrics.)
Metric
Title
Definition
Table/Entity
Derived From
C1R
New Radiation Case
A case is an instance of a patient with a specific
diagnosis at a specific submitting hospital. A new
radiation case is counted when a patient has a first
clinic visit with a physician (see appendix 2 for
complete list) for a specific diagnosis at a specific
submitting hospital.
Clinic Visit
C2R
Radiation Follow up
Visits
All radiation clinic visits with a physician (see
appendix 2 for complete list) that are not New
Radiation Case Visits.
Clinic Visit
C3R
Total number of
radiation clinic visits
The sum of the new radiation case visits and the
follow up radiation visits. C3R = C1R + C2R
Clinic Visit
R1
Radiation Planning
Visits - Mould Room
Mould/immobilization activity visits.
Radiation
R2
Radiation Planning
Visits - Simulation
Treatment simulation visits, this includes
conventional simulation, CT simulation, and emerging
imaging methods.
Radiation
R3
Radiation Planning
Visits – Clinical Markup
Clinical mark-up visits that require mark-up activities
only.
Radiation
R4
Radiation Planning
Radiation visits including dosimetry and planning
Radiation
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Cancer Care Ontario
Metric Methods - ALR Radiation Methods
Metric
DRAFT
Table/Entity
Derived From
Title
Definition
Visits – Planning and
Dosimetry
activities that occur outside of Mould Room,
Simulation, Clinical Mark-up and Treatment visits.
R5
Radiation Review
Visits
A review visit with the radiation oncologist, usually
occurring weekly during the period of treatment. A
radiation review is counted only if it is not the first
clinic visit with a radiation oncologist.
Clinic Visit
R6*
Total Radiation
Planning & Review
Visits
The sum of Mould Room, Simulation, Clinical Markup,
Planning and Dosimetry and Patient Radiation Review
Visits (R1 + R2 + R3 + R4 + R5)
Radiation
R40
Total Radiation
Planning
Total Radiation Planning. Some NHPIP codes not
counted under R6 are counted under R40. This
metric was created in 2008.
Radiation
R23
Radiation Treatment
Visits - Cobalt
A treatment visit where radiation treatment is given
with a Cobalt treatment unit.
Radiation
R24
Radiation Treatment
Visits – Linear
Accelerator
A treatment visit where radiation treatment is given
with a Linear Accelerator treatment unit.
Radiation
R25
Radiation Treatment
Visits – Megavoltage
A treatment visit where radiation treatment is given
with a Megavoltage treatment unit. This is the sum
of the Cobalt and Linear Accelerator treatments.
Radiation
(R25 = R23 + R24)
R26
Radiation Treatment
Visits – Superficial &
Orthovoltage
A treatment visit where radiation treatment is given
with a Superficial/Orthovoltage treatment unit.
Radiation
R14
Radiation Treatment
Visits – Brachytherapy
A treatment visit where radiation treatment includes
interstitial, intra-cavitary and treatment
moulds/applicators.
Radiation
R15
Total Radiation
Treatment Visits
The total Radiation Treatment Visits includes the sum
of Megavoltage, Superficial/Orthovoltage and
Brachytherapy treatment visits.
Radiation
(R15 = R25 + R26 + R14)
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Cancer Care Ontario
Metric Methods - ALR Radiation Methods
DRAFT
Metric
Title
Definition
Table/Entity
Derived From
R16*
Total Radiation
Treatment & Planning
Visits
The sum of Mould Room, Simulation, Clinical Markup,
Planning and Dosimetry and Patient Radiation Review
Visits (Planning/Review visits) and the Radiation
Treatment Visits.
Radiation
(R16 = R6 + R15)
R7
Radiation Fractions –
Cobalt
Radiation fractions delivered with a cobalt treatment
unit.
Radiation
R8
Radiation Fractions –
Linear Accelerator
Radiation fractions delivered with a linear accelerator
(linac) treatment unit.
Radiation
R9
Radiation Fractions –
High-Energy (Cobalt &
Linac)
Radiation fractions delivered using a Megavoltage
treatment unit. This is a sum of the Cobalt and Linear
Accelerator fractions.
Radiation
R10
High Energy NHPIP
Minutes
Sum of activity minutes for HIGH energy treatment
NHPIP CODES
Radiation
R11
Radiation Fractions –
Superficial &
Orthovoltage
Radiation fractions delivered using
superficial/orthovoltage treatment units.
Radiation
RLE
Radiation Fractions –
Low-Energy
(Superficial &
Orthovoltage)
Sum of activity minutes for LOW energy treatment
NHPIP CODES
Radiation
BRACHY
FRACTIONS
Radiation Fractions –
Brachytherapy
Radiation fractions delivered using brachytherapy
(includes interstitial, intra-cavitary and treatment
moulds/applicators.)
Radiation
R12
Total Radiation
Fractions
Radiation fractions delivered using a Megavoltage
treatment units and Low Energy treatment units.
Radiation
(R12 = R7+R8+R11+BRACHY FRACTIONS)
R13
Total Treatments
NHPIP Minutes
Sum of activity minutes for all treatment NHPIP
CODES includes Megavoltage,
Superficial/Orthovoltage.
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Radiation
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
DRAFT
Metric
Title
Definition
Table/Entity
Derived From
R17
Radiation Treated
Cases – Cobalt
Unique cases that received at least one cobalt
radiation therapy treatment in the reporting period.
Treatment in other programs may also have been
administered.
Radiation
R18
Radiation Treated
Cases – Linear
Accelerator
Unique cases that received at least one linac
radiation therapy treatment in the reporting period.
Treatment in other programs may also have been
administered.
Radiation
R19
Radiation Treated
Cases – Superficial &
Orthovoltage
Unique cases that received at least one
superficial/orthovoltage radiation therapy treatment
in the reporting period. Treatment in other programs
may also have been administered.
Radiation
R20
Radiation Treated
Cases – Brachytherapy
Unique cases that received at least one
Brachytherapy treatment in the reporting period.
Treatment in other programs may also have been
administered.
Radiation
R21
Total Radiation
Treated Cases
The number of unique cases which received at least
one type of radiation therapy treatment in the
reporting period. (Note: Since a case can have more
than one type of radiation treatment in a reporting
period, this may not be the sum of the Cobalt Cases +
Linear Accelerator Cases + Superficial/Orthovoltage
Cases + Brachytherapy Cases.)
Radiation
R30
New Radiation
Treated Cases
The number of NEW cases which received the first
radiation treatment, of any type, in the reporting
period.
Radiation
R31*
Previously Treated
Radiation Cases
The number of cases who received at least one type
of radiation therapy treatment in the current
reporting period, and who’s first treatment case
occurred in a previous reporting period.
Radiation
*Derived Metrics not available in the activity table
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Cancer Care Ontario
Metric Methods - ALR Radiation Methods
DRAFT
3. The ALR process
CCO utilizes the data for determining case volumes for the purposes of funding and assessing
performance against several quality metrics.
ALR attribute names in blue highlight coincide with attribute names in Databook.
We are using the following attributes submitted in DataBook:
#
DataBook Entity
DataBook Attribute
Attribute Description
1
Patient
Patient Chart Number
Patient identifier code that is unique within the
healthcare facility.
2
Disease
Disease Sequence Number
The numeric sequence assigned to a primary
cancer for a patient at a specific healthcare facility.
3
Patient
Submitting Hospital Number
The MOHLTC healthcare facility that submits
activity to CCO.
4
Clinic Visit
Visit Program Code
Primary cancer programs for clinic, planning and
treatment activity. Includes; Radiation (RAD),
Systemic (SYS), Surgical (SUR), Research (RE),
Palliative (PA), or Preventive oncology (PO).
5
Clinic Visit
Visit Type
Identifies the method of contact for clinic visits.
(example: Face to face, Telephone), by flagging
Telephone Visits. Face to face includes visits that
allow both parties to see each other (ie. includes
video conferencing). Telephone visits include
modes such as teleconference and email.
6
Clinic Visit
Radiation Review Flag
Identifies physician reviews that occur in the
radiation therapy area during a patient’s course of
treatment.
7
Radiation
NHPIP Code
National Health Productivity Improvement
Program activity code for radiation therapy
workload. Define different radiation tasks.
Identifies ALR activity and allows calculation of
fractions
8
Healthcare
HCP Number
Healthcare professional identifier code for the
physician or non-physician who is most
responsible for the patient. This code is unique to
the submitting healthcare facility.
Professional
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Cancer Care Ontario
Metric Methods - ALR Radiation Methods
DRAFT
An ALR case is defined by CCO as an instance of a patient (identified by patient chart number) with a
specific diagnosis (identified by disease sequence number) at a specific facility (identified by submitting
hospital number).
ALR metrics are generated only for visits or radiation treatments performed by health care professionals
flagged as physicians (see appendix 2 containing the HCP codes for fiscal year 2014) .
ALR Metrics - Clinic Visit Entity
There are 2 main metrics based on radiation clinic visits: C1R and C2R. The third metric (C3R) is a
derived metric: C3R=C1R + C2R.
C1R Metric - New Radiation Case
A new radiation case (C1R) is counted when a patient has a first radiation clinic visit with a physician
(see appendix 2 for a complete list) for a specific diagnosis at a specific submitting hospital.
We flag a clinic visit as C1R if all following conditions are true:
1) Visit Program Code = ‘RAD’
2) The visit is face-to-face: Visit Type (in Clinic Visit entity) has one of the following values:
'OC',NULL
3) HCP is a physician (see appendix 2)
4) The ALR case was not reported under program=RAD as “historical case” (in so called one time
submission called “ALR baseline”).
5) Is the first radiation clinic visit.
Note: An ALR case will not have any C1R visits if the case was flagged as “historical case” and a record
for program RAD exists in the ALR Baseline for that ALR case. If your organization didn’t submit an ALR
Baseline, please ignore all paragraphs referring to “ALR Baseline”.
C2R Metric – Radiation Follow up Visits
We flag a clinic visit as C2R if all following conditions are true:
1) Visit Program Code = ‘RAD’
2) The visit is face-to-face: Visit Type (in Clinic Visit entity) has one of the following values:
'OC',NULL
3) HCP is a physician (see appendix 2)
4) Clinic visit was not already identified and flagged as a C1R (new radiation case)
R5 Metric - Radiation Review Visits
Range of Possible Values: 0 or greater
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Cancer Care Ontario
Metric Methods - ALR Radiation Methods
DRAFT
Definition: A review visit (Visit Program Code = ‘RAD’ and Radiation Review Flag=’R’) with the radiation
oncologist, usually occurring weekly during the period of treatment. The visit should be face-to-face:
Visit Type (in Clinic Visit entity) has one of the following values: 'OC',NULL
A radiation review is counted only if it is not the first clinic visit with a radiation oncologist.
Method: If the first visit with a radiation oncologist is for a radiation review visit, it is reclassified as a
new case visit and is not counted as a radiation review. Subsequent visits as long as they occur on
separate days are considered for review and are counted in R5.
ALR Metrics - Radiation Entity
The ALR metrics are based on NHPIP codes. Table below shows the NHPIP codes included in each ALR
radiation metric.
 Radiation Planning Visits
R1 Metric - Radiation Planning Visits - Mould Room
Range of Possible Values: 0 or greater
Definition: Mould/immobilization activity visits.
Method: A visit is considered a Mould Room Planning visit for the purposes of calculating R1 if the
following NHPIP codes are entered for the activity:
NHPIP_ACT_CD
202
206
207
208
209
210
211
214
220
240
260
200
201
203
204
205
213
215
234
241
242
NHPIP_ACT_DESC
IMMOBILIZATION (H&N, CNS, VACKLOK, HIPFI
CUSTOM MADE MOUTHBITE
CUSTOM MADE HEAD/NECK REST
FITTING OF STEREOTACTIC FRAME(MULTIFRAC)
FITTING OF STEREOTACTIC(SINGLE FRACTION)
FITTING H&N PLASTIC SHELL + EYE & MOUTH
FITTING OF PLASTIC BREAST/BODY SHELL
IMMOBILIZATION ADJUSTMENT
SHIELDING TEMPLATE CALCULATION
SIMPLE FORM WAX TO OUTLINE WITH PATIENT
MOULD/PLAQUE APPLICATOR WITH PATIENT
HEAD AND NECK PLASTER
BREAST/BODY SHELL PLASTER
FITTING OF PLASTIC BODY SHELL
PRODUCTION OF ALPHA-CRADLE DEVICE
AQUAPLAST
VERIFICATION/INSPECTION OF SHELL FIT
CONTOUR FROM SHELL OR MOULD (PMH)
CERROBEND SHIELD MODIFIC. COMPLEX (PMH)
COMPLEX WAX COMPENSATOR WITH PATIENT
CUSTOM MADE CERROBEND,EYE (PMH)
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NHPIP_ACTIVE_STATUS
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
No
No
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
NHPIP_ACT_CD
253
259
261
263
264
390
DRAFT
NHPIP_ACT_DESC
MANUAL PREP LEAD,WAX COMPENSATOR WITH PT
PREPARATION PB SHIELD OR CUT-OUT
HAMMERED AND FITTED LEAD SHIELD WITH PT
SURFACE MOULD OR PLAQUE APPLICATOR (PMH)
PREP EDUCAT'N + MOULD FABR,INC.CATHETERS
CUT-OUTS OF FOAM BLOCKS,ASSESS OF X-RAY
NHPIP_ACTIVE_STATUS
No
No
No
No
No
No
*Note, there are other codes that constitute an Activity Type of Mould Room(‘M’), however, the remaining codes have a suffix of X, which are
codes that do not involve a patient who is present and are not counted towards R1.
For instances where multiple visits on the same day for the same diagnosis and activity occur, the visit
with the most senior physician (determined by using the lowest HCP number among the physicians
visited) is the only one counted towards R1.
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Metric Methods - ALR Radiation Methods
DRAFT
R2 Metric - Radiation Planning Visits – Simulation
Range of Possible Values: 0 or greater
Definition: Treatment simulation visits, this includes conventional simulation, CT simulation, and
emerging imaging methods.
Method: A visit is considered a Planning visit for the purposes of calculating R2 if the following NHPIP
codes are entered for the activity:
NHPIP_ACT_CD
100
101
102
107
150
151
152
160
161
170
180
190
191
368
369
370
371
372
377
378
379
380
103
104
105
106
110
111
115
120
130
212
373
NHPIP_ACT_DESC
FLUOROSCOPY ONLY IN SIMULATOR
SET UP OF ONE FIELD
SET UP OF TWO FIELDS
VERIFICATION OF TREATMENT SET-UP
CYSTOGRAPHY W CATHETER INSERTED IN SIM
CYSTOGRAPHY W/WO CATHETER PREV INSERTED
I.V.P. PROCEDURE
UPPER G.I. TRACT WITH CONTRAST
LOWER G.I. TRACT WITH CONTRAST
CONTOUR USING SIMULATOR SSD SCALE
SHIELDING BLOCK OR MASK CHECK
INTERNAL SOURCE CHECKS
PLACEMENT OF VAGINAL DUMMY
SIMULATION USING TX CONEBEAM
TREATMENT PLANNING CT SCAN WITH IV CONTR
TREATMENT PLANNING C.T.SCAN
TREATMENT PLANNING CT SCAN WITH GI CONTR
TREATMENT PLANNING MRI
ULTRASOUND FOR LOCALIZATION (PLANNING)
GOLD SEED MARKER IMPLANT
PLANNING PET CT
4DCT IMAGE ACQUISITION
SET UP OF THREE FIELDS
SET UP OF FOUR FIELDS
SET UP OF FIVE FIELDS
SET-UP 6 FIELDS-SIM (CONFORMAL THERAPY)
BREAST TANGENTS & ANGLE CALCULATION
ANGLE DOWN PAIR (PMH)
SIMULATION OF ASYMMETRIC BREAST
EXTENDED SSD
WHOLE CNS
SCOUT FILM POSITIONING DURING FITTING
RX PLANNING CT STEREOTACTIC
NHPIP_ACTIVE_STATUS
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
No
No
No
*Note, there are other codes that constitute an Activity Type of Simulation (‘S’), however, the remaining codes have a suffix of X, which are
codes that do not involve a patient who is present and are not counted towards R2.
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Metric Methods - ALR Radiation Methods
DRAFT
R3 Metric - Radiation Planning Visits – Clinical Mark-up
Range of Possible Values: 0 or greater
Definition: Clinical mark-up visits that require mark-up activities only.
Method: A visit is considered a Clinical Mark-up visit for the purposes of calculating R3 if the following
NHPIP code is entered for the activity:
NHPIP_ACT_CD
305
NHPIP_ACT_DESC
CLINICAL MARK UP
*Note: If the NHPIP code = 305, this radiation activity record becomes a Clinical Mark-Up visit (R3)
For instances where multiple visits on the same day for the same diagnosis and activity occur, the visit
with the most senior physician (determined by using the lowest HCP number among the physicians
visited) is the only one counted towards R3.
R4 Metric - Radiation Planning Visits – Planning and Dosimetry
Range of Possible Values: 0 or greater
Definition: Radiation visits including dosimetry and planning activities that occur outside of Mould
Room, Simulation, Clinical Mark-up and Treatment visits.
Method: A visit is considered a Planning and Dosimetry visit for the purposes of calculating R4 if the
following NHPIP codes are entered for the activity:
Planning:
NHPIP_ACT_CD
306
235
350
374
NHPIP_ACT_DESC
TRIAL SET UP
REMOVAL OF CERROBEND,CLEAN TRAYS
TOTAL/HEMI BODY PLANNING ON TRMT UNIT
KIDNEY LOCALIZATION
NHPIP_ACTIVE_STATUS
Yes
No
No
No
Dosimetry:
NHPIP_ACT_CD
826
250
251
320
327
328
339
342
360
361
NHPIP_ACT_DESC
EXPOSURE OF TLDS WITH PAT IN SET-UP
AUTOMATED PREP COMPENSATOR WITH
PATIENT
MANUAL PREP COMPENSATOR WITH PATIENT
INITIAL CALCULATION DIRECT FIELD W PT
STEREOTACTIC CALC (30 MIN PER ISOCENTER)
6 FLD INITIAL CALC CONFORMAL
8 FLD DISTRIBUTION
IMRT PLANNING
TOT/HEMI BODY DOSIM CALC FOR BOLUS THICK
TBI PLANNING
14
NHPIP_ACTIVE_STATUS
Yes
No
No
No
No
No
No
No
No
No
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
NHPIP_ACT_CD
381
382
DRAFT
NHPIP_ACT_DESC
AUTOMATED CONTOUR FROM SSD SCALE
COMPUTERIZED CONTOUR FROM TP/CT
NHPIP_ACTIVE_STATUS
No
No
Planning and Dosimetry activities are counted as R4 if only if NO clinical mark-up, mould, simulation, or
treatment activity is occurring at the same moment (same day/hour/minute).
In other words, if the same (patient/disease/submitting hospital/visiting hospital/visit date & time)
received any clinical mark-up, mould, simulation, or treatment activity at the same moment as another
Planning & Dosimetry visit, no R4 visit will be counted at all.
R6 Metric - Total Radiation Planning & Review Visits
Range of Possible Values: 0 or greater
Definition: The sum of Mould Room, Simulation, Clinical Markup, Planning and Dosimetry and Patient
Radiation Review Visits.
Method: To obtain the number of Total Radiation Planning & Review Visits, the ALR Metrics R1 (Mould
Room), R2 (Simulation), R3 (Clinical Markup), R4 (Planning and Dosimetry) and R5 (Patient Radiation
Review Visits) are first calculated and then those totals are summed to derive R6.
R6 = R1 + R2 + R3 + R4 + R5
R40 Metric - Total Radiation Planning
Range of Possible Values: 0 or greater
Definition: Radiation Planning Visits.
Method: A visit is considered a Planning and Dosimetry visit for the purposes of calculating R4 if the
following NHPIP codes are entered for the activity:
NHPIP_ACT_CD
100
101
102
107
150
151
152
160
161
170
180
190
191
NHPIP_ACT_DESC
FLUOROSCOPY ONLY IN SIMULATOR
SET UP OF ONE FIELD
SET UP OF TWO FIELDS
VERIFICATION OF TREATMENT SET-UP
CYSTOGRAPHY W CATHETER INSERTED IN SIM
CYSTOGRAPHY W/WO CATHETER PREV
INSERTED
I.V.P. PROCEDURE
UPPER G.I. TRACT WITH CONTRAST
LOWER G.I. TRACT WITH CONTRAST
CONTOUR USING SIMULATOR SSD SCALE
SHIELDING BLOCK OR MASK CHECK
INTERNAL SOURCE CHECKS
PLACEMENT OF VAGINAL DUMMY
15
NHPIP_ACTIVE_STATUS
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
NHPIP_ACT_CD
202
206
207
208
209
210
211
214
220
240
260
305
306
368
369
370
371
372
377
378
379
380
826
103
104
105
106
110
111
115
120
130
200
201
203
204
205
212
213
215
234
235
241
242
250
251
253
DRAFT
NHPIP_ACT_DESC
IMMOBILIZATION (H&N, CNS, VACKLOK, HIPFI
CUSTOM MADE MOUTHBITE
CUSTOM MADE HEAD/NECK REST
FITTING OF STEREOTACTIC FRAME(MULTIFRAC)
FITTING OF STEREOTACTIC(SINGLE FRACTION)
FITTING H&N PLASTIC SHELL + EYE & MOUTH
FITTING OF PLASTIC BREAST/BODY SHELL
IMMOBILIZATION ADJUSTMENT
SHIELDING TEMPLATE CALCULATION
SIMPLE FORM WAX TO OUTLINE WITH PATIENT
MOULD/PLAQUE APPLICATOR WITH PATIENT
CLINICAL MARK UP
TRIAL SET UP
SIMULATION USING TX CONEBEAM
TREATMENT PLANNING CT SCAN WITH IV CONTR
TREATMENT PLANNING C.T.SCAN
TREATMENT PLANNING CT SCAN WITH GI CONTR
TREATMENT PLANNING MRI
ULTRASOUND FOR LOCALIZATION (PLANNING)
GOLD SEED MARKER IMPLANT
PLANNING PET CT
4DCT IMAGE ACQUISITION
EXPOSURE OF TLDS WITH PAT IN SET-UP
SET UP OF THREE FIELDS
SET UP OF FOUR FIELDS
SET UP OF FIVE FIELDS
SET-UP 6 FIELDS-SIM (CONFORMAL THERAPY)
BREAST TANGENTS & ANGLE CALCULATION
ANGLE DOWN PAIR (PMH)
SIMULATION OF ASYMMETRIC BREAST
EXTENDED SSD
WHOLE CNS
HEAD AND NECK PLASTER
BREAST/BODY SHELL PLASTER
FITTING OF PLASTIC BODY SHELL
PRODUCTION OF ALPHA-CRADLE DEVICE
AQUAPLAST
SCOUT FILM POSITIONING DURING FITTING
VERIFICATION/INSPECTION OF SHELL FIT
CONTOUR FROM SHELL OR MOULD (PMH)
CERROBEND SHIELD MODIFIC. COMPLEX (PMH)
REMOVAL OF CERROBEND,CLEAN TRAYS
COMPLEX WAX COMPENSATOR WITH PATIENT
CUSTOM MADE CERROBEND,EYE (PMH)
AUTOMATED PREP COMPENSATOR WITH
PATIENT
MANUAL PREP COMPENSATOR WITH PATIENT
MANUAL PREP LEAD,WAX COMPENSATOR WITH
16
NHPIP_ACTIVE_STATUS
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
NHPIP_ACT_CD
259
261
263
264
320
327
328
339
342
350
360
361
373
374
381
382
390
DRAFT
NHPIP_ACT_DESC
PT
PREPARATION PB SHIELD OR CUT-OUT
HAMMERED AND FITTED LEAD SHIELD WITH PT
SURFACE MOULD OR PLAQUE APPLICATOR (PMH)
PREP EDUCAT'N + MOULD FABR,INC.CATHETERS
INITIAL CALCULATION DIRECT FIELD W PT
STEREOTACTIC CALC (30 MIN PER ISOCENTER)
6 FLD INITIAL CALC CONFORMAL
8 FLD DISTRIBUTION
IMRT PLANNING
TOTAL/HEMI BODY PLANNING ON TRMT UNIT
TOT/HEMI BODY DOSIM CALC FOR BOLUS THICK
TBI PLANNING
RX PLANNING CT STEREOTACTIC
KIDNEY LOCALIZATION
AUTOMATED CONTOUR FROM SSD SCALE
COMPUTERIZED CONTOUR FROM TP/CT
CUT-OUTS OF FOAM BLOCKS,ASSESS OF X-RAY
NHPIP_ACTIVE_STATUS
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
No
For instances where multiple visits on the same day for the same diagnosis and activity occur, the visit
with the most senior physician (determined by using the lowest HCP number among the physicians
visited) is the only one counted towards R40.
 Radiation Treatment Visits
R23 Metric - Radiation Treatment Visits - Cobalt
Range of Possible Values: 0 or greater
Definition: A treatment visit where radiation treatment is given with a Cobalt treatment unit.
Method: A visit is considered a Radiation Treatment Visit – Cobalt for the purposes of calculating R23 if
the following NHPIP codes are entered for the activity:
NHPIP_ACT_CD
572
520
521
522
523
524
525
526
527
NHPIP_ACT_DESC
GAMMA KNIFE TREATMENT
CO-60 DIRECT FIELD
CO-60 PAIR - TWO FIELDS
CO-60 THREE FIELDS
CO-60 FOUR FIELDS
CO-60 FIVE FIELDS
CO-60 ARC/ROTATION
CO-60 EXTENDED SSD
COMPLEX EXTENDED SSD COBALT
17
NHPIP_ACTIVE_STATUS
Yes
No
No
No
No
No
No
No
No
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
528
529
DRAFT
CO-60 WHOLE/HALF BODY
CO-60 WHOLE CNS
No
No
For instances where multiple visits on the same day for the same diagnosis and activity occur, the visit
with the most senior physician (determined by using the lowest HCP number among the physicians
visited) is the only one counted towards R23.
R24 Metric - Radiation Treatment Visits – Linear Accelerator
Range of Possible Values: 0 or greater
Definition: A treatment visit where radiation treatment is given with a Linear Accelerator treatment
unit.
Method: A visit is considered a Radiation Treatment Visit – Linear Accelerator for the purposes of
calculating R24 if the following NHPIP codes are entered for the activity:
NHPIP_ACT_CD
530
531
532
533
534
535
536
538
540
542
548
549
575
592
594
596
597
519
537
539
541
NHPIP_ACT_DESC
LINAC DIRECT FIELD
LINAC PAIR - TWO FIELDS
LINAC THREE FIELDS
LINAC FOUR FIELDS
LINAC FIVE OR MORE FIELDS
LINAC ARC/ROTATION
LINAC EXTENDED SSD
LINAC WHOLE/HALF BODY
LINAC ELECTRONS
TOTAL BODY ELECTRONS
STEREOTACTIC TREAT
(1 FRACT-1HR/ISOCENTR)
STEREOTACTIC TREAT
(MULTIFRAC-30MIN/ISOC)
TOMOTHERAPY TREATMENT
IMRT TREATMENT
VMAT / RAPIC ARC TREATMENT CODE
CYBERKNIFE TREATMENT (SINGLE FRACTION)
CYBERKNIFE TREATMENT (MULTI-FRACTIONS)
8 FLD LINAC TREATMENT
LINAC COMPLEX EXTENDED SSD
LINAC WHOLE CNS
6 FIELD-6 FIELDS/ISOCENTER
NHPIP_ACTIVE_STATUS
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
For instances where multiple visits on the same day for the same diagnosis and activity occur, the visit
with the most senior physician (determined by using the lowest HCP number among the physicians
visited) is the only one counted towards R24.
18
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
DRAFT
R25 Metric - Radiation Treatment Visits – Megavoltage
Range of Possible Values: 0 or greater
Definition: A treatment visit where radiation treatment is given with a Megavoltage treatment unit.
This is the sum of the Cobalt and Linear Accelerator treatments.
Method: To obtain the number of Radiation Treatment Visits – Megavoltage, the ALR Metrics R23
(Radiation Treatment Visits - Cobalt) and R24 (Radiation Treatment Visits - Linear Accelerator) are first
calculated and then those totals are summed to derive R25.
R25 = R23 + R24
R26 Metric - Radiation Treatment Visits – Superficial & Orthovoltage
Range of Possible Values: 0 or greater
Definition: A treatment visit where radiation treatment is given with a Superficial/Orthovoltage
treatment unit.
Method: A visit is considered a Radiation Treatment – Superficial & Orthovoltage (R26) visit for the
purposes of calculating R26 if the following NHPIP codes are entered for the activity.
Superficial NHPIP Codes (TS):
NHPIP_ACT_CD
500
501
503
NHPIP_ACT_DESC
SUPERFICIAL X-RAY SIMPLE
SUPERFICIAL X-RAY WITH INTERNAL SHIELD
RT 50 TREATMENT PAPPION (PMH)
NHPIP_ACTIVE_STATUS
Yes
Yes
No
Orthovoltage NHPIP Codes (TD):
NHPIP_ACT_CD
510
511
512
NHPIP_ACT_DESC
ORTHOVOLTAGE SIMPLE
ORTHOVOLTAGE WITH INTERNAL SHIELD
INTRA-OPERATIVE RADIATION THERAPY
NHPIP_ACTIVE_STATUS
Yes
Yes
Yes
For instances where multiple visits on the same day for the same diagnosis and activity occur, the visit
with the most senior physician (determined by using the lowest HCP number among the physicians
visited) is the only one counted towards R26.
R14 Metric - Radiation Treatment Visits – Brachytherapy
Range of Possible Values: 0 or greater
Definition: A treatment visit where radiation treatment includes interstitial, intra-cavitary and
treatment moulds/applicators.
19
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
DRAFT
Method: A visit is considered a Radiation Treatment – Brachytherapy (R14) visit for the purposes of
calculating R14 if the following NHPIP codes are entered for the activity:
Interstitial Codes (TT):
NHPIP_ACT_CD
570
571
573
574
NHPIP_ACT_DESC
INTERS. SOURCE MAN. AFTR LOAD FULL INVOL
INTERS. SOURCES LIMITED INVOLVEMENT
REMOTE LOADING INTERS.SOURCE FULL INVOLV
REMOTE LOADING INTERS.SOURCE LIMT INVOLV
NHPIP_ACTIVE_STATUS
Yes
Yes
Yes
Yes
Interacavitary Codes (TV):
NHPIP_ACT_CD
561
563
565
566
568
NHPIP_ACT_DESC
INTRAC SOURCES TOT. INVOLVE-AFTERLOADING
LIMITED INVOLVEMENT MAN. AFTER LOADING
REMOTE LOADING TOTAL INVOLVEMENT
NO DOSIMETRY FOR REMOTE SOURCES LOADING
PREP,O.R. PROC,COMP DOSIM,ENDOVAS.TX PMH
NHPIP_ACTIVE_STATUS
Yes
Yes
Yes
Yes
Yes
NHPIP_ACT_DESC
DAILY APPLICATION OF SURFACE MOULD
NHPIP_ACTIVE_STATUS
Yes
Mould Codes (TM):
NHPIP_ACT_CD
581
For instances where multiple visits on the same day for the same diagnosis and activity occur, the visit
with the most senior physician (determined by using the lowest HCP number among the physicians
visited) is the only one counted towards R14.
R15 Metric - Total Radiation Treatment Visits
Range of Possible Values: 0 or greater
Definition: The total Radiation Treatment Visits includes the sum of Megavoltage,
Superficial/Orthovoltage and Brachytherapy treatment visits.
Method: To obtain the number of Total Radiation Treatment Visits, the ALR Metrics R14 (Radiation
Treatment Visits - Brachytherapy), R25 (Radiation Treatment Visits - Megavoltage) and R26 (Radiation
Treatment Visits - Superficial & Orthovoltage) are first calculated and then those totals are summed to
derive R15.
Derivation Logic:
R15 = R25 + R26 + R14
20
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
DRAFT
R16 Metric - Total Radiation Treatment & Planning Visits
Range of Possible Values: 0 or greater
Definition: The sum of Mould Room, Simulation, Clinical Markup, Planning and Dosimetry and Patient
Radiation Review Visits (Planning/Review visits) and the Radiation Treatment Visits.
Method: To obtain the number of Total Radiation Treatment & Planning Visits, the ALR Metrics R6
(Total Radiation Planning & Review Visits) and R15 (Total Radiation Treatment Visits) are first calculated
and then those totals are summed to derive R16.
Derivation Logic:
R16 = R6 + R15
 Radiation Fraction Activities
R7 Metric - Radiation Fractions – Cobalt
Range of Possible Values: 0 or greater
Definition: Radiation fractions delivered with a cobalt treatment unit.
Method: A visit is considered a Radiation – Cobalt visit for the purposes of calculating R7 if the following
NHPIP codes are entered for the activity:
NHPIP_ACT_CD
572
520
521
522
523
524
525
526
527
528
529
NHPIP_ACT_DESC
GAMMA KNIFE TREATMENT
CO-60 DIRECT FIELD
CO-60 PAIR - TWO FIELDS
CO-60 THREE FIELDS
CO-60 FOUR FIELDS
CO-60 FIVE FIELDS
CO-60 ARC/ROTATION
CO-60 EXTENDED SSD
COMPLEX EXTENDED SSD COBALT
CO-60 WHOLE/HALF BODY
CO-60 WHOLE CNS
NHPIP_ACTIVE_STATUS
Yes
No
No
No
No
No
No
No
No
No
No
The Radiation Fractions for these visits are then added to R7. For instances where multiple visits on the
same day for the same diagnosis and activity occur, the fractions for each of the instances will be
counted towards R7.
21
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
DRAFT
R8 Metric - Radiation Fractions – Linear Accelerator
Range of Possible Values: 0 or greater
Definition: Radiation fractions delivered with a linear accelerator (linac) treatment unit.
Method: A visit is considered a Radiation– Cobalt visit for the purposes of calculating R8 if the following
NHPIP codes are entered for the activity:
NHPIP_ACT_CD
530
531
532
533
534
535
536
538
540
542
548
549
575
592
594
596
597
519
537
539
541
NHPIP_ACT_DESC
LINAC DIRECT FIELD
LINAC PAIR - TWO FIELDS
LINAC THREE FIELDS
LINAC FOUR FIELDS
LINAC FIVE OR MORE FIELDS
LINAC ARC/ROTATION
LINAC EXTENDED SSD
LINAC WHOLE/HALF BODY
LINAC ELECTRONS
TOTAL BODY ELECTRONS
STEREOTACTIC TREAT(1 FRACT1HR/ISOCENTR)
STEREOTACTIC TREAT(MULTIFRAC30MIN/ISOC)
TOMOTHERAPY TREATMENT
IMRT TREATMENT
VMAT / RAPIC ARC TREATMENT CODE
CYBERKNIFE TREATMENT (SINGLE FRACTION)
CYBERKNIFE TREATMENT (MULTI-FRACTIONS)
8 FLD LINAC TREATMENT
LINAC COMPLEX EXTENDED SSD
LINAC WHOLE CNS
6 FIELD-6 FIELDS/ISOCENTER
NHPIP_ACTIVE_STATUS
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
The Radiation Fractions for these visits are then added to R8. For instances where multiple visits on the
same day for the same diagnosis and activity occur, the fractions for each of the instances will be
counted towards R8.
R9 Metric - Radiation Fractions – High-Energy (Cobalt & Linac)
Range of Possible Values: 0 or greater
Definition: Radiation fractions delivered using a Megavoltage treatment unit. This is a sum of the Cobalt
and Linear Accelerator fractions.
Method: To obtain the number of Radiation Fractions - High-Energy, the ALR Metrics R7 (Radiation
Fractions - Cobalt) and R8 (Radiation Fractions - Linear Accelerator) are first calculated and then those
totals are summed to derive R9.
22
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
DRAFT
Derivation Logic:
R9 = R7 + R8
R10 Metric - High Energy NHPIP Minutes
Range of Possible Values: 0 or greater
Definition: Sum of activity minutes for HIGH energy treatment NHPIP CODES.
Method: The sum of NHPIP_DURATION_UNIT minutes from NHPIP codes captured in Cobalt (R7) and
Linac (R8) fraction visits for a given period. Real duration is not captured in Data Book.
R11 Metric - Radiation Fractions – Superficial & Orthovoltage
Range of Possible Values: 0 or greater
Definition: Radiation fractions delivered using superficial/orthovoltage treatment units.
Method: A visit is considered a Radiation– Superficial & Orthovoltage visit for the purposes of
calculating R11 if the following NHPIP codes are entered for the activity.
Superficial NHPIP Codes (TS):
NHPIP_ACT_CD
500
501
503
NHPIP_ACT_DESC
SUPERFICIAL X-RAY SIMPLE
SUPERFICIAL X-RAY WITH INTERNAL SHIELD
RT 50 TREATMENT PAPPION (PMH)
NHPIP_ACTIVE_STATUS
Yes
Yes
No
Orthovoltage NHPIP Codes (TD):
NHPIP_ACT_CD
510
511
512
NHPIP_ACT_DESC
ORTHOVOLTAGE SIMPLE
ORTHOVOLTAGE WITH INTERNAL SHIELD
INTRA-OPERATIVE RADIATION THERAPY
NHPIP_ACTIVE_STATUS
Yes
Yes
Yes
The Radiation Fractions for these visits are then added to R11. For instances where multiple visits on
the same day for the same diagnosis and activity occur, the fractions for each of the instances will be
counted towards R11.
RLE Metric - Radiation Low Energy NHPIP Minutes – Superficial & Orthovoltage
Range of Possible Values: 0 or greater
23
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
DRAFT
Definition: Sum of activity minutes for LOW energy treatment NHPIP CODES.
Method: The sum of NHPIP_DURATION_UNIT minutes from NHPIP codes captured in Superficial &
Orthovoltage (R11) fraction visits for a given period. Real duration is not captured in Data Book.
BRACHY FRACTIONS Metric - Radiation Fractions – Brachytherapy
Range of Possible Values: 0 or greater
Definition: Radiation fractions delivered using brachytherapy.
Method: A visit is considered a Radiation– brachytherapy visit for the purposes of calculating BRACHY
FRACTIONS if the following NHPIP codes are entered for the activity.
Interstitial Codes (TT):
NHPIP_ACT_CD
570
571
573
574
NHPIP_ACT_DESC
INTERS. SOURCE MAN. AFTR LOAD FULL INVOL
INTERS. SOURCES LIMITED INVOLVEMENT
REMOTE LOADING INTERS.SOURCE FULL INVOLV
REMOTE LOADING INTERS.SOURCE LIMT INVOLV
NHPIP_ACTIVE_STATUS
Yes
Yes
Yes
Yes
Interacavitary Codes (TV):
NHPIP_ACT_CD
561
563
565
566
568
NHPIP_ACT_DESC
INTRAC SOURCES TOT. INVOLVE-AFTERLOADING
LIMITED INVOLVEMENT MAN. AFTER LOADING
REMOTE LOADING TOTAL INVOLVEMENT
NO DOSIMETRY FOR REMOTE SOURCES LOADING
PREP,O.R. PROC,COMP DOSIM,ENDOVAS.TX PMH
NHPIP_ACTIVE_STATUS
Yes
Yes
Yes
Yes
Yes
NHPIP_ACT_DESC
DAILY APPLICATION OF SURFACE MOULD
NHPIP_ACTIVE_STATUS
Yes
Mould Codes (TM):
NHPIP_ACT_CD
581
The Radiation Fractions for these visits are then added to BRACHY FRACTIONS. For instances where
multiple visits on the same day for the same diagnosis and activity occur, the fractions for each of the
instances will be counted towards BRACHY FRACTIONS.
R12 Metric - Total Radiation Fractions
Range of Possible Values: 0 or greater
Definition: Radiation fractions delivered using a Megavoltage treatment units and Low Energy
treatment units.
24
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
DRAFT
Method: To obtain the number of Total Radiation Fractions, the ALR Metrics R7 (Radiation Fractions Cobalt), R8 (Radiation Fractions - Linear Accelerator), R11 (Radiation Fractions - Superficial &
Orthovoltage) and BRACHY FRACTIONS are first calculated and then those totals are summed to derive
R12.
Derivation Logic:
R12 = (R7+R8+R11+BRACHY FRACTIONS)
R13 Metric - Total Treatments NHPIP Minutes
Range of Possible Values: 0 or greater
Definition: The sum of NHPIP_DURATION_UNIT minutes from NHPIP codes captured in Cobalt (R7),
Linac (R8) and Orthovoltage (R11) fraction visits for a given period.
Method: The sum of NHPIP_DURATION_UNIT minutes from NHPIP codes captured in Superficial &
Orthovoltage (R11) fraction visits for a given period. Real duration is not captured in Data Book.
 Radiation Treated Cases
R17 Metric - Radiation Treated Cases – Cobalt
Range of Possible Values: 0 or greater
Definition: Unique cases that received at least one cobalt radiation therapy treatment in the reporting
period. Treatment in other programs may also have been administered.
Method: A case is considered a Radiation Treated Case – Cobalt for the purposes of calculating R17 if
the following NHPIP codes are entered for the activity:
NHPIP_ACT_CD
572
520
521
522
523
524
525
526
527
528
529
NHPIP_ACT_DESC
GAMMA KNIFE TREATMENT
CO-60 DIRECT FIELD
CO-60 PAIR - TWO FIELDS
CO-60 THREE FIELDS
CO-60 FOUR FIELDS
CO-60 FIVE FIELDS
CO-60 ARC/ROTATION
CO-60 EXTENDED SSD
COMPLEX EXTENDED SSD COBALT
CO-60 WHOLE/HALF BODY
CO-60 WHOLE CNS
25
NHPIP_ACTIVE_STATUS
Yes
No
No
No
No
No
No
No
No
No
No
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
DRAFT
All instances of a patient with a particular disease at a particular submitting institution are counted as a
single case.
Example 1: Two separate institutions submit information regarding patient X with disease A, how many
cases will this situation create for R17?
Answer: 2, since there were 2 different submitting hospitals
Example 2: 5 records are found for the same patient in the month of January 2005. All of the records
are for the same disease and are from the same submitting institution. How many cases will this
situation create for R17?
Answer: 1, since the records were all for the same patient with the same disease and the same
submitting hospital
R18 Metric - Radiation Treated Cases – Linear Accelerator
Range of Possible Values: 0 or greater
Definition: Unique cases that received at least one linac radiation therapy treatment in the reporting
period. Treatment in other programs may also have been administered.
Method: A case is considered a Radiation Treated Case – Linear Accelerator for the purposes of
calculating R18 if the following NHPIP codes are entered for the activity.
NHPIP_ACT_CD
530
531
532
533
534
535
536
538
540
542
548
549
575
592
594
596
597
519
537
539
541
NHPIP_ACT_DESC
LINAC DIRECT FIELD
LINAC PAIR - TWO FIELDS
LINAC THREE FIELDS
LINAC FOUR FIELDS
LINAC FIVE OR MORE FIELDS
LINAC ARC/ROTATION
LINAC EXTENDED SSD
LINAC WHOLE/HALF BODY
LINAC ELECTRONS
TOTAL BODY ELECTRONS
STEREOTACTIC TREAT(1 FRACT1HR/ISOCENTR)
STEREOTACTIC TREAT(MULTIFRAC30MIN/ISOC)
TOMOTHERAPY TREATMENT
IMRT TREATMENT
VMAT / RAPIC ARC TREATMENT CODE
CYBERKNIFE TREATMENT (SINGLE FRACTION)
CYBERKNIFE TREATMENT (MULTI-FRACTIONS)
8 FLD LINAC TREATMENT
LINAC COMPLEX EXTENDED SSD
LINAC WHOLE CNS
6 FIELD-6 FIELDS/ISOCENTER
26
NHPIP_ACTIVE_STATUS
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
DRAFT
All instances of a patient with a particular disease at a particular submitting institution are counted as a
single case.
Example 1: Two separate institutions submit information regarding patient X with disease A, how many
cases will this situation create for R18?
Answer: 2, since there were 2 different submitting hospitals
Example 2: 5 records are found for the same patient in the month of January 2005. All of the records
are for the same disease and are from the same submitting institution. How many cases will this
situation create for R18?
Answer: 1, since the records were all for the same patient with the same disease and the same
submitting hospital
R19 Metric - Radiation Treated Cases – Superficial & Orthovoltage
Range of Possible Values: 0 or greater
Definition: Unique cases that received at least one superficial/orthovoltage radiation therapy treatment
in the reporting period. Treatment in other programs may also have been administered.
Method: A case is considered a Radiation Treated Case – Superficial & Orthovolage for the purposes of
calculating R19 if the following NHPIP codes are entered for the activity.
Superficial NHPIP Codes (TS):
NHPIP_ACT_CD
500
501
503
NHPIP_ACT_DESC
SUPERFICIAL X-RAY SIMPLE
SUPERFICIAL X-RAY WITH INTERNAL SHIELD
RT 50 TREATMENT PAPPION (PMH)
NHPIP_ACTIVE_STATUS
Yes
Yes
No
Orthovoltage NHPIP Codes (TD):
NHPIP_ACT_CD
510
511
512
NHPIP_ACT_DESC
ORTHOVOLTAGE SIMPLE
ORTHOVOLTAGE WITH INTERNAL SHIELD
INTRA-OPERATIVE RADIATION THERAPY
NHPIP_ACTIVE_STATUS
Yes
Yes
Yes
All instances of a patient with a particular disease at a particular submitting institution are counted as a
single case.
Example 1: Two separate institutions submit information regarding patient X with disease A, how many
cases will this situation create for R19?
Answer: 2, since there were 2 different submitting hospitals
27
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
DRAFT
Example 2: 5 records are found for the same patient in the month of January 2005. All of the records
are for the same disease and are from the same submitting institution. How many cases will this
situation create for R19?
Answer: 1, since the records were all for the same patient with the same disease and the same
submitting hospital
R20 Metric - Radiation Treated Cases – Brachytherapy
Range of Possible Values: 0 or greater
Definition: Unique cases that received at least one Brachytherapy treatment in the reporting period.
Treatment in other programs may also have been administered.
Method: A case is considered a Radiation Treated Case – Brachytherapy for the purposes of calculating
R20 if the following NHPIP codes are entered for the activity.
Interstitial Codes (TT):
NHPIP_ACT_CD
570
571
573
574
NHPIP_ACT_DESC
INTERS. SOURCE MAN. AFTR LOAD FULL INVOL
INTERS. SOURCES LIMITED INVOLVEMENT
REMOTE LOADING INTERS.SOURCE FULL INVOLV
REMOTE LOADING INTERS.SOURCE LIMT INVOLV
NHPIP_ACTIVE_STATUS
Yes
Yes
Yes
Yes
Interacavitary Codes (TV):
NHPIP_ACT_CD
561
563
565
566
568
NHPIP_ACT_DESC
INTRAC SOURCES TOT. INVOLVE-AFTERLOADING
LIMITED INVOLVEMENT MAN. AFTER LOADING
REMOTE LOADING TOTAL INVOLVEMENT
NO DOSIMETRY FOR REMOTE SOURCES LOADING
PREP,O.R. PROC,COMP DOSIM,ENDOVAS.TX PMH
NHPIP_ACTIVE_STATUS
Yes
Yes
Yes
Yes
Yes
NHPIP_ACT_DESC
DAILY APPLICATION OF SURFACE MOULD
NHPIP_ACTIVE_STATUS
Yes
Mould Codes (TM):
NHPIP_ACT_CD
581
All instances of a patient with a particular disease at a particular submitting institution are counted as a
single case.
Example 1: Two separate institutions submit information regarding patient X with disease A, how many
cases will this situation create for R20?
28
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
DRAFT
Answer: 2, since there were 2 different submitting hospitals
Example 2: 5 records are found for the same patient in the month of January 2005. All of the records
are for the same disease and are from the same submitting institution. How many cases will this
situation create for R20?
Answer: 1, since the records were all for the same patient with the same disease and the same
submitting hospital
R21 Metric - Total Radiation Treated Cases
Range of Possible Values: 0 or greater
Definition: The number of unique cases which received at least one type of radiation therapy treatment
in the reporting period. (Note: Since a case can have more than one type of radiation treatment in a
reporting period, this may not be the sum of the Cobalt Cases + Linear Accelerator Cases +
Superficial/Orthovoltage Cases + Brachytherapy Cases.)
Method: To obtain the number of Total Radiation Treated Cases, the ALR Metrics R17 (Radiation
Treated Cases - Cobalt), R18 (Radiation Treated Cases - Linear Accelerator), R19 (Radiation Treated
Cases - Superficial & Orthovoltage) and R20 (Radiation Treated Cases - Brachytherapy) are first
calculated and then those totals are summed to derive R21.
Derivation Logic:
1) R21 = R17 + R18 + R19 + R20  this will result in double counts. It is not the sum it is the distinct
count.
2) Count of the distinct/unique combination of a patient and the disease number in a specific
submitting organization.
R30 Metric - New Radiation Treated Cases
Range of Possible Values: 0 or greater
Definition: The number of NEW cases which received the first radiation treatment, of any type, in the
reporting period.
Method: The number of cases who received for the first time at least one type of radiation therapy
treatment in the current reporting period.
Derivation Logic: First radiation treatment flagged as R21 is also flagged as R30
R31 Metric - Previously Treated Radiation Cases
Range of Possible Values: 0 or greater
29
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
DRAFT
Definition: The number of cases who received at least one type of radiation therapy treatment in the
current reporting period, and who’s first treatment case occurred in a previous reporting period.
Method: R31 = R21 - R30
Possible data quality issues that may have an impact on the ALR metrics
Each flag is set only if ALL conditions are met. Here are examples when the flag may not be set properly
(treatment is not counted in the right ALR metric):
 The Physician HCP Number or Specialty for physician is unknown
 For clinic visits, Visit Type is not set (Y or N)
 NHPIP Code is unknown
30
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
DRAFT
Appendix 1 – NHPIP Codes (including inactive codes)
National Hospital Productivity Improvement Program (NHPIP) is a listing of radiotherapy procedures with their respective measures of output
(workload). Thereby, radiotherapy workload can be measured by specific procedure performed. The list of NHPIP codes in the table below are available in the
online FY2014-15 DataBook under Appendix 1.14 (updated January 2014).
Legend
Change 327 to 327X, retained original 327 description
Added Suffix "X"
Description Change
New Code
Deactivated Code
NHPIP_ACT_CD
NHPIP_ACT_TYPE
NHPIP_ACT_DESC
327X
D
235X
P
342X
805X
806X
D
QA
QA
860
QA
861
862
QA
QA
863
QA
305
P
STEREOTACTIC CALC (30 MIN
PER ISOCENTER)
REMOVAL OF
CERROBEND,CLEAN TRAYS
IMRT PLANNING
QA CRASH CART (PMH)
VERIFY DAILY START UP
PROCEDURE (PMH)
KV/MV FLUOROSCOPIC IMAGE
ACQUISITION
KV/MV IMAGE REGISTRATION
KV/MV RADIOGRAPH
ACQUISITION
KV/MV VOLUMETRIC IMAGE
ACQUISITION
CLINICAL MARK UP
NHPIP_DURATION_UNIT
31
NHPIP_MAX_DOSE_PF
NHPIP_USAGE_CD
NHPIP_ACTIVE_STATUS
30
P
Yes
10
P
Yes
180
30
20
P
R
R
Yes
Yes
Yes
1
P
Yes
5
1
P
P
Yes
Yes
2
P
Yes
20
P
Yes
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
306
369
P
S
534
864
290X
311X
TL
QA
M
D
323X
D
338X
D
553X
QA
555X
QA
830X
D
107
S
202
M
361X
368
D
S
371
S
372
594
S
TL
596
TL
DRAFT
TRIAL SET UP
TREATMENT PLANNING CT
SCAN WITH IV CONTRAST
LINAC FIVE OR MORE FIELDS
OPTICAL WAND TRACKING
MANUFACTURE OF BOLUS
COMPUTERIZED PLAN
GENERATION 3 OR MORE
FIELDS
INITIAL CALCULATION 3 OR
MORE FIELDS W/O PT
INDEPENDENT CALC CHECK
(ALTERNATE METHOD)
PLAN CHECK, SIMPLE 1 OR 2
FIELDS
PLAN CHECK, 3 OR MORE
FIELDS
SENDING IMAGES/DATA TO
OTHER FACILITIES
VERIFICATION OF TREATMENT
SET-UP
IMMOBILIZATION (H&N, CNS,
VACKLOK, HIPFIX, etc.)
TBI PLANNING
SIMULATION USING TX
CONEBEAM
TREATMENT PLANNING CT
SCAN WITH GI CONTRAST
TREATMENT PLANNING MRI
VMAT / RAPIC ARC TREATMENT
CODE
CYBERKNIFE TREATMENT
(SINGLE FRACTION)
32
10
45
P
P
Yes
Yes
22
5
30
30
20 P
P
R
P
Yes
Yes
Yes
Yes
12
P
Yes
15
P
Yes
5
P
Yes
15
P
Yes
20
R
Yes
15
P
Yes
20
P
Yes
60
15
P
P
Yes
Yes
45
P
Yes
30
45
P
13 P
Yes
Yes
60
55 P
Yes
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
597
TL
706
PS
867
QA
218X
M
236X
344X
M
D
868X
100
QA
S
101
102
150
S
S
S
151
S
152
160
S
S
161
S
170
S
180
S
190
191
S
S
206
M
DRAFT
CYBERKNIFE TREATMENT
(MULTI-FRACTIONS)
SPECIAL PROCEDURE
EDUCATION
ULTRASOUND LOCALIZATION
FOR TREATMENT
CUT OUT OF TX FIELDS FROM
IMMOBILIZATION DEVICE
ELECTRON CUT OUT
VOLUMETRIC/RAPID ARC
PLANNING
PEER REVIEW QA
FLUOROSCOPY ONLY IN
SIMULATOR
SET UP OF ONE FIELD
SET UP OF TWO FIELDS
CYSTOGRAPHY W CATHETER
INSERTED IN SIM
CYSTOGRAPHY W/WO
CATHETER PREV INSERTED
I.V.P. PROCEDURE
UPPER G.I. TRACT WITH
CONTRAST
LOWER G.I. TRACT WITH
CONTRAST
CONTOUR USING SIMULATOR
SSD SCALE
SHIELDING BLOCK OR MASK
CHECK
INTERNAL SOURCE CHECKS
PLACEMENT OF VAGINAL
DUMMY
CUSTOM MADE MOUTHBITE
33
60
20 P
Yes
20
P
Yes
7
P
Yes
20
P
Yes
20
180
P
P
Yes
Yes
10
15
P
P
Yes
Yes
20
28
20
P
P
P
Yes
Yes
Yes
10
P
Yes
20
5
P
P
Yes
Yes
10
P
Yes
3
P
Yes
25
P
Yes
30
22
P
P
Yes
Yes
15
P
Yes
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
207
M
208
M
209
M
210
M
211
M
214
220
M
M
240
M
260
M
307
370
PS
S
377
S
378
379
380
500
S
S
S
TS
501
510
TS
TD
511
512
TD
TD
DRAFT
CUSTOM MADE HEAD/NECK
REST
FITTING OF STEREOTACTIC
FRAME(MULTIFRAC)
FITTING OF
STEREOTACTIC(SINGLE
FRACTION)
FITTING H&N PLASTIC SHELL +
EYE & MOUTH
FITTING OF PLASTIC
BREAST/BODY SHELL
IMMOBILIZATION ADJUSTMENT
SHIELDING TEMPLATE
CALCULATION
SIMPLE FORM WAX TO OUTLINE
WITH PATIENT
MOULD/PLAQUE APPLICATOR
WITH PATIENT
TATTOOING (PMH)
TREATMENT PLANNING
C.T.SCAN
ULTRASOUND FOR
LOCALIZATION (PLANNING)
GOLD SEED MARKER IMPLANT
PLANNING PET CT
4DCT IMAGE ACQUISITION
SUPERFICIAL X-RAY SIMPLE
SUPERFICIAL X-RAY WITH
INTERNAL SHIELD
ORTHOVOLTAGE SIMPLE
ORTHOVOLTAGE WITH
INTERNAL SHIELD
INTRA-OPERATIVE RADIATION
34
20
P
Yes
60
P
Yes
30
P
Yes
15
P
Yes
15
P
Yes
10
10
P
P
Yes
Yes
15
P
Yes
90
P
Yes
5
30
P
P
Yes
Yes
20
P
Yes
30
45
60
11
P
P
P
20 P
Yes
Yes
Yes
Yes
22
12
20 P
20 P
Yes
Yes
22
60
20 P
20 P
Yes
Yes
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
530
531
532
533
535
536
538
540
542
TL
TL
TL
TL
TL
TL
TL
TL
TL
548
TL
549
557
558
TL
QA
QA
560
TO
561
TV
562
TO
563
TV
565
TV
566
TV
567
TO
568
TV
DRAFT
THERAPY
LINAC DIRECT FIELD
LINAC PAIR - TWO FIELDS
LINAC THREE FIELDS
LINAC FOUR FIELDS
LINAC ARC/ROTATION
LINAC EXTENDED SSD
LINAC WHOLE/HALF BODY
LINAC ELECTRONS
TOTAL BODY ELECTRONS
STEREOTACTIC TREAT(1 FRACT1HR/ISOCENTR)
STEREOTACTIC
TREAT(MULTIFRAC30MIN/ISOC)
PORTAL IMAGING ASSESSMENT
PORTAL IMAGING ACQUISITION
INTRACAVITARY SOURCES
PREPARATION
INTRAC SOURCES TOT.
INVOLVE-AFTERLOADING
PREP. CLEAN-UP ONLY
INTERCAV SOURCES
LIMITED INVOLVEMENT MAN.
AFTER LOADING
REMOTE LOADING TOTAL
INVOLVEMENT
NO DOSIMETRY FOR REMOTE
SOURCES LOADING
REMOTE LOADING PROG &
HOOK UP ONLY
PREP,O.R. PROC,COMP
DOSIM,ENDOVAS.TX PMH
35
10
12
17
19
12
13
40
10
30
11
11
11
11
11
11
11
15
11
P
P
P
P
P
P
P
P
P
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
60
25 P
Yes
30
3
5
14 P
P
P
Yes
Yes
Yes
20
P
Yes
180
40 P
Yes
75
P
Yes
100
40 P
Yes
150
40 P
Yes
90
60 P
Yes
30
P
Yes
150
40 P
Yes
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
570
TT
571
572
TT
TC
573
TT
574
575
TT
TL
580
TO
581
582
592
TM
TP
TL
600
610
TO
TO
700
PS
705
710
PS
PS
802
QA
826
D
865
QA
866
900
QA
PS
DRAFT
INTERS. SOURCE MAN. AFTR
LOAD FULL INVOL
INTERS. SOURCES LIMITED
INVOLVEMENT
GAMMA KNIFE TREATMENT
REMOTE LOADING
INTERS.SOURCE FULL INVOLV
REMOTE LOADING
INTERS.SOURCE LIMT INVOLV
TOMOTHERAPY TREATMENT
SOURCES - MOULDS
INITIAL/FINAL TASKS
DAILY APPLICATION OF
SURFACE MOULD
PDT TREATMENT
IMRT TREATMENT
ISOLATION OR STERILE
TECHNIQUE
ANAESTHESIA
SCHEDULED SUPPORT FOR
REVIEW/OBSERVATION
PT EDUCATION FOR F/L DAY OF
TREATMT
UNSCHEDULED SUPPORT
STEREOTACTIC QA PROCEDURE
(PMH)
EXPOSURE OF TLDS WITH PAT
IN SET-UP
ACTIVE BREATHING CONTROL
DEVICE
RESPIRATORY GATING
TREATMENT
TRANSPORTATION
36
200
145 P
Yes
90
60
145 P
70 P
Yes
Yes
150
16 P
Yes
30
30
11 P
11 P
Yes
Yes
60
P
Yes
15
80
45
40 P
150 P
20 P
Yes
Yes
Yes
25
1
P
P
Yes
Yes
8
P
Yes
10
5
P
P
Yes
Yes
30
P
Yes
10
P
Yes
15
P
Yes
15
12
P
P
Yes
Yes
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
210X
M
211X
M
220X
M
221X
M
225X
D
232X
M
240X
M
251X
D
261X
M
300X
301X
PS
P
308X
PS
309X
D
310X
D
315X
D
320X
D
321X
322X
QA
D
DRAFT
PREP/MANUFACT PLASTIC H/N
SHELL W/O PT
PREP/MANUFAC PLASTIC
BREAST SHELL W/O PT
SHIELDING TEMPLATE
CALCULATION W/O PT
SHIELDING TEMPLATE FROM
COMPUTER PLAN
MLC DIGITIZATION (10 MIN PER
FIELD)
SHIELDING BLOCKS CUSTOM
MADE DIVERGENT
SIMPLE FORM WAX TO OUTLINE
W/O PATIENT
MANUAL PREP COMPENSATOR
W/O PATIENT
HAMMERED AND FITTED LEAD
SHIELD W/O PT
PRETREATMENT SCHEDULING
W/O PT
PLAN CONSULTATION
PDT PRE-TREATMENT
PROCEDURE
COMPUTER PLAN GENERATION
1 FIELD W/O PT
COMPUTERIZED PLAN
GENERATION 2 FIELDS
COMPUTERIZED PLAN
STEREOTACTIC RX
INITIAL CALCULATION DIRECT
FIELD W/O PT
PROGRAM DATA INTO RECORD
& VERIFY -TDMS
INITIAL CALCULATION 2 FIELDS
37
33
P
Yes
60
P
Yes
10
P
Yes
11
P
Yes
10
P
Yes
100
P
Yes
15
P
Yes
20
P
Yes
20
P
Yes
10
30
P
P
Yes
Yes
45
P
Yes
15
P
Yes
15
P
Yes
20
P
Yes
6
P
Yes
15
10
P
P
Yes
Yes
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
333X
D
340X
D
341X
343X
375X
D
D
D
376X
D
547X
QA
559X
650X
651X
QA
TO
TO
652X
TO
711X
712X
PS
PS
800X
802X
807X
808X
810X
811X
825X
QA
QA
QA
QA
QA
QA
D
826X
827X
D
D
DRAFT
W/O PT
TREAT PLAN/TARGET
DEFIN/DOSE COMPUT/EVAL
SURFACE MOULD
CALCULATIONS
INTERNAL SOURCE
CALCULATIONS
COMPOSITE DISTRIBUTION
IMAGE FUSION
CT CONTOURING NORMAL
STRUCTURES
STEREOTACTIC QA (30 MIN PER
ISOCENTER)
PORTAL IMAGINGREFERENCE(10 MIN PER FLM)
PDT ROOM SET-UP
PDT ROOM CLEAN UP
PDT EQUIPMENT CLEANING
AND STERILIZING
COORDINATION OF PATIENT
MATERIAL
DOCUMENTATION
ROOM AND EQUIPMENT CHECK
W/O PT.
STEREOTACTIC CONVERSION
PORTAL IMAGER QA
IMRT LEAF CHECK
LEAK TEST OF SOURCES W/O PT.
WEEKLY SAFE COUNT W/O PT.
PREPARATION OF TLDS W/O PT.
EXPOSURE OF TLDS W/O PAT
(CONTROLS)
READ AND OBTAIN RESULTS OF
38
180
P
Yes
120
P
Yes
120
45
30
P
P
P
Yes
Yes
Yes
30
P
Yes
30
P
Yes
10
10
10
P
R
R
Yes
Yes
Yes
20
P
Yes
10
5
P
P
Yes
Yes
20
30
15
120
5
30
25
R
P
P
P
R
R
P
Yes
Yes
Yes
Yes
Yes
Yes
Yes
10
50
R
P
Yes
Yes
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
840X
D
A01X
QA
A02X
QA
A03X
QA
B01X
QA
C1AX
QA
C1BX
QA
C1CX
QA
C1DX
QA
C1EX
QA
C1FX
QA
C1GX
C1HX
QA
QA
DRAFT
TLDS W/O PT.
CALIBRATION OF SEEDS W/O
PT.
No changes recommended;
follows usual policy/protocol
No changes recommended;
deviates from usual
policy/protocol
No changes recommended;
review policy/protocol for
future
Documentation change
recommended; revision to plan
documentation
Minor clinical impact: Minor
change recommended; target
volume coverage
Minor clinical impact: Minor
change recommended; OAR
Minor clinical impact: Minor
change recommended;
technique/dosimetry
Minor clinical impact: Minor
change recommended; other
Minor clinical impact: Major
plan change recommended;
target volume coverage
Minor clinical impact: Major
plan change recommended;
OAR
Minor clinical impact: Major
plan change recommended;
technique/dosimetry
Minor clinical impact: Major
39
45
R
Yes
1
P
Yes
1
P
Yes
1
P
Yes
1
P
Yes
1
P
Yes
1
P
Yes
1
P
Yes
1
P
Yes
1
P
Yes
1
P
Yes
1
1
P
P
Yes
Yes
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
C2AX
QA
C2BX
QA
C2CX
QA
C2DX
QA
C2EX
QA
C2FX
QA
C2GX
QA
C2HX
QA
O01X
QA
O02X
QA
O03X
QA
DRAFT
plan change recommended;
other
Significant clinical impact:
Minor change recommended:
target volume coverage
Significant clinical impact:
Minor change recommended:
OAR
Significant clinical impact:
Minor change recommended:
technique/dosimetry
Significant clinical impact:
Minor change recommended:
other
Significant clinical impact: Major
plan change recommended;
target volume coverage
Significant clinical impact: Major
plan change recommended;
OAR
Significant clinical impact: Major
plan change recommended;
technique/dosimetry
Significant clinical impact: Major
plan change recommended;
other
No Change recommended; no
change implemented
Change recommended; change
implemented
Change recommended; no
change implemented
40
1
P
Yes
1
P
Yes
1
P
Yes
1
P
Yes
1
P
Yes
1
P
Yes
1
P
Yes
1
P
Yes
1
P
Yes
1
P
Yes
1
P
Yes
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
DRAFT
NHPIP Deactivated Codes
NHPIP_ACT_CD
NHPIP_ACT_TYPE
NHPIP_ACT_DESC
103
104
105
S
S
S
106
S
110
111
S
S
115
120
130
200
201
203
S
S
S
M
M
M
203X
M
204
205
M
M
212
S
213
M
215
M
215X
216X
M
M
SET UP OF THREE FIELDS
SET UP OF FOUR FIELDS
SET UP OF FIVE FIELDS
SET-UP 6 FIELDS-SIM
(CONFORMAL THERAPY)
BREAST TANGENTS & ANGLE
CALCULATION
ANGLE DOWN PAIR (PMH)
SIMULATION OF ASYMMETRIC
BREAST
EXTENDED SSD
WHOLE CNS
HEAD AND NECK PLASTER
BREAST/BODY SHELL PLASTER
FITTING OF PLASTIC BODY SHELL
PREP/MANUFACT PLASTIC BODY
SHELL W/O PT
PRODUCTION OF ALPHA-CRADLE
DEVICE
AQUAPLAST
SCOUT FILM POSITIONING
DURING FITTING
VERIFICATION/INSPECTION OF
SHELL FIT
CONTOUR FROM SHELL OR
MOULD (PMH)
CONTOUR FROM SHELL OR
MOULD W/O PT
SIMPLE CUT OUT OF TX FIELDS
NHPIP_DURATION_UNIT
41
NHPIP_MAX_DOSE_PF
NHPIP_USAGE_CD
36
44
52
P
P
P
NHPIP_ACTIVE_STATUS
No
No
No
45
P
No
40
57
P
P
No
No
45
60
60
44
70
20
P
P
P
P
P
P
No
No
No
No
No
No
60
P
No
20
30
P
P
No
No
20
P
No
5
P
No
20
P
No
20
15
P
P
No
No
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
217X
M
222X
223X
D
D
224X
D
230X
M
231X
M
233X
M
234
M
241
M
241X
M
242
M
250
D
250X
D
251
D
252X
M
253
M
253X
M
DRAFT
FROM SHELL
COMPLEX CUT OUT OF TX FIELDS
FROM SHELL
PB MARK-UP ON FILM (5 MIN PER
FILM)
MLC WORK-UP (5 MIN PER FIELD)
MLC PROGRAMMING (3 MIN PER
FIELD)
STANDARD SHIELDING BLOCKS
NON DIVERGENT
SHIELDING BLKS CUSTOM-MADE
NON-DIVERGENT
MODIF. EXISTING CERROBEND
SHIELDS SIMPLE
CERROBEND SHIELD MODIFIC.
COMPLEX (PMH)
COMPLEX WAX COMPENSATOR
WITH PATIENT
FORM WAX EMBED BASEPLATE
W/O PATIENT
CUSTOM MADE CERROBEND,EYE
(PMH)
AUTOMATED PREP
COMPENSATOR WITH PATIENT
AUTOMATED PREP
COMPENSATOR W/O PATIENT
MANUAL PREP COMPENSATOR
WITH PATIENT
AUTO PREP LEAD,WAX
COMPENSATOR W/O PT
MANUAL PREP LEAD,WAX
COMPENSATOR WITH PT
MANUAL PREP LEAD,WAX
COMPENSATOR W/O PT
42
50
P
No
5
5
P
P
No
No
3
P
No
20
P
No
50
P
No
15
P
No
60
P
No
50
P
No
50
P
No
15
P
No
20
P
No
20
P
No
20
P
No
1
P
No
10
P
No
10
P
No
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
254X
D
259
M
261
262X
M
M
263
M
264
M
300
PS
312X
D
313X
D
314X
D
316X
D
317X
D
318X
D
319X
D
320
D
324X
D
325X
326X
D
D
DRAFT
CALCULATIONS IN
COMPENSATOR PREP W/O PT
PREPARATION PB SHIELD OR CUTOUT
HAMMERED AND FITTED LEAD
SHIELD WITH PT
MANUFACT CUPROUS OXIDE
SURFACE MOULD OR PLAQUE
APPLICATOR (PMH)
PREP EDUCAT'N + MOULD
FABR,INC.CATHETERS
PRETREATMENT PROCEDURE
SCHEDULING
COMPUTERIZED PLAN
GENERATION 4 FIELDS
COMPUTERIZED PLAN
GENERATION EXTEND SSD
COMPUTERIZED PLAN
GENERATION WHOLE CNS
COMPUTERIZED PLAN 6 FIELDS
(CONFORMAL)
4 FLD CONFORMAL
DISTRIBUTION
5 FLD DISTRIBUTION NONCONFORMAL
6 FLD DISTRIBUTION NONCONFORMAL
INITIAL CALCULATION DIRECT
FIELD W PT
INITIAL CALCULATION 4 FIELDS
W/O PT
INITIAL CALCULATION FOR
ARCS/ROTATIONS
COMPLEX CALCU,SHIELD,WEDGE
43
5
P
No
10
P
No
20
35
P
P
No
No
180
P
No
180
P
No
10
P
No
45
P
No
120
P
No
20
P
No
270
P
No
240
P
No
120
P
No
150
P
No
6
P
No
15
P
No
15
5
P
P
No
No
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
327
328
329X
330X
331X
D
D
D
D
D
332X
D
334X
335X
336X
339
D
D
D
D
350
P
360
371X
D
P
372X
373
374
374X
P
S
P
P
381
D
382
D
390
M
503
519
TS
TL
DRAFT
EXTENDED SSD
STEREOTACTIC CALC (30 MIN PER
ISOCENTER)
6 FLD INITIAL CALC CONFORMAL
6 FLD INITIAL CALC
TIMCAL, SIMPLE (PMH)
TIMCAL, COMPLEX (PMH)
CALCULATION,EQ.SQUARES
"IRREG" (PMH)
4 FLD INITIAL CALC NONCOPLANAR
5 FLD INITIAL CALC
5 FLD INITIAL CALC CONFORMAL
8 FLD DISTRIBUTION
TOTAL/HEMI BODY PLANNING
ON TRMT UNIT
TOT/HEMI BODY DOSIM CALC
FOR BOLUS THICK
CT RECONSTRUCTION (PMH)
CT/SIMULATOR
RECONSTRUCTION
RX PLANNING CT STEREOTACTIC
KIDNEY LOCALIZATION
KIDNEY LOCALIZATION
AUTOMATED CONTOUR FROM
SSD SCALE
COMPUTERIZED CONTOUR FROM
TP/CT
CUT-OUTS OF FOAM
BLOCKS,ASSESS OF X-RAY
RT 50 TREATMENT PAPPION
(PMH)
8 FLD LINAC TREATMENT
44
30
30
20
10
20
P
P
P
P
P
No
No
No
No
No
25
P
No
15
20
25
250
P
P
P
P
No
No
No
No
15
P
No
25
15
P
P
No
No
60
60
45
10
P
P
P
P
No
No
No
No
10
P
No
20
P
No
20
P
No
22
30
30 P
11 P
No
No
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
520
521
522
523
524
525
526
527
528
529
537
539
541
550
TC
TC
TC
TC
TC
TC
TC
TC
TC
TC
TL
TL
TL
QA
551X
QA
552
QA
552X
QA
553
554X
555
556
590
591
QA
QA
QA
QA
TI
TI
620
640
690
TO
TO
PS
801
QA
DRAFT
CO-60 DIRECT FIELD
CO-60 PAIR - TWO FIELDS
CO-60 THREE FIELDS
CO-60 FOUR FIELDS
CO-60 FIVE FIELDS
CO-60 ARC/ROTATION
CO-60 EXTENDED SSD
COMPLEX EXTENDED SSD COBALT
CO-60 WHOLE/HALF BODY
CO-60 WHOLE CNS
LINAC COMPLEX EXTENDED SSD
LINAC WHOLE CNS
6 FIELD-6 FIELDS/ISOCENTER
PORT (CHECK) FILM
DEV.,LABEL,VERIFY CHECK PORT
FILM
DIGITAL COPYING EXPANDED 5MIN PER PHOTO
FILM COPYING (EXPANDED-5 MIN
PER FILM)
PLAN CHECK, SIMPLE 1 OR 2
FIELDS
MLC QA (3 MIN PER FIELD)
PLAN CHECK, 3 OR MORE FIELDS
LIVE PORTAL IMAGING
RADIONUCLIDE THERAPY 131I
RADIONUCLIDE THERAPY 32P
HYPERBARIC OXYGEN
PROCEDURE
HYPERTHERMIA
BLOOD IRRADIATION
QA IMMOBILIZATION DEVICE
(PMH)
12
15
20
26
30
13
20
35
40
30
30
30
30
5
45
11
11
11
11
11
11
11
11
11
11
11
11
11
P
P
P
P
P
P
P
P
P
P
P
P
P
P
No
No
No
No
No
No
No
No
No
No
No
No
No
No
5
P
No
5
P
No
5
B
No
5
3
15
7
90
32
P
P
P
P
40 P
40 P
No
No
No
No
No
No
1
1
15
P
P
B
No
No
No
30
P
No
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
803
QA
804
QA
812X
QA
820X
850
QA
QA
D
329X
DRAFT
QA HYPERTHERMIA EQUIPMENT
(PMH)
CALIBRATION TEMPERATURE
PROBES (PMH)
WEEKLY CHANGE OF FLETCHER
INSERTS W/O P.
CALIBRATION OF ALL UNITS
INCLUDING RT 50
GENERATE DISTRIBUTIONS (PMH)
6 FIELD INITIAL CALCULATION
46
15
R
No
20
R
No
5
R
No
30
120
30
R
R
P
No
No
No
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
DRAFT
Appendix 2: Health Care Provider (HCP) Specialty Codes
The list below contains all Specialty codes that are included in the metrics described above (last updated for FY 2014). The list is reviewed each fiscal year. For
an up-to-date list, please contact informatics@cancercare.on.ca
HCP_SPECIALTY_CD
00000
00001
00002
00003
00004
00006
00010
00011
00012
00013
00014
00015
00016
00017
00018
00019
00020
00021
00022
00023
00024
00025
00026
00027
00028
HCP_SPECIALTY_DESC
Physician Group
Family Practice/General Practice Medicine
Community Medicine
Emergency Medicine
Trauma Medicine
Resident
Internal Medicine
Clinical Immunology and Allergy
Cardiology
Dermatology
Endocrinology and Metabolism
Gastroenterology
Nephrology
Neurology
Respirology
Rheumatology
Pediatrics
Pediatric Immunology and Allergy
Pediatric Cardiology
Pediatric Dermatology
Pediatric Endocrinology and Metabolism
Pediatric Gastro-Enterology
Pediatric Nephrology
Pediatric Neurology
Pediatric Respirology
47
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
HCP_SPECIALTY_CD
00029
00030
00031
00032
00034
00035
00036
00037
00038
00039
00040
00041
00042
00044
00045
00046
00047
00048
00049
00050
00051
00052
00053
00054
00055
00056
00057
00058
00059
DRAFT
HCP_SPECIALTY_DESC
Pediatric Rheumatology
General Surgery
Cardiac Surgery
Neurosurgery
Orthopedic Surgery
Plastic Surgery
Thoracic Surgery
Vascular Surgery
Cardiothoracic Surgery
Urology
Pediatric General Surgery
Pediatric Cardiac Surgery
Pediatric Neurosurgery
Pediatric Orthopedic Surgery
Pediatric Plastic Surgery
Pediatric Thoracic Surgery
Pediatric Vascular Surgery
Pediatric Cardiothoracic Surgery
Pediatric Urology
Obstetrics and Gynecology
Gynecologic Reproductive Endocrinology and Infertility
Urogynaecology
Urogynaecology
Maternal-Fetal Medicine
Critical Care Medicine
Clinical Pharmacology
Anaesthesiology
Pediatric Anaesthesiology
Colorectal Surgery
48
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
HCP_SPECIALTY_CD
00060
00061
00062
00063
00064
00065
00066
00067
00068
00070
00072
00073
00074
00075
00076
00077
00078
00080
00082
00083
00085
00086
00089
00090
00092
00093
00096
00097
00120
DRAFT
HCP_SPECIALTY_DESC
Otolaryngology
Pediatric Otolaryngology
Ophthalmology
Pediatric Ophthalmology
Psychiatry
Pediatric Psychiatry
Hematology
Pediatric Hematology
Clinical Immunologist
Physical Medicine and Rehabilitation
Geriatric Medicine
General Surgical Oncology
Medical Oncology
Radiation Oncology
Gynecologic Oncology
General Pathology
Medical Microbiology
Diagnostic Radiology
Medical Genetics
Anatomical Pathology
Hematological Pathology
Neuropathology
Nuclear Medicine
Medical Biochemistry
Pediatric Radiology
Neuroradiology
Infectious Diseases
Neonatal-Perinatal Medicine
Pediatric Development
49
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
HCP_SPECIALTY_CD
00121
00122
00123
00124
00125
00126
00127
00128
00129
00130
00999
01000
01001
01002
01003
01004
01005
01006
01007
01008
01009
01010
01011
01012
01013
01014
DRAFT
HCP_SPECIALTY_DESC
Palliative Medicine
Adolescent Medicine
Forensic Pathology
Forensic Psychiatry
Geriatric Psychiatry
Occupational Medicine
Paediatric Emergency Medicine
Transfusion Medicine
General Internal Medicine
Pain Medicine
Palliative Care Physician
Dentistry Group
Dentistry
Dental Surgery
Oral Surgery
Orthodontistry
Paedodontistry
Periodontistry
Oral Pathology
Endodontistry
Oral Radiology
Dental Hygiene Technology
Denturology
Pediatric Oral Surgery
Pediatric Dentistry
Prosthodontics
50
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
DRAFT
Appendix 3 – NHPIP Codes submitted to DataBook in 2013-2014 and used to calculate ALR metrics for
Radiation Therapy
(1=counted; 0=not counted)
NHPIP
CODE
R1
R2
R3
R4
R7
R8
R9
R10
RLE
100
0
1
0
0
0
0
0
0
0
101
0
1
0
0
0
0
0
0
102
0
1
0
0
0
0
0
107
0
1
0
0
0
0
150
0
1
0
0
0
0
151
0
1
0
0
0
152
0
1
0
0
160
0
1
0
0
161
0
1
0
170
0
1
180
0
1
190
0
191
202
R11
R13
R14
R15
R17
R18
R19
R20
R21
R23
R24
R25
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
206
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
207
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
208
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
209
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
210
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
210X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
211
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
211X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
214
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
218X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
220
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
220X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
221X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
51
R26
BRACHY
FRACTIONS
R12
R40
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
NHPIP
CODE
DRAFT
R1
R2
R3
R4
R7
R8
R9
R10
RLE
225X
0
0
0
0
0
0
0
0
0
232X
0
0
0
0
0
0
0
0
0
235X
0
0
0
0
0
0
0
0
236X
0
0
0
0
0
0
0
240
1
0
0
0
0
0
240X
0
0
0
0
0
0
251X
0
0
0
0
0
260
1
0
0
0
261X
0
0
0
0
290X
0
0
0
300X
0
0
301X
0
0
305
0
306
307
R11
R13
R14
R15
R17
R18
R19
R20
R21
R23
R24
R25
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
308X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
309X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
310X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
311X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
315X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
320X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
321X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
322X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
323X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
327X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
333X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
338X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
340X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
341X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
342X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
343X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
344X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
361X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
52
R26
BRACHY
FRACTIONS
R12
R40
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
NHPIP
CODE
DRAFT
R1
R2
R3
R4
R7
R8
R9
R10
RLE
368
0
1
0
0
0
0
0
0
0
369
0
1
0
0
0
0
0
0
0
370
0
1
0
0
0
0
0
0
371
0
1
0
0
0
0
0
372
0
1
0
0
0
0
375X
0
0
0
0
0
0
376X
0
0
0
0
0
377
0
1
0
0
378
0
1
0
0
379
0
1
0
380
0
1
500
0
0
501
0
510
511
R11
R13
R14
R15
R17
R18
R19
R20
R21
R23
R24
R25
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
1
1
1
1
0
1
0
0
1
0
1
0
0
0
1
0
0
0
0
0
0
0
0
0
1
1
1
1
0
1
0
0
1
0
1
0
0
0
1
0
0
0
0
0
0
0
0
0
0
1
1
1
1
0
1
0
0
1
0
1
0
0
0
1
0
0
0
0
0
0
0
0
0
0
1
1
1
1
0
1
0
0
1
0
1
0
0
0
1
0
0
530
0
0
0
0
0
1
1
1
0
0
1
1
0
1
0
1
0
0
1
0
1
1
0
0
0
531
0
0
0
0
0
1
1
1
0
0
1
1
0
1
0
1
0
0
1
0
1
1
0
0
0
532
0
0
0
0
0
1
1
1
0
0
1
1
0
1
0
1
0
0
1
0
1
1
0
0
0
533
0
0
0
0
0
1
1
1
0
0
1
1
0
1
0
1
0
0
1
0
1
1
0
0
0
534
0
0
0
0
0
1
1
1
0
0
1
1
0
1
0
1
0
0
1
0
1
1
0
0
0
535
0
0
0
0
0
1
1
1
0
0
1
1
0
1
0
1
0
0
1
0
1
1
0
0
0
536
0
0
0
0
0
1
1
1
0
0
1
1
0
1
0
1
0
0
1
0
1
1
0
0
0
538
0
0
0
0
0
1
1
1
0
0
1
1
0
1
0
1
0
0
1
0
1
1
0
0
0
540
0
0
0
0
0
1
1
1
0
0
1
1
0
1
0
1
0
0
1
0
1
1
0
0
0
542
0
0
0
0
0
1
1
1
0
0
1
1
0
1
0
1
0
0
1
0
1
1
0
0
0
547X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
548
0
0
0
0
0
1
1
1
0
0
1
1
0
1
0
1
0
0
1
0
1
1
0
0
0
549
0
0
0
0
0
1
1
1
0
0
1
1
0
1
0
1
0
0
1
0
1
1
0
0
0
553X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
555X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
557
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
558
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
559X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
53
R26
BRACHY
FRACTIONS
R12
R40
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
NHPIP
CODE
DRAFT
R1
R2
R3
R4
R7
R8
R9
R10
RLE
560
0
0
0
0
0
0
0
0
0
561
0
0
0
0
0
0
0
0
0
562
0
0
0
0
0
0
0
0
563
0
0
0
0
0
0
0
565
0
0
0
0
0
0
566
0
0
0
0
0
0
567
0
0
0
0
0
570
0
0
0
0
571
0
0
0
0
572
0
0
0
573
0
0
574
0
0
575
0
580
581
R11
R13
R14
R15
R17
R18
R19
R20
R21
R23
R24
R25
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
1
1
0
0
0
1
1
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
1
1
0
0
0
1
1
0
0
0
0
1
0
0
0
0
0
1
0
1
1
0
0
0
1
1
0
0
0
0
1
0
0
0
0
0
1
0
1
1
0
0
0
1
1
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
1
1
0
0
0
1
1
0
0
0
0
1
0
0
0
0
0
0
0
1
0
1
1
0
0
0
1
1
0
0
0
0
1
0
0
1
0
1
1
0
0
1
1
0
1
1
0
0
0
1
1
0
1
0
0
0
0
0
0
0
0
0
0
0
1
0
1
1
0
0
0
1
1
0
0
0
0
1
0
0
0
0
0
0
0
0
0
1
0
1
1
0
0
0
1
1
0
0
0
0
1
0
0
0
0
0
1
1
1
0
0
1
1
0
1
0
1
0
0
1
0
1
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
1
1
0
0
0
1
1
0
0
0
0
1
0
582
0
0
0
0
0
0
0
0
1
1
1
1
0
1
0
0
1
0
1
0
0
0
1
0
0
592
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
592
0
0
0
0
0
1
1
1
0
0
1
1
0
1
0
1
0
0
1
0
1
1
0
0
0
594
0
0
0
0
0
1
1
0
0
0
1
0
0
1
0
1
0
0
1
0
1
1
0
0
0
594
0
0
0
0
0
1
1
1
0
0
1
1
0
1
0
1
0
0
1
0
1
1
0
0
0
596
0
0
0
0
0
1
1
0
0
0
1
0
0
1
0
1
0
0
1
0
1
1
0
0
0
596
0
0
0
0
0
1
1
1
0
0
1
1
0
1
0
1
0
0
1
0
1
1
0
0
0
597
0
0
0
0
0
1
1
0
0
0
1
0
0
1
0
1
0
0
1
0
1
1
0
0
0
597
0
0
0
0
0
1
1
1
0
0
1
1
0
1
0
1
0
0
1
0
1
1
0
0
0
600
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
610
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
652X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
700
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
705
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
706
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
710
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
711X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
712X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
54
R26
BRACHY
FRACTIONS
R12
R40
Cancer Care Ontario
Metric Methods - ALR Radiation Methods
NHPIP
CODE
DRAFT
R1
R2
R3
R4
R7
R8
R9
R10
RLE
800X
0
0
0
0
0
0
0
0
0
802X
0
0
0
0
0
0
0
0
0
806X
0
0
0
0
0
0
0
0
807X
0
0
0
0
0
0
0
808X
0
0
0
0
0
0
810X
0
0
0
0
0
0
825X
0
0
0
0
0
826
0
0
0
1
826X
0
0
0
0
827X
0
0
0
830X
0
0
840X
0
0
860
0
861
861
R11
R13
R14
R15
R17
R18
R19
R20
R21
R23
R24
R25
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
862
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
862
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
863
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
863
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
864
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
865
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
866
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
867
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
868X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
900
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
900
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
A01X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
O01X
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
55
R26
BRACHY
FRACTIONS
R12
R40