Workflow efficiency for the treatment planning process in CT-guided high-dose-rate brachytherapy for cervical cancer

Abstract Purpose To investigate process efficiency, we present a prospective investigation of the treatment planning phase of image-guided brachytherapy (BT) for cervical cancer using a specific checklist. Methods and Materials From October 2012 to January 2014, 76 BT procedures were consecutively performed. Prospective data on the CT-based treatment planning process was collected using a specific checklist which details the following steps: ( 1 ) dosimetry planning, ( 2 ) physician review start, ( 3 ) physician review time, ( 4 ) dosimetry processing, ( 5 ) physics review start, ( 6 ) physics review, and ( 7 ) procedural pause. Variables examined included the use of a pre-BT MRI, clinic duty conflicts, resident teaching, and the use of specific BT planners. Analysis was performed using descriptive statistics, t -test, and analysis of variance. Results Seventy-five prospectively gathered checklists comprised this analysis. The mean time for treatment planning was 95 minutes (med 94, std 18). The mean intervals in the above steps were ( 1 ) = 42, ( 2 ) = 5, ( 3 ) = 19, ( 4 ) = 10, ( 5 ) = 6, ( 6 ) = 13, and ( 7 ) = 26 minutes. There was no statistical difference in patients who had a pre-BT MRI. Resident teaching did not influence time, p = 0.17. Treatment planning time was decreased with a specific planner, p = 0.0015. Conclusions A skillful team approach is required for treatment planning efficiency in image-guided BT. We have found that the specific BT planners can have a significant effect on the overall planning efficiency. We continue to examine clinical and workflow-related factors that will enhance our safety and workflow process with BT.