Longitudinal Review of the White Board Implementation Shows Improved Efficiency in Radiation Therapy Planning

Abstract

Radiation therapy has a planning process that begins when a patient decides to undergo radiation therapy and spans to the time when the patient starts his/her treatments. This process can be lengthy due to the complex work flow that takes place between CT simulation and treatment delivery. The process also requires detailed communication between physicians, physicists, planners and other support staff. Any delays or mistakes in the work flow can cause safety concerns, patient anxiety and/or decrease the efficiency of the center. Our growing department uses a system of Smarter Radiation Oncology tools, which, among other things, includes the use of our home grown electronic tracking system called “Treatment Planning White Board” to streamline the process of radiation therapy treatment planning. In this study we evaluate the longitudinal efficiency of the Treatment Planning White Board. From 2016 – 2018, we tracked 5860 patient treatments’ (2016:391; 2017: 2494; 2018: 2975) using the Treatment Planning White Board. There are 9 steps that are tracked between CT simulation (CT SIM) to virtual simulation (VSIM) prior to treatment. Each step is assigned a predetermined time limit and personnel responsible for each of the steps are sent reminders throughout the process. We calculated the work hours (WHrs) (excluding nights, weekends and holidays) for each step of the process. We report the overall and prostate cancer external beam planning specific WHrs averages with the standard error of mean. With the implementation of the White Board, there was a significant improvement in WHrs of the treatment planning process (from CT SIM to VSIM): 2016, 155 +/- 8.5 WHrs; 2017, 113 +/- 2.3 WHrs; 2018, 86 +/- 1.2 WHrs. In 2018, there was a 45% and 25% improvement in overall treatment planning WHrs compared to 2016 and 2017, respectively. The most significant changes occurred in the physics and planning parts of the process, including plan generation after contour review and QA aspects. There were no differences in the physician aspects of the process: contour time, MD plan review or MD sign off. When we further evaluated the WHrs for prostate cancer external beam planning, these differences persisted. CT SIM to VSIM WHrs were: 2016, 160 +/- 15.5 WHrs; 2017,127 +/- 6.3 WHrs; 2018, 104.3 +/- 4 WHrs. In 2018, there was a 35% and 18% improvement in prostate cancer treatment planning WHrs compared to 2016 and 2017, respectively. Similar to the overall trends, the improvement were seen in the physics and planning aspects of the process. Treatment Planning White Board implementation has led to longitudinal improvement in efficiency in radiation therapy planning at our busy academic center mainly by improving the physics and planning aspects of the treatment. We hope to use this data to refine planning time and alleviate patient anxiety, by providing them with better estimates and transparency of the planning process.