Implant time and process efficiency for CT-guided high-dose-rate brachytherapy for cervical cancer

Jyoti Mayadev, Lihong Qi, Susan Lentz, Stanley H Benedict, Jean Courquin, Sonja Dieterich, Mathew Mathai, Robin L Stern, Richard K Valicenti

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Purpose: This investigation details the time and teamwork required for CT-guided tandem and ring high-dose-rate brachytherapy. Methods and Materials: From 2010 to 2012, 217 consecutive implantations were identified on 52 patients. We gathered key workflow times: preoperative, applicator insertion, CT image, treatment planning, treatment, patient recovery, and total time in clinic. Linear fixed-effects models were used, and key workflow times were the outcome variables and factors including age, body mass index, stage, outside referral, number of implant per patient, number of implants per day, and year of implantation were examined as fixed effects. Results: Of the 52 patients, 62% of the patients were Fédération Internationale de Gynécologie et d'Obstétrique Stage 2B, 88% were treated with concurrent chemotherapy, and 23% were treated at an outside facility and referred for the procedure. The mean times (minutes) for each step were as follows: preoperative evaluation, 93; insertion, 23; imaging, 45; treatment planning, 137; treatment, removal, and recovery, 115; total clinic time, 401. For the insertion time, the greater implant number per patient was significantly associated with a decreased total insertion time, with and without adjusting for other covariates, p= 0.002 and p= 0.0005, respectively. Treatment planning time was expedited with increasing number of implant per patient and comparing treatment times in 2012 with those in 2010, p= 0.01 and p < 0.0001, respectively. Conclusions: Gynecologic brachytherapy requires a skillfully coordinated and efficient team approach. Identifying critical components and the time required for each step in the process is needed to improve the safety and efficiency of brachytherapy. Continuous efforts should be made to enhance the optimal treatment delivery in high-dose-rate gynecologic brachytherapy.

Original languageEnglish (US)
Pages (from-to)233-239
Number of pages7
JournalBrachytherapy
Volume13
Issue number3
DOIs
StatePublished - 2014

Fingerprint

Brachytherapy
Uterine Cervical Neoplasms
Workflow
Therapeutics
Age Factors
Body Mass Index
Referral and Consultation
Safety
Drug Therapy

Keywords

  • Brachytherapy
  • Cervical cancer
  • High-dose rate
  • Image guided
  • Workflow

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Implant time and process efficiency for CT-guided high-dose-rate brachytherapy for cervical cancer. / Mayadev, Jyoti; Qi, Lihong; Lentz, Susan; Benedict, Stanley H; Courquin, Jean; Dieterich, Sonja; Mathai, Mathew; Stern, Robin L; Valicenti, Richard K.

In: Brachytherapy, Vol. 13, No. 3, 2014, p. 233-239.

Research output: Contribution to journalArticle

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abstract = "Purpose: This investigation details the time and teamwork required for CT-guided tandem and ring high-dose-rate brachytherapy. Methods and Materials: From 2010 to 2012, 217 consecutive implantations were identified on 52 patients. We gathered key workflow times: preoperative, applicator insertion, CT image, treatment planning, treatment, patient recovery, and total time in clinic. Linear fixed-effects models were used, and key workflow times were the outcome variables and factors including age, body mass index, stage, outside referral, number of implant per patient, number of implants per day, and year of implantation were examined as fixed effects. Results: Of the 52 patients, 62{\%} of the patients were F{\'e}d{\'e}ration Internationale de Gyn{\'e}cologie et d'Obst{\'e}trique Stage 2B, 88{\%} were treated with concurrent chemotherapy, and 23{\%} were treated at an outside facility and referred for the procedure. The mean times (minutes) for each step were as follows: preoperative evaluation, 93; insertion, 23; imaging, 45; treatment planning, 137; treatment, removal, and recovery, 115; total clinic time, 401. For the insertion time, the greater implant number per patient was significantly associated with a decreased total insertion time, with and without adjusting for other covariates, p= 0.002 and p= 0.0005, respectively. Treatment planning time was expedited with increasing number of implant per patient and comparing treatment times in 2012 with those in 2010, p= 0.01 and p < 0.0001, respectively. Conclusions: Gynecologic brachytherapy requires a skillfully coordinated and efficient team approach. Identifying critical components and the time required for each step in the process is needed to improve the safety and efficiency of brachytherapy. Continuous efforts should be made to enhance the optimal treatment delivery in high-dose-rate gynecologic brachytherapy.",
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AU - Qi, Lihong

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AU - Benedict, Stanley H

AU - Courquin, Jean

AU - Dieterich, Sonja

AU - Mathai, Mathew

AU - Stern, Robin L

AU - Valicenti, Richard K

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AB - Purpose: This investigation details the time and teamwork required for CT-guided tandem and ring high-dose-rate brachytherapy. Methods and Materials: From 2010 to 2012, 217 consecutive implantations were identified on 52 patients. We gathered key workflow times: preoperative, applicator insertion, CT image, treatment planning, treatment, patient recovery, and total time in clinic. Linear fixed-effects models were used, and key workflow times were the outcome variables and factors including age, body mass index, stage, outside referral, number of implant per patient, number of implants per day, and year of implantation were examined as fixed effects. Results: Of the 52 patients, 62% of the patients were Fédération Internationale de Gynécologie et d'Obstétrique Stage 2B, 88% were treated with concurrent chemotherapy, and 23% were treated at an outside facility and referred for the procedure. The mean times (minutes) for each step were as follows: preoperative evaluation, 93; insertion, 23; imaging, 45; treatment planning, 137; treatment, removal, and recovery, 115; total clinic time, 401. For the insertion time, the greater implant number per patient was significantly associated with a decreased total insertion time, with and without adjusting for other covariates, p= 0.002 and p= 0.0005, respectively. Treatment planning time was expedited with increasing number of implant per patient and comparing treatment times in 2012 with those in 2010, p= 0.01 and p < 0.0001, respectively. Conclusions: Gynecologic brachytherapy requires a skillfully coordinated and efficient team approach. Identifying critical components and the time required for each step in the process is needed to improve the safety and efficiency of brachytherapy. Continuous efforts should be made to enhance the optimal treatment delivery in high-dose-rate gynecologic brachytherapy.

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