title: A change in treatment process with a modern record and verify system.
abstract: OBJECTIVE
  With the introduction of new treatment devices, such as a multileaf collimator (MLC) and dynamic wedge (DW), therapists have an increased responsibility to ensure correct treatment. Simultaneously, three-dimensional treatment planning (3DTP) has led to an increased number of portals and table movements. To counteract this challenge and maintain efficiency, a comprehensive record and verify (R&V) system is mandatory. We evaluated a commercial system (Varis) for reliability, ease of use, efficiency, and integration with our planning systems.
  
  
  METHODS
  Some key elements of the Varis system are: integration of MLC and DW; auto setup for MLC, jaw, collimator, gantry, and limited table parameters; direct download of simulation beam data; and a regimented field scheduling system that prescribes all beam data for particular fractions. Evaluation of the system was driven by treatment time analysis, error rates, and an increased workload. These issues were governed by how we disseminated duties and how the system accommodated or changed our processes.
  
  
  RESULTS
  Most data entry is performed by our dosimetry staff. Data can be downloaded from the simulator, but more patients now move from CT simulation and/or 3DTP to the treatment machine. Varis does not link to these systems. The physics staff confirms all entries to correct data entry errors. The workload for dosimetrists increased by an average of 8 minutes/patient entry; physics time increased by 7 minutes/patient entry; the weekly electronic chart check takes approximately 3 minutes/patient. Therapists who used Varis efficiently showed a slight decrease in treatment times, attributed to MLC integration and auto-setup. Some therapists experienced a decrease in efficiency, because of unfamiliarity and excess intervention. On a positive note, notable events have decreased by a factor of 10 since full initiation. Unfortunately, the remaining errors are often the result of a therapist relying on incorrect electronic information.
  
  
  CONCLUSIONS
  The Varis R&V system has had an impact on our clinic's process and efficiency. Checking of all beam data and related field scheduling have helped reduce errors and misconceptions. We feel a dual-energy machine can be operated with two experienced therapists and an up-to-date R&V system more accurately and efficiently than with three therapists working without an integrated R&V. We anticipate future Varis releases will further promote efficiency and accuracy.
authors.affiliation: Radiation Oncology Center, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA.
authors.forename: E E
authors.initials: EE
authors.lastname: Klein
authors.forename: R E
authors.initials: RE
authors.lastname: Drzymala
authors.forename: R
authors.initials: R
authors.lastname: Williams
authors.forename: L A
authors.initials: LA
authors.lastname: Westfall
authors.forename: J A
authors.initials: JA
authors.lastname: Purdy
mesh_terms: D003195:Computer Communication Networks; D004526:Efficiency; D006801:Humans; D008499:Medical Records; D018787:Radiation Oncology / Q000379:methods*; D011874:Radiometry; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D016526:Workload