title: Technology enhancements and changes in radiotherapy throughput in New South Wales.
abstract: OBJECTIVE
  To assess the effect that the age of linear accelerators and recent changes in technology have had on linear accelerator throughput in New South Wales, Australia.
  
  
  METHODS
  Duration was measured (time of patient entry into the treatment room to time of exit) of each radiotherapy treatment fraction delivered on each linear accelerator over a 5-day period. Patient-, treatment- and equipment-based variables were collected for all treatment fractions, and assessed for their effect on fraction duration. Comparisons were made between these data and similar productivity data collected from a study carried out in 1996. Since the sample sizes for both the study periods were large enough, the distributions of the means were assumed normal (Central Limit Theorem). Specific analyses were carried out to assess the affect that new technologies, such as automatic field-sequencing (AFS) and multi-leaf collimator (MLC), have had on fraction duration.
  
  
  RESULTS
  A total of 12 892 treatment fields and 4316 treatment fractions were delivered on 27 linear accelerators over 135 days. Comparison between the 2003 and 1996 productivity data showed an increase in the mean number of patients treated per hour by 11% and fields treated per hour by 31%. The mean number of fields treated per fraction increased by 15%. The mean fraction duration was reduced by 13% for linear accelerators of less than the median age of 7 years that were equipped with MLC/AFS, or both, compared with older linear accelerators without AFS and MLC. This reduction was more obvious for complex techniques, such as four-field breast treatments (27% decrease in fraction duration). The mean number of fields treated per hour was 43% more on the newer machines equipped with AFS and MLC.
  
  
  CONCLUSIONS
  An increase in productivity has been observed between the 1996 and 2003 study periods, as measured by patients or fields per hour, despite an increase in treatment complexity as measured by fields per fraction. The application of AFS and MLC, and the use of newer linear accelerators, significantly shortened the mean duration per fraction for the common treatment techniques.
authors.affiliation: Collaboration for Cancer Outcomes Research Evaluation (CCORE), Department of Radiation Oncology, South Western Sydney Area Health Service, New South Wales, Australia. geoff.delaney@swsahs.nsw.gov.au
authors.forename: G P
authors.initials: GP
authors.lastname: Delaney
authors.forename: R J
authors.initials: RJ
authors.lastname: Shafiq
authors.forename: B B
authors.initials: BB
authors.lastname: Jalaludin
authors.forename: M B
authors.initials: MB
authors.lastname: Barton
mesh_terms: D006748:Hospital Departments / Q000706:statistics & numerical data; D006801:Humans; D009517:New South Wales; D010315:Particle Accelerators / Q000706:statistics & numerical data; D018787:Radiation Oncology; D011878:Radiotherapy / Q000706:statistics & numerical data / Q000639:trends*; D013679:Technology, Radiologic; D013997:Time Factors