title: The impact of introducing intensity modulated radiotherapy into routine clinical practice.
abstract: OBJECTIVE
  Intensity modulated radiotherapy (IMRT) at the Royal Marsden Hospital London was introduced in July 2001. Treatment delivery was dynamic using a single-phase technique. Concerns were raised regarding increased clinical workload due to introduction of new technology. The potential increased use of resources was assessed.
  
  
  METHODS
  IMRT patient selection was within guidelines of clinical trials and included patients undergoing prostate plus pelvic lymph node (PPN) irradiation and head and neck cancer (HNC) treatment. Patient planning, quality assurance and treatment times were collected for an initial IMRT patient group. A comparative group of patients with advanced HNC undergoing two- or three-phase conventional radiotherapy, requiring matched photon and electron fields, were also timed.
  
  
  RESULTS
  The median overall total planning time for IMRT was greater for HNC patients compared to the PPN cohort. For HNC the overall IMRT planning time was significantly longer than for conventional. The median treatment time for conventional two- or three-phase HNC treatments, encompassing similar volumes to those treated with IMRT, was greater than that for the IMRT HNC patient cohort. A reduction in radiographer man hours per patient of 4.8h was recorded whereas physics time was increased by 4.9h per patient.
  
  
  CONCLUSIONS
  IMRT currently increases overall planning time. Additional clinician input is required for target volume localisation. Physics time is increased, a significant component of this being patient specific QA. Radiographer time is decreased. For HNC a single phase IMRT treatment has proven to be more efficient than a multiple phase conventional treatment. IMRT has been integrated smoothly and efficiently into the existing treatment working day. This preliminary study suggests that IMRT could be a routine treatment with efficient use of current radiotherapy resources.
authors.affiliation: Radiotherapy Department, Royal Marsden NHS Foundation Trust, London and Sutton, UK.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Miles
authors.forename: Catharine H
authors.initials: CH
authors.lastname: Clark
authors.forename: M Teresa Guerrero
authors.initials: MT
authors.lastname: Urbano
authors.forename: Margaret
authors.initials: M
authors.lastname: Bidmead
authors.forename: David P
authors.initials: DP
authors.lastname: Dearnaley
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Harrington
authors.forename: Roger
authors.initials: R
authors.lastname: A'Hern
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Nutting
mesh_terms: D015331:Cohort Studies; D019583:Dose Fractionation, Radiation; D017598:Efficiency, Organizational; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011785:Quality Assurance, Health Care; D050397:Radiotherapy, Intensity-Modulated; D013997:Time Factors; D016526:Workload