title: Implant time and process efficiency for CT-guided high-dose-rate brachytherapy for cervical cancer.
abstract: OBJECTIVE
  This investigation details the time and teamwork required for CT-guided tandem and ring high-dose-rate brachytherapy.
  
  
  METHODS
  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.
authors.affiliation: Department of Radiation Oncology, University of California Davis Medical Center, Sacramento, CA. Electronic address: jyoti.mayadev@ucdmc.ucdavis.edu.
authors.forename: Jyoti
authors.initials: J
authors.lastname: Mayadev
authors.affiliation: Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of California Davis, Davis, CA.
authors.forename: Lihong
authors.initials: L
authors.lastname: Qi
authors.affiliation: Department of Radiation Oncology, University of California Davis Medical Center, Sacramento, CA.
authors.forename: Susan
authors.initials: S
authors.lastname: Lentz
authors.affiliation: Department of Radiation Oncology, University of California Davis Medical Center, Sacramento, CA.
authors.forename: Stanley
authors.initials: S
authors.lastname: Benedict
authors.affiliation: Department of Radiation Oncology, University of California Davis Medical Center, Sacramento, CA.
authors.forename: Jean
authors.initials: J
authors.lastname: Courquin
authors.affiliation: Department of Radiation Oncology, University of California Davis Medical Center, Sacramento, CA.
authors.forename: Sonja
authors.initials: S
authors.lastname: Dieterich
authors.affiliation: Department of Radiation Oncology, University of California Davis Medical Center, Sacramento, CA.
authors.forename: Mathew
authors.initials: M
authors.lastname: Mathai
authors.affiliation: Department of Radiation Oncology, University of California Davis Medical Center, Sacramento, CA.
authors.forename: Robin
authors.initials: R
authors.lastname: Stern
authors.affiliation: Department of Radiation Oncology, University of California Davis Medical Center, Sacramento, CA.
authors.forename: Richard
authors.initials: R
authors.lastname: Valicenti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011879:Radiotherapy Dosage; D061089:Radiotherapy, Image-Guided / Q000379:methods; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*
keywords: Brachytherapy; Cervical cancer; High-dose rate; Image guided; Workflow