title: MR-guided brachytherapy for cervical cancer: Quantifying process waste and identifying opportunities for system performance improvement.
abstract: OBJECTIVE
  The aim of this study was to evaluate the current cervical cancer magnetic resonance-guided brachytherapy (MRgBT) process in the study institution and seek opportunities to improve efficiency and optimize quality of care.
  
  
  METHODS
  Eight procedures were observed where the time, location, and activities performed by health care professionals were recorded using Lean method principles. Wastes, as defined within Lean methodology, were identified during the observation. Workflow was illustrated by process maps. Milestone activities were identified for final time analysis. Finally, the research team developed solutions by eliminating wastes in the workflow.
  
  
  RESULTS
  The mean procedure time ± standard deviation was 8.2 ± 0.41 hours, including 1.9 ± 0.18 hours spent on Lean wastes (84% waiting, 16% transportation). The most inefficient high-level activity was MRI with 1.1 hours spent on waiting and transportation. The parallel processing solution yields a 2.3 hours' time saving in each case. The optimal solution recommends an integrated MRgBT suite and dedicated human resource, yields a 4.1 hours' time saving (50% increase in efficiency) in each case.
  
  
  CONCLUSIONS
  This was the first study to quantify the performance of an MRgBT process. This study can serve as a template for other brachytherapy process improvements.
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Center and University Health Network, Toronto, Ontario, Canada. Electronic address: kitty.chan@rmp.uhn.on.ca.
authors.forename: Kitty
authors.initials: K
authors.lastname: Chan
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Center and University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Tara
authors.initials: T
authors.lastname: Rosewall
authors.affiliation: Lean Process Improvement, University Health Network, Toronto, Ontario, Canada.
authors.forename: Brenda
authors.initials: B
authors.lastname: Kenefick
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Center and University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Milosevic
mesh_terms: D001918:Brachytherapy / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000628:therapy*