title: Workflow efficiency for the treatment planning process in CT-guided high-dose-rate brachytherapy for cervical cancer.
abstract: To investigate process efficiency, we present a prospective investigation of the treatment planning phase of image-guided brachytherapy (BT) for cervical cancer using a specific checklist.
  
  
  
  From October 2012 to January 2014, 76 BT procedures were consecutively performed. Prospective data on the CT-based treatment planning process was collected using a specific checklist which details the following steps: (1) dosimetry planning, (2) physician review start, (3) physician review time, (4) dosimetry processing, (5) physics review start, (6) physics review, and (7) procedural pause. Variables examined included the use of a pre-BT MRI, clinic duty conflicts, resident teaching, and the use of specific BT planners. Analysis was performed using descriptive statistics, t-test, and analysis of variance.
  
  
  
  Seventy-five prospectively gathered checklists comprised this analysis. The mean time for treatment planning was 95 minutes (med 94, std 18). The mean intervals in the above steps were (1) = 42, (2) = 5, (3) = 19, (4) = 10, (5) = 6, (6) = 13, and (7) = 26 minutes. There was no statistical difference in patients who had a pre-BT MRI. Resident teaching did not influence time, p = 0.17. Treatment planning time was decreased with a specific planner, p = 0.0015.
  
  
  
  A skillful team approach is required for treatment planning efficiency in image-guided BT. We have found that the specific BT planners can have a significant effect on the overall planning efficiency. We continue to examine clinical and workflow-related factors that will enhance our safety and workflow process with BT.
authors.affiliation: Department of Radiation Oncology, UC Davis Comprehensive Cancer Center, Sacramento, CA.
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Michaud
authors.affiliation: Department of Radiation Oncology, UC Davis Comprehensive Cancer Center, Sacramento, CA.
authors.forename: Stanley
authors.initials: S
authors.lastname: Benedict
authors.affiliation: Department of Radiation Oncology, UC Davis Comprehensive Cancer Center, Sacramento, CA.
authors.forename: Eliseo
authors.initials: E
authors.lastname: Montemayor
authors.affiliation: Department of Radiation Oncology, UC Davis Comprehensive Cancer Center, Sacramento, CA.
authors.forename: Jon Paul
authors.initials: JP
authors.lastname: Hunt
authors.affiliation: Department of Radiation Oncology, UC Davis Comprehensive Cancer Center, Sacramento, CA.
authors.forename: Cari
authors.initials: C
authors.lastname: Wright
authors.affiliation: Department of Radiation Oncology, UC Davis Comprehensive Cancer Center, Sacramento, CA.
authors.forename: Mathew
authors.initials: M
authors.lastname: Mathai
authors.affiliation: Department of Radiation Oncology, UC Davis Comprehensive Cancer Center, Sacramento, CA. Electronic address: jmayadev@ucdavis.edu.
authors.forename: Jyoti S
authors.initials: JS
authors.lastname: Mayadev
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy; D057189:Checklist; D017598:Efficiency, Organizational; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D017064:Process Assessment, Health Care; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D061089:Radiotherapy, Image-Guided; D013996:Time and Motion Studies; D014057:Tomography, X-Ray Computed; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*; D057188:Workflow
keywords: Brachytherapy; Cervical cancer; Process efficiency; Workflow