title: Workflow optimisation for multimodal imaging procedures: a case of combined X-ray and MRI-guided TACE.
abstract: This study presents a framework for workflow optimisation of multimodal image-guided procedures (MIGP) based on discrete event simulation (DES). A case of a combined X-Ray and magnetic resonance image-guided transarterial chemoembolisation (TACE) is presented to illustrate the application of this method. We used a ranking and selection optimisation algorithm to measure the performance of a number of proposed alternatives to improve a current scenario. A DES model was implemented with detail data collected from 59 TACE procedures and durations of magnetic resonance imaging (MRI) diagnostic procedures usually performed in a common MRI suite. Fourteen alternatives were proposed and assessed to minimise the waiting times and improve workflow. Data analysis observed an average of 20.68 (7.68) min of waiting between angiography and MRI for TACE patients in 71.19% of the cases. Following the optimisation analysis, an alternative was identified to reduce waiting times in angiography suite up to 48.74%. The model helped to understand and detect 'bottlenecks' during multimodal TACE procedures, identifying a better alternative to the current workflow and reducing waiting times. Simulation-based workflow analysis provides a cost-effective way to face some of the challenges of introducing MIGP in clinical radiology, highligthed in this study.
authors: a Institute for Medical Science and Technology, Division of Imaging and Technology , University of Dundee , Dundee , UK.
authors: Fabiola
authors: F
authors: Fernández-Gutiérrez
authors: b Saarland University Medical Center , Clinic of Diagnostic and Interventional Neuroradiology , Homburg , Germany.
authors: Malgorzata
authors: M
authors: Wolska-Krawczyk
authors: c Saarland University Medical Centre , Clinic of Diagnostic and Interventional Radiology , Homburg , Germany.
authors: Arno
authors: A
authors: Buecker
authors: d Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School , Dundee , UK.
authors: J Graeme
authors: JG
authors: Houston
authors: a Institute for Medical Science and Technology, Division of Imaging and Technology , University of Dundee , Dundee , UK.
authors: Andreas
authors: A
authors: Melzer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D064847:Multimodal Imaging / Q000379:methods*; D015641:Radiography, Interventional / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D057188:Workflow
keywords: MRI; TACE; Workflow; discrete event simulation; optimisation