Automated planning stage tracking and analysis through an integrated whiteboard system.

PURPOSE: One of the common challenges in delivering complex healthcare procedures such as radiation oncology is the organization and sharing of information in ways that facilitate workflow and prevent treatment delays. Within the major vendors of Oncology Information Systems (OIS) is a lack of tools and displays to assist in task timing and workflow processes. To address this issue, we developed an electronic whiteboard integrated with a local OIS to track, record, and evaluate time frames associated with clinical radiation oncology treatment planning processes. METHODS: We developed software using an R environment hosted on a local web-server at Seattle Cancer Care Alliance (SCCA) in 2017. The planning process was divided into stages, and time-stamped moves between planning stages were recorded automatically via Mosaiq (Elekta, Sweden) Quality Check Lists (QCLs). Whiteboard logs were merged with Mosaiq-extracted diagnostic factors and evaluated for significance. Interventional changes to task time expectations were evaluated for 6 months in 2021 and compared with 6 month periods in 2018 and 2019. RESULTS: Whiteboard/Mosaiq data from the SCCA show that treatment intent, number of prescriptions, and nodal involvement were main factors influencing overall time to plan completion. Contouring and Planning times were improved by 2.6 days (p<10-14) and 2.5 days (p<10-11), respectively. Overall time to plan completion was reduced by 33% (5.1 days; p<10-11). CONCLUSIONS: This report establishes the utility of real-time task tracking tools in a radiotherapy planning process. The whiteboard results provide data-driven evidence to add justification for practice change implementations.

Dosimetric comparison of single-beam multi-arc and 2-beam multi-arc VMAT optimization in the Monaco treatment planning system.

The purpose of this study was to evaluate the dosimetric and practical effects of the Monaco treatment planning system "max arcs-per-beam" optimization parameter in pelvic radiotherapy treatments. We selected for this study a total of 17 previously treated patients with a range of pelvic disease sites including prostate (9), bladder (1), uterus (3), rectum (3), and cervix (1). For each patient, 2 plans were generated, one using an arc-per-beam setting of "1" and another with an arc-per-beam setting of "2" using the volumes and constraints established from the initial clinical treatments. All constraints and dose coverage objects were kept the same between plans, and all plans were normalized to 99.7% to ensure 100% of the planning target volume (PTV) received 95% of the prescription dose. Plans were evaluated for PTV conformity, homogeneity, number of monitor units, number of control points, and overall plan acceptability. Treatment delivery time, patient-specific quality assurance procedures, and the impact on clinical workflow were also assessed. We found that for complex-shaped target volumes (small central volumes with extending arms to cover nodal regions), the use of 2 arc-per-beam (2APB) parameter setting achieved significantly lower average dose-volume histogram values for the rectum V20 (p = 0.0012) and bladder V30 (p = 0.0036) while meeting the high dose target constraints. For simple PTV shapes, we found reduced monitor units (13.47%, p = 0.0009) and control points (8.77%, p = 0.0004) using 2APB planning. In addition, we found a beam delivery time reduction of approximately 25%. In summary, the dosimetric benefit, although moderate, was improved over a 1APB setting for complex PTV, and equivalent in other cases. The overall reduced delivery time suggests that the use of mulitple arcs per beam could lead to reduced patient-on-table time, increased clinical throughput, and reduced medical physics quality assurance effort.