Forecasting Institutional LINAC Utilization in Response to Varying Workload.

ObjectivesPandemics, natural disasters, and other unforeseen circumstances can cause short-term variation in radiotherapy utilization. In this study, we aim to develop a model to forecast linear accelerator (LINAC) utilization during periods of varying workloads. Methods: Using computed tomography (CT)-simulation data and the rate of new LINAC appointment bookings in the preceding week as input parameters, a multiple linear regression model to forecast LINAC utilization over a 15-working day horizon was developed and tested on institutional data. Results: Future LINAC utilization was estimated in our training dataset with a forecasting error of 3.3%, 5.9%, and 7.2% on days 5, 10, and 15, respectively. The model identified significant variations (≥5% absolute differences) in LINAC utilization with an accuracy of 69%, 62%, and 60% on days 5, 10, and 15, respectively. The results were similar in the validation dataset with forecasting errors of 3.4%, 5.3%, and 6.2% and accuracy of 67%, 60%, and 58% on days 5, 10, and 15, respectively. These results compared favorably to moving average and exponential smoothing forecasting techniques. Conclusions: The developed linear regression model was able to accurately forecast future LINAC utilization based on LINAC booking rate and CT simulation data, and has been incorporated into our institutional dashboard for broad distribution. Advances in knowledge: Our proposed linear regression model is a practical and intuitive approach to forecasting short-term LINAC utilization, which can be used for resource planning and allocation during periods with varying LINAC workloads.

Development of a Collaboration Model between Two Cancer Centres to Maintain Patient Access to Radiation Therapy during the Replacement of a Sole CT Simulator at a Regional Cancer Centre.

INTRODUCTION: Replacement of a sole computed tomography (CT) simulator at a Regional Cancer Centre risks interruption of patient access to radiation therapy clinical services. This study reports a collaboration model between two cancer centres to maintain patient access to radiation therapy during the replacement period. METHODS: Representatives from each cancer centre collaborated to plan and facilitate offsite CT simulation. Activities required were identified and included process coordination, patient consent, patient registration, requisitions, appointment bookings, immobilization equipment, staffing strategy, clinical practice protocols, data transfer, and cost recovery. The logistics of each activity were planned and mapped, with roles identified to perform each activity. During the 2-week replacement duration, from April 30 to May 11, 2018, patients consulted for radiotherapy were offered offsite CT simulation. RESULTS: A detailed process was developed to outline the flow of activities for successful coordination of offsite CT simulations. A total of 14 patients consented to radiation treatment during the CT simulator replacement downtime, of which 8 patients agreed to offsite CT simulation. A total of 11 body regions were simulated for the 8 patients. CT images acquired offsite were electronically transferred to the primary cancer centre to proceed with treatment planning and delivery. DISCUSSION: A collaboration model between two cancer centres was successfully developed and implemented to maintain patient access to radiation therapy during the replacement of a sole CT simulator at a regional cancer centre. CONCLUSION: This strategy and process developed could be valuable for future major equipment upgrades/replacements at other centres.

Factors Influencing Radiation Therapists' Perceptions of Performing Manual Monitor Unit Calculations in a Computer-Based Work Environment.

INTRODUCTION: Despite increased automation in the field of radiation therapy, the need to perform monitor unit calculations manually still exists for a small number of clinical situations. Challenges in maintaining the skill of performing infrequently occurring clinical tasks have been identified among other health professions, but no study has been performed for similar issues in radiation therapy. The aim of this study was to explore radiation therapists' (RT) perceived changes in comfort level to perform manual calculations (MC), an infrequently occurring clinical task, and to evaluate factors that may have influenced the change in comfort level. METHODS AND MATERIALS: The study sample consisted of RTs working within the radiation therapy department of a cancer hospital. A questionnaire soliticing RTs' comfort level with MC and potential influencing factors was sent to each participant. The difference in responses based on key study variables, including initial mastery of MC, ongoing exposure to MC, recent exposure to MC, and MC continuing education, was analyzed. In addition, a wave analysis was performed to determine whether the responses gathered with the questionnaire were representative of those who did not respond. RESULTS: Fifty-one responses were obtained. The wave analysis suggested that our study results may reflect the views of those of RTs who were eligible to participate, but did not respond. Ninety percent of the participants reported that their comfort level in performing MC had decreased over the years. A significantly smaller proportion of participants reported being comfortable with orthovoltage MC (14%) compared to other types of MC (75-84%). Participants' years of work experience did not appear to influence their comfort level in performing MC. A higher proportion of participants that had recent or ongoing exposure to MC, including those that performed a MC within the last 12 months, worked in dosimetry, were engaged in on-call activities, or were engaged in continuing education on MC, reported being more comfortable in MC than those participants who did not engage in such activities (91%-92% vs. 47%-71%, P < .001). DISCUSSION/CONCLUSION: Initial mastery and ongoing exposure were identified in the literature as important factors that influence practitioners' ability in performing clinical tasks. Although initial mastery was found to influence comfort level in performing MC, our study also revealed that ongoing exposure may be relatively more important. Lessons drawn from this study will become more important to the field of radiation therapy as more manually performed clinical tasks become less frequent over time. To address potential reduction in RTs' ability in performing this infrequent clinical task, individual radiotherapy departments have historically put in place effective strategies to assure accuracy. Yet, alternatives to performing MC should be explored in order to maximize safety, efficiency, and quality of patient care.

10 Years Of Exposure to a Radiation Therapist Research Culture: Where Are We Now?

INTRODUCTION: Over the past 10 years, various programmatic changes have been implemented in our radiotherapy department to increase radiation therapist (RT) research activities. The aim of this qualitative study was to investigate the attitudes of RTs who have been working in a research-rich environment concerning current research activities and the presence of enablers and inhibiters. MATERIALS AND METHODS: After obtaining research ethics approval, 5 focus groups and 6 interviews were conducted with a group of 30 RTs with varying levels of clinical experience, who were currently employed in our department. Data were audiotaped, transcribed, then analyzed independently by two investigators using a thematic approach. Emerging themes and categories were captured and evaluated. RESULTS: RTs most frequently engaged in research activities from a desire for patient service improvement and professional development. The main enablers identified were a system of process support and mentorship, and access to useful research tools and databases (e.g., patient imaging databases). The most commonly noted inhibitor to research activities was securing protected research time. CONCLUSIONS: After 10 years of developing a research-rich environment, this study found that the majority of RTs were directly involved in some form of research, although the definition of research varied significantly. Enablers were identified as factors that support the practical aspects of RT research, rather than the gaining of theoretical knowledge. Although some of the inhibitors noted are similar to those working in research-naive departments, they also add the practical considerations of balancing research and clinical practice. The practical nature of both the enablers and inhibitors found in this study support the hypothesis that generating a research-rich environment for RTs has shifted their priorities from "thinking about research" to "doing research."

Investigating Patient Wait Times for Daily Outpatient Radiotherapy Appointments (A Single-Centre Study).

INTRODUCTION: Patient satisfaction is an important indicator of quality in health care. Radiotherapy (RT) requires patients to attend daily treatment through outpatient appointments (OPA). Therefore, wait times (WT) for daily RT OPAs can have a significant impact on patient satisfaction. This study aims to quantify WTs associated with daily RT OPAs and investigate the cause of identified delays. METHODS: A total of 128 outpatients scheduled on eight different linear accelerators for RT were included in this ethics-approved study. Radiation therapists recorded the entry time (time patient entered the treatment room) for each OPA over 10 consecutive treatment days. Where applicable, radiation therapists recorded the cause for appointment delays. Subsequently, WTs were calculated as the difference between the scheduled appointment time and the entry time. Subgroup analysis by time of appointment and anatomical treatment sites was performed. RESULTS: Mean WT ± standard deviation (SD) was 7.2 ± 27 min. for 866 OPAs. A total of 382/866 (44%) OPAs were early or on time (-12 ± 21 min.); 484/866 (56%) were delayed (22 ± 20 min.). The delays were primarily attributed to an indirect cause of catching up from previous delayed appointments (73%). The WT was ≤20 min. for 693/866 OPAs (80.0%). The mean WT ± SD was longest for midday appointments (10:30 AM-2:30 PM) at 9.5 ± 29 min. and was statistically significant (P = .020). The comparison of WTs by treatments sites showed pelvis site (majority prostate cancer patients) experiencing the longest WT ± SD at 11 ± 22 min. (P < .0001), caused by specific radiotherapy treatment protocol. CONCLUSION: Most OPAs (80%) were treated within 20 min. of their scheduled time. Reported delays were influenced by clinic workflow and coordination of multiple appointments throughout the day. The findings of this study will assist in the formulation of strategies to improve efficiency and patient satisfaction.

The Influence of Programmatic Change on Radiation Therapist Research Capacity-A Single-center Case Study.

PURPOSE: To identify various programmatic changes implemented in a Canadian radiotherapy department to build therapist research capacity, and to determine their combined impact on quantitative metrics of therapist research output. METHODS AND MATERIALS: This was a single-center case study design. Programmatic changes were retrospectively identified from various departmental documentary sources. Those changes, which were active between January 2004 and December 2008 and were implemented with the intention of increasing therapist research output, were categorized by primary purpose according to published criteria from the Allied Health Professions Research and Development Action Plan. Therapist research output was collected over the same time period by an annual department-wide e-mail request for information and verified through various independent sources. RESULTS: Five educational initiatives had the potential to build therapist research knowledge and skills (e.g., journal club). Changes implemented to provide infrastructure to sustain therapist research included the creation of roles incorporating a formal research component. Four initiatives had the potential to promote research dissemination and networking (e.g., writing group). The number of therapist principal authors increased during the 5 years (from 4 to 14 per annum), with approximately 60% of articles published in international radiation medicine journals. The number of therapists presenting at conferences increased from 32 in 2004 to 63 in 2008, with 94% of submitted abstracts accepted for presentations in 2008. Therapists accumulated over $52,000 in peer-reviewed grant funds as principal investigators and the proportion of research-based therapist academic appointments has increased from 10% to 33% of appointees. CONCLUSION: Invaluable progress has been made in a Canadian radiotherapy department by combining multiple research capacity building programmatic changes to establish a culture that encourages and supports therapist research pursuits. This has increased both the quantity and quality of therapist research activity.