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Novel and Programmatic Improvements to Departmental Brachytherapy Workflow

S Roles*, J Hepel , K Leonard , D Wazer , G Cardarelli , M Schwer , E Klein , T Roth , J Brindle , M Rivard , Rhode Island Hospital / Warren Alpert Medical, Providence, RI


(Sunday, 7/14/2019) 2:00 PM - 3:00 PM

Room: 301

Purpose: The non-invasive breast brachytherapy (NIBB) AccuBoost treatment procedure is well-established, but overall treatment quality relates to the efficiency of the workflow delivery. Renovation of the brachytherapy program at a leading cancer center has yielded new processes and determined a novel method for dose calculations within the electronic medical record (EMR) system.

Methods: Following a failure-modes and effects and criticality analysis (FMECA), data were gathered on the current approach for guiding implementation of communicational coherence and procedural training. This study highlights advantages of such implementations and the resulting impact on the overall treatment workflow efficiency. As described in the AAPM TG-100 report, use of FMECA highlighted areas of the workflow with potential quality lapses. As a method to workflow improvement, all paper-based documentation was revised and converted to electronic templates for use within the EMR. Brachytherapy dose calculations with self populating equations were embedded within tabular cells in the templates to instantaneously provide HDR 192Ir brachytherapy dwell positions and times as needed for patient treatment. Additional renovations include reorganization of many procedural duties and staff training in the newly introduced methods.

Results: EMR usage to track treatment workflow and dose calculations decreased pre-treatment patient time, overall treatment time, and likelihood of a dose calculation error. Reprioritization of procedural duties and staff training in the new workflow and processes resulted in enhanced team communication, satisfaction, and treatment quality.

Conclusion: The current AccuBoost brachytherapy workflow was evaluated with a FMECA-approach, which highlighted procedural inefficiencies. Improvements included crafting and implementing dose calculation tools embedded within the EMR electronic template, diminishing preparatory time needed preceding treatment (while the patient’s breast is under compression), enhancements to procedural quality through the exercise of analyzing the departmental workflow. Further, these methods are being extended to departmental SRS procedural workflows and all other radiotherapy treatment techniques.


Not Applicable / None Entered.


TH- Brachytherapy: General (most aspects)

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