An Innovative Collaboration and Workflow Management Platform for Surface Electronic Brachytherapy

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  • Volume 87 Number 2S Supplement 2013 Poster Viewing Abstracts S591

    diabetes (35.3%). Factors associated with longer times spent by each

    specialist are indicated in the table. Among patients with heart disease or

    diabetes, 19.7% had downstream ED visits related to cancer, vs 0% of

    those without (p < 0.001). Patients with borderline resectable or unde-

    termined disease stage had a greater mean number of ED visits (1.6 v 1.0,

    pZ .07). Patients with borderline resectable or undetermined disease stagewere more likely to call after clinic day than those without (1.6 v 1.0 calls,

    p Z .002).Conclusions: Disease stage, particularly borderline resectable and yet-undetermined, and heart disease were associated with both longer room

    times and the need for downstream clinical encounters. Scheduling such

    patients for more clinic time proactively (while decreasing time allotted for

    others) could not only enhance clinic workflow, but also improve patient

    safety and future resource utilization by addressing potentially preventable

    problems upfront.

    Author Disclosure: S.M. Elnahal: None. A.T. Wild: None. A.S. Dholakia:

    None. K.Y. Fan: None. P. Huang: None. J.M. Herman: None.

    3019An Innovative Collaboration and Workflow Management Platformfor Surface Electronic BrachytherapyD.R. Henrich,1 T. Kasturi,2 F. Rafie,1 R. Patel,1 and A. Bhatnagar3,4; 1The

    Targeted Radiation Institute of VMOC, Pleasanton, CA, 2Radion, Inc,

    Cupertino, CA, 3Cancer Treatment Services Arizona, Casa Grande, AZ,4University of Pittsburgh School of Medicine, Pittsburgh, PA

    Purpose/Objective(s): The purpose of this study is to assess the feasi-bility of a customized web-based resource management and automated

    workflow platform for electronic brachytherapy.

    Materials/Methods: The electronic brachytherapy system was utilized forsurface brachytherapy for multi-fraction treatment across multiple facili-

    ties. A total of 2000 consecutive treatments were analyzed. A custom web-

    based platform was developed to facilitate workflow management and

    automation in an effort to improve efficiency and patient safety. The

    following were studied: (1) Aworkflow (non-sequential) model configured

    for multiple locations; (2) Time captured from Consult to Sim, Consult to

    Treatment, Cutout prep, Cutout measurement, Physics calculations, and

    Recalculations in a manual and managed workflow environment; (3)

    Efficiency gained between manual and automated workflow management;

    (4) A structured approach to capture prescriptions, cutouts and depen-

    dencies between Source failures, Source calculations, cutout factors and

    prescription changes; (5) Key workflow processes [including: (a) Entering

    of Simulation parameters; (b) Daily QA of Source and controller; (c)

    Physician prescriptions, change in prescriptions mid-treatment (changing

    depth, cone size, dose); (d) Automatic peer review of physics calculations;

    (e) Source failures resulting in recalculations; and (f) Communication

    between Physicians, Physicists, RTT, MA, and Administrators; and (6)

    Chart checks in single and multiple locations were observed which include

    review, approval, and sign off on simulation note, dosimetric calculations,

    and daily treatment, post treatment, post calibration, and end of treatment


    Results: Total Physicist time spent on each physics calculation has beenreduced from average of 30 Minutes to less than 10 minutes. Web-based

    chart checks (Physician and Physicists) have been reduced from average of

    Poster Viewing Abstract 3020; Table Integral doses to organs at risk across differen

    Organ Density g/cc Volume cc ID_3D Gy kg ID_RA Gy kg ID_HT G

    Brain 1.03 1686.9 63.4 62.6 63.4Spine 1.03 532.7 20.5 19.8 20.5Thyroid 1.05 5.6 0.10 0.12 0.14Heart 1.08 206.3 4.4 1.6 2.4Lung R .38 550.8 2.3 2.4 2.7Lung L .38 539.6 1.6 2.4 2.1Liver 1.06 462.7 5.1 4.4 5.1Breast 1.02 5.93 0.01 0.02 0.03Bowel 1.04 1575.6 35.7 14.8 23.2

    15 minutes to less than 5 minutes per chart check. Multi-location chart

    checks required no physical onsite visit.

    Conclusions: A workflow management system that enables automateddocumentation, quality assurance and source management is feasible and

    improves efficiency while reducing the risk of systematic errors in patient

    care for surface electronic brachytherapy. The following were observed: 1)

    A configurable workflow adaptable to each center is critical to streamline

    efficiencies in a multiple center organization; 2) A 50%-75% time savings

    in Physicist prep time; 3) A 100% paper less environment which improved

    patient safety by avoiding manual errors; and 4) A 50% time savings for

    Physician review and approval by automating note generation tied to

    complex workflow.

    Author Disclosure: D.R. Henrich: None. T. Kasturi: None. F. Rafie: None.

    R. Patel: None. A. Bhatnagar: E. Research Grant; PI for Industry Spon-

    sored Prospective Trial for Electronic Brachytherapy for Primary Treat-

    ment of Non-Melanoma Skin Cancer. G. Consultant; Consultant for


    3020Three-Dimensional Conformal Radiation Therapy, VolumetricIntensity Modulated Arc Therapy, and Helical Tomotherapy forPediatric Craniospinal Irradiation: Dosimetric Analysis of IntegralDoseR. Basu Achari, D. Gowardhanan, B. Arun, P. Dharmendran, S. Prasath,

    S. Chatterjee, and I. Mallick; Tata Medical Center, Kolkata, India

    Purpose/Objective(s): There is an assumption that use of modern radi-ation therapy techniques in children may increase the risk of second

    primary neoplasms by increasing integral dose to healthy tissues. With

    increasing long term survival in medulloblastomas it is important to

    balance disease control and late effects of therapy. The purpose of this

    study was to compare integral doses between three dimensional conformal

    radiation therapy (3DCRT), volumetric intensity modulated arc therapy

    (RA), and helical tomotherapy (HT) plans for pediatric craniospinal


    Materials/Methods: Computerized Tomography data sets of four patientsof high risk medulloblastoma were evaluated. Craniospinal planning target

    volume was prescribed 35-36 Gy in 20-21 fractions over 4 weeks. Forward

    planning was used for 3DCRT plans. Four arcs were used for the RA plans

    to adequately cover the PTV length and tomotherapy was planned on the

    tomotherapy planning system. Tissue densities were averaged from direct

    readouts from planning systems. Plans were comparatively analyzed based

    on doses to targets, organs at risks (OAR), and conformity and homoge-

    neity indices. Integral doses (ID) to OAR and targets were compared.

    Results: Significant normal tissue sparing and dose homogeneity wasachieved with RA and HT across all dose levels for OARs and target

    volumes respectively. Integral doses across patients were comparable or

    lower for most organs (Table) with IMRT. Although integral doses to

    breast buds were higher with both IMRT techniques, the quantum of

    absolute doses were minimal (Table). Volumetric intensity modulated arc

    therapy has shorter imaging and delivery time compared to HT.

    Conclusions: Comparable integral doses can be achieved by refining lowdose constraints to OARs during planning large volume IMRT for children.

    This is possible by redistributing low dose scatter into target volumes at the

    cost of accepting small volumes of target getting higher than prescribed

    t techniques for craniospinal radiation

    y kg ID_RA/ID_3D Gy kg ID_HT/ID_3D Gy kg ID_HT/ID_RA Gy kg

    0.99 1 1.010.96 1 1.030.66 0.77 1.160.36 0.55 1.531.04 1.15 1.141.46 1.29 0.880.88 1 1.132 3 0.150.41 0.64 1.56

    Outline placeholderConclusions

    An Innovative Collaboration and Workflow Management Platform for Surface Electronic BrachytherapyPurpose/Objective(s)Materials/MethodsResultsConclusions

    Three-Dimensional Conformal Radiation Therapy, Volumetric Intensity Modulated Arc Therapy, and Helical Tomotherapy for Pedi ...Purpose/Objective(s)Materials/MethodsResultsConclusions


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