Download - An Innovative Collaboration and Workflow Management Platform for Surface Electronic Brachytherapy
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 stage
were 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 for
surface 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
note.
Results: Total Physicist time spent on each physics calculation has been
reduced 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 automated
documentation, 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
DermEbx.
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
irradiation.
Materials/Methods: Computerized Tomography data sets of four patients
of 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 was
achieved 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 low
dose 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