Improving brachytherapy efficiency with dedicated dosimetrist planners

Purpose: To investigate the different factors affecting the procedure duration for high-dose-rate brachytherapy for gynecologic malignancies.

Methods and materials: We prospectively recorded 86 consecutive vaginal cylinder (VC) treatments and 82 tandem and ovoid treatments. Key time points in the brachytherapy process, identity of the planner and checker, number of treatments per day, and fraction number per patient were recorded. The data were analyzed in a mixed effects linear regression model to account for the within patient correlation. Post hoc pair-wise comparisons were performed using a Dunnett's adjustment for comparisons to a single control group and using a Tukey adjustment for all pair-wise comparisons.

Results: We focused on several key time intervals in the treatment: total, nursing/anesthesia preprocedure, procedure, contouring, and planning times. In analysis, multiple factors significantly influenced VC timing but not tandem and ovoid timing. The planners were separated and analyzed based on experience and profession. Inexperienced physicists planning times were on average 18 min (p = 0.0010) and 14 min (p = 0.0038) slower than dedicated brachytherapy dosimetrist and experienced physicists, respectively. An increase in the number of procedures for the day of treatment increased the VC total time (p = 0.0218). The VC procedure time changed depending on whether it was the patients' first, second, or third VC treatment (p < 0.0001).

Conclusions: The use of dosimetrists as dedicated planners for brachytherapy is more cost and time efficient. There are multiple variables affecting brachytherapy treatment with actionable opportunities to improve procedure scheduling.