Journal of Radiation Oncology

, Volume 8, Issue 2, pp 177–183 | Cite as

Whiteboard patient tracking system improves radiation oncology treatment planning workflow

  • Christopher Freese
  • Neil Forster
  • Brittany Prater
  • Meredith Amlung
  • Michael Lamba
  • Vinita TakiarEmail author
Original Research



As care delivery becomes ever more complex, and physicians and health care systems face increasing demands, improved efficiency within radiation oncology departments is essential. The workflow required for quality radiation treatment delivery necessitates detailed communication between multiple specialized team members and emerging technologies, sometimes at different locations. In this study, we compare the time required for completion of several components of this process, before and after whiteboard implementation, hypothesizing that whiteboard usage would decrease the time required to complete the designated task, thereby improving workflow.


We retrospectively reviewed dosimetric workflow data from 578 patients treated between January 2015 and January 2017 (320 pre- and 258 post-whiteboard). The whiteboard system cataloged various patient clinical factors as well as workflow metrics. Departmental workflow was then examined and time from simulation date to contour approval, plan approval, and start date of the prescribed therapy were compared. Statistical analyses were performed using Mann-Whitney tests or paired t tests.


There was a 17% reduction in the time from simulation to contour approval, 3.0 to 2.5 days, respectively (p = 0.007). There was also a 24% reduction in the time from simulation to plan approval, 6.3 to 4.8 days (p < 0.001). On subset analysis by individual disease site, head and neck cancer as well as lung cancer cases showed statistical improvement in the time from simulation to plan approval. Two of the three physicians evaluated demonstrated a statistical improvement in the time from simulation to plan approval. Physician 1 improved from 6.9 to 5.5 days (p = 0.001) and physician 3 from 8.7 to 8.3 days (p = 0.002).


Whiteboard implementation resulted in a significant decrease in time from CT simulation date to contour approval and plan approval. When used effectively, an automated whiteboard system facilitates improved workflow.


Whiteboard Workflow Physics Dosimetry Radiation planning 



A special thanks to Walter Niesz, Senior IT Systems Analyst, UC Physicians, for his assistance in development, implementation, and support for the whiteboard and to Rahul Veldurthi for the helpful feedback on the final manuscript. We also would like to thank Dr. Roman Jandarov, assistant professor of biostatistics and bioinformatics in the Department of Environmental Health at the University of Cincinnati, for his assistance with our statistical analysis.

Compliance with ethical standards


No funding was provided for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human or animal participants performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

13566_2019_385_MOESM1_ESM.docx (123 kb)
ESM 1 (DOCX 123 kb)


  1. 1.
    WHO | Cancer Statistics. (2017). Accessed: June 19
  2. 2.
  3. 3.
    Cancer of Any Site - Cancer Stat Facts. (2017). Accessed: June 19
  4. 4.
    Delaney G, Jacob S, Featherstone S, Barton M (2005) The role of radiotherapy in cancer treatment: estimating optimal utilization from a review of evidence-based clinical guidelines. Cancer. 104(6):1129–1137. CrossRefGoogle Scholar
  5. 5.
    Pan HY, Haffty BG, Falit BP, Buchholz TA, Wilson LD, Hahn SM, Smith BD (2016) Supply and demand for radiation oncology in the United States: updated projections for 2015 to 2025. Int J Radiat Oncol Biol Phys 96(3):493–500. CrossRefGoogle Scholar
  6. 6.
    Joshi CP (2014) Patient safety in an environment of rapidly advancing technology in radiation therapy. Journal of medical physics 39(2):61–63. CrossRefGoogle Scholar
  7. 7.
    Klein EE, Fontenot J, Dogan N (2017) The ever-evolving role of the academic clinical physicist. Int J Radiat Oncol Biol Phys 98(1):18–20. CrossRefGoogle Scholar
  8. 8.
    Mazur L, Mosley P, Jackson M, Chang S, Deschesne Burkhardt K, Adams R, Jones E, Xu J, Rockwell J, Marks L (2011) Quantitative assessment of workload and stressors in clinical radiation oncology: a step toward improving patient safety. Int J Int J Radiat Oncol Biol Phys 81(2):S140–S141. CrossRefGoogle Scholar
  9. 9.
    Marks LB, Jackson M, Xei L et al (2011) The challenge of maximizing safety in radiation oncology. Pract Radiat Oncol 1(1):2–14. CrossRefGoogle Scholar
  10. 10.
    Tariq MB, Meier T, Suh JH, et al. (2019) Departmental workload and physician errors in radiation oncology [published online ahead of print June 28, 2016]. J Patient Saf. doi:
  11. 11.
    Monden Y (2011) Toyota production system: an integrated approach to just-in-time, 4th edn. CRC Press, Boca Raton, FLCrossRefGoogle Scholar
  12. 12.
    Anderson D (2009) Kanban: Successful Evolutionary Change for Your Technology Business. Blue Hole, Sequim, WAGoogle Scholar
  13. 13.
    KanbanFlow - Lean project management (2017). Simplified. Accessed: July 1, 2017
  14. 14.
    McDonald C (2014). Restructuring the flow of radiation oncologist workflow in an out-patient cancer centre. [MSc thesis]. Dublin: Royal College of Surgeons in IrelandGoogle Scholar
  15. 15.
    Pohar S, Fung C, Hopkins S et al (2013) American Society for Radiation Oncology (ASTRO) 2012 Workforce Study: the radiation oncologists’ and residents’ perspectives. Int J Radiat Oncol Biol Phys 87(5):1135–1140. CrossRefGoogle Scholar
  16. 16.
    DiCostanzo D, Thompson D, Woollard J, Gupta N, Ayan A (2015) An electronic whiteboard to manage the treatment planning process. Int J Radiat Oncol Biol Phys 93(3):E499–E500. CrossRefGoogle Scholar
  17. 17.
    Wolfgang JA, Hong TS (2012) Radiation oncology whiteboard: data and workflow manager for enhanced communication and task management. J Clin Oncol Off J Am Soc Clin Oncol 30(34):S34. Google Scholar
  18. 18.
    Taveira R, Beecher R (2014) Implementing an electronic dosimetry whiteboard. Oncology Issues 29(3):20–29. CrossRefGoogle Scholar
  19. 19.
    Mallalieu LJ, Sharma A, Jamshidi A et al (2011) A virtual whiteboard for improvement of coordination of physics processes in a multi-site radiation therapy department. Int J Radiat Oncol Biol Phys 81(2):S697. CrossRefGoogle Scholar
  20. 20.
    Lin YH, Hung SK, Lee MS et al (2017) Enhancing clinical effectiveness of pre-radiotherapy workflow by using multidisciplinary-cooperating e-control and e-alerts: a SQUIRE-compliant quality-improving study. Medicine 96(24):e7185 vol. 96, no. 24, p. e7185.
  21. 21.
    Rosenthal DI, Liu L, Lee JH, Vapiwala N, Chalian AA, Weinstein GS, Chilian I, Weber RS, Machtay M (2002) Importance of the treatment package time in surgery and postoperative radiation therapy for squamous carcinoma of the head and neck. Head Neck 24(2):115–126. CrossRefGoogle Scholar
  22. 22.
    Shaverdian N, Gondi V, Sklenar KL, Dunn EF, Petereit DG, Straub MR, Bradley KA (2013) Effects of treatment duration during concomitant chemoradiation therapy for cervical cancer. Int J Radiat Oncol Biol Phys 86(3):562–568. CrossRefGoogle Scholar
  23. 23.
    Parsons JT, Mendenhall WM, Stringer SP, Cassisi NJ, Million RR (1997) An analysis of factors influencing the outcome of postoperative irradiation for squamous cell carcinoma of the oral cavity. Int J Radiat Oncol Biol Phys 39(1):137–148. CrossRefGoogle Scholar
  24. 24.
    Burton GE, Pathak DS, Zigli RM (1976) The effects of organizational communication on job satisfaction and motivation factors for management. J Manag 2(2):17–23. Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Christopher Freese
    • 1
  • Neil Forster
    • 1
  • Brittany Prater
    • 1
  • Meredith Amlung
    • 1
  • Michael Lamba
    • 1
  • Vinita Takiar
    • 1
    Email author
  1. 1.Department of Radiation Oncology, Barrett Cancer CenterUniversity of Cincinnati College of MedicineCincinnatiUSA

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