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Time management in radiation oncology: evaluation of time, attendance of medical staff, and resources during radiotherapy for prostate cancer

The DEGRO-QUIRO trial

Zeitmanagement in der Strahlenonkologie: Zeiterfassung und Ressourcen bei der Bestrahlung des Prostatakarzinoms

Die DEGRO-QUIRO-Studie

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Abstract

Purpose

In order to evaluate resource requirements, the German Society of Radiation Oncology (DEGRO) recorded the times needed for core procedures in the radio-oncological treatment of various cancer types within the scope of its QUIRO trial. The present study investigated the personnel and infrastructural resources required in radiotherapy of prostate cancer.

Methods

The investigation was carried out in the setting of definitive radiotherapy of prostate cancer patients between July and October 2008 at two radiotherapy centers, both with well-trained staff and modern technical facilities at their disposal. Personnel attendance times and room occupancy times required for core procedures (modules) were each measured prospectively by two independently trained observers using time measurements differentiated on the basis of professional group (physician, physicist, and technician), 3D conformal (3D-cRT), and intensity-modulated radiotherapy (IMRT).

Results

Total time requirements of 983 min for 3D-cRT and 1485 min for step-and-shoot IMRT were measured for the technician (in terms of professional group) in all modules recorded and over the entire course of radiotherapy for prostate cancer (72–76 Gy). Times needed for the medical specialist/physician were 255 min (3D-cRT) and 271 min (IMRT), times of the physicist were 181 min (3D-cRT) and 213 min (IMRT). The difference in time was significant, although variations in time spans occurred primarily as a result of various problems during patient treatment.

Conclusion

This investigation has permitted, for the first time, a realistic estimation of average personnel and infrastructural requirements for core procedures in quality-assured definitive radiotherapy of prostate cancer. The increased time needed for IMRT applies to the step-and-shoot procedure with verification measurements for each irradiation planning.

Zusammenfassung

Ziel

Zur Evaluation des Ressourcenverbrauchs führte die Deutsche Gesellschaft für Radioonkologie (DEGRO) im Rahmen der QUIRO-Studien an unterschiedlichen Karzinomen eine Zeiterfassung für die wichtigsten Kernprozesse in der Radioonkologie durch. In dieser Arbeit wurden die notwendigen personellen und räumlichen Ressourcen bei der Bestrahlung des Prostatakarzinoms untersucht.

Methodik

Die Untersuchung bei der definitiven Strahlenbehandlung von Patienten mit Prostatakarzinomen erfolgte an zwei personell gut und technisch modern ausgestatteten Radiotherapiezentren zwischen Juli und Oktober 2008. Die zeitliche Erfassung von Personalbindungs- und Raumbelegungszeiten für wesentliche Arbeitsschritte/Module wurde prospektiv durch jeweils zwei unabhängige geschulte Untersucher mit Zeitmessungen differenziert nach Berufsgruppen [Arzt, Physiker und Medizinisch-technische Assistenten im Fachbereich Radiologie (MTAR)] sowie nach 3-D-konformaler- (3D-cRT) und intensitätsmodulierter Radiotherapie (IMRT) durchgeführt.

Ergebnisse

Bei der Strahlenbehandlung des Prostatakarzinoms zeigt sich über alle erfassten Module und die gesamte Bestrahlungsserie (72–76 Gy) eine zeitliche Gesamtbelastung der MTAR (als Berufsgruppe) von 983 min bei einer 3D-cRT beziehungsweise 1485 min bei einer „Step-and-shoot“-IMRT Bestrahlung. Der Zeitaufwand für den Facharzt lag bei 255 (3D-cRT) und 271 min (IMRT) sowie für den Physiker bei 181 (3D-cRT) und 213 min (IMRT). Der zeitliche Unterschied war signifikant, wobei Schwankungen in den Zeitspannen vor allem durch unterschiedliche Probleme bei der Behandlung der Patienten auftraten.

Schlussfolgerung

Durch die Untersuchung ist es erstmals möglich, eine realistische Abschätzung des durchschnittlichen Personal- und Raumbedarfs für die Kernprozesse einer qualitätsgesicherten definitiven Strahlentherapie des Prostatakarzinoms zu erhalten. Der erhöhte Zeitbedarf für eine IMRT gilt hier für das „Step-and-shoot“-Verfahren mit Verifikationsmessungen jedes Bestrahlungsplans.

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Compliance with ethical guidelines

Conflict of interest. L. Keilholz, J. Willner, H.-J. Thiel, N. Zamboglou, H. Sack, and W. Popp state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

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Authors and Affiliations

  1. Abteilung für Strahlentherapie, Klinik und MVZ für Strahlentherapie, Klinikum Bayreuth GmbH, Preuschwitzer Str. 101, 95445, Bayreuth, Germany

    L. Keilholz & J. Willner

  2. Abteilung für Radioonkologie, Sozialstiftung Bamberg, Bamberg, Germany

    H.-J. Thiel

  3. Abteilung für Strahlentherapie, Klinikum Offenbach GmbH, Offenbach, Germany

    N. Zamboglou

  4. Deutsche Gesellschaft für Radioonkologie, Berlin, Germany

    H. Sack

  5. Prime Networks AG, Basel, Switzerland

    W. Popp

Authors
  1. L. Keilholz
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  2. J. Willner
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  3. H.-J. Thiel
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  4. N. Zamboglou
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  5. H. Sack
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  6. W. Popp
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Corresponding author

Correspondence to L. Keilholz.

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Keilholz, L., Willner, J., Thiel, HJ. et al. Time management in radiation oncology: evaluation of time, attendance of medical staff, and resources during radiotherapy for prostate cancer. Strahlenther Onkol 190, 17–25 (2014). https://doi.org/10.1007/s00066-013-0440-0

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  • DOI: https://doi.org/10.1007/s00066-013-0440-0

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