Last year, a new hybrid CT planning team at BC Cancer – Vancouver found an administrative efficiency that allows select patients to be booked for CT planning in 30 minute increments instead of 60 minute appointments. This change in procedure has increased capacity enabling up to four more patients to be scanned each day.
The hybrid CT planning team was developed through a need to train more staff in the radiation therapy planning department and a need to make important workflow changes ahead of equipment replacement and upgrades. The implementation of the hybrid team allowed the department to tackle both those needs.
"Previously, patients that would have the CT scan and treatment the same day or the next day would be booked for 60 minute appointments, but they would only need 30 minutes to complete their CT planning scan – the other 30 minutes of their appointment was allocated for staff to process and prepare the treatment plan and complete safety plan checks," says Luminita (Lumi) Nica, manager, Clinical Services, BC Cancer – Vancouver.
The previous method divided radiation therapy planning into two main groups; CT simulator, the process that allows a radiation oncologist to identify the targets unique to each patient's anatomy, and dosimetry, who design a radiation treatment plan to those targets while minimizing doses to nearby organs. The new hybrid CT Planning team will allow for more flexibility between CT simulator and dosimetry; creating a more efficient workflow.
"With this new approach, we separate the time allocated to patient scanning from the time needed to prepare the treatment plans. Under the new process, a hybrid team will do the prep and calculations within a few hours after their CT scan."
This results not only in a more efficient use of CT time, but also the collaborative, hybrid approach helps to speed the prep work.
"Before, the work was divided between the two groups with little crossover," says Jason Hui, resource radiation therapist, BC Cancer – Vancouver. "Each group would rely on the other to perform specific tasks like contouring, image registrations, and quality assurance plan checking. The new model allows more sharing of tasks to tackle the workload more efficiently."
For patients, there will be relatively no change to their appointments – they will still have 30 minute CT planning scans, however the added capacity has the potential to allow for more timely access to care at the centre.
"The plan for the pilot project included a timeline, training documents, equipment needs, communication, staff training, evaluation and feedback," says Jason.
If other centres are interested in learning more, the Vancouver centre team is happy to share their process. "Planning departments at each of the regional cancer centres function slightly differently and have their own workflow – a close analysis of this model would be needed at each centre to determine what would work best taking unique staffing and resources into consideration to adapt for their own departments," says Lumi.
The next innovation for the BC Cancer – Vancouver radiation team is to look at how the volume of work after scanning can be streamlined. They are working to make the contouring process – the process that marks cancer tumours from normal tissue – more efficient by introducing AI driven auto contouring tools to reduce the time radiation therapists spend contouring organs at risk; a critical step in the radiation therapy treatment planning. It is hoped this will decrease the time between CT planning and treatment.
Congratulations to radiation therapists Juo Lee, Vivian Cheung, Jana Adams, Heidi Wong, Jonathan Chau, and Lynne Williams for this innovation as well as resource and educators Tania Arora, Robynn Ferris, Jason Hui, and Kerry James. Thanks to the BC Cancer – Vancouver physics team for their support during the training process and RT leadership who provided essential staffing levels to allow this work to happen.