Using a whiteboard web application for tracking treatment workflow metrics for dosimetrists and physicians

Abstract

We present a framework for collecting data which elucidates detailed clinical flow timelines for different treatment sites, modalities, planners, and physicians in radiotherapy treatments. A web based tool, the Whiteboard, was developed which allows communication between the physicians and staff about the current state of the radiotherapy treatment plan and provides detailed time data for each stage of the patient's journey from simulation to treatment. Detailed timestamped data was collected over a period of 6 years which included 22 discrete steps of the treatment planning process. Whiteboard data was combined with data in the treatment planning database Aria (Varian Medical Systems, Palo Alto, CA) using the Eclipse Scripting API to include treatment plan information. Over 6 years, 110,477 patient statuses were time-logged for 9683 courses of treatment using our Whiteboard software, which allowed determination of patient volumes per individual and the time to perform planning tasks. The mean planning volume per dosimetrist was 375.8 ± 142.4 plans and 71.03 ± 27.10 plan revisions per year. The mean planning volume per physician was 218.9 ± 110.8 plan approvals with 41.55 ± 43.73 plan revisions per year. Physician contour time was a mean of 79.59 ± 84.61 hours, but varied greatly by diagnosis category and physician. The longest median modality planning time of 119.6 hours was for the IMRT plans with 8 or more fields. The shortest median times were 48.25, 49.53, and 50.98 hours for plans with 5, 4, and 3 fields, respectively. We demonstrated a framework that could help facilities in staff planning and aid in workload distribution, and could be used to improve understanding of radiotherapy timelines for patients, payers, and other institutions involved in radiotherapy processes.