The use of the Australian Basic Treatment Equivalent (BTE) workload measure for linear accelerators in Canada

The Inter Society of Radiation Oncologists of North America (ISRON) workload standard for linear accelerators is the one most widely used; it regards the treatment of 250 or more patients per year as an acceptable limit. Nevertheless, there is concern that this standard does not represent the current workload of linear accelerators, given that the complexity of techniques and equipment has increased significantly since the ISRON model was developed in the late 1980s. Delaney et al. recently validated a workload indicator for Australian (AUS) centres, known as the basic treatment equivalent (BTE). They showed that this was a better predictor of workload and that there was less variation between centres using this model than there would have been by using fields/hour. This centre attempted to validate this model for use in a Canadian centre, by collecting treatment data on all linear accelerator-treated patients during February 1998. The linear accelerators at this centre delivered 2,295 fractions (6,928 fields) in 662 hours during February 1998. When 15 minutes was used as a denominator, the BTE model functioned as a better workload indicator than simple measures such as fields/hour. It also had better performance in reducing variability between machines. A BTE of 3,403 was calculated for these machines. The mean value for fields/hour, BTE/hour and BTE/fraction for this centre fell within the range of values quoted by AUS centres. The BTE/fraction value for this centre was relatively high compared with the AUS mean, indicating this centre's reliance on the use of a high number of complex techniques. We recommend that the model should be further refined for the Canadian context by developing BTE values with the use of local time and motion studies, including factors such as multileaf collimators and enhanced dynamic wedges.