Departmental quality initiative to establish turnaround times from simulation to treatment

The process of treatment delivery involves a series of steps from patient evaluation, therapeutic simulation (simulation), followed by dosimetric treatment planning, pre-treatment quality assurance and plan verification, and ultimately treatment delivery. Each step has a strict precedence relationship, requiring the preceding task to be completed prior to the initiation of the next task. The minimum time for a patient to undergo treatment is based on the summation of times of the individual tasks. Nevertheless, patients are often scheduled based on factors that do not directly consider the overall time required to complete these steps.

To better help in scheduling patients and to ensure quality and safety of treatment planning and delivery, we undertook a quality initiative based on team members tabulating time required to complete tasks required for treatment delivery. We established "fastest possible" turnaround times based how quickly a task could be accomplished if there were minimal or no competing obligations, as well as processing times under routine operating conditions.

For urgent situations, we found that our center can accommodate treatment within 24 h. For routine plans using 3D conformal radiation, an approximately 1-week turnaround time is needed. For patients being treated with IMRT/VMAT an approximately 2-week turnaround time is needed.

The growing complexity of radiotherapy delivery also requires additional steps which has increased turnaround times from simulation to treatment compared to historical standards. We report our estimates for turnaround time based on plan type and acuity level. While our turnaround times may not be applicable to all centers, we believe that this exercise was helpful to facilitate inter- and intra- departmental communication regarding reasonable start times for patients.