Optimization of treatment workflow for 0.35T MR-Linac system

Area of Science:

• Radiation Oncology
• Health Economics
• Medical Physics

Background:

• Magnetic resonance guided radiotherapy (MRgRT) offers advanced treatment capabilities but requires thorough workflow evaluation.
• Integrating safety and cost analyses is crucial for optimizing MRgRT implementation and clinical adoption.
• Existing frameworks may not fully capture the complexities of MRgRT workflows.

Purpose of the Study:

• To develop and apply a novel framework combining Failure Modes and Effects Analysis (FMEA) and Time-Driven Activity-Based Costing (TDABC) for evaluating MRgRT workflows.
• To assess the safety, quality, and economic implications of the 0.35T MRIdian MR-Linac system's clinical workflow.
• To provide data-driven insights for healthcare practitioners and administrators to inform decision-making regarding MRgRT systems.

Main Methods:

• A multidisciplinary team utilized the TG-100 methodology for FMEA to identify potential failure modes in the MRgRT workflow.
• Workflow optimization and failure mode mitigation preceded the Time-Driven Activity-Based Costing (TDABC) analysis.
• TDABC was applied to compare MRgRT and computed tomography-guided RT (CTgRT) for five-fraction stereotactic body radiotherapy (SBRT) treatments, analyzing total workflow and costs.

Main Results:

• A total of 279 failure modes were identified, with 31 classified as high-risk, guiding targeted safety interventions.
• Risk Priority Numbers (RPNs) were calculated for each care team member, identifying critical personnel for risk management.
• Technological advancements in MRgRT, such as real-time MLC tracking and auto-segmentation, demonstrated potential for significant cost savings.

Conclusions:

• The integrated FMEA and TDABC approach provides a comprehensive evaluation of MRgRT workflows and associated costs compared to CTgRT.
• FMEA identified critical failure modes, offering actionable insights for enhancing patient safety in MRgRT.
• While MRgRT presents unique advantages, TDABC analysis indicated potentially higher costs, emphasizing the need for cost-effective strategies and technological advancements for widespread adoption and financial sustainability.