Quality Improvement and Process Redesign for the Clinical Integration of Automated Breast Radiation Therapy Planning

The study objective is to improve breast radiation therapy clinical workflows through a quality improvement approach rooted in implementation and improvement science methodologies. This study aims to demonstrate the effectiveness of these data-driven, multidisciplinary processes in optimizing complex clinical processes within radiation oncology.

A multidisciplinary stakeholder team applied an improvement science methodology to identify the root cause of inefficiencies in a pretreatment breast radiation therapy workflow. The intervention involved redesigning the task sequence and implementing an automated breast treatment planning solution to replace manual planning. The study evaluated the outcome measure of the target contouring time by the radiation oncologist and the treatment planning time by the medical dosimetrist. The outcome measures for 3 cohorts were analyzed: (1) the initial cohort with manual planning prior to any process change, (2) the pilot cohort with a limited stakeholder team for rapid change cycles with the modified clinical workflow and automated planning solution, and (3) a comprehensive rollout with the entire clinical team. The balancing quality measures of dosimetric compliance to dose-volume histogram planning objectives were also assessed across the 3 cohorts.

From 2020 to 2022, 515 patients were included in the analysis. The task times from the initial cohort to the comprehensive rollout cohort were 0.2 (± 0.07) hours and 0.2 (± 0.03) hours for radiation oncologist contouring time and 8 (± 4) hours and 4 (± 1) hours for medical dosimetrist planning time, respectively. At the conclusion of the comprehensive rollout, total professional task time was decreased, and treatment plan quality was maintained. The approach successfully scaled from the smaller stakeholder team to the entire clinical workforce, demonstrating the effectiveness of implementation and improvement science methodologies.

This study provides a comprehensive description and evaluation of a data-driven, sustainable process change in a multidisciplinary breast radiation therapy workflow. The methodology used serves as a model for clinical workflow optimization across radiation oncology settings.