Optimising the breast radiotherapy planning pathway: a quality improvement project at a regional cancer centre

At the South West Wales Cancer Centre, breast radiotherapy accounts for 24% of the radiotherapy workload. In 2021, only 16% of patients started treatment within 14 days compared with the Welsh time-to-radiotherapy quality metric target of 80%. Delays risk poorer outcomes for patients and create inefficiencies as tasks are often batched and staff alternate between idle and peak workload periods.Earlier analysis showed that only 1%-2% of the overall breast radiotherapy pathway time was value-adding activity. Key delays occurred at several stages of the pathway, where the total duration of each stage, including time spent waiting in the queue and time actively worked on, averaged around 50% longer than scheduled. For example, CT simulation was typically scheduled for 2 days but took more than 4 days while organ at risk (OAR) delineation was scheduled for 2 days but took approximately 2.5 days. Our improvement strategy targeted these delays through: (1) expansion of the technologist plan approval (TPA) pathway, (2) introduction of daily workflow meetings and clearer, standardised planning protocols and (3) implementation of artificial intelligence (AI) auto-contouring for OAR delineation. These changes were tested using the Model for Improvement, with statistical process control monitoring of metrics plus staff feedback.The mean total radiotherapy breast pathway time from consent-to-treatment decreased from 19.5 days to 14.8 days, with patients commencing treatment within 14 days increasing from 16% to 55%. Use of the TPA pathway increased from 61% to 95% and plan queries reduced from 11% to 3%, reducing oncologist workload. Daily workflow meetings and improved protocols reduced average planning times from 4 days to 1.5 days and were valued by staff for improving workload equity and team cohesion. AI auto-contouring reduced OAR delineation from 2.3 to 0.6 days, though ongoing validation of contour quality is required.