To track linear accelerator performance issues, an online event recording system was developed in‐house for use by therapists and physicists to log the details of technical problems arising on our institution's four linear accelerators. In use since October 2010, the system was designed so that all clinical physicists would receive email notification when an event was logged. Starting in October 2012, we initiated a pilot project in collaboration with our linear accelerator vendor to explore a new model of service and support, in which event notifications were also sent electronically directly to dedicated engineers at the vendor's technical help desk, who then initiated a response to technical issues. Previously, technical issues were reported by telephone to the vendor's call center, which then disseminated information and coordinated a response with the Technical Support help desk and local service engineers. The purpose of this work was to investigate the improvements to clinical operations resulting from this new service model. The new and old service models were quantitatively compared by reviewing event logs and the oncology information system database in the nine months prior to and after initiation of the project. Here, we focus on events that resulted in an inoperative linear accelerator (“down” machine). Machine downtime, vendor response time, treatment cancellations, and event resolution were evaluated and compared over two equivalent time periods. In 389 clinical days, there were 119 machine‐down events: 59 events before and 60 after introduction of the new model. In the new model, median time to service response decreased from 45 to 8 min, service engineer dispatch time decreased 44%, downtime per event decreased from 45 to 20 min, and treatment cancellations decreased 68%. The decreased vendor response time and reduced number of on‐site visits by a service engineer resulted in decreased downtime and decreased patient treatment cancellations.PACS numbers: 87.56.bd, 87.55.Qr
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Purpose: To develop an online framework that tracks a patient's plan from initial simulation to treatment and that helps automate elements of the physics plan checks usually performed in the record and verify (RV) system and treatment planning system. Methods: We have developed PlanTracker, an online plan tracking system that automatically imports new patients tasks and follows it through treatment planning, physics checks, therapy check, and chart rounds. A survey was designed to collect information about the amount of time spent by medical physicists in non‐physics related tasks. We then assessed these non‐physics tasks for automation. Using these surveys, we directed our PlanTracker software development towards the automation of intra‐plan physics review. We then conducted a systematic evaluation of PlanTracker's accuracy by generating test plans in the RV system software designed to mimic real plans, in order to test its efficacy in catching errors both real and theoretical. Results: PlanTracker has proven to be an effective improvement to the clinical workflow in a radiotherapy clinic. We present data indicating that roughly 1/3 of the physics plan check can be automated, and the workflow optimized, and show the functionality of PlanTracker. When the full system is in clinical use we will present data on improvement of time use in comparison to survey data prior to PlanTracker implementation. Conclusion: We have developed a framework for plan tracking and automatic checks in radiation therapy. We anticipate using PlanTracker as a basis for further development in clinical/research software. We hope that by eliminating the most simple and time consuming checks, medical physicists may be able to spend their time on plan quality and other physics tasks rather than in arithmetic and logic checks. We see this development as part of a broader initiative to advance the clinical/research informatics infrastructure surrounding the radiotherapy clinic. This research project has been financially supported by Varian Medical Systems, Palo Alto, CA, through a Varian MRA.
Purpose: A new model of service and support has been developed between our institution and a linear accelerator vendor. Previously, a user would report machine breakdown events verbally by telephone to a dispatch center, which then coordinated repair actions with the technical helpdesk and local service engineer. In the new model, events are reported electronically directly to the vendor technical helpdesk, who can then contact the user immediately to coordinate a response. The purpose of this work is to report on a new model for vendor/institution collaboration to improve clinical operations. Methods: We developed a new on‐line event recording system that connected our clinic events directly to the linear accelerator vendor. Between February 2012 and 2013, our institutional electronic quality reporting database was reviewed. A machine down event was defined as a technical problem with the linear accelerator that interrupted, prevented, or required rescheduling or cancellation of patient treatments. Machine down time, vendor support response time, and whether the event was resolved by a service engineer visit or by physicists liaising with the technical helpdesk, were recorded. Results: Over 259 clinical days, there were 76 machine down events, with 45 before introduction of the new service model and 31 after. Under the new model, the average time for service response decreased by 92%, from 128 to 10 minutes and the number of times a service engineer had to be dispatched decreased by 70%. The down time per event decreased by 47% from 135 minutes to 71 minutes. Treatment cancellations or rescheduling decreased by 54%. Conclusion: A new model of linear accelerator support and service delivery was implemented and was found to decrease vendor response time and reduce the number of on‐site visits required by service engineers. These performance gains resulted in decreased machine downtime and decreased patient treatment cancellations. The work was undertaken in cooperation with Varian Medical Systems.
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