Poster Presentation – Abstracts Archive

UK & Ireland Prostate Brachytherapy Conference 2013

Abstract number 7

Lean Principles in HDR Prostate Brachytherapy Significantly Reduces Procedure Time

Michelle Boyle
Specialist Brachytherapy Radiographer, The Christie Hospital NHS Foundation Trust, Manchester. Christie Medical Physics and Engineering
Laura Lane
Lead Brachytherapy Radiographer, The Christie Hospital NHS Foundation Trust, Manchester. Christie Medical Physics and Engineering
David Wood
Advanced Brachytherapy Radiographer The Christie Hospital NHS Foundation Trust, Manchester. Christie Medical Physics and Engineering

Introduction/Aims: The Christie began HDR prostate brachytherapy in April 2008 and to date have treated over 400 patients, around 90 patients annually. Current protocol is a single fraction boost of 15Gy in combination with EBRT (37.5Gy in 15#)

With increasing demands on resources, a need to maximise HDR availability and increase patient numbers “lean” management principles were applied to the HDR patient pathway. The aim was to remove any aspects that were not directly delivering ˜value” in achieving a quality implant with excellent patient care. 

Materials/Methods: All stakeholders in the process were involved in charting the procedure pathway, identifying bottlenecks and providing solutions. Work instructions were reviewed and amended, admin workflow streamlined and an upgrade from OCPv3 to OCP v4 implemented. Examples of strategies employed:

-Reduced duplicate checking and unnecessary imaging -Reduce the number of non-essential staff in theatre -Introduced a new procedure for probe decontamination -Removed prostate fiducial markers

Results: Our procedure time (Probe in: treatment complete) prior to the introduction of lean principles was on average 3h04. This reduced to an average of 2h27 post lean measures implementation.

Conclusions: The HDR procedure time has been reduced by an average of 30 minutes (20%) as a result of the lean approach. Significant benefits include increased patient throughput, reduced anaesthetic times and overnight stays with associated cost savings.

The introduction of the new cart has not has yet reduced this time further but may well prove to do so in the future. Further logistical improvements in the pre-treatment pathway will arise from the completion of a specialist brachytherapy ward in Autumn 2013 incorporating dedicated brachytherapy trained nursing staff and a convenient location close to theatre. Overall many small gains throughout the HDR procedure with minimal resource investment have produced a significant reduction in procedure time with no negative effect on treatment quality.