Developing an intraoperative 3T MRI-guided brachytherapy program within a diagnostic imaging suite: Methods, process workflow, and value-based analysis.
Brachytherapy
/ economics
Female
Genital Neoplasms, Female
/ radiotherapy
Health Care Costs
Health Personnel
/ economics
Health Resources
/ economics
Humans
Intraoperative Period
Magnetic Resonance Imaging
/ economics
Radiology, Interventional
/ organization & administration
Radiotherapy, Image-Guided
Tomography, X-Ray Computed
/ economics
Workflow
Cervical cancer
HDR brachytherapy
Health care value
TDABC
Journal
Brachytherapy
ISSN: 1873-1449
Titre abrégé: Brachytherapy
Pays: United States
ID NLM: 101137600
Informations de publication
Date de publication:
Historique:
received:
25
06
2019
revised:
11
09
2019
accepted:
21
09
2019
pubmed:
2
12
2019
medline:
14
4
2021
entrez:
2
12
2019
Statut:
ppublish
Résumé
We integrated a brachytherapy procedural workflow within an existing diagnostic 3.0-T (3T) MRI suite. This setup facilitates intraoperative MRI guidance for optimal applicator positioning, particularly for interstitial needle placements in gynecologic cases with extensive parametrial involvement. Here we summarize the multidisciplinary collaboration, equipment, and supplies necessary to implement an intraoperative MRI-guided brachytherapy program; outline the operational workflow via process maps; and address safety precautions. We evaluate internal resource utilization associated with this progressive approach via time-driven activity-based costing methodology, comparing institutional costs to that of a traditional workflow (within a CT suite, followed by separate postprocedure MRI) over a single brachytherapy procedural episode. Resource utilization was only 15% higher for the intraoperative MRI-based workflow, attributable to use of the MRI suite and increased radiologist effort. Personnel expenses were the greatest cost drivers for either workflow, accounting for 76-77% of total resource utilization. However, use of the MRI suite allows for potential cost-shifting opportunities from other resources, such as CT, during the procedural episode. Improvements in process speed can also decrease costs: for each 10% decrease in case duration from baseline procedure time, total costs could decrease by roughly 8%. This analysis supports the feasibility of an intraoperative MRI-guided brachytherapy program within a diagnostic MRI suite and defines many of the resources required for this procedural workflow. Longer followup will define the full utility of this approach in optimizing the therapeutic ratio for gynecologic cancers, which may translate into lower costs and higher value with time, over a full cycle of care.
Identifiants
pubmed: 31786169
pii: S1538-4721(19)30588-4
doi: 10.1016/j.brachy.2019.09.010
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
427-437Informations de copyright
Copyright © 2019. Published by Elsevier Inc.