Chan Kitty, Cashell Angela, Rosewall Tara
Radiation Medicine Program, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada.
Radiation Medicine Program, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada.
J Med Imaging Radiat Sci. 2017 Dec;48(4):394-401. doi: 10.1016/j.jmir.2017.09.010. Epub 2017 Nov 29.
International brachytherapy consortiums are advocating for the incorporation of magnetic resonance imaging (MRI) into the cervical brachytherapy process as a standard-of-care. Although some evaluations have been performed to quantify the effect on procedural time, little is known about the views and experiences of key stakeholders during the transition from computed tomography to MR-guided brachytherapy. This qualitative research project explored insights from key stakeholders related to a change in the gynaecologic brachytherapy process.
Semi-structured interviews were designed using Lean Methodology principles and all key members in the gynaecologic brachytherapy team were approached for participation: radiation oncologists, medical physicists, radiation therapists, the lead MR technologist, and the ward nurse manager. Interviews were recorded and transcribed, and analysis was performed to identify themes from the data.
Ten of 12 (83% participation rate) key members of the team were interviewed. Four themes emerged from the data: challenges to efficiency, staff availability, patient history and disease characteristics, and team communication. The stakeholders expressed that the challenges during this transition were procedural inefficiency (sharing of the MRI scanner and increased procedure length because of increased complexity in contouring and planning), and staff availability (radiation oncologist and transportation staff). The clinical team identified the value of communicating patient history and disease characteristics ahead of the brachytherapy procedure day and also using an inclusive mode of communication during the procedure was beneficial.
This research provides nuanced insights into process and practice changes that occur when one imaging technology is simply swapped for another, emphasizing how intertwined and complex brachytherapy procedures can be. It emphasizes that not all challenges to efficiency are considered Lean Wastes, and that seemingly simple procedural changes can result in unanticipated differences in staff availability, communication pathways, and knowledge requirements.
国际近距离放射治疗协会主张将磁共振成像（MRI）纳入宫颈癌近距离放射治疗流程，作为一种标准治疗手段。尽管已经进行了一些评估以量化其对治疗时间的影响，但对于从计算机断层扫描向磁共振引导的近距离放射治疗转变过程中关键利益相关者的观点和经验知之甚少。这个定性研究项目探讨了关键利益相关者对妇科近距离放射治疗流程变化的见解。
采用精益方法原则设计半结构化访谈，并邀请妇科近距离放射治疗团队的所有关键成员参与：放射肿瘤学家、医学物理学家、放射治疗师、首席磁共振技术专家和病房护士长。访谈进行录音和转录，并对数据进行分析以确定主题。
该团队12名关键成员中有10名（参与率83%）接受了访谈。数据中出现了四个主题：效率挑战、人员可用性、患者病史和疾病特征以及团队沟通。利益相关者表示，这一转变过程中的挑战包括程序效率低下（磁共振扫描仪的共享以及由于轮廓勾画和治疗计划复杂性增加导致治疗时间延长）和人员可用性（放射肿瘤学家和运输人员）。临床团队确定了在近距离放射治疗日之前交流患者病史和疾病特征的价值，并且在治疗过程中采用包容性的沟通方式也很有益。
本研究对一种成像技术简单替换为另一种成像技术时发生的流程和实践变化提供了细致入微的见解，强调了近距离放射治疗程序可能是多么相互交织和复杂。它强调并非所有效率挑战都被视为精益浪费，看似简单的程序变化可能导致人员可用性、沟通途径和知识需求方面出现意想不到的差异。
