Bai Ti, Ray Xenia, Parsons David, Lin Mu-Han
Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas.
Department of Radiation Medicine & Applied Sciences, UC San Diego Health, San Diego, California.
Int J Radiat Oncol Biol Phys. 2025 Jul 15;122(4):884-892. doi: 10.1016/j.ijrobp.2025.03.070. Epub 2025 May 2.
This study aimed to provide insights into the staffing and workflow requirements for cone beam computed tomography (CBCT)-guided online adaptive radiation therapy (ART) systems to guide institutions in optimizing staffing strategies and to promote broader ART adoption.
We conducted a nationwide survey to collect data on ART program metrics, clinician roles during online treatment, and physicist staffing models, along with free-text feedback for sharing of insights and challenges. Additionally, we reviewed 26 published articles describing ART workflows across various anatomic sites and performed a literature-based timing analysis to provide further context on workflow efficiency.
We received 19 responses from a range of institutions. Medical schools and university hospitals reported the highest ART patient throughput, averaging 4 patients per machine per day. Overall, most institutions treat 1 to 2 ART patients per machine daily, with average session duration of 1 hour. Therapists are primarily responsible for CBCT scans, whereas physicists oversee almost all ART stages. The physicians are mainly responsible for on-treatment contouring and plan selection/approval. As ART cases increase, more full-time equivalent (FTE) physicists are needed, with >5 cases per day typically requiring an additional FTE. The online adaptive workflow adds about 20 minutes to treatment time compared with image guided radiation therapy, resulting in a total on-table time of ∼40 minutes.
Implementing ART programs requires careful planning and flexible staffing models to balance resource availability with treatment quality. The findings from this survey highlight the importance of interdisciplinary collaboration, defined clinician roles, and evolving staffing solutions for ART implementation. Medical physicists are essential in all stages of the ART process, with higher adaptive case volumes directly driving the need for additional FTEs to maintain effective workflow and treatment quality. This study's insights can guide health care facilities in establishing efficient and sustainable ART workflows, ultimately enhancing patient care outcomes.
本研究旨在深入了解锥束计算机断层扫描（CBCT）引导的在线自适应放射治疗（ART）系统的人员配备和工作流程要求，以指导机构优化人员配备策略，并促进更广泛地采用ART。
我们进行了一项全国性调查，以收集有关ART计划指标、在线治疗期间临床医生的角色以及物理师人员配备模式的数据，同时收集自由文本反馈以分享见解和挑战。此外，我们回顾了26篇描述不同解剖部位ART工作流程的已发表文章，并进行了基于文献的时间分析，以进一步了解工作流程效率。
我们收到了来自一系列机构的19份回复。医学院和大学医院报告的ART患者吞吐量最高，平均每台机器每天4例患者。总体而言，大多数机构每台机器每天治疗1至2例ART患者，平均治疗时间为1小时。治疗师主要负责CBCT扫描，而物理师几乎监督ART的所有阶段。医生主要负责治疗中的轮廓勾画和计划选择/批准。随着ART病例的增加，需要更多的全职等效（FTE）物理师，通常每天>5例病例需要额外增加一名FTE。与图像引导放射治疗相比，在线自适应工作流程使治疗时间增加了约20分钟，导致总治疗台上时间约为40分钟。
实施ART计划需要仔细规划和灵活的人员配备模式，以平衡资源可用性与治疗质量。本次调查结果突出了跨学科合作、明确临床医生角色以及不断发展的人员配备解决方案对ART实施的重要性。医学物理师在ART过程的所有阶段都至关重要，更高的自适应病例量直接推动了对额外FTE的需求，以维持有效的工作流程和治疗质量。本研究的见解可指导医疗机构建立高效且可持续的ART工作流程，最终改善患者护理结果。
