Background: The length of CT Simulation appointments impacts access to radiotherapy services; longer appointment lengths can result in decreased capacity for patient simulation.
Aim: To develop evidence-based guidelines for CT simulation appointment length to increase capacity and improve access to radiotherapy clinical resources.
Methods: Phase 1 was a retrospective chart review of 60 patients selected in reverse chronological order from the CT simulation schedule for the following radiotherapy techniques: Breast tangent, CNS (brain and spine) IMRT and SBRT, Lung (including mesothelioma) IMRT and SBRT, Liver IMRT, Upper GI IMRT, Lymphoma mantle and Total Body Irradiation (TBI), and Head and Neck (H&N) IMRT. The duration of the CT simulation procedure was measured for each patient as the difference between the first and last time stamps in the radiation therapy electronic medical record. In Phase 2 an additional 5 minutes was added to each appointment length in Phase 1 to account for routine patient care activities (e.g. patient education) extending beyond the documented time stamps. Evidence-based appointment lengths for each technique were averaged, peer reviewed, and validated by CT simulation radiation therapist specialists. Current appointment lengths were matched to the evidence-based appointment lengths.
Results: Liver, Lymphoma TBI, CNS spine SBRT, Lung SBRT and Mesothelioma evidence-based appointment lengths (45 min) were 25% less than current appointment lengths (60 min). Breast, CNS brain, Lung, Upper GI and H&N evidence-based appointment lengths (20 min) were 33% less than current appointment lengths (30 min). Implementation of the evidence-based appointment lengths at an academic cancer centre with 4 CT simulators resulted in an overall net gain of 2880 minutes (equivalent to 96 30 minute appointments) of CT simulation time per month.
Conclusions:This retrospective evaluation and peer review of CT simulation appointment lengths identified opportunities to increase clinical capacity and improve access to service.