Evaluation of the Safety and Efficiency of MRI-guided Adaptive Brachytherapy for Cervix Cancer

Abstract Description

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Authors (including presenting author) :

Yip C(1), Wu P(1), Wong T(2), Hung HM(1), Law LYA(1) , Chan SM(1), Wong E(3), Yeung MWR(1), Soong IS(1)

Affiliation :

Departments of (1)Clinical Oncology, (2)Medical Physics, (3)Diagnostic Radiology, Pamela Youde Nethersole Eastern Hospital Authority

Introduction :

Adaptive MRI-guided 3D brachytherapy is an emerging standard of care for the radical treatment of cervix cancer. MRI-guided brachytherapy was established in our institution in January 2015. Due to the complexity of this advanced technical radiotherapy procedure that requires multidisciplinary effort, departmental guidelines were provided to ensure an optimal treatment schedule and precise radiotherapy delivery, safe and efficient operational workflow, adequate nursing and medical attention during the hospitalization. In the fourth quartile of 2017, an audit was conducted to evaluate the brachytherapy treatment process.

Objectives :

To check the compliance against departmental guidelines to ensure safe and efficient delivery of MRI-guided brachytherapy service

Methodology :

We audited the whole operational workflow i.e. from the step of obtaining consent, hospitalization for brachytherapy applicator insertion at the operating theatre, MRI imaging and transport, nursing and medical attention, brachytherapy delivery, to lastly discharge. The professional time required for each step of our institutional workflow was analyzed. The target was to achieve at least 90% compliance against the service guidelines.

Result & Outcome :

The first audit reviewed 35 patients with cervix cancer who received definitive radiotherapy between March 2015 and March 2017. In response to deficiencies identified, measures were devised to improve the workflow and operational care of patients. This includes creation of a refined post-operative order and a comprehensive peri-operative pain and symptom assessment chart by nursing staff, as well as liaison with Department of Diagnostic Radiology on early planning of MRI appointment slots and contingency plan in case of network breakdown. A second audit was conducted that included 8 patients treated between Jan 2018 and June 2018. Overall, the compliance rate against the departmental guidelines improved from 78% to 96% for informed consent, 84% to 99% for medical care, 83% to 98% for nursing care, 66% to 100% for pain assessment and 64% to 100% for symptom assessment after the interventions. In conclusion, sound treatment planning, patient monitoring and effective team communication on improvement measures are imperative to ensure patients’ safety and quality service delivery in the complex procedure of MRI-guided brachytherapy that requires the concerted efforts from multiple disciplines.