Main Session
Sep
27
PQA 02 - Pediatric Cancer, Sarcoma and Cutaneous Tumors, Medical Education & Professional Development, and Health Services Research
2303 - Clinical Workflow Cost Analysis of Parallel vs. Sequential MR-Linac SBRT for Prostate and Pancreatic Cancer using Time-Driven Activity-Based Costing
Presenter(s)
Wing Yun Au, BS - University of Virginia Health Systems, Charlottesville, VA
W. Y. Au1, Z. Feldt1, M. Mistro2, E. Janowski3, C. Luminais3, M. Conley4, M. Miller5, and C. McLaughlin6; 1University of Virginia School of Medicine, Charlottesville, VA, 2University of Virginia Department of Radiation Oncology, Charlottesville, VA, 3Department of Radiation Oncology, University of Virginia, Charlottesville, VA, 4University of Virginia, Department of Radiation Oncology, Charlottesville, VA, 5Miami Cancer Institute, Miami, FL, 6Department of Radiation Oncology, University of Virginia Health, Charlottesville, VA
Purpose/Objective(s):
Magnetic resonance linear accelerators (MR-linac) enable daily adaptation and real-time tumor visualization but are limited by long treatment times, low throughput, and inefficient workflow. Recent software updates enable a shift from a sequential to a parallel workflow which could potentially reduce resource utilization. However, the magnitude of optimization this creates is not well quantified. This study evaluated the cost impact of these workflow changes using Time-Driven Activity-Based Costing (TDABC). We hypothesized that parallel MR-linac workflows for stereotactic body radiation therapy (SBRT) in prostate and pancreatic cancer would significantly reduce direct costs by shortening treatment time, streamlining delivery steps, and decreasing resource utilization.Materials/Methods:
TDABC was used to estimate direct costs for sequential and parallel workflows at an academic medical center. Process maps for each appointment type across non-adaptive prostate, adaptive prostate, and adaptive pancreas SBRT were constructed from process measurements, staff interviews, and administrative data. Institutional cost rates were applied to determine per-minute costs for space, equipment, personnel, and materials. These per-minute costs were then applied to process maps to compare total treatment course costs between parallel and sequential workflows.Results:
Total treatment costs for parallel workflows were $10,746.60 (non-adaptive prostate), $11,772.37 (adaptive prostate), and $10,323.11 (adaptive pancreas). Sequential workflow costs were higher at $11,196.91, $14,813.86, and $13,636.36, respectively. This corresponds to a cost reduction of 4%, 21%, and 24% in favor of parallel workflows. The largest savings were found in space and equipment utilization: $3,342 vs $3870 (non-adaptive prostate), $4,098 vs $6,650 (adaptive prostate), and $6,352 vs $9,246 (adaptive pancreas). Cost reductions were concentrated in workflow steps directly affected by the new software, including contouring, imaging, 2D shift application, and plan review.Conclusion:
A parallel MR-linac workflow substantially reduces direct costs for prostate and pancreatic SBRT, primarily by decreasing space and equipment time during on-table adaptive steps. These findings highlight the operational impact of software-enabled workflow redesign and identify high-yield targets for continued optimization. This operational efficiency raises potential for further investigations into improved patient experience, outcomes, and throughput, and may support broader MR-linac adoption.