3585 - Online Adaptive Radiotherapy: Evaluating Adaptor Models

Purpose/Objective(s): Online adaptive radiotherapy (ART) allows for personalized treatments with daily adjustments to treatment plans to account for interfractional anatomic changes. However, online ART is resource and time intensive with various coverage models employed by different clinics. This study sought to evaluate the human resource cost ($USD) of online ART coverage models using time-driven activity-based costing (TD-ABC).

Materials/Methods: Four staffing models were hypothesized based on staff acting as the primary adaptor (person responsible for contouring): Radiation Oncologist (RO), Physicist, Dosimetrist, or Advanced Practice Radiation Therapist (APRT). The models include two treating therapists present for the entire treatment, an adaptor present from initial imaging to contour completion, and RO and Physicist from end of adaptor contouring to start of treatment. Clinical adaptive SBRT timing data utilizing a CBCT-guided adaptive radiotherapy system, and cost per unit time for various staff was used to calculate the average total human resource cost for an online ART fraction for each staffing model. A cost comparison is shown by projecting total cost for online ART clinics of varying patient volume.

Results: The average TD-ABC for an SBRT online ART fraction was $257, $216, $198, $193 for the RO, Physics, Dosimetry, and APRT models, respectively. Projected total human resource cost is shown in Table 1. The non-RO staffing models can reduce the time an RO is required to spend at the machine from 35 minutes to 14 minutes per adaptive treatment.

Conclusion: TD-ABC analysis demonstrates the most cost-effective staffing model utilizes an APRT specially trained to contour for online ART. Additionally, specially trained personnel can alleviate the additional time burden of online ART for ROs in adaptive SBRT clinic regardless of volume. These findings suggest that incorporating a dedicated APRT to contouring for online adaptive radiotherapy not only enhances operational efficiency but is a task-shifting solution for physicians and physicists to help manage ever increasing workloads. Moreover, the APRT position may offer a new career pathway for radiation therapists, potentially addressing critical issues like job satisfaction and staff retention.