Intra-operative process efficiency for in-room MRI-guided combined intracavitary/interstitial brachytherapy for cervical cancer.
Magnetic resonance image-guided brachytherapy (MRgBT) is the gold-standard treatment for cervical cancer. This study examined workflow times in an integrated MRgBT suite and conventional operating room (OR), and factors contributing to intraoperative efficiency. Consecutive patients with FIGO stage IB-IVA cervical cancer who underwent MRgBT procedures between 2019-2022 were retrospectively reviewed. Workflow times were collected: applicator insertion, MR-imaging, contouring, treatment planning, treatment execution and total procedure time. Procedure durations between applicators and over time were compared. The 161 patients included in this study underwent 267 procedures in the MRgBT suite, and 56 procedures in the OR using ovoid and tandem applicator (O&T, 46%), ring and tandem (R&T, 28%), or Syed-Neblett template (Template, 27%). The median duration (minutes) of each step was: general anesthesia induction (18), applicator insertion (31), MR-imaging (28), parallel contouring (48) and applicator/needle registration & treatment plan optimization (83), and treatment execution (19). Total procedure time was much longer in the OR (488 minutes) than MRgBT suite (205 minutes). Template cases were significantly longer in insertion, MR-imaging, contouring, planning and total procedure time (by 52 minutes) compared with those using the R&T/O&T applicators (p<0.001). Total procedure time for Template cases reduced by 10 minutes/year since 2019 (p<0.001). Regardless of applicator type, total procedure time for subsequent insertions was 21 minutes less than the first (p<0.001). MRgBT procedure time was longer for Syed-Neblett template cases, but shorter in subsequent insertions. The overall procedure time was much shorter in the integrated MRgBT suite than conventional OR.