Exhibit Hall | Forum 1
Purpose: To describe a new IORT workflow for the INTRABEAM PRS500 system (Zeiss, Germany) based on implementing TG262 recommendations including the integration into R&V EMR, electronic charting and automation. An emphasis was placed on improving workflow efficiency in the OR, developing a fully paperless IORT service and automating the manual independent verification of INTRABEAM dose/time calculation.
Methods: The efficiency of our IORT clinical workflow was improved by incorporating Care Paths and Encounters in ARIA (Varian Medical Systems) to automate reporting tasks and eliminate hard-copy documentation. The written directive was integrated in a new IORT Care Path. Electronic checklists for pre-treatment QA, treatment time-out and self-populating Microsoft word templates for special physics consultations were created. Enhanced safety was achieved by implementing a semi-automated independent verification of treatment parameters, based on independently fitting the manufacturer provided dose-rates and transmission tables to support the use of spherical, flat and surface applicators. The choice between TARGIT/V4.0 dose rates was automated based on treatment site. Independently calculated Treatment parameters were validated against INTRABEAM system values for all applicators across the entire range of clinically relevant treatment depths.
Results: The risk of occurrence of several potential failure modes including incorrect dose rate selection based on treatment site, incorrect transmission value from selecting the wrong applicator serial number, and simple mathematical errors were reduced by automating those tasks with our paperless independent calculation. The new IORT workflow was integrated within Aria seamlessly, resulting in a reduction of physics time and personnel needed during IORT.
Conclusion: The use of Care Paths, Encounters and embedded verification spreadsheet optimized the efficiency of our IORT workflow while improving patient safety through minimizing the risk of human errors. This approach can be expanded to other non-traditional therapy devices to improve safety.