Determination of the durations and variations in the workflow of brachytherapy for locally advanced cervical cancer according to the EMBRACE II protocol between academic centres in the Netherlands and analysis of the impact of MR-imaging on these brachytherapy workflows

The objective of this study was to identify all tasks required for an LACC brachytherapy treatment procedure and to assess differences in procedure times and specific tasks among Dutch academic centres. The study evaluated the impact of imaging on this procedure. A time-motion study (TMS) was employed to document the procedural steps in real-time, focusing on the duration and execution of tasks. The research identified 94 (sub-)steps necessary for a brachytherapy procedure for LACC. The analysis revealed variations in procedure times among the observed hospitals, with a mean procedure time of 6 hours. The most remarkable variations were observed during contouring, determining dose points, and plan optimisation, MRI scan time, and plan evaluation. Over half of the treatment time is spent on imaging-related activities or activities influenced by imaging. Imaging tasks were performed in all observed procedures with almost the same duration, demonstrating no difference between academic centres in the Netherlands. The study provides insights into the impact of imaging on the workflow. The main limitations of the research include the limited amount of observations, its focus on Dutch academic centres only, and the omission of tumour staging, needles used, and fraction number, thereby ignoring inevitable variation among patients.