A change in treatment process with a modern record and verify system

Purpose: With the introduction of new treatment devices, such as a multilea f collimator (MLC) and dynamic wedge (DW), therapists have an increased res ponsibility to ensure correct treatment. Simultaneously, three-dimensional treatment planning (3DTP) has led to an increased number of portals and tab le movements. To counteract this challenge and maintain efficiency, a compr ehensive record and verify (R&V) system is mandatory. We evaluated a commer cial system (Varis) for reliability, ease of use, efficiency, and integrati on with our planning systems. Methods and Materials: Some key elements of the Varis system are: integrati on of MLC and DW; auto setup for MLC, jaw, collimator,gantry, and limited t able parameters; direct download of simulation beam data; and a regimented field scheduling system that prescribes all beam data for particular fracti ons. Evaluation of the system was driven by treatment time analysis, error rates, and an increased workload. These issues were governed by how we diss eminated duties and how the system accommodated or changed our processes. Results: Most data entry is performed by our dosimetry staff. Data can be d ownloaded from the simulator, but more patients now move from CT simulation and/or 3DTP to the treatment machine. Varis does not link to these systems . The physics staff confirms all entries to correct data entry errors. The workload for dosimetrists increased by an average of 8 minutes/patient entr y; physics time increased by 7 minutes/patient entry; the weekly electronic chart check takes approximately 3 minutes/patient. Therapists who used Var is efficiently showed a slight decrease in treatment times, attributed to M LC integration and auto-setup. Some therapists experienced a decrease in ef ficiency, because of unfamiliarity and excess intervention. On a positive n ote, notable events have decreased by a factor of 10 since full initiation. Unfortunately, the remaining errors are often the result of a therapist re lying on incorrect electronic information. Conclusion: The Varis R&V system has had an impact on our clinic's process and efficiency. Checking of all beam data and related field scheduling have helped reduce errors and misconceptions. We feel a dual-energy machine can be operated with two experienced therapists and an up-to-date R&V system m ore accurately and efficiently than with three therapists working without a n integrated R&V. We anticipate future Varis releases will further promote efficiency and accuracy. (C) 1998 Elsevier Science Inc.