Technology assessment of multileaf collimation: A North American users survey

Purpose: The American Association of Physicists in Medicine (AAPM) initiate d an Assessment of Technology Subcommittee (ATS) to help the radiotherapy c ommunity evaluate emerging technologies. The ATS decided to first address m ultileaf collimation (MLC) by means of a North American users survey. The s urvey attempted to address issues such as MLC utility, efficacy, cost-effec tiveness, and customer satisfaction. Methods and Materials: The survey was designed with 38 questions, with cros s-tabulation set up to decipher a particular clinic's perception of MLC. Th e surveys were coded according to MLC types, which were narrowed to four: E lekta, Siemens, Varian 52-leaf, and Varian 80-leaf. A 40% return rate was d esired. Results: A 44% (108 of 250) return was achieved. On an MLC machine, 76.5% o f photon patients are being treated with MLC. The main reasons for not usin g MLC were stair stepping, field size limitation, and physician objection. The most common sites in which MLC is being used are lung, pelvis, and pros tate. The least used sites are head & neck and mantle fields. Of the facili ties, 31% claimed an increase in number of patients being treated since MLC was installed, and 44% claimed an increase in the number of fields. Though the staffing for block cutting has decreased, therapist staffing has not. However, 91% of the facilities claimed a decreased workload for the therapi sts, despite the increase in daily treated patients and fields. Of the faci lities that justified MLC purchase for more daily patients, 63% are actuall y treating more patients. Only 26% of the facilities that justified an MLC purchase for intensity-modulated radiotherapy (IMRT) are currently using it for that purpose. The satisfaction rating (1 = low to 5 = high) for depart ment groups averaged 4.0. Therapists ranked MLC as 4.6. Conclusions: Our survey shows that most users have successfully introduced MLC into the clinic as a block replacement. Most have found MLC to be cost- effective and efficient. The use of MLC for IMRT has progressed slower, but users anticipate escalated use. (C) 1999 Elsevier Science Inc.