Radiotherapy department at The Christie reduces next treatment slot wait times by more than 75 percent in three months

The Christie NHS Foundation Trust (The Christie, Manchester, UK) is a comprehensive specialist cancer center treating around 7,800 patients with photon radiotherapy every year. Faced with a surge in cancer diagnoses driven by national screening programs, their radiotherapy department faced acute treatment capacity challenges in October 2023. In response, The Christie turned to Elekta ONE Analytics to address mounting treatment demands and uncover operational efficiencies.

“The beauty of Analytics is that it makes the data stored in MOSAIQ more accessible – available at the touch of a button. This opens up a world of opportunities,” says Dr. John Archer, Head of Radiotherapy and Proton Services (2022-25) at The Christie. “We needed Analytics to help identify opportunities to improve our treatment capacity; to quantify what these opportunities might look like; and then to demonstrate that we’ve delivered on these opportunities.”

Using Analytics, the team at The Christie began to look at where potential time savings could be made in order to create additional treatment capacity. One area that they looked at was scheduled treatment appointment duration, to see if this could be reduced for certain indications. To establish a baseline, they compared the average appointment duration scheduled to the actual duration that the treatment plan was open on the sequencer for all indications. Then they did the same for individual treatment techniques to identify if there were any time saving opportunities. Where potential opportunities were identified, they would ask their clinical experts to explore if change was plausible.

“All of a sudden, we were able to shave five minutes off our lung VMAT appointment duration …We just didn’t know where the low hanging fruit was, and Analytics has helped us find it.”

“One of the best examples of an opportunity realized is seen with our lung treatments,” Dr. Archer explains. “Through Analytics we were able to identify a potential time-saving opportunity, and our radiographers investigated. Previously, we scheduled 20 minutes for lung VMAT but, looking at all these patients, the radiographers were confident that treatment could be delivered in 15 minutes without any problems. All of a sudden, we were able to shave five minutes off our lung VMAT appointment duration. It’s just as safe. Quality hasn’t been impacted. We just didn’t know where the low hanging fruit was, and Analytics has helped us find it.”

Optimizing the use of VMAT

Analytics also allowed the team to visualize the proportion of lung patients that were currently being treated using VMAT, compared to those still being treated using IMRT.

“Using Analytics, we could see that 90 percent of our non-SABR radical lung cases were treated using VMAT, but 10 percent were still being treated using step and shoot,” Dr. Archer comments. “We asked our physics colleagues to investigate if there was an opportunity to further increase the use of VMAT, knowing that it is quicker and requires a shorter appointment duration. After exploring solutions for the types of patients that fell within the 10 percent bracket, we have now practically eliminated step and shoot for non-SABR lung.

“The combination of these two opportunities… has saved us around 4.5 hours per day of treatment capacity.”

“The combination of these two opportunities – performing more lung VMAT and reducing lung VMAT appointment time – has saved us around 4.5 hours per day of treatment capacity.”

Increasing prostate SABR

Following the recent promising results of the PACE-B trial¹, which demonstrate the value of delivering prostate SABR in five fractions, the team at The Christie has also identified an opportunity to increase and monitor the uptake of prostate SABR.

“…increasing prostate SABR has saved almost an hour of treatment capacity per day.”

“We have been performing some prostate SABR for the last few years but, since the results of the PACE-B trial, we have accelerated the use of prostate SABR with our urology team. In consultation with our experts, we knew we could realistically aim to deliver 30 percent of our radical prostate cases in five fractions. Monitoring our progress in Analytics, we can see that the proportion of prostate SABR has increased from 10 percent to about 25 percent now. At 20 percent, we could already demonstrate that increasing prostate SABR has saved almost an hour of treatment capacity per day.”

Impact on treatment capacity

By identifying these and other opportunities in Analytics and then engaging with the clinical experts to translate these opportunities into time savings where appropriate, the department has been able to free up 7.8 hours of machine capacity per day, just by reducing the average appointment time alone.

… since 22 December 2023, our consult to treatment pathway has been reduced by over 75 percent.”

“Analytics helped us to respond to a major challenge,” says Dr. Archer. “In October 2023, we began to address treatment capacity issues and now, since 22 December 2023, our consult to treatment pathway has been reduced by over 75 percent.”

“The first benefit of our increased capacity is that radiotherapy patients are receiving treatment much quicker than they were in the past,” he comments. “Also, reducing the length of attendance for a patient, and reducing the number of attendances, provides a better patient experience. Secondly, it benefits the morale of our teams. In the past, we were so busy, and the days ran quite late. Now, we’re finishing on time, and we have created capacity for our radiographers to explore other interesting activities, in addition to treating patients.”

“In addition, by delivering such efficiencies, it helps us to meet our annual cost improvement program targets without cutting posts,” he adds. “This impacts the overall performance of the entire hospital.”

Moving forward with Analytics

It’s early days for The Christie, in terms of their use of Analytics. The opportunities they have identified so far have been heavily centered around operational aspects of the department in response to their biggest need. Now the department is starting to look at how they can use Analytics from a ‘business as usual’ perspective.

“We have a monthly meeting where we report on all areas of our service,” says Dr. Archer. “Analytics will help us to demonstrate quantitative aspects of our performance and allow us to review this as a team. It is a valuable tool, not just to demonstrate the impact of the amazing work we’ve done over the last six months to transform our treatment capacity, but also to explore how we now maintain this. Patient volume will continue to increase and so moving into a phase of continual improvement is really important to us. Instead of waiting for things to deteriorate, we will constantly look for opportunities to improve.”

“We have four sites, with the main site in the center of Manchester. Using Analytics, we can really make sure that we’re using the capacity to its full potential at the satellite centers as well as here in Manchester,” he continues. “Analytics is also helping us to think about our clinical model and to understand our demand and capacity a bit better. We want to be able to treat patients as close to home as possible, but we also need to distribute our activity evenly across all our sites to ensure patients get their radiotherapy in a timely manner.”

“With Analytics we have been able to show that we can harness our subject matter expertise to do more with what we’ve got.”

“With Analytics we have been able to show that we can harness our subject matter expertise to do more with what we’ve got,” he concludes. “As a result, we’ve established a really healthy relationship with our executive-level leaders.”

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*References: 1. van As, N. et al. Int J Radiat Oncol Biol Phys 2023; 117(4): E2-E3.

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