International brachytherapy consortiums are advocating for the incorporation of magnetic
resonance imaging (MRI) into the cervical brachytherapy process as a standard-of-care.
Although some evaluations have been performed to quantify the effect on procedural
time, little is known about the views and experiences of key stakeholders during the
transition from computed tomography to MR-guided brachytherapy. This qualitative research
project explored insights from key stakeholders related to a change in the gynaecologic
Methods and Materials
Semi-structured interviews were designed using Lean Methodology principles and all
key members in the gynaecologic brachytherapy team were approached for participation:
radiation oncologists, medical physicists, radiation therapists, the lead MR technologist,
and the ward nurse manager. Interviews were recorded and transcribed, and analysis
was performed to identify themes from the data.
Ten of 12 (83% participation rate) key members of the team were interviewed. Four
themes emerged from the data: challenges to efficiency, staff availability, patient
history and disease characteristics, and team communication. The stakeholders expressed
that the challenges during this transition were procedural inefficiency (sharing of
the MRI scanner and increased procedure length because of increased complexity in
contouring and planning), and staff availability (radiation oncologist and transportation
staff). The clinical team identified the value of communicating patient history and
disease characteristics ahead of the brachytherapy procedure day and also using an
inclusive mode of communication during the procedure was beneficial.
This research provides nuanced insights into process and practice changes that occur
when one imaging technology is simply swapped for another, emphasizing how intertwined
and complex brachytherapy procedures can be. It emphasizes that not all challenges
to efficiency are considered Lean Wastes, and that seemingly simple procedural changes
can result in unanticipated differences in staff availability, communication pathways,
and knowledge requirements.