Utilization of an APRT for Online Adaptive Radiotherapy with Time-Driven Activity-Based Costing

Summary: Online adaptive radiotherapy (oART), which tailors treatment plans in real-time to patient anatomy changes, has widened the therapeutic index for various malignancies. Despite these innovations, delivering such care remains resource intensive. This study assessed the impact of implementing an advanced practice radiation therapist (APRT), as a physician-extender, on contouring times. Using clinical timing data, a time-driven activity-based costing (TD-ABC) analysis was done comparing the cost (USD $) of five oART staffing models. A 2-year analysis of our high-volume oART SBRT program was done to evaluate the effect that the APRT had on contouring times, adaptive process times, and overall treatment times compared to the physicians across a large SBRT patient cohort. All timing data were stratified and compared depending on whether the APRT was present and contouring or if the APRT was absent (MD Fraction). The collective data was then used to assess the financial impact of various hypothesized coverage models through TD-ABC, a method in which the cost of an overall process is calculated via cost per unit time for the sub-processes. Timing data was recorded for 530 adaptive SBRT fractions for 117 individual SBRT patients. The APRT was the primary adaptor for 339/530 fractions, while an RO was primary adaptor for 191/530 fractions. APRT contouring was performed by one APRT, and physician contouring was performed by a team of seven physicians. Data indicated that APRTs significantly reduced contouring times by 10 minutes on average, compared to MD fractions (p< 0.001). This alleviated physicians' workload by 15 minutes per adaptive session on average. The TD-ABC analysis, shown in the table, highlighted that the physician as primary adaptor model was the most expensive, while APRT based models were less expensive. The results show that a specially trained therapist can alleviate the additional time burden of oART for physicians in a high volume oART SBRT clinic. Additionally, clinical timing data and TD-ABC analysis demonstrated cost reduction with APRT based staffing models. By redefining the roles within the adaptive radiotherapy team, substantial improvements in workflow and cost-effectiveness can be achieved, promoting a sustainable approach to delivering personalized cancer treatments. These findings suggest that incorporating APRTs not only enhances operational efficiency but offers a new career advancement pathway for radiation therapists, addressing critical issues like job satisfaction and staff retention. Robbie Beckert, BS, RT(R)(T) (Presenting Author) - Washington University School of Medicine in St. Louis; Eric Laugeman, MS, DABR (Co-Author) - Washington University School of Medicine in St. Louis; Alex Price, PhD, DABR (Co-Author) - Case Western Reserve University; Eric Morris, PhD, DABR (Co-Author) - Washington University School of Medicine in St. Louis