Financial Impact on Physician Time for Technologic Advances in Adaptive Stereotactic Partial Breast Irradiation

Summary: Adaptive radiotherapy (ADT) is growing due to improved dosimetry and potential toxicity reduction [1]. However, this treatment can increase demands on the treatment team. This study looked at technologic advancements including artificial intelligence (AI) and remote contour and plan review to reduce physician time at the treatment console when treating adaptive stereotactic partial breast irradiation (A-SPBI). Our CBCT-based adaptive workflow includes adjusting contours by trained radiation therapists followed by revision of contours by a physician and plan generation and approval. To reduce the physician time at console, physicians are paged to review contours and approve plans using the developed remote system instead of being physically present. For adaptive workflow with Gammapod, a device dedicated for A-SPBI, AI has reduced physician contouring time. The total ART time, remote call time with physician, and time spent on contouring have been recorded pre and post implementation of the new technologies. Employee’s cost per minute, using the weighted average attending salary was calculated as $2.53 [2]. The consult cost is estimated as $693 based on Medicare 2024. The mean contour, plan optimization & review and total ART time for CBCT-based adaptive workflow were 17.9 ± 5.5 min, 5.8 ± 1.6 min, 23.5 ± 5.8 min. After remote contour and plan review, the estimated physician time saving per fraction was 12.3 ± 1.0 minutes, with each remote call lasting 1.3 ± 0.7 minutes. This equates to an estimated total time saving of approximately 13 hours per month, which is equal to 13 more consults per month. The average cost saved is $1973.4. The estimated increase in revenues from consults are $9,009. For Gammapod, the contour and planning time and total treatment time (from cup fitting to cup removal) pre versus post-implementation were: 54 min, 133 min, versus 18 min, 77 min. The estimated time saving per month was 2,016 minutes which equals to 33 hour-long consults. The average cost saving for physician time is $5100, and a potential increase in consult revenue of $22,869. ART is a costly investment with a steep learning curve, but with modern advances in AI and remote review, it can make a positive impact by streamlining the process and increasing physician availability to expand patient access to physicians and novel treatment modalities.