Quality improvement methodology implementation for timely MRI-based brachytherapy treatment delivery in watch-and-wait expectant rectal cancer patients

Purpose:
Long-course chemoradiation followed by a brachytherapy boost is one of the acceptable treatment options for watch-and-wait (W&W) eligible rectal cancer patients. However, MRI acquisition, planning, and treatment delivery delays can affect patient satisfaction and treatment success. This study used the classical quality improvement methodology to optimise the MRI-based rectal brachytherapy process.

Material and methods:
A multidisciplinary core team was formed, including a radiation oncologist, radiologist, medical physicist, specialist technologist and nurse. Data on wait times from MRI to brachytherapy treatment were collected for patients receiving rectal brachytherapy between August and November 2022. We aimed to reduce the number of days of the gap between the planning MRI day and the treatment delivery day from a median (D_median) and mean (D_mean) of 14 and 15 days, respectively, to < 1 day each (primary goal) and to increase the number of same-day treatments (D_0%) from currently 0% to at least 70% (secondary goal) by 31st January 2023. The balancing measure was treatment errors or delays. Quality improvement measures were implemented using the Plan-Do-Study-Act (PDSA) cycles.

Results:
The post-implementation data at PDSA 1 and 2 from 14 patients each were analysed. The post-change D_median, D_mean and D_0% improved to 3, 3 days and 35.7% for PDSA 1. This further improved to zero, 0.2 days and 78.9%, respectively, for PDSA 2. A sustained shift in the process was apparent on a control run chart, suggesting sustainability. Further in the sustenance phase, the D_median, D_mean and D_0% were maintained at 0.3, 0 days and 74%, respectively, for over 42 patients.

Conclusions:
Using the classical quality improvement methodology, we sustainably reduced the delay between the planning MRI day and the treatment delivery day. These strategies may serve as a model for other institutions implementing MRI-based brachytherapy programmes for the W&W approach in suitable rectal cancer patients.

keywords: rectal cancer, brachytherapy, MRI, quality improvement, A3 methodology