From Computed Tomography-Guided to Magnetic Resonance Imaging-Guided Intracavitary Brachytherapy for Cervical Cancer: What Do the Key Stakeholders Have to Say about the Transition?

Background: 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 brachytherapy process.

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.

Results: 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.

Conclusions: 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.