2203 - Distribution of Responsibility across the HDR Brachytherapy Team: Results of a Nationwide Survey

J. E. Zoberi¹, J. Meyer², H. A. Al-Hallaq³, A. Landers⁴, J. L. Leif⁵, and H. Kim⁶; ¹Washington University School of Medicine, Department of Radiation Oncology, St. Louis, MO, ²Department of Radiation Oncology, University of Washington/ Fred Hutchinson Cancer Center, Seattle, WA, ³Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, ⁴University of Washington, Seattle, WA, ⁵IROC MD Anderson, Houston, TX, ⁶Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA

Purpose/Objective(s): To report resource allocation practice patterns for high dose rate (HDR) brachytherapy (BT), and cast light on the workload, stress levels, and job satisfaction of medical physicist providers. Materials/

Methods: A comprehensive survey regarding practice patterns for HDR BT was designed by a group of authorized medical physicists (AMPs) from multiple institutions, and then distributed to physicists across the United States in October 2023. 429 respondents completed the survey of which 365 (85%) provide brachytherapy services. Respondents were asked to select “who is predominantly responsible” for 15 workflow steps to assess workload distribution across team members including the AMP, physician authorized user (AU), physics and physician residents, dosimetrist (DOS), therapist (RTT), nurse, physics assistant, other, and unknown. Multiple members could be selected for each step. The frequency (N) of the selected member was recorded for each task. Respondents were asked to select the number of AMPs or DOS involved for planning (excluding contouring) and checking of different HDR treatment types. Respondents were also asked 5-point Likert type questions regarding stress and job satisfaction.
Results: The AMP was selected as one of the predominantly responsible members for all 15 steps and was most frequently selected in 10 steps. Of these, 6 steps were QA-related (daily, source exchange, applicator, inventory, planning system, plan checks) and 4 steps were treatment-related (treatment planning, applicator connection, operation of treatment console, treatment delivery). Contouring was a task shared between the AMP (N=212) and AU (N=234). The 4 remaining steps (and most frequently selected member) were applicator insertion (AU), simulation (RTT), applicator sterilization (nurse), and scheduling (split between RTT [N=184] and nurse [N=181]). “2 AMPs” and “0 DOS” were most frequently selected (54-68% and 79-88%, respectively) for planning/checking of the different treatment types. Of the 365 respondents, 82% and 73%, respectively, agreed that “covering the HDR service is more stressful than covering the external beam (EB) service" and that “switching between multiple services adds additional stress”. Respondents indicated that “better understanding and appreciation by superiors/admin of effort and stress levels when doing complex procedures” (76%) and “more consideration in patient scheduling for physics availability” (72%) would have at least some impact on job satisfaction.
Conclusion: To our knowledge, this is the first nationwide survey of medical physicists for HDR BT practice patterns, staffing, and stress. While HDR BT involves multiple team members, survey results show that the AMP carries the bulk of responsibility. Most respondents agree HDR is more stressful than EB. The survey suggests there may be some opportunity to re-distribute certain tasks to other HDR team members, i.e., DOS and RTT, or provide more physics FTE to support these complex treatments.