How many simulations per day per scanner can your therapists get done?

[emt409]

We are having MAJOR issues in our department with our main campus sim staff. Currently, we can only get 6-8 ppl simmed each day. Adding on emergent inpatients is always drama. I feel like other departments I've rotated through comfortably get through twice as many patients. Obviously, the simulation efficiency depends on a number of factors, but I'm looking for ballpark averages.

Those of you with really efficient simulation process, what are your tips and tricks?

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[medgator]

6-8 outpatients is generally what we do on a given a day, but if we have an emergency, we can usually squeeze it in with one of the other non-contrast palliative SIMs (which generally take a half hour or less), allowing 2 sims in an hour

 

[seper]

6-8 per shift is a lot, IMO

 

[nkmiami]

6-8 per shift is a lot, IMO

Typical sim times should be 30 minutes for palliative/prostate/breast, 45 if you are doing 4d /contrast /stereo/ brain. If you are doing 8 + sims a day- you probably will need 2 therapists. Some places do consents, discuss treatment with pt at time of sim which can also take up time, but could be moved out of the sim...

 

[medgator]

Typical sim times should be 30 minutes for palliative/prostate/breast, 45 if you are doing 4d /contrast /stereo/ brain. If you are doing 8 + sims a day- you probably will need 2 therapists. Some places do consents, discuss treatment with pt at time of sim which can also take up time, but could be moved out of the sim...

We use a dedicated CT tech +/- therapist trained in CT when needed, along with our PET/CT simulator. Having a dedicated CT tech is nice, able to place IVs for contrast etc. I do agree regarding those timings though

 

[emt409]

We use a dedicated CT tech +/- therapist trained in CT when needed, along with our PET/CT simulator. Having a dedicated CT tech is nice, able to place IVs for contrast etc. I do agree regarding those timings though

Do you utilize a separate staging area outside of the scanner room for mask/cradle fabrication?

 

[medgator]

Do you utilize a separate staging area outside of the scanner room for mask/cradle fabrication?

Yes when doing PET/CT simulation, we use the CT simulator to do the mask or vacloc first. It would not be a bad idea for any practice with a single busy scanner though

 

[McConaughey]

~8/day is ok. It’s a busy day. Simulations take time.


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[2014XRT]

I mean....6-8 is pretty standard. is it not?

especially at an academic center with more and more of these likely involving ABC or 4D (this is true at many private centers as well of course)

I'm sure at main campus you guys have more than 1 simulator tho

 

[metallica81788]

What are the hours the CT is running (9-3 or 8-5 or 6)? Can those hours be extended in either direction without paying overtime or causing stress amongst the staff? Is there an hour "lunch break" that can be used for add-ons or emergencies? Sometimes I feel that our main CT could do more than the average 6-7 per day and those are usually the questions posed.

 

[scarbrtj]

8 sims/day = 40 sims/week = 40 new starts a week = ~160-200 patients on treatment

That's pretty busy. Of course, it could be like that time a kid I knew in HS said he went 50 miles in 5 minutes on his motorcycle in LA traffic. I was like, "You mean you went 600mph?" And he was like, "OK... maybe it was 10 minutes."

 

[emt409]

8 sims/day = 40 sims/week = 40 new starts a week = ~160-200 patients on treatment

That's pretty busy. Of course, it could be like that time a kid I knew in HS said he went 50 miles in 5 minutes on his motorcycle in LA traffic. I was like, "You mean you went 600mph?" And he was like, "OK... maybe it was 10 minutes."

The issue is we probably have about 100 intracranial SRS's per year, many of which come from inpatient. And are only on beam, 1 to 5 days. Working them in has become a major challenge. And, patients travelling in from long distances having to return in a week for a sim, and then 1.5wks later is a major disruption to workflow and patient logistics.

 

[lhl]

8 sims/day = 40 sims/week = 40 new starts a week = ~160-200 patients on treatment

That's pretty busy. Of course, it could be like that time a kid I knew in HS said he went 50 miles in 5 minutes on his motorcycle in LA traffic. I was like, "You mean you went 600mph?" And he was like, "OK... maybe it was 10 minutes."

160-200 on treats divided by 40 new starts a week would be an average of 4-5 weeks of treatment per patient. This may have been true 10 years ago but seems high for current practice. I'm sure there is quite a range based on patient mix, disease site, and practice pattern, but at our center the average time on treatment is probably 3 weeks right now (most palliation and SBRT in 1-5 fractions)

I'm curious what other's average time on treatment or number of fractions is?

 

[seper]

As you yourself alluded to, the answer would wary enormously between types of practices. In our clinic, there is a lot of prostate HDR monotherapy.

160-200 on treats divided by 40 new starts a week would be an average of 4-5 weeks of treatment per patient. This may have been true 10 years ago but seems high for current practice. I'm sure there is quite a range based on patient mix, disease site, and practice pattern, but at our center the average time on treatment is probably 3 weeks right now (most palliation and SBRT in 1-5 fractions)

I'm curious what other's average time on treatment or number of fractions is?

 

[Palex80]

With more and more adaptive RT been carried out I feel like our CT simulation capacity is suffering from all the re-simulations we need to do.

Furthermore some special CTs tie up capacity like special immobilization for SBRT, DIBH "exercises" and 4D-CT.

 

[evilbooyaa]

I think 8 is a good number to average per day. If overtime needs to be paid to get inpatient emergencies done then so be it - sometimes techs will offer to come in an hour early the next morning which is usually fine for inpatient whole brain.