Table 2.

Factors contributing toward treatment-planning delays or treatment delays as reported and analyzed based on our incident-reporting and analysis system.

Treatment-planning and treatment delays
PLANNING PROCEDURE DELAYS (58%)
Contour or prescription delays: additional information needed (previous RT treatment, additional images, MD peer review, new diagnostic workup or findings, pathology reviews), case complexity, late image import into TPS, management (MD availability and handoffs), re-contouring, delinquency
Plan delay: insufficient time for planning (case complexity, physics coordination, delay-rush processes), plan modifications (plan deliverability issues on Linac, prescription or constraint modifications, modality change, re-contouring), problems with plans (protocol requirements not achieved, inconsistent with directives), management (planner availability and handoffs), delinquency
Modifications to previous SIM required: fit or placement of treatment aid inadequate, changes in patient anatomy (surgical procedures, device implants), images unacceptable for treatment-planning (artifacts, anatomical coverage), patient preparation inadequate (bladder, rectal filling)
PLAN VERIFICATION DELAYS (23%)
Second Physics checks: fields not approved in EMR, IMRT QA delays or issues, plan documents not in EMR, problems identified with plans, physics coordination
Problems noted by therapists in V-SIM checks: problems identified with plans (ambiguous plans in EMR, dose mismatch error, incorrect DRRs, incorrect field size, delinquent patient accessory requests), plan deliverability issues, pre-treatment repeat CT required, treatment machine issues, missing approvals
ENVIRONMENT (10%)
Informatics issues (problems with EMR, network communications issues, PACS, TPS), scheduling, and coordination of appointments; weather related issues
COORDINATION-OF-CARE WITH NON RT MDS (5%)
Other procedures or MD availability: chemotherapy, admittance to hospital, blood work, dental work, erbitux therapy, heart monitoring, infection treatment, medical oncology appointments, other exams needed, neurosurgeon availability
Additional information presented: pathology reports, protocol screening, surgical consultation, tumor rounds, biopsy, laboratory tests, further diagnostic workup results
PATIENT FACTORS LEADING TO DELAYS (4%)
Patient not amenable to/compliant with RT procedures, receiving treatment for other health/medical problems, scheduling unsatisfactory or required change, transportation issues, personal factors, obtaining second opinions, declined MRI, debilitation, deteriorating medical conditions
SIMULATION DELAY (1%)
Simulation stopping events, image quality problems

Numbers in parentheses correspond to the percentage of cases for each sub-category.