# Optimization of treatment workflow for 0.35T MR‐Linac system

## TL;DR

This study evaluates the workflow and costs of MR-guided radiotherapy using FMEA and TDABC methods to improve safety and cost-effectiveness.

## Contribution

A novel integration of FMEA and TDABC to assess MRgRT workflow safety, quality, and costs compared to CTgRT.

## Key findings

- 279 failure modes were identified, with 31 classified as high-risk.
- MRgRT costs were higher than CTgRT, but technological improvements led to cost savings.
- FMEA and TDABC together offer insights for optimizing MRgRT workflow and safety.

## Abstract

This study presents a novel and comprehensive framework for evaluating magnetic resonance guided radiotherapy (MRgRT) workflow by integrating the Failure Modes and Effects Analysis (FMEA) approach with Time‐Driven Activity‐Based Costing (TDABC). We assess the workflow for safety, quality, and economic implications, providing a holistic understanding of the MRgRT implementation. The aim is to offer valuable insights to healthcare practitioners and administrators, facilitating informed decision‐making regarding the 0.35T MRIdian MR‐Linac system's clinical workflow.

For FMEA, a multidisciplinary team followed the TG‐100 methodology to assess the MRgRT workflow's potential failure modes. Following the mitigation of primary failure modes and workflow optimization, a treatment process was established for TDABC analysis. The TDABC was applied to both MRgRT and computed tomography guided RT (CTgRT) for typical five‐fraction stereotactic body RT (SBRT) treatments, assessing total workflow and costs associated between the two treatment workflows.

A total of 279 failure modes were identified, with 31 categorized as high‐risk, 55 as medium‐risk, and the rest as low‐risk. The top 20% risk priority numbers (RPN) were determined for each radiation oncology care team member. Total MRgRT and CTgRT costs were assessed. Implementing technological advancements, such as real‐time multi leaf collimator (MLC) tracking with volumetric modulated arc therapy (VMAT), auto‐segmentation, and increasing the Linac dose rate, led to significant cost savings for MRgRT.

In this study, we integrated FMEA with TDABC to comprehensively evaluate the workflow and the associated costs of MRgRT compared to conventional CTgRT for five‐fraction SBRT treatments. FMEA analysis identified critical failure modes, offering insights to enhance patient safety. TDABC analysis revealed that while MRgRT provides unique advantages, it may involve higher costs. Our findings underscore the importance of exploring cost‐effective strategies and key technological advancements to ensure the widespread adoption and financial sustainability of MRgRT in clinical practice.