Forecasting and optimization of the kilovoltage X-ray therapy office within the framework of clinical guidelines of the Association of oncologists of Russia (AOR) of the Ministry of health of the Russian Federation

Abstract

One of the elements of the quality of medical care is its accessibility, which depends on the material and technical base of the institution, as well as on the availability of stuff and work management. Implementation of the new clinical guidelines of the Association of Oncologists of Russia (AOR) for the treatment of non-melanoma skin cancer (NRC), revealed the problem of increasing the load on stuff and equipment. Purpose of the study. To investigate and forecast the load of the kilovoltage X-ray therapy unit taking into account the updated clinical guidelines for the treatment of patients with non-melanoma skin cancer using radiotherapy. Determine the clinical and organizational changes in the technology of x-ray therapy for non-melanoma skin cancer within the day-hospital department for the skin cancer size more than 2 cm after implementation of new clinical guidelines and fraction regimes in compare with previously used schemes; derive a mathematical model of the work of the kilovoltage x-ray therapy room. Materials and methods. Data from the kilovoltage X-ray therapy office of radiotherapy unit No. 2 of the Sverdlovsk Regional Oncology Dispensary (SROD) were used. The average duration of radiotherapy sessions per patient was estimated and calculated using timekeeping. The results were evaluated using correlation analysis. In order to forecast the use of material and human resources, an economic method of mathematical modeling was used. Results. The analysis of the kilovoltage X-ray therapy unit of radiotherapy department No. 2 of the SROD for 3 years showed an increase from 10.4 to 17.3 in the average number of therapeutic fractions per patient after the implementation of the updated clinical guidelines. An increase in the average number of radiotherapy sessions leads to a doubling of the average bed-day of the patient's stay in the day-hospital. The formula was proposed for predicting the work of the unit. There is a clear correlation between the duration of treatment, the dynamics of hospitalization and the number of treated patients. The calculated results obtained using a mathematical model fully correspond to the actual performance of the radiotherapy room. Conclusion. To ensure optimal availability of medical care, it is necessary to match treatment technologies with available resources of the organization. The introduction of new treatment programs may require both the expansion of staff (medical, nursing), and an increase in the number of units of medical equipment. The obtained mathematical model of the kilovoltage X-ray therapy room allows to predict the optimal mode of work of employees while maintaining the quality and accessability of medical care.