KEV SELL RADIATION ONCOLO GREG

Transcription

1 C KEV SELL RADIATION ONCOLO y GREG

2 1. Executive Summary 1 ( : V C 11. Appendices 2 7. Options Time study analysis & formulation 9 9. Potential Revenue Recommendations Department Operation 6 4. Methodology 7 5. Survey analysis 8 8. Bluebook standards Introduction 5 ThLE OF CONTEN

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6 Purchase a new treatment unit as soon as possible so that blue book standards are maintained. The cost of technologists to ( - operate this new unit would be approximately $14. Instruct doctors to make an effort to sign patients during consultations so that the simulation wait times can be reduced. At the time of the consultation the patient is already in the department, has been assigned an examination room, and the physician is present. Eliminating the need for these conditions to be replicated at the time of the actual simulation will increase efficiency. During the time study period between 8% and 9% of the simulation wait times could have been eliminated if the patient had been previously signed. This nonproductive period represents the equivalent of over one fourth of an FTE over the course of a year.

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10 O- ft ) O (1) -co ft (n SM t ) CO < t )1 Cl) (1) 1 D ti [1)1 MO) (DO) - ft ) M Ct) - Ci Cl -CL S cn O-fl ty - 1 (D Cn )< it () JL< ft )1 MCi :3 Ci ft ) C ) - I rt )--çt ft to it - rt < ft ft ft -) Di CO - - (O -) -- I itco CoO -j M Cl> ft C X M Cl) Ci Co Ii - () --) -Q (DO it Di b ftc ) hi < j ct -)1 - ) -t to 5 co < t ft. 1 (I) (Oft - - CI McO D 5 OcO -- -O) - - S x ft (). O) - (nfj çt D 1) 5<5 ito C) -hi < (flit Cl) ) Ci -COO )) hi hi - - Ca - ft S I t it i O it C) < - - hi O ) ( Ft X - ) Cl) < <) o> o < hi- ft Ca ) 1-1 it. ) Co 3 - o - hi ft ft it C-I- > C) - - (1) M D,- Di 5 hi > ft it ft Oft Oft -. < 3 - M - - M ( O-- ) ) () <) (O-CL Di ft ) - tl E i Di S cq it 1 ( it Qft -<) co -, ft - o it 3 3 ) t t LQ - < t3 -ti his - ()1 X CO Oti sit it Cl) ) M T) ) M - ft ()1 it hi - - t-1 (DO CI M hi --O - < it (Oco -MO) CL -P) ) Z C) CO it ft hi 3 ( )1 co i it i 5< (( (( ft - (Dti - -5 ( (() M t1 - -ft )1 < 5 >-- )) Ci ti MX - :3)1)1 ) ((5 - - J ()) it (O 5) ft Cl) O) 1 t it < >- ito) >- -it J X CO (( - 5 it V )1 - ) O ) (( E - it ft Co M - (DO) O- him -O (Dfl ft COt,) - :3 5) ft -Q ( 5 Cl) - - )1) <C- - --Cl) ft <ft Co -t> O Ii - ti -t- ( 1 M CO ft ft - (l> < ) ) l3ciirj 3 j < (I) Ct) ( - C - - it Di CO [1 ito) -CL Di ci -) ft < ) it MO) hicq o -O ti ON 1 CI - - co -5..,- (( - ft <hi tim o) ()1-1 it )1M )-- ) - ) - ). ( ) -co < C-tO it itch ti 5( 3 <it,1 - M O trhipj 5)) ) ( > -. ftp) <Cl) hi(d < o it i < - - ) tj ft -Il (< ft I ft N ft ) t II hi ti O CL ti co t )) - ) -M (1) hi ) - C/) S it ) l hi - -hi - C hi X ) - Mp) t> it it - > hi ) > Di Co < - M 3 3 (((t) ) - -ti t3 - ft <-, - ) - (Dcl) C)) ito - Di < Ci - CL M 5 it - CL it < -- 5 it - - Ci Di (:3 it (DO ci -t > ()1 (( -Cl Oft Li-CT, ft -<5 fta t, it < M - ) tim-. )1ft Il MCI - - (I) -CO ft hi ( :3 3 - ) ( ft t3-co ( - ) ) it )) ft ft Ci ( it C ) - hi - (l Ci it )1 - )1 ) C-I- C)) tie MD) hi -ti Z ft Cl < -P) - ft Ci ) - ft 3 - it < (,, ) () (DC) ft (t) Ct) Ci ( ft ) < <ItI MO) - (I) CO -O Ci) ti ft ft Ci) - it f it ( hi çt (5 ft ()1 - - ti ) Ci) it.. Cl) <I :3 C ) CO t) COO ft Di ( >-

11 C) S C,, Ci, S U) Si - it M C) U) hi hi it E Ct Ct U) U) C) (I) L5 M M C) Cl,- -Ct Cl hi (D (U hi E t) it (1) U) it hi -C - )- - ) T t- ti U) < hi U) ( U) hi t3 5 t-t -5 U) i-- Q. 5 it it c C) it Cl Q3 i -U) U) OC) i ()) CU1) Cl S hi c (DO ME t) hi t-le U) OX t) i,-ca o. it U) ti Cl(D t) ito Cl ClU) ititriq it CU rt (U -5 r it - it - - it U) çt - Cn t) -t - D hi U) Cl S t- t3 j < hi C) t) Cl) it C) QO (I). it hi < < j - - CT) U).Q t) (1) it it U) 1< it it k< < C) - hi U) ti t) t) C) it -U) it M U) it U) -hi (1) (1) M ti it it Ct it tyz it t)u) - L< ( <- U) T -C Cl it -U) YU) M itq U) t) (1) U) U) t) M i it it CT) -C) C) - CC - U) MM U) it C) it S -- Cl b t) hi U) MO 5 U). (U C) it it i -(D ) t) t) t)d C) (U hi t) -i - C) Si hi -(U M -< Cl O S U) < - t) c U) -Cl, U) -Si i - i-t i- - t) ty - I -t) -C) - U) b C) it -O t) t) - t) it & CO MO I C) 5 it itt) it U) C) Cl Si hi 11 -i - U) hi I t) -U) M hi < C), -CU U) t) C) I M o C < U) U) hi Sirj (D t) CltJ ti hi it Co C) C) I Co U) tit Sit) (ULJ-ClM Ct U) U) 5 t) - Q. U) t) I it < - U) ClitClO - t) t)it SiLO < hi <( I I it - -, U) it < -ti Si -- - J rt C) I it - Cl U) Co ito U) C) t) U) tnt M I It) E it i -U) -j-c1) im &U) ti --E ci Cl) I I Cl tn it it U) M U) U)rj M it it E Cl) - I I U) I M t5< it - o M M tnu) it (I) I I t5 I U) It) S C) 1 Cl< Jt3 <(U Cl) I I it Cl U) ho M Cl I I Cl) I ici -U) Q (C (1). it i U) s Cl -ti (t) hi i I 5 U) U) < U) -U) Cl< - C) Si -D C) - it I M I I I (C it i U) U) it j hi -5 a) <U) (C I I Cl (U it MO - U) hi U) J hi it (I) I I I I hi U) (U hi hi -U) tn(d hi ito- - I ID tn it < t) C)) (C ti - Cl) -it I O M. - O S - U)< -D(I j C I-j N) i CUE it it it CO - M U) it C a) (DO - (U U) - hi -It) a)clo hi t-) J: i S C) M U) it ). C hi O ID < Cl i M hi t) - i-tie Cl tn ) it < - < (to -tn C -it it C) < it -it it U) C)) M it,u) - C - C Si ti Cl) - - o hi < it -ti ti CUE ) C S ti E Si U) C) -.it < (3 it Cl) C) -it U) tt ti - - it - ) it tn -hi tn tn ClC) it I I U) - it - ito < ti ti (I) E - - it his S it it U) -3 hi 5 -U) U) Cl itc L< it (I) -- - M tn it< Ct) (1) U) U) (DO M 5 (C - it C) hi U) ii- M C ) 5 hi it ( Ci it U) o it U) (U U) t) t)i U) hi Cl it 5. I I C tn CO hi Si b - (3 ft. -(D U) it (DEE SE - - hi t) U) - U) C Cl it U) C) it it Cl ti,l) it U) tjq it (Ut) it CT) 1(1 (1)5 tn it - U) it Si () CU - Si - Cn it c it ( 5 itci i tno t3 tj U)- -U) < U) Clhi 1 1 t) - Cl M - t3 - (i< Cl) it t) C < - U) l 4 t) (3 - ito - Cl< -fl 5 Cl rj U) U) it hi Si(D ) it it O(3 ti 5 C) U) hi I f s hi Cl - - hi -it i-b hi, U) Cl it E Si o hi o U) U) t i-i, ti C it U) LQ ti Cl Cl) it it U)

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13 ft ftt3 W J M ft (1 (r Cl) Cl M Di F- C: - ft C) M (Ii. < (Cl Fl ft - c-f - (Cl Cui C - C Fl - 1 (Cl -Cl) Z C) C (C) M 1 tux) Di Cl. C/) C: (Cl (V ft ft o çt Cl) - -Q (Cl ft - iq ç ft Cflj ) OQ (C) -< Fl - it CL - i Cl) C/) C)) t ft Cl) it ft t3 -Di i -- ) ft (C) rtlq t5 I-I C) Cl) C) C: çt - ç-t Cl ft3 Fl C) ) Cl E tu Cli SI) - T -ft - Fl -< Cl Cl ft C)) Cl C: ti T Cl Fl ft - i cd) (Cl Di - ç CC) C) ft Cl) (t Fl 3 J ç Fl C) Di Di Cl (C) C) LCS Fl I- i Cl) CC) ClFO 1 it - Cl) C: C) Fl ft - ito ft O < Z k< Di U- 5 Cl) -C) Q ft< ti Di ftc) C: S C3 ft i ) ft t5 ft TM - Di Cl Cl Cl) - ft ft - (Cl - ito ) -3 ft (Cl (l) Y (I) P ti Cl) ft Cl) t Di ft ft C/) Cl ftp) < ) (C) Cl Cl) - Y Fl Cl) Fl ) NP) Cl Cl) Fl DiD) ft -C) C: ft Cli Cl CI i t Cl) Fl Di D a Fl I trt < ( Cl) Di ç, Cl < - - ft b Fl < (D Ii ft Di - ClDi 5 Cl) tt ) -< ft O) ftq ft Cl C Cn ft Fl -ci t3 Cl) C/) Fl Fl Di Fl -Ct) Fl 5 (1) ft CL I <D) Cl) DiD) ft Co Ui ct ft C I - 3 Cl) - ft I h - C) Cl) Clb- Cu it ft (D -C5 C) Cl S ) C) Cl CoD) ft -Di - i ft - Fl (1) i i - < - - < Ct) ci i Cl) -fl it Di Cl Cit - ) ft ft C: Fl C) ft - M Di - < -ti P) Cl) 3 i ft (I) p - i Cl) Fl Cl :;- Cl) - ft i Fl Di ft - ft S ft Cl) C/) Cl.. Fl i it ft Di Q. i-i - - Ui -MO C:.1) 3 5<. C: 5 Di rj i i C: cc, C - C: i - (A) - -- O -C- i (A)Cl) < S Fl> Q Cl) I Fl Di ft iq Cu C < ct- Cl boo ti - - C CL< ft Cl) Cu MMM Cl) (Cl (Cl Cl) CO 5 ft5 cu M ::i dp SM çu -ClC Clft -- - C: C ft ft o 5 tj t3q - D it ft Cu - L< it C/) S F 3 --Cl) Cl) CO - - < ti C) C: (l) Di Cl) Cl TO Cl) i - Fl C: L< Di ft S Cl. )i Z < xj Ci)Cl -S t Di - C: (C) -i ii Cl) MC), t) C: Cl Fl C/) 5 Q Cl) ft ft 3C1) Cl) Cl) C --C ft m ftc - ft E i i S Fl - ft Cl - ft ft -< C (1) 5M Jci< Fl ii< Cl) i(d - It Cl-i (Cl Ti (1) - 5 D -C) Cl) Cl) -Cl (1) C) P) ft (l) Cl -ft L.i.) C: C) Cl) -) s < Cl) Cl) C - - o (1) CO - CO cn (DO Fl Cli Cl M - 1-4(1) I I ft i PJ OD Fl I I Cl cn is CO T3 -Q CiCo i 5 Cl)Ø I I ft Cl) ft i J -ft I I -I Cl) ft ft Cl) Cl) (/) < I I I I ft M(V - b C) Q ft -C: ft I I I I -< C) ft - - cn I I C)) I I ii ft Cl Cl) q, Cl I I I I ftp, -Ci Y - i 5 ft iq N I I I I I MO - (Cl i Cu Di Ci - I I I I i - Fl Ct) Cl) i - i- (Cl ft,- I I I I C) Di Cl O Di - I I I I I Cl) < -Ci C/) Fl C I I 1.1 I 1 t) Di - I I I I I Cl) ft MM it i (C) Cl) I I I I I ft Cl) Cl) -O -t Fl Cl Cl) C I I I I Fl 5 II C)) CC) -C I I I I I C: <Cl I I I I C) ft it ft -Cl) ft I I I I I ft II CiCl) - lc, CO M - I I I I I - < -5 < Cl - I I I I I + 5(C) Cl -Cl Cl) CL 5 i ft C: CoOCJ1 --- Cfl C Di -Ci < Di Cl) (VP) ft 5 (Do Fl C!) (C) Cl) ft ci Cl Fl (Cl Cl, (A) Cl) ft - Cl - - ft CL - - L< (V ::i jft 5 S S S S (VP) Co II i Oft :i Clçt ft ; cp) (1) C: ft ft C: C C C: - -C/) Di O ftft ft it it OQ 5 C <Di - (D (C) (Cl ft j - Cl) C/) C/) Cl) Cl) Cl) ft II Cl Ii - Cl CC) Di - Cl) - -Q Cl) Di (I) CO 5 it Di

14 n ci ci C) E U) U) U) O-U) C) C) O-rt Tj T -ci t\) 3_ 3_ U) 1) I i II (D 3 - -X U) :3 :3 -I Ii Ct O 3 :3 ci U) Ct -Q çt (no - Cl ci -ct C) I -C - i fl Oct. b - < Ci _ jo-1 3 ti 3 U) 1 yo ) -U) C) 1 U) o - Q ct -1 Z çt J ci çt (D ci ci 1 U)Q. U) U) -F--i rj C) J(D (U - U) U) ç-t U) ci (1) Ct U) (DO -.. I CY :3 U) U) -i Cl) ci U) - cid 1 U) ci < U) 11 - CL (1) C C) Ct ci 3 D ci - - ci ci 1 t ci i << - ct U) Q- -ti :3 ci Cl - - o 3- U) ci C) < 1) U ci TU) O <OQ C) O-ct ci (U ci tl < 3_U) t1, -U) C) < -- O U U) ci 1 -j U) U) t3 çt U) Cl -. () - 3_ < U) (DC) p (I). çt - -< xj C,, ci ci ci 1 ci -t :311 U -U) U) - t-tq. U) -(D X Oct -O ci - (t) - U) U) ct a- ci o ci,-ç ci) -l- i rt,- ci Ct. ty,-1 < Ct 3_ ci ct ci -- ci - 1 (() C). 3 U) 11 C), -, O Y) Cl ci ti ) city I U) I-I 1-h ci - < ci U) 1-h (1) U) Cl) O-t - U) ci. 1 -o U O ci < -t ty ty ctd d Dci -1 - C!) U 1. -I) 11 C) I 1 CnU) -ct 11 (Dci - < U) (U - U) W ci C I-i C!) :3(1 -ct C - C) U) - - ci C). C!) i-c) ci U U) 3_ci (Dci t3 U) U) - ci 11 ci ci Ct ci 11 U) Ct - t U) ci Cl) (D U) 11 (DO çt < ((111 i U) II ci ci city -< cn 1 ci I I ) ci a --ti ov U) ci U) - cio- :3 < (1) (Dci -I I U) U) I - ci - U) <ci ci C) to a U) U) ci i- :3 I ci I U) t3 ci d fl U) U) - ci U) (DC C) ci I I - I I 1- U) ci -Mci Oct C) t ci I 1 I I (l)ci ci a ti a ci :3 - Ct :3 U) - U) 11 ti D 1< I I I I (1) - U), U 11 I I Cn I I U) U) CYC tyq U) ci Q ty ci U) <. O- - (DO-a t) I I I I I i - a < C/) - 1 a - - U) t) -rjq C!) C!) I I I I I I -. U) ci U) M ci i-i U) I I) O) - -ti I I I I I I ci -U) Cl - U) ci ci Cl -- ci I I I I I I t5 ty U) ty 1-- U) Cl) -Cl) ci, I I I I I I O- 1 Cl) - Cl I I I I I I -ct ctc) 1 U) a. -(D ct - Co ci U) I I I 3 3 ci ci :3 -i 11 a U CY U) a - -a ci ci i I i I I I cio X U) cic) -C) 3_ C U) - U) Ii Cl 3_ - I I I I I I U) ci (DO -ct 3 ti (Dci ci <:3 ci C!) 3 (1). I I I I I I.. - U) U) O- U). U) ci I I I I I I 11 t)3_ U) ci ci (Dci I-I Cl) II -C t) U) I I I I I U) - cia U) - - U), 11 :3 ci (1) I I I I I Drj :3 (Dci C) ci U Do C) o a < U) U) C 3iU) ci, rl C) U) ci 1 Ø U) tq 11 ci < U) t5 I). c W ci U) 11 (DC) 3C (Dci (Dci ty Cl.U) a t Q- (l U) J OX IJ(4)OWC) - :3 U) -(1 ci - I:3 ci 3 ci G- Oct -ct (no i ij.- (Dci -C a II ci J N) O(DOO 11 :3 C!) i -O - 1 ci U) U 1 (Dci - tj ciq. -b -1 cio t1 ci C) (I) U) - ci - -Cl (DO < U) 1(l Ct 3 U) ti ty-hh- ClClct - ci (DO I h- (1) () Ct U) ci ci ci i ci ci ci M ) ci 11 tj ci U). Ci ci U) U) U) ci ci ci 1 ci ci ci ci ci ci ci i Q --s < - CM Y (D - ci U) - (1) U) ci - (Ci ci (U -a ( U) U) U) Co U) ci ci (DO- ci ci.- t ti U) - U) U) C ty (1) ci U) < -ct :i i U) U i-h 11 1 ci U) ci :3

15 in Ct 1 Di rttl )rt -3 Ct Corj <rj3 Co Ti Ci C4 Ci Cl h- -P.) z II Di (I) - Di hi Di t J Di Ct ) it C t Ct () Ct it Ci Ci hi o Ct hi - Ct) (31 - Ci J Di -Ci Ci C -C - C rt TI C ) CO hi hi - ClW çt- COO i 5 ClO hi Di it Ct Cl) Ci Ci Di Ci Di Di l- hi hi < Ci Ci Ct pirt i ] Ct Ct ). -r-t it hi çt it -< it it C < 5 ) - Cl. - Ci hi COO P.) - Cl) - hi C hi 5 j Cl rt Cl) CO çt Ci C çt pi Cl it Di Di S it Ci hi Ci Ci CO it ø. Di rt hi it CtCI W Cl) it O Di Ci. hi - o) Ct Di -CO Di t3hi < -CO C l it Y( < CfCO 5 -J CO hi pi - Di - hi < --Ct it Y Ci -CO a Di hi Di hi - it -(D Ct Ct 5-5 P.) Cl it Cl it Cl S it - Ci) Ct hi -< C a) hi Di - 5 Ci Cia) Di co it< Cl) Ci i. : g Ci C Ci it >< it Di ( Ci pi Di CO CO Ct Di 1t Cl - hi hi hi Li- Q Ci hi Ci J Di - hi ii it P.) hi (t o (P. CT) C Di çt Cl - it Co Di Ci Cl n < it C) CC) >V Ci Ci - Di P.) CO CO Ct hi Cl) Ci 3- P.) Ci - hi Di (C) Ct COO c C) Ci it ) it Ct Ci çt (C) it (Dpi -Ci it -. (3) Ci TI Di - 5 S (1 - Cl Ct t )- CO hi hi hi Ci it )it it ) hi Ct. Dl CO -< X (t C hi CO Ci Ci Ci) Ci hi Ci - Ct Ct CiO b CO it Ci (D hio hi Di Ct Ct Ct ] Cl 3Ci ) I CO YCt U CO ) -C CO - hi -CO (1(D p, CO YDi Di it Di CLCO hi Ct S I Ci Ct (3) it Ci hi CL (1 CiCt I hi o D Ct < Tit hi -WCL(1Q. it it o I I Di Ci < Ci (3) - < (DO C E Ci Cl) I I it CO Ci hi C < it - 32 E hi 5 ) Ct I I P.) Ct Ct ClP) (DO - it it Ci Di Ci Ci Ci -pi C hi it C I I CO hi hi Di CO hi hi Cl it Ci Di Cl I I CO Ci P.1 Cl) Cl) Ct Di < L< CO <-< I )pi - ClCi CiCO CiDi (3) E hiq - o Di Ct hi I I Ct Di hi -Di Ct O Di < it 5 Ci Ci it C hi I I hi Di hi C S - - it - a Cl Ci (D (1< Di Di COO CO Ci it. - ty< Ci Cl) Ci COlD -Ct Cl Ci - < Ci ). hi ] E rt hi Ci - Ct(D - C Cl) ClCi Ci Cio CO Z Di CO CJ)(3J O )y a) S Ci rt N--.Q Cl - - Ci.Q Ci Di fl Ci) Ci 1 ( - hi - CO 5 Di J (1) hi Ci 3 P.) <3N() ) - l CC < I-< S it CL t- (/) )it. - 1 Ci ] 3-E o <L< C Ci C ) b C hi o P. CO.C- - Ci Di C COC) C - C Di Cit Ci ) - it Ci C - -Ct (3) it T3 -C Cl C) CO Ci hi C C Di CO Di - C - Ct Ci W Ct C Ci Ct hi it it O hi Z - C) Co - Cl hi S Ct Ci Cl) hi Ci C ] hi hi - c, Ct Cl C - CO ( 1 Ci) Ci Di ) hi Di CO TI Di Ci - Ti hi -CO Cl Ct C C CO - Ct TY P.-,-t Ci ) - - Ci Ci - Di -< it hi Cu Ci Di (DCL Di it - Ct Ci - 1 Ct -Ct C O Ci it Ci Ct C hi Ci - Ct Ci Cl) 1 -Ca) it CiCi- 321) pi Cl) Ci Ci.. Cl) Ci CLhi Ci CO 3CO pi CO - Ct Ci Di C Ci) Ct,-- it Ci Ct hi CO hi Cl) Ci it S Ci - Cl) CO Cl - a Ci Ct S D CO CO Ci - - hi hi Ct hi ClDi t3 Cl hi CO CO CiS Ci 5 Ci Co Ci CO b Ci hi C1 C S - Ci Ci Ct C Di C Ct Cl S Di 5 i a Ci Ci Ct ) CO CO hi hi Di -a) ) - Q Ct 1< Cl CO it CO Ci L< Ct Q) 3 CO Cl - - (1) hi )

16 C frt - Ct Ct Cf l ft ) Ct --) LC O) rt rt ç-t Cf 5 ( ) Y YtJM C) C 3 CLO Ct CC) ) (C) :j - CU!5 M ( (CC) Q CL çt CL < -CU CL i-to i-- - rt ri CU ) C ) b - CO C. ) çt ) Ct< C (U CU C) w - i <(1)) Ct t Ct Ct -,. - Ct I ft ft M ) (I) - 5 CL t Ct ) - nr3 rt ) -ct C) 55 ft - Co I< Ct T Tft< ft C) 55 p CT tq ) CO <) C I C ç, < < c-- < -c) N ft CO E ci M( ( CO CE) CE) ) C3 3 (C) ft - cj -Co C MM 5C5 I Ct ft CLI 1 CU ) Ct C) CT) C) Ct (U- (1) C( Ct ) çi ft i E )) - Ct CL Ct> ( MD) Ct -- p-co C)LQ - F i rj i C C co CO Ii E Ct C) C -CU C Co co MM ) ) a ft ) TQ- C) Co ft C Ct ) i CL E ft <.5 -CO O - - i y -C) )(1J. -P) - citi ft Ct ) Ct - ) - ) Ct ) I- - ft Ct C () CO CO J ). Ct O) rt C) tort - ) )Q -I) ft Cl- C) (i) I - > tj ) 5 < Y) COO c ft C icc) ) C) C) (I) -(D i -<ti --CU C 5 C ) J U) ft Ct CL 5) CL tom CL :D- C) (1) C) i< CO tort C) ( MM (1 (1) - -Ct Co Co -CL S E CLp, ) CCL Cl) CItI ) CO Cl- (C) c C (C) E CU C) ) t3 ( i rt. I )) ) CtC5 Ct - 5 ft (O l C)- CUrl (I) E Cci CL I ft Cf CL -Ct ) t-t ft - CC) ft C U) I-I - p 55 Cl) )) ) Cl- ft 5 C) C) ) I C) C ft i Ct - 5 o - ft - (J) ) J p)) (1) - p to E Ct ri C) -t CL CO ft 3 CU -Ct CL CT CO Co to ft ft Co ) Ct i E - - -t - Ci) CL )5 - C) C Ct C ) < S rt- ) CO (I) Cl) - CL Cl-. Ci) ti i ti ft Ct Co Ct ) - - ft - CL &C) (DO Ct Cl) i I p q --CL M ri- ft C) l- - ) ft ft t) ft 1< l-h I ) -E CU P- E < CO Oft )) 5 Cl) ti ft )- I ) ) -Ct COO i< M Ci) Ct - Cl) ft MM - (1 C i i O CO - ) -ft CO CO S O) Co < CC) ft i - C Ct C -) C S Ii ftt CTC ) E Ct -CL M - -Q - (D E tie Cl ) C)) COO. Ct ) CU - t) ft c ) -Cl) < ) (l)lq C O S -, Ct S CU CU CO Cl i U) C) Co -Ct ) )) (DO ) 5 CO 5. Ct C) < , i. - ft CCC) 1 JC CL t -CL t3 ft i Ct CLft - :i Ct < Cl- - ft i-ti C!) tt -ft C C CL )) tjz - 55 Ct) - ft Ct ft ft ti ) Cl- ft C -S ft -ft (DQ CO MO Ct ). -o CO -<(DC). Co - C) CO CL C C ft Ct j - ti ft (1 ti I - C ) - c1 - ft ft < - CO E S Ct. tl 2 C) Ci ft - E C) ti ft <- CO ti ) C - CU U) ( (D Co Co - Z ) o -Ct ft ft C E CL < Q-S CO ttctco SCOCI) ti C) - t ft ft Cl) Co C) Ct) - MO t5 ft -C i C -CU CO C - C ti (1) E Cl- ict ) ) ((( Cl) CT CT Mill a -ft ft CO I) to O ti t3 (j) ( E 1 CO -Ct ft - ft M -O o -- ft ( - (_ ft M 5M CT t i ) J ) (1) i< CT C) CL Ci) CL ti ) ft - - CL C ft C ) CC) X3 CLQ ft CL CL CU..) CC) CT ft I t ( Cl) t-ti ft (I) C, )) - - M - O-CT) ) ft (C) CO ) - ti M(D ) t C) Cl) (1).. - ft CO CO CT ft Co - < (1) ft ft i -- Ct ft - C) E C) ft C CO Cl-C CU ti (( O ft CL CL < -

17 it it < it ç-t it U) it (1) () - M çt < U) it Cl> Ct ci U) C -- U) M -(fl t) U) C U) t)u) t) (D ito U) C) C) C) t) it U) ci C) t) Cf (DC) MM M ci ci C) < Ct D3) t) J ci -U) C) -t5 it ito U) U) C)DU) it -U) itt) it Cl r-iit cq x < (it) Cl> M Ct) it t) U) M U) - C).. O (D -ci (Dci I) U)C) it M ts C) it Z M ClU) ti M U) O D U) t) U) C) U) t) it -(t) U) U) U> ci frtct) it U) U) -Ct).. it I-t) it- U) C) it it C) iq C) i Q Cl it ti - M (t MCi t) - it ttj it > Mit - < t) M itq Cl f.ct - t) ( C U) ty t) Ui t5 < M M t) > t) t) Cl t3 it it ci U) (1) Q ci it (l U) U) ci Cl> it ci it U) W M C) _> M it C) Cl) ito Cf U> (1 Ct) (I) L) it it >t5 (U. - M ty > W l> o p- ci Cl MM t) C M -O C) - cr> Mir C) M rjclco. ci C) ci M itt) M M C Cl -U) t) M C) U) o (lit t) ( U) U)?s) MM U) >< U) U) < M it ci ty t) M ito it U) > (I) ç>> (1) U). C) it - (l Q MM o it Cl C3 -it Mi -C) C it U) ci it M -U) ci. M (Ci ocl> j- C) U) M d Cit II t) t) - MM C) U) Mit Cfl ci ci Cit U) < -U) it < U) U) rr YM (1) - it Cl C) t) t) M >1 ( U) - - (U C) it t ) C) C) M < i >- it M< U) t)u) C j< cpic - (DO ( cc) - Clt3 C U) Mci O -it t C -b CU) U) U)Q (1 U) j U)C t3 ci C) frt l> < ti -M L< it (Dci (U I-b it MU) t.3 U) C) o it CT CU) U) it < t5 - it CM t) - U) it - c U) U).Cr t) M Cl it - a-> U) it U) o I CY M Cl) -it -C cy CU) U> Cl t) Ct) U) it U) it 1-f> U) Cl t3u) ri C) i U) tj- U) l> C Cl M - Ct) -t) >ci Cr Cfl Cl Mi U) it C) Cl - Mit M MMM > M it U) U) M - - it C Cl M ( - t) (fl U) it it - -CA) Ø < U) C) -it Cl U) U) it.cr t) t) - C) C) CU) -ti it ci Cci t - - C) - (1 U) it< C) : C) Cl f) M.- >it (3 it it U) U) - C U)ci it< o Mt U) it U). -ci t) U) Cl> itq ito ti Ct -it CX) t) o>ptj C) it Cit. C-> ti U) t)-f---m tic) < -ou)t5 (U U) Ci ty Cl Ci Cl) Cit t) -. C) o M t) Cl Cr t5 it O <I it itt) U)- it it U) Ci 11 >- U) t) -. - U) < it ( t). it -U) U) -i it ti b - it it C) C) U> > o- Cit ttmi Cit t)y ci (3 U) C) it it U) ti M Cl ci :i U) - Cl t)it MM f>- it U) it -< it< J t) it (DC) I ti - U) ID Mi 3 - U) U) Cl c ( - - O-U) U) o )it ft it ClV t U) MU) Cit OC) -. -C QU) C) ->Q U> - CO ci o it it. it it C) ci U) M t) it C) (3 -Ci ito O it 3 it - it M - Q Cl) it MU) O U> M - (DO. t) - ci Cl - i - it t), t) (r) > < U) U) N C) t) t) Ct) U) i C) Cl it (U U) U) tj it ti - it Cl) >< >_i-c) t) -C) E < Q U) i ty Cit it -> tt Ct) >< U> Cr - CT -j U) it CC t t) it (D - U) CU) tim - M -U) U) i Cii - -U) ti ito U) c) Ct C CT) - is is i LL) C i3 it Mi ci oy ii -Cl) 3 U) l- L ci U> Mi C ito U) Cl Cit it C U) is <Cii Cl f-f> Tit O U). - C - - Cl C > ii- ci -. - j) ci

18 -rt çt CO )11 cc Ct CO 3Cl) Opt) 3 MF J CT> o (T) rt(t) CO CO I-h (I) ti CO CO (Cl (,jpt, Z 11 CT) $2 (1) Cl) ()< CO tti çt Q t t-cn Cl) -Il - Q ) ) C1- - Ci Ci çt < Q CO Ci - ) Cl) ty D CO - t t- ii Ci -Q, O ) çt (Cl (1 - - $2C1) ft ( ) ft () ( -4 ftc t3 Cl) I-h () -(t CO.:T ct çt (Cl Cli çt 1 () 3 Cli - I- --o o. Ct o -Cl) Cl) -t CL- < ti D rt 5 rt rt Oo I - j -Ct TCi - :) i. ) - Cf Cl) 1 o - Cli C)> ) -çt 1 Cl) Ct $2-3 ft - CT) (I) (D OX çt 3Ct< t3 Ct -J O- çt I ) ft C C)) Ct b :i II I 1 Q CT> Cli -, $2 11 I I ) > c - E + -Ct Ctpt C)) -J Cl) Ct) I I I rt o C o CO - l) - tj a I I CT> -,> O - + I I i Ct Ct Co L 1< 1 II CO C)) < I I -< >C ft - ft i I I 3 Cl) Ct - )) $2 o I-h I I - II 3 1-i I-h + - Cf - - r i I I I Ct- L) rt Ct Ct P..) Ci I I I I. W ) I I I - Ui Q 1Ø CO Cf (Cl C)) LI - ft I I Cl) CO $2 Ci + $2 ) O t-ç CT) ) Ct X - I I I C Ci - CO ) (1) o i I - -- CO I I I Cl) rt.j CO CO Ci u Ct $2 I I -CC) - (1) - - Cl) - rt I I I CO (I) 3 <.J + a -CO Ci 1-4 o I 1< ) COrt - I D CO CO Ci II C)) CO - I I Co LQ Ci II ) < ) x o f - Ci C)) CO CO i CI - t ) I > iapt5 CO - U).b CO - O b 11-1 P..) Ci < Ci Co O (7 -J. (7 $2 CO ) CO - X - ft Cf -1 Ci Pj Pxj Pj hj - T Cl) ft CO - CO II Ci CO CO ft -CO ft X - CO ft D Cl r CO CO I I I I - CO - t, Ci I I I -O) U) - Cl I I t, CO O Ci CO 2 Ci Ci D 1< 1hCi tio (Y rt t, Pt, CT) COO CO I CO t C)) CO CO (Cl CO CO ft Ct) L-) s:i - (1 a o (U -ç CO Y CO CO - < 1 Cl - CO ft C) CT) COO Ct Ci - t, CO CO - CO Cl) U) Cl) 1-f, Ci (Cl o - - CO Ci - (_.Q 1 o - Ci C5 - $23 CO O Ct o Ct 1-b Cl

19 cn o5 i it W ci çt w Cl Co t-tct 1 ft hip) -Cl Pi g Cl P3 Cn CO Y W P3 (DO M it -1 it 1Y - (1) C) C) t ) X COO it ClQ - Q (D DC ii - 3 YW CO P3 F-it C!) c9p 3 3 ci Cl I i -ct C!) C) it C) Cl < - I t 3 çt 3 I i Cl Cl it M (D ci - it Y P3. U) - -çt Ci L1 - ft. COW < -Q - -. it Co b Ct it it -Cl t I ci it Cl P -CO < OW M)ft (fl - CO it it + --O -Ct 3 it 1 E Ct< 7j Fl Cl Fl 1 it ht Fl t3 Fl Ctt) -OP3 it I Ci. 3 3 c it < P3 ::i O Fl Ci P3 - P3 ft - o it (C) Cl F-t Cl it Q. o rt it.i CoO U fl Ci Cl - T ci < - F- i < it. i F-t (W j. - JJLn- it- Q< ocn 1 Cl - Ci o -- ii < - CT C). CO - Ci Fl CO CO Cl) tf ft F-I Co - - < - <Ci Cl COP -. 3 (11 it Cl X W it it ) -y ito. t D< - (P-it it to - I i j P- -e it 3) 1 -i -. i r Cl it Clii C) < Fl Fl () - Cl P3 i COO Cl CO - p 3 Cl) ty< ii I I P3 ii C!) it - it ti - < 3 I I --b CO P3 Q CO O CO CO it 3 it C ) - Ii it - CO Co - - Ci - P9. - Cl - : Ct - CO CO Cl Co ii ii Fl it CO P3 ci Co I - ii Cl Cl) - ii CO -I Co ii Cl P3 ii it it -it Cl - -F-i t3 b - it it - -CO it b it it O 3 Cl P3 Cl it it P3 - ii F-I CO F-I ii - CO I I - 1 ii it it I ii Cl ii o I I P3 - çt ii - < ii C/) CO - CO I I Pip, ti ct it >< to I I CO F--F-h 3 ) < OW it - I ii fr F-i Fl. Ci - ii Cl ti I I. it - CO Cl) P3 - it I I it t Cl) ft it P3 Ci Fl it id 3 I I o Q CO it - I ti Co II C3 h -. rj I I I - 1 Cl) <1.Li-(D - --q it P3 L Fl ) tr CO Ci it Fl CO (t> it 1 - it Cl it - ii ir Ci it ii- I- it 3 - F--I it it Ci Co - -J (J Ci 3 - Cl,-tO 3 ct - F--h - ii ri- CO ii Co t J F--i 3 ii - it F-I ii - ii it it it it ii 33 - ii - (3 : it (D CO J Co COp, Fl it < C) it Co Fl Co Q Ci - - Ci D Fl - Ci -i Cl ci Co 3 ii it Co Co - ii it ii CO Co (t) - Cl F-I -cl Co Co ii Cl ii it ) it it :i it WOO) - Ci tt (Do -- - Cl) it - Cl C 3 -Fl ii ii it Co it < -Cl - - CI - it ii O- C) P3 Ci CT) it Fl -it it ii Fl it it L< - C) it O oci-.- -ii 3 3 ii < - CO P3 Ci 3(T).3 ii Cl - Co -CO CO 3 -. it CO - - Q Fl (1) ti 3 CO Co Cl ( it - ii CO < Q - it ii ii Cl Co Ci - -C) ft ii F-Do < Co - -I Cl it Co - 1 P1< Ci Co..- O Q. t t Y-

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21 Y 3tCtCs ( 3 Di (DCJ Jrt O ft Q li Di > I-I C) II li ft ( -Co I i I - it I I I I Co Di (Oft Co -it I I I I : it Ii D ( C) (1 CO J IC) Dirt 5< t3 rt c-t- it Ci CoO J -Cl CoO. D Di (DO l-i Ci ti < (t) 11 - : -Ci Fl S ( ti Di Co (1 D 5 ) t1 C) Ci Ci ((( ito --SM S Di Di ft Ci Ci Co Co - 11( Di ft Co ) ft Co ft. ft - boo Co CoO Ci Ct 5 oft ( Ct Co (( Mi Di. 11 Ci rt (1 ti (O II X lift < ) Fl ti Co (1 ç-t Ci -O Co 5 (OCt r-t Co --ft ft -- COO (1 Cl Mi (I) CL -Ct). ) 5 Co (Oft i T O Di it -li ft ti X Ct ct Di Q c D- a it MiQ (I) CL 11 Ct - Co Ct :i o O ) Cl) - ft - Di - Co - < S ( CL Co ( Di Ci CO 11 Ci (( (D (I).Q Cicn 5-11(1) ( Cl) Ct) II - (O- D 3 Ct ft Cl) i it ( Ci Ci 11 Cl) Co 5 Ci) < Co Co I - -CO Cl) (1 J W< Co Cl) CI) ft 3 ( (1) it Ci 11 -ct (DCI). Co O (OCt ( flft Cl -Q i i Co ft < Fl rj S 3 Co - Ct 11 O Di Co )i (1) (1(i) 5 fr-s- ((( Co -CO ft ( Co Fl ft rt 1 CY O Q 11 CO < ) Øt- Mi (Oft li (1 O Cl) ( 11 ftty Ci) it O Mi 3it Ci Co Co Q I <ft CLFl Dirt - ftco -li Ci ) Di ft Ci - (I) ( ft (I) it it Ct (I) ) ft C) Ii Di ft ft i 11( (I) Di ) Di -Oft S DiM 5 Cl) CLMiW ft ) Co ft< CT) 5 -Ct Di ft (( ). -O Z C o11 Di Ct ( - Q. rt CI) Y ft Fl Co 5 Ci - 5 Mi Co ) -. Cl) (I) E (( 5 ft N 1< ( i Q ft Ci Di O- <) ft it Di l-(d Co Co Co rt 11 ft Ci S ft Ci Ci C!) Cli -Ci Cl) ft Ci -O Co 11 Fl b o o - (1 --) - D J CoO -Ct ( Dl it C,) - Fl ft - S Cl) 5 (OCt - < i 1-15 < ft it - ft l (O Fl - it Ci Ct) Di Ct Co ( Di (1 (1) Ct -- Ct ) D Mi - - ( ) DiN,- It) O) Mi 5 Di Ct ) C/) ft Mi 3 Mi i -<(( - (Olift C!) CO Dlii J Q ftq Fl Q-Fl Co (1O (1( -Fl (1 Fl ) - 11 Z o i -ø (1) MO CoO ft Di Ci. Cl) ft (Q i ft Di (( -ft Di ft (1 ti Cl) MM Cl) - OCt - - Di Ct < ft - I ( ) Ct (( ft ftd - it CO (I) I ( 1 Ct D3 ft Co Co S (O- it C ) -li O (Dli - (I) Mi Q. ft (D C/) < (( Dl -Co (ii O S ts i ft (l (11 Di Cl) - ft - ( 11 l -(t) Ct D CO Co 11 tip) ( 11 (1) t IC) Ci (I Co CO t (1 Ct o M 5MM -- F- Co - Co ft D C/) ti (OCt ft ft Ci ft ( CI Cl) ( OW 11 (oct (O- (ift C)- ft 11 i.. O t5 (1 Mi Ci 11( 5 r3 Co fto O- ft -Q -((( Cli 11( ((1( Di t3 Co ( (111 (oft -Co -(1 Co Cli ( 1 C/) ft i - - ( Ci (I) O-Co Cl) Co ty Co - CC CI - ft Co ft -< -O Co ( Di ( Ci) Oft ft Co Ci ) Q Oct Co Mi Co t 11) ) Cl) -t - ) P1( Ct ft ) ft Ci OFI Di ) Di fto Co 5 (I) CO ft X3 ft Cl) Mi O-O Cl) - Ci ( it Ii CT) Ci - ( ) (- ti ft,- 3 Mi 11 it Ci ft DiD) ( Dl DiD) CO CO - 1 r <Ct 11 CoO Cl) Fl Co - Di F- - - II Di - Mi - it it ( ft Di (1 - Fl Co

22 a

23 C C extremities body and patients Contour Films Fluoroscopy Take Appendix 1.1 Simulation Procedural Flow Chart and Align Immobilize no yes

24 Appendix 1.2: Treatment Procedural Flow Chart C Patient Treatment Setup: 1. greet patient and explain 2. position gantry, aids, and the patient Port Films: Are 1. take and es port I based on number develop films of ports to be 2. compare needed treated no I Are tbe yes Treatment: 1. chart time films 2. apply accurate? radiation no Goto simulation Cleanup schedule Patient Out

25 Technologists per treatmont simu lation Treatments (mm) First Basic Simu lations (mm) Total Patients Total Treatments SPVEs Ports per pahent Source: survey Feb.-Mar. 1987

26 Treat Simu ment lation First Basic (miii) Patients Treatments SPVEs lations Total Total per (mm) Si mu Ports per patient Technologists Treatments peuix : urvey uata tcqflt.) 1987 Feb.-Mar. Survey Source:

27 Appendix 3: Simulation Data IP 2P 3P # of ports 4P 5P th simulation type student lnitai Rosim Vsim yes no wait oostj educe (6) L Source: lime Study viar 1987

28 s. #_of_ports simulation typo student 1P 2P 3P 4P 5P th Initial Resim Vsim yes no wait 3oostl Reduce source: Elm e study :eb. JI 1 I 987

29 . treatment type # of ports basic first I P 2P 3P 4P SP th RMS yes student no (8) ;, ource: lime Study :eb V. 1987

30 Appendix 4: Treatment Data (cont.) treatment tvdr # of ports basic first 1P 2P 3P 4P 5P th RMS yes student no p2(6) 2(7) () ource: ime tudy :eb

31 -- - # Appendix 4: Treatment Data (cont.) # treatment basic first 1 P 2P of ports 3P 4P 5P th RMS yes student no P ource: rime 3tudy -z lar. 1987

32 Appendix 4: Treatment Data (cont.) K treatment # of ports Woe basic first 1P 2P 3P 4P 5P th RMS yes student no source: ime study :eb.4ar. I 987

33 Appendix 4: Treatment Data (cont..) treatment lyde #OfpOflS basic first IP 2P 3P 4P 5P th RMS yes student no 3 3 (8) (8) q ource: I ime 5tudy :eb. 1ar. 987

34 Appendix 5: Trend information 9 Average Films per Patient by year Treatment Aids per Patient by year II I Source:istorical data

35 25 Average Treatments per Technologist by year 2421 Appendix 5: Trend Information (cont.) SPVE Treatments by year Source: istorical data

36 AppendIx 5: Trend nfomatlon (cont.) Average SPVE Treatments per Patient by year :: Average SPVE Treatments per Technologist by year :::: ii i Source: istorical data

37 RESULTS:, 28 (rms) I of observations average of observations UM Department x Department y Surveys Appendix 6: Data Analysis of the surveys ( C Technologists per Treatment Technologists per length of first treatment in minutes length of basic treatments in minute length of simulations in_minutes number of patients number of treatments SPVEs Ports per Patient Source: Analysis of survey information Silat ion

38 Appendix 6: Data Analysis ot simulations RESULTS: Si m u I at I on s # of ports # of observatons average of observations 1 Port Port Port Port Port Other C Simulation Re-Sim Vsim Student: YES Wait Boost/Reduce Source: Analysis of time study data

39 Type Basic I of observations average of observatior standard deviation Treatments RESULTS: C. Source: Analysis of time study data no yes Student RMS Other Port 3Port 4Port Port # of ports Port First ppenciix : Data inaiysis of treatments

40 X Y OR Direct (#weeks/months per year) = I (Techs/indirect activity) (Time/activity per week/month) Indirect Y = $ technologists required X = I new patients FORMULAT IQli C. 284Y X = 1 After time study adjustments rewritten as: (1248 tech minutes/year) Total time = I PWT + Vacation minutes = Total time minutes ((346 days) + (31 days) (Y 1)) (48 minutes/day) = Sick/vacation (1.67) ( T + S + I ) = Paid working minutes (PWT) Combining indirect and direct After time study adjustments rewritten as: 1335.OX T (Tx tech mins) (1 + PF factor + NP factor> T (Tx mjns/unjt) (I techs/unjt) = Treatment tech minutes Tx minutes/unit (Predicted I treatments) (Avg time/treatment type) = (Time study avg) + (RMS addition) = Avg time/tx type Treatments After time study adjustments rewritten as: 33.4X = $ (Sim tech mins) (1 + PF factor + NP factor) = S (Simulation time/unit) (4 techs/unit) = Sim tech minutes Simulation time/unit (Predicted I procedures> (Average time/procedure) = Simulations (1392) (Y) = I After time study adjustments rewritten as: Appendix 7.1 Formulation

41 () Time Out: Problems: Number of Fi1m: Student: Time In: Basic Treatment: Ports: Blocks/kids: C First start end start end start end Time Treatment Ports: Blocks/kids: Name: Treatment Area: Appendix 8.1 : Treatment time study form Clean/Schedule/Mark: end Chart Time: start start end start end Treatment Setup Treatment Set Up Take/Develop Cozttpare Explanation Time: RMS:

42 3: 2: Immobilize/Align: Explanation time: Call Resident: Films-Setup and Take: 1: Call Doctor: Time in: C Nane: Treatment Area: Ports: Student: Appendix 8.2 : Simulation lime study form Time away from patient: Time Out: Problems: Call Dosimetrist: ark/clean/schedule: Polaroids: Computer log: Charts: Chart Time: Label films: Contour: Call Resident:. Call Doctor: 4:

43 JUNE OCT. DEC. AUG. NOV. AUG. NOV. SEPT. SEPT. JULY JULY JUNE.1.5 MRS 9.5 RS JAN. FEB. APRIL.1 R. TIMES DOWN TIMES DOWN )7. / VENDER CALLED! C I 5.5 MRS 1/5 4. MRS. 1/1 PMI 1/2 3/9 2/2 2/4 2/8 /2 TIMES DOWN TIMES DOWN VENDER CALLED/ 6/1 VENDER CALLED I MACINE DOWNTIME 1986 VENDER CALLEDZ JAN. FEB. APRIL JAN. FEB. APRIL 5. RS DEC. AUG. NOV. SIM.2 JUNE JULY OCT. DEC..5 MRS MRS. SEPT. 1 MRS 6.75 MRS. 1/2 3.5 MRS /1 MRS 1/2 MRS /1 1/3 RUNNING /4 1/2 -- TIMES DOWN VENDER CALLED/ 2. MRS.2/5 1 PMI (MACMINE UP AND DOWN FIRST WEEK) /1 /1 / MRS 1/2 1 PMI /1 /2 12 MRS. 4/4CL-18 ( OCT. DUAJ : (FROST)D.T;8 3-FEB-1987 Q9:j7 Page 1 MARC MAY MARC MAY MARC MAY 1.5 MRS 2.75 MRS MRS. 13 MRS. 2. MRS MRS. -,A; i. MOVED MOVED MOVED.26 MRS /2 3. MRS 5Th MRS /4.5 MRS.1.5 MRS I

44 J)UA1 : [FROST JD.T ii 2 APR I :28 Page C MAC I NE DNT I ME CL-IS VENDER CALLED! 6/1 VENDER CALLED! TI ME S D(3M4 T I ME S DCN JAN. 3 mm. /1 4.5 hrs. 1/2 P.M.I. FEB..75 RS 1/1 M&Rc 3 MIN. / 3 MIN / APRIL MkY JUNE JULY AUG. SEPT. ocr. NOV. DEC. 18 VENDER CALLED! SIM.1 VENDER CALLED! T IME S D(YM4 T I ME S D(YM 1 JAN. 7 days, 3 mins. asym. jaws FEB. MRC 3 DAYS, 1 OUR 1/3 ( APRIL - MY JUNE JULY AUG. SEPT. OCT. NOV. DEC. SIM.2 VENDER CALLED! TIMES D(YN JAN. FEB. M&RC APR! L MY JUNE JULY AUG. SEPT. ocr. NOV. DEC.

45 TOTAL TOTAL TOTAL TOTAL TOTAL TOTAL TOTAL #OF #OF #OF #OF OF OF OF OF OF OF OF SCEDULED OF PATIENTS I I 75 TOTAL ONSULTS 2 I TOTAL P32 I NTRACAVI TARY- 2 * OF RESIMS I TOT.L I 1 o NEW STARTS 4 I 7 I 4 15 PATIENTS UNDER TREATMENT 18 I 26 I 22 I I 66 PATIENTS ON REST 5 I I 4 I I 18 I 6/1 I ORThO I TOTAL C DATE: OCTOBER 21,1986 [From Wed. to the following Tues.] CIEF TEC. REPORT SIM I SIM 2 TOTAL PATiENTS TX D ON SATURDAY-S TEC. OUR S TO T EAT CELLS-I.5 OUR S CELLS-2 NOT 32] NEW PAT I ENTS ml S {)NT- 46 [LAST WEEK TERE WERE ONLY 31, FOLLCW-UPS=2 I AFTER OUR CALL-INS- TOTAL TOTAL # TOTAL TOTAL # EYE PLAQUES- INTERSTITIAL= OF SIMS. BILLED FOR * OF NEW SIMJLATIONS TOTAL # OF TREA1MENTS 94 I I 1328 DR. DIAZ S PATIENTS 6 I I I 16 I I 23 # T.I.D. PATIENTS I I I DR. LICTER S PATIENTS 8 I 13 I 4 I I 25 # B.I.D. PATIENTS 2 I I I 2 M&C 1 NE D(YNT IME I I I I # M4C I NE START S I I I I I 2 o DR. PEREZ TAMkYO S PATIENTS DUA1 : [FROST]CTR OCT :47 I I 13 I 28

46 I 1A PT1EN1 C9& C, 1 1k1ZA11X D_INIC VISITS S1?U..ATt LOCk.IZATIO6 IE 6/l 1, tho, Cc 6 1 air M STItLATIX I I I I I i I, I I I I I I I I I I Date [w :flat:s1ts 1 TIC*6 IFIELDS S1 TAU fleld 9.LTS IFS I I hi I II DI : : 1 1, o: 1 vi 2 2 OI Dl 1 I O II bi OI 1 I II Cl : 1 1 Ii L 3: 2 I ni O, Al 5 4: 1 O OI i: o: o: : I A I I II O v1 3, I Al : o: : Dl 1 v, 1 I Al a 1 1, Vi O o: 1 o: : 1 o: 1 I 41 Al 1 1: o: 1 2: I Al 1 4: 21, 1l o: 1: o: : I II o Dl a: o: 1: a: o: a: 4: Al I ii : 21 1 : 9: I I I 13 5 LI OiI LI I 1 O 11 5: : o: Oi ; i L I VI Ii I Al 15 1 : Dl a o: a: a: a: DI v o: Ol 16 5 t I I i I I a II 1 1 ; 1, 31 2 I I I Al O 1: 1 11 o: o. I I 18 3: a: a: 1 1 : a: o: a: D i O, o: : 1 5: a I II : a: a: 3: 2 I Al V Ol a: a: o: o: : a: o: a : : : 23 2: 1 I. I i : a: a: I ;. Al I 11 7 II I 24 3: : : ; 1 I I I lii Dl : Dl O b 4: I II I ii, I II D Dl 1 o I I I 1 II 4 Cl : 1 l 4, I 4 I Al Dl 1 : 1 1 Dl D 1 VI 1 I Al 29 Dl 1 : 1 : 1 v, Dl I II II çi l 21 : 1 Li I 1 L 1 I OiI I Al : 3 1., : a l I I I I I I I I, _...,_i I I I I I I I I I I OflLYiDTcL ; : 91 2: Cl I I I I I I I I I 1 I I I I I I I I i I I I YThIUTAL 518: 1 :162: 43212: 77: , II 7t.V CAS YTO 1t1 CAKE 616 -CCASES

47 I TAT?DTS #tzport$, 1 1LY TATENtS OT R TAflNT 1S I P2 ( kte :PTS1PTS:PATSPA1 PR PRT1PRTSPATS1PRT51PTS :1I11flS:18O 18 :6I1TC:C 861? P*UENT WGL 1 1 I 1 1T II tluim. I IRC 1 I IE T:FCTON:I 1E TR:P1C1I 18 :1rIP1IE1AI! I 1 o a: ::1:: 11 o:o:o:o:o:o: 1 a: a a: a: a: : 23: : :1: 1: 1 : 36: 37: 1 I Aj ill v 59 2U1 o:o: : a: io 391 : o: I IC 4 i: : : a: a: : o: : a: a: a; a: : Dl : 5: 14: U 631: a: a: 1,. U 66 4 I 4. a: U U 67: U U U U U 1 U Sil U I I 7 a 1 O14;4 A, U U I Al 8 a a: a: a: o:o,. a: a: o:o:o:o:o:a: a: a: a : U a: 9 A 6:2:24:3111:14123:, V 6111: : 54: a: U a: a: U U U U 6 62, 361 s: : 11 4: l7 :1 59:1:: : 34: U 12 5: as;o:o:o:o:o:o; l U 91 U U U U U U 1 73 i 691 U I, I 14 II 1 1,, 7 i 11 81U1 U U I AS 15 a a: a: o:o:o: : : o:a::o:o:oiv.o: o a: a: a: 16 UDI 1? : UOU 74: 971 a: 17 A U 1 :4:31133:411, v 74U U 76 1 : 18 O UO 41 : : 67:OUQ::: 77: 8U U U?6I2OUOUO U. 4e1 6Q1 U 2 4: : 1 : 331 Dl 1 : ::: U I Al 2.1 a: a: a: a: a: a: :o:o1::o:o: : 1 : 941 1:: ô1 a; U U I Al I Al : : 3 v. 82 U11. v ; U U 72 UGI UU 1 1 oo 45: 61 U U o: 79:11111 U U V : :1 a; U 83 S I II : : U U 78 54; 631 : 31 3:3 2:2426 I Li I U 84111:1U a: I Al I I I S I I I I I I I I I I I I I I I II U I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I II r1ptttc , ,878:3177:5162 II?:13,51:: 2113: 2:1, i.2?i112799:7,116l,829 1 Al I I I I I I I I I I I I I I I I I I I I, U U :1: U 1 U OOOUOOUO U 1 1 U a: a: a: o, : a: : 1 VI 1 U 2: 1 a: U U :212: U ; U 2111 U 31 : U P1ATi NX

48 DEPARNE1 RADIATiON ONCOLOSY ISTORICAL SP1TL PROCEDUR(5 DATA C FEE DESCRIPTION CODE I I - Follow up clinic visit extended Follow up clinic visit intermediate Follow up clinic visit - brief Teleradiotherapy consult.tion extended-lnpatient only IC Teleradiotherapy consultation-intermediate Teleradiotherapy consultation brief leteradiotherapy consultation no charge Treatment plan (inclusive of procedures ) Patient contour localization of internal structures Setting of treatment port (per port) Simulator aided field setting-simple S Simulator aided field setting interiediate Simulator aided field setting-complex Central axis depth dose computation c Isodose plan (1 or 2 beams) Isodose plan intermediate (3 or more beams) Isodose plan complex Isodose plan - wedge fields Isodose plan arc fields Isodose plan rotation fields ! dose plan moving strip fields odose plan - isocentric (additional) Tissue 6 geometric inhosegeneity correction (addtiona1) Tissue I electron beam (additional) Tissue I special beam consideration (additional) Treatment planning interpretation of special testing Daily treatment management simple Daily treatment management intermediate ? Daily treatment management complex Treatment port verification films Is needed Daily transvaginal external radiation Daily per oral external radiation treatment Daily superficial external radiation treatment auxilia Daily orthovoltage external treatment Weekly treatment management - simple Weekly treatment maragement intermediate Weekly treatment management - complex Irradiation of body fluids/tissue Treatment Planning - Simple Treatment Planning - Complex ltiplanar 3 C Treatment Plan, Addl ultiplanar CT Treatment Plan Addl Isodose Plan ultiplanar 3-, AddI Isodose Plan ultiplanar Cl, Addl ge filter design and fabrication us design and fabrication Th 74 Field block design and fabrication Compensation filter design and fabrication oldc or casts for immobilization I I

49 : ? A I A I A I I, I Id I V A I A I A I V V V I I CONSULTS AND FOLLOW-UPS - NSP ONLY 1, ,49 1,83 1 2, ,496 OSPITAL PROCEDURES 14, , , , ,888 TREATNENTS 8, , , , ,8 AVERASE TREATMENTS PER PATiENT F1LRS 1,58 1 2, ,62 1 5, ,668 AVERABE FiLMS PER PATIENT TREAThENT PLANNING 3, , ,929 11, ,4Th TREATMENT PLANN1NS PER PATIENT TREATMENT AIDS ,583 I 2,758 I 2,63 TREATMENT AIDS PER PATIENT NUMBER OF TECNOLO6ISTS ON TREATMENT UNITS Stents r bite blocks infusion of radioactive saterials far therapy Application done by SYN service, supervision of rid ther Rathatior therapy after hours dius dosimetry and interpretation of application Continuing physics charge TLD or aicrodossetry Radioisotope dosimetry and interpretation of application Radioisotope handling & loading (included in 1665,7666, Radius handling and loading (included in ) Cost of providing radio-element; gold seeds Cost of providing radio element; strontium Cost of providing radio-element; irridius Cost of providing radio decent; cesium Cost of providing radio-element; iodine seeds Interstitial radius application Interstitial radioisotope application Intracavity radius application Intracavity radioisotope application rsternal coapensating shield for radioisotope sources Etirna1 coepentng shield 4or radius sources I A I I A I V I V I V I A I V I i I V I I o : 1 1 o I I I I I I I I TOTAL PROCEDURES 16,89 1 2, , , ,384 Total ports (per census reports) 29,299 tv 2 1t LIC

50 AVERA6E TREAThENTS PER TECNOLOGIST 2, , ,t3?.83 2, ,42.97 (VERA6E FI1S PER TECNOLOGIST ( ,52 AVERABE TREAThENI AIDS PER TECNOLOGIST SPVE TRERThENTS 13, ,629 19, , ,32 AVERAGE SPVE TREATNENTS PER PATIENT ii AVERA6E SPVE IREAThENTS PER TECNOLOSIST a 3, , , , ,35.38 Through February a ii prorated to year and OPSREVI C:\I23FILES 3/24/87 ( (.

51 The University of Michigan Medical School February 19, 1987 Stanford University Medical Center 3 Pasteur Drive Stanford, CA 9435 Dear Sir/Madam In an effort to determine appropriate staffing levels for Radiation Oncology technologists at The University of Michigan ospitals, we are conducting a study of our current departmental demands and resources. This will include an effort to obtain information from a number of peer institutions on their recent treatment volume, number of treatment units, procedures, and so on. Enclosed is your copy of a survey which we hope will enable us to assess current norms for radiation therapy departments across the country. We have also included a list of the institutions to which this survey is being sent. We ask that each department s chief technologist or an appropriate person complete the survey and return it as soon as possible. (At the latest 3/16/87.) We will send to each responding institution the results of the survey when we have arrived at the results and conclusions. Please be informed that all responses are completely confidential. Though we feel each question to be important, you may decline to answer any question. If certain information is unavailable, please estimate and indicate that your response is an estimation. Any and all information which you provide is greatly needed and appreciated. If you have any questions, feel free to contact me at (313) Thank you for your time and effort. Sincerely, Kathy Frost, Chief Technologist Nathan arris, Student Engineer Kevin Sell, Student Engineer Greg Randall, Student Engineer End Aoir,crI, flfl

52 assignments? 2. ow many FTE tecnnologists(not including the chief technologist) do you 3. ow are these technologists distributed among the units and other employ in your department? 1. List your treatment and simulation units. ospital/organization Name: Survey Questions: Phone $: Title: Name: ( General Information: Appendix 1.2 : Survey form

53 Immobilization: Simulation: Subsequent treatments: First treatment: below? 11. ow much time do you schedule for each patient per tre :ment type listed If so, about how long does it take? If so, about how much time does this add to patients 9 Do technologists perform a morning quality assurance check U MONDAY TUESDAY WEDNESDAY TURSDAY FRIDAY SATURDAY 7. Are resident doctors utilized? 6. Are you a teaching facility? If so, during what hours? 5. Do you have technologists on call? 1. DQ you utilize computerized record and verification on treatment units? treatment? year? 4. ow many vacation and sick days is each technologist allotted per 8. For the corresponding days list what hours treatments are conducted. Appendix 1.2 continued

54 15. Approximately, how much time per technologist per month is spent in Average FTE technologists Average Ports/Patient Total Treatment Aids Total treatments Total Films Taken Total Procedures New patients -Complex treatments Intertnediate treatments Simple treatments 86 & Do you conduct periodic department port film review? how often? 13. Do you conduct periodic chart checks? If so, how often? C you conduct periodic port film checks? 12. Do Appendix 1.2 continued for each of the categories listed. 16. For the fiscal years listed below please supply the corresponding data iriservice attendence? If so, how often? If so,

55 C Edward ines Jr. VA ospital 5th Avenue & Roosevelt Rd. ines, IL 6141 Michael Reese ospital and Medical Center 29 South Etlis Avenue Chicago, IL 6616 Joint Center for Rad. Therapy SO Binney Street Boston, MA 2115 Presbyterian-University ospital 23 Lothrop Street Pittsburgh, PA Allegheny General ospital School of Radiation Therapy and Nuclear Medicine 32 E. North Street Pittburgh, PA Good Samaritan ospital 133 E. McDowell Road Phoenix, AZ 856 Los Angeles County University of Southern California Medical Center 12 N. State Street Los Angeles, CA 933 St. Joseph ospital Medical Center Buena Vista At Alameda Burbank, CA 9155 Penrose Cancer ospital 2215 N. Cascade Colorado Springs, CO insdale Sanitarium & ospital 12 N. Oak Street insdale, IL 6521 I

56 Chicago, IL Palo Alto, CA th Street, SW 3 omer Avenue Canton, OK 4471 Palo Alto Medical Clinic Salt Lake City, UT Goodman Street 5 N. Medical Drive University of Virginia Medical Center University Medical Center Roanoke, VA 2433 Belleview & Jefferson Street Philadelphia, PA Central & Shelmire Avenues American Oncologic ospital Fox Chase Center Cincinnati, O Cincinnati General ospital Aultman ospital Roanoke Memorial ospital St. Louis, MO 6311 Jefferson Park Avenue 51 S. Kingshighway Mallinckrodt Institute of Radiology Baltimore, MD N. Broadway Charlottesville, VA 2291 The John opkins ospital Superior & Fairbanks Court, - Radiation Therapy Center Wesley Pavilion Northwestern emorial ospital

57 3 Morgantown, WV 2656 West Virginia University Medical Center Rockford, IL 6111, 14 Charles Street 2278 University ospitals. Inc. Stanford, CA 9435 C 3 Pasteur Drive Stanford University Medical Center Norfolk, VA Gresham Drive Medical Center ospitals San Antonio, TX Medical Drive Cancer Therapy & Research Center Ft. Worth, TX th Avenue Moncrief Radiatinn Center Charleston, SC Ashley Avenue Medical University of South Carolina Syracuse, NY 1321 ( 75 E. Adams Street SUNY Upstate Medical Ctr. Little Rock, AR P.O. Box 5668 Markham & University Central AR Radiation Therapy Institute Portland. ME Bramhall Street Southern Maine Radiation Therapy Institute New aven, CT oward Avenue Yale-New aven Medical Center Swedish American ospital

58 4 Boston, W% 2114 Walter Reed Army Medical Center Massachusetts General ospital arper Grace ospital Washington, DC 27A Washington, DC John R St. 38 Reservoir Rd., NW Medical College of Virginia Department of Therapeutic Radiology Georgetown University Medical Center New York, NY York Avenue 2799 W. Grand Blvd. enry Ford ospital Richmond, V Memorial Sloan-Kettering Cancer Center San Francisco, CA University of California, San Francisco Boston, M 2111, 171 Tufts New England Medical Center Box 58 arrison Avenue Toledo, O Portland, O Medical College of Ohio 3rd and Parassus ( 925 Sw Barnes Rd. St. Vincent ospital Detroit, MI 4821 Detroit, MI 4822

59 5 Milwaukee, WI W. Wisconsin Ave. Roswell Park Memorial Swedish ospital Tumor Clinic Medical College of Wisconsin Seattle, WA 9814 New aven, CT 651 Chicago, IL 6637 Box S. Maryland University of Chicago Radiation and Medical Research Center Buffalo, NY University of Nebraska Medical Center Cleveland, O nd and Dewey Ave. 95 Euclid Ave. Educational Foundation Cleveland Clinic Philadelphia, PA Cedar St. Mercy Radiation Therapy Center Ft. Worth, TX Enderly Place East Omaha, NE 6815 Monmouth Medical Center Michael Reese! Department of Therapeutic Rad. Yale University C Royal Oak, MI Second Avenue 361 W. 13 Mile Rd. 333 Cedar St. 666 Elm Long Branch, NJ Madison St. Department of Radiation OncoloQj Beamount ospital

60 6 Nashville, TN Garland & 21st Ave. Division of Allied ealth Vanderbilt University ospital ouston, TX 773 Washington, DC ilgard Ave. UCLA Center for ealth Sciences St. Vincent s Medical Center One Baylor Plaza Chicago, II th and College St., NW oward University Jacksonville, FL 3223 P.O. Box W. Congress Parkway St. Luke s Medical Center 18 Barrs St. Rush-Presbyterian College of Medicine Rochester, MN 5595 Baylor College of Medicine Desk R Los Angeles, CA 924 Mayo Clinic surveyli St