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Jenny Kouri
DOS 752
11/14/15
Flow Charts
As a dosimetrist, it is highly important to understand the full treatment process of a
patient from consult to the very last treatment. The process of this workflow can be shaken up
during times of department reconstruction or replacement of a new linear accelerator or
simulator. Prior to the first phases of remodeling or modality upgrades, the radiation oncology
team should regroup to assess their normal workflow and see if it will still apply or need
adjustments during the construction phase. If a radiation oncology team can be fully prepared
for a change in workflow, there will be a lower chance of error, minimal miscommunication
during patient simulation and treatments, reduction of tension/frustration between co-workers,
and decreased prolonged waiting times (especially for patients who need prompt radiation).
At the VA Medical Center in Minneapolis, the delayed reconstruction phase has finally
begun in full force with the addition of a new CT simulator. To eliminate chaos and confusion,
the team designed a plan to sim patients without the departments Philips Big-Bore simulator
(until the arrival and commissioning of the new Toshiba Big Bore). The Radiology and PET/CT
departments of the VA have kindly offered to share their machines with the Radiation Oncology.
Our department was given allotted time slots each day that we can schedule patients for
simulation. I have created a flow chart to help us dosimetrists distinguish the importing
differences between Radiology and PET/CT. This is shown in Figure 1 (I had to break the image
up into 3 separate images to put into this document).
For this assignment, I found a flowchart that illustrated a radiation oncology departments
workflow that incorporated four phases: consultation, simulation/imaging, pre-treatment, and
treatment. This flowchart was found in article, A simulation of a radiotherapy treatment system:
A case study of a local cancer centre. The purpose of this case study was to describe a UK cancer
centers interactions between patients and treatment machinery and the obstacles faced that can
impede the radiation oncology workflow. Identifying complexities and understanding the
treatment process can overcome dilemmas that may surface.1
The flow chart begins with the patients consult and ends with the end of treatment. I
thought it was great to see that the patients signed consent was implanted in the workflow, as

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that is a make or break in the process. Boxes were utilized in the design of the flow chart, which
indicated a task that needed to be met. Triangles were also used, which indicated a question. Is a
physician present? Is the simulator available? Did the physician complete the contours? Was the
plan signed? Overall, the flowchart was simple and direct. As I continued reading the case study,
other flowcharts were created to showcase the workflow for the brachytherapy process. This
flowchart is shown in Figure 2. (Sorry about the clarity of the image!). This is the website of the
article: https://curve.coventry.ac.uk/open/file/ee59b370-9eb7-4968-a020762fdcd2fd29/1/orp3comb.pdf

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Figures

Figure 1. Flowchart for VA Medical Centers CT-simulation process

Figure 2: UK cancer centers Patient workflow in a flow chart

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References
1. Kapamara T, Sheibani K, Petrovic D, et al. A simulation of a radiotherapy treatment system: A
case study of a local cancer centre, in Proceedings of ORP3, EURO: Cadiz, Spain, 2014:1-7.
https://curve.coventry.ac.uk/open/file/ee59b370-9eb7-4968-a020-762fdcd2fd29/1/orp3comb.pdf