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Radiotherapy capacity in the UK is increasingly under pressure due to historic lack of provision, rising incidence of cancer in an aging population and technological developments improving and expanding treatment options. Varian’s Halcyon™ has the potential to increase capacity through accelerated treatment times and improved workflow but is there an impact on patient care and staff satisfaction?

Only the 5th Halcyon to go live in the UK, our local institution became the first UK department to adopt a 10-minute appointment time from the start of clinical use, utilising a structured framework to facilitate treating up to 51 patients per day, covering a variety of treatment sites.

Prior to working on the Halcyon, RTTs expressed concerns that patient care could deteriorate and staff become overstretched from the rapid throughput. They were also worried that the perceived simplicity of operating the new linac would lead to deskilling of RTTs.

To maintain the quality of patient care and staff wellbeing on Halcyon, it was important to look at these concerns.

A questionnaire was used to ascertain RTTs’ confidence levels in maintaining patient care, managing workflow and their own skill levels before having their training on Halcyon. They were also asked to indicate which feelings or descriptions they felt were relevant. The same questions were then asked at the end of a single day’s experience. This looked to understand their perceptions of starting to treat patients on Halcyon and how these views changed with experience.

A timing audit facilitated understanding of linac workflow. Consideration was made for patients who had severe mobility issues, pacemakers or other significant needs.

The numbers of patients treated each day on all linacs in the department were reviewed in the run up to full capacity on Halcyon to understand implications of integrating new equipment but also to quantify the impact on capacity in a busy department.

Confidence levels increased for all topics surveyed. This was across all staff surveyed regardless of staff skill level.

Average time in room per patients was 10:22mins (range 11:09-09:19).

Patient numbers treated on Halcyon exceeded those on other linacs (iX) from the start of 4th week of operation with up to 51patients treated per day. This represents an absolute increase in number of patients treated per day on other linacs over the same period, which treated an average of 32 patients per day (range 28.5-35.3).

After a minimum of 1 day on Halcyon, radiographers advised increased confidence levels in achieving timings and maintaining patient care levels. They also showed increased confidence in matching CBCTs, with the greatest rise seen in newly qualified radiographers.

While treating more patients than any other linac, in-room times under 11 mins per patient were routinely achieved. The structure of the day was very important and including hourly 10 min catch up bookings facilitated a smooth workflow.