Clinical experience and cost evaluation of magnetic resonance imaging -only workflow in radiation therapy planning of prostate cancer

BACKGROUND AND PURPOSE: In radiation therapy (RT), significant improvements have been made recently particularly in the practices of planning imaging. This study aimed to conduct a cost evaluation between magnetic resonance imaging (MRI) -only and combined computed tomography (CT) and MRI workflows. MATERIALS AND METHODS: The time-driven activity-based costing (TDABC) model was used to conduct a cost evaluation between the two workflows in those steps, where cost differences were expected. Costs were divided into capital costs and operational costs. The former consisted of fixed, one-time expenses, e.g. the purchase of a scanner, whereas the latter were partially based on the amount of activity consumed i.e. time required for image acquisition, image registration and structure contouring. RESULTS: In a review over a period of 10 years for 300 annual prostate cancer patients, the total cost of the workflow steps included in the study for an individual patient applying the MRI-only workflow was 903 € (100%), comprised of 537 € (59%) capital costs and 366 € (41%) operational costs. The corresponding total cost for an individual patient applying the CT + MRI workflow was 922 € (100%), comprised of 197 € (21%) capital costs and 726 € (79%) operational costs. In 10 years for 3000 patients, a total saving of 58,544 € (2%) was achieved with the MRI-only workflow compared with the dual imaging workflow. CONCLUSIONS: MRI-only workflow is a feasible and economic way to perform clinical RT for localized prostate cancer, in particular for medium- and large-sized departments treating a sufficient number of patients.