A study of perceived workload and ‘Levels of Automation’ in low-dose rate brachytherapy

A study of perceived workload and ‘Levels of Automation’ (LOA) was performed at the ‘Treatment delivery’ stage of Low-Dose Rate (LDR) prostate brachytherapy, which is a modality of cancer treatment. Five research questions were researched on the topics of perceived workload, automation, ‘levels of automation’, and automation-related issues, such as trust in automation, reliance on automation, perceived reliability of equipment performance, and ‘preferred LOA’ in LDR prostate brachytherapy. LDR prostate brachytherapy was mapped among the core team members by using a Hierarchical Task Analysis: Radiation oncologists, Radiologists (where applicable), Medical physicists, Nurses, and Anaesthetists. NASA-TLX was applied to the core team members’ main operations in order to assess the perceived workload straight after each of the 48 LDR prostate brachytherapy treatment cases carried out across four hospital sites in Ireland, and also to identify the critical perceived workload levels that could compromise patient safety among the core team members. Low, but still an acceptable workload was identified among Radiation oncologists. High, but still an acceptable workload was identified among Medical physicists, Nurses and Anaesthetists. No critical workload levels were identified. The main three predominant TLX dimensions were “Mental Demand”, “Temporal Demand” and “Effort”. A ‘Modified Levels of Automation’ (MLOA) model for brachytherapy with four LOA action stages previously identified by Parasuraman et al. (2000) “Information Acquisition”, “Information Analysis”, “Decision Selection”, and “Action Implementation”, was developed and applied to the current LDR prostate brachytherapy system. A ‘MLOA’ identified medium LOA at “Information Acquisition” action stage among the Radiation oncologists and Anaesthetists, and low LOA among the rest of the core team members at the other three LOA action stages. Small and moderate correlation between the perceived workload and ‘MLOA’ action stages was found among the Radiation oncologists & Radiologists, and between Medical Physics team in the present system, and a strong correlation for the Medical physicist #2 in the future system. ANOVA has shown that there are differences between the levels of perceived workload and ‘MLOA’. In future systems the higher LOA will result in reduced core team members’ operations. Their roles will change into supervisory roles; the perceived workload will stay at optimal levels, while the level of patient safety remains exceptional