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Alexander DA, Decker SM, Jermyn M, Bruza P, Zhang R, Chen E, McGlynn TL, Rosselot RA, Lee J, Rose ML, Williams BB, Pogue BW, Gladstone DJ, Jarvis LA. One Year of Clinic-Wide Cherenkov Imaging for Discovery of Quality Improvement Opportunities in Radiation Therapy. Pract Radiat Oncol 2023; 13:71-81. [PMID: 35777728 PMCID: PMC10984217 DOI: 10.1016/j.prro.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/20/2022] [Accepted: 06/07/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE Cherenkov imaging is clinically available as a radiation therapy treatment verification tool. The aim of this work was to discover the benefits of always-on Cherenkov imaging as a novel incident detection and quality improvement system through review of all imaging at our center. METHODS AND MATERIALS Multicamera Cherenkov imaging systems were permanently installed in 3 treatment bunkers, imaging continuously over a year. Images were acquired as part of normal treatment procedures and reviewed for potential treatment delivery anomalies. RESULTS In total, 622 unique patients were evaluated for this study. We identified 9 patients with treatment anomalies occurring over their course of treatment, which were only detected with Cherenkov imaging. Categorizing each event indicated issues arising in simulation, planning, pretreatment review, and treatment delivery, and none of the incidents were detected before this review by conventional measures. The incidents identified in this study included dose to unintended areas in planning, dose to unintended areas due to positioning at treatment, and nonideal bolus placement during setup. CONCLUSIONS Cherenkov imaging was shown to provide a unique method of detecting radiation therapy incidents that would have otherwise gone undetected. Although none of the events detected in this study reached the threshold of reporting, they identified opportunities for practice improvement and demonstrated added value of Cherenkov imaging in quality assurance programs.
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Affiliation(s)
- Daniel A Alexander
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire.
| | - Savannah M Decker
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire; Dose Optics LLC, Lebanon, New Hampshire
| | - Michael Jermyn
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire; Dose Optics LLC, Lebanon, New Hampshire
| | - Petr Bruza
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire; Dose Optics LLC, Lebanon, New Hampshire
| | - Rongxiao Zhang
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire; Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Dartmouth Cancer Center, Lebanon, New Hampshire
| | - Erli Chen
- Cheshire Medical Center, Keene, New Hampshire
| | | | | | - Jae Lee
- Dartmouth Cancer Center, Lebanon, New Hampshire
| | | | - Benjamin B Williams
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire; Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Dartmouth Cancer Center, Lebanon, New Hampshire
| | - Brian W Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire; Dose Optics LLC, Lebanon, New Hampshire; Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - David J Gladstone
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire; Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Lesley A Jarvis
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Dartmouth Cancer Center, Lebanon, New Hampshire
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Das IJ, Kalapurakal JA, Strauss JB, Zawislak BR, Gopalakrishnan M, Bajaj A, Mittal BB. Adaptability and Resilience of Academic Radiation Oncology Personnel and Procedures during COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5095. [PMID: 34065801 PMCID: PMC8151822 DOI: 10.3390/ijerph18105095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/03/2021] [Accepted: 05/10/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND A comprehensive response to the unprecedented SARS-CoV-2 (COVID-19) challenges for public health and its impact on radiation oncology patients and personnel for resilience and adaptability is presented. METHODS The general recommendations included working remotely when feasible, implementation of screening/safety and personal protective equipment (PPE) guidelines, social distancing, regular cleaning of treatment environment, and testing for high-risk patients/procedures. All teaching conferences, tumor boards, and weekly chart rounds were conducted using a virtual platform. Additionally, specific recommendations were given to each section to ensure proper patient treatments. The impact of these measures, especially adaptability and resilience, were evaluated through specific questionnaire surveys. RESULTS These comprehensive COVID-19-related measures resulted in most staff expressing a consistent level of satisfaction in regard to personal safety, maintaining a safe work environment, continuing quality patient care, and continuing educational activities during the pandemic. There was a significant reduction in patient treatments and on-site patient visits with an appreciable increase in the number of telemedicine e-visits. CONCLUSIONS Survey results demonstrated substantial adaptability and resilience, including in the rapid recovery of departmental activities during the reactivation phase. In the event of a future public health emergency, the measures implemented may be adopted with good outcomes by radiation oncology departments across the globe.
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Affiliation(s)
- Indra J. Das
- Department of Radiation Oncology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Galter Pavilion, LC-178, Chicago, IL 60611, USA; (J.A.K.); (J.B.S.); (B.R.Z.); (M.G.); (A.B.); (B.B.M.)
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Hong DS, Boike T, Dawes S, Klash SJ, Kudner R, Okoye C, Rosu-Bubulac M, Watanabe Y, Wright JL, Jennelle RL. Accreditation Program for Excellence (APEx): A Catalyst for Quality Improvement. Pract Radiat Oncol 2020; 11:101-107. [PMID: 33279669 DOI: 10.1016/j.prro.2020.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 09/09/2020] [Accepted: 10/19/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE In 2014 the American Society for Radiation Oncology's Accreditation Program for Excellence (APEx) was created in response to the Target Safely campaign. APEx is a powerful tool to measure and drive quality improvement in radiation oncology practices. METHODS AND MATERIALS A task group from the American Society for Radiation Oncology's Practice Accreditation Committee was formed to provide an overview of the APEx accreditation program including analysis from specific program data. RESULTS Through initiatives encouraged by the APEx program, participants are able to evaluate teamwork and effectiveness, implement documented procedures aimed at improving quality and safety, and establish quality management at the practice. The program's Self-Assessment measures performance with program requirements and indicates where compliance lacks standardization. Methods to address these deficiencies form part of on-going quality improvement. These quality outcomes promote the delivery of safe, high-quality care. CONCLUSION The accreditation process through APEx is a commitment to an ongoing safety culture. Any worthwhile accreditation program should provide a meaningful assessment of practice operations, supply the tools to identify deficiencies and provide the opportunity to showcase growth and development. A commitment to completing APEx is a commitment to excellence for patients and all those who care for them.
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Affiliation(s)
- David S Hong
- University of Southern California, Department of Radiation Oncology, Los Angeles, California
| | | | - Samantha Dawes
- American Society for Radiation Oncology, Arlington, Virginia.
| | | | - Randi Kudner
- American Society for Radiation Oncology, Arlington, Virginia
| | | | - Mihaela Rosu-Bubulac
- Virginia Commonwealth University, Department of Radiation Oncology, Richmond, Virginia
| | - Yoichi Watanabe
- University of Minnesota, Department of Radiation Oncology, Minneapolis, Minnesota
| | | | - Richard L Jennelle
- University of Southern California, Department of Radiation Oncology, Los Angeles, California
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Royce TJ, Dwyer K, Yu-Moe CW, DeRoo C, Jacobson JO, Tishler RB. Medical Malpractice Analysis in Radiation Oncology: A Decade of Results From a National Comparative Benchmarking System. Int J Radiat Oncol Biol Phys 2019; 103:801-808. [DOI: 10.1016/j.ijrobp.2018.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/01/2018] [Accepted: 11/03/2018] [Indexed: 01/06/2023]
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Huo M, Gorayski P, Poulsen M, Thompson K, Pinkham M. Evidence-based Peer Review for Radiation Therapy – Updated Review of the Literature with a Focus on Tumour Subsite and Treatment Modality. Clin Oncol (R Coll Radiol) 2017; 29:680-688. [DOI: 10.1016/j.clon.2017.04.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 03/30/2017] [Accepted: 04/06/2017] [Indexed: 12/16/2022]
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