1
|
Lastrucci A, Esposito M, Serventi E, Marrazzo L, Francolini G, Simontacchi G, Wandael Y, Barra A, Pallotta S, Ricci R, Livi L. Enhancing patient safety in radiotherapy: Implementation of a customized electronic checklist for radiation therapists. Tech Innov Patient Support Radiat Oncol 2024; 31:100255. [PMID: 38882236 PMCID: PMC11176772 DOI: 10.1016/j.tipsro.2024.100255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/19/2024] [Accepted: 05/27/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction The radiotherapy workflow involves the collaboration of multiple professionals and the execution of several steps to results in an effective treatment. In this study, we described the clinical implementation of an electronic checklist, developed to standardize the process of the chart review prior to the first treatment fraction by the radiation therapists (RTTs). Materials and Methods A customized electronic checklist was developed based on the recommendations of American Association of Physicists in Medicine (AAPM) Task Groups 275 and 315 and integrated into the Record and Verify System (RVS). The checklist consisted of 16 items requiring binary (yes/no) responses, with mandatory completion and review by RTTs prior to treatment. The utility of the checklist and its impact on workflow were assessed by analysing checklist reports, and by soliciting feedback to RTTs through an anonymized survey. Results During the first trial phase, from June to November 2023, 285 checklists were completed with a 98% compilation rate and 94.4% review rate. Forty errors were detected, mainly due to missing signed treatment plans and absence of Beam's Eye View documentation. Ninety percent of detected errors were fixed before the treatment start. In 4 cases, the problem could not be fixed before the first fraction, resulting in a suboptimal first treatment. The feedback survey showed that RTTs described the checklist as useful, with minimal impact on workload, and supported its implementation. Discussion The introduction of a customized electronic checklist improved the detection and correction of errors, thereby enhancing patient safety. The positive response from RTTs and the minimal impact on workflow underscore the value of the checklist as standard practice in radiotherapy departments.
Collapse
Affiliation(s)
- Andrea Lastrucci
- University of Florence, Florence, Italy
- Department of Allied Health Professions, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Marco Esposito
- Medical Physics, The Abdus Salam International Centre for Theoretical Physics, Trieste 34151, Italy
| | - Eva Serventi
- Radiation Oncology Unit, Santo Stefano Hospital, Department of Allied Health Professions, Azienda USL Toscana Centro, Prato 59100, Italy
| | - Livia Marrazzo
- Department of Experimental and Clinical Biomedical Sciences "M. Serio" - University of Florence, Florence, Italy
- Medical Physics Unit - Careggi University Hospital, Florence, Italy
| | - Giulio Francolini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Gabriele Simontacchi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Yannick Wandael
- Department of Allied Health Professions, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Angelo Barra
- Department of Allied Health Professions, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Stefania Pallotta
- Department of Experimental and Clinical Biomedical Sciences "M. Serio" - University of Florence, Florence, Italy
- Medical Physics Unit - Careggi University Hospital, Florence, Italy
| | - Renzo Ricci
- Department of Allied Health Professions, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences "M. Serio" - University of Florence, Florence, Italy
| |
Collapse
|
2
|
Sardeli C, Athanasiadis T, Stamoula E, Kouvelas D. Pharmacologic Stewardship in a Rural Community Pharmacy. Healthcare (Basel) 2023; 11:2619. [PMID: 37830656 PMCID: PMC10572962 DOI: 10.3390/healthcare11192619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/13/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Pharmacotherapy is an essential part of patient care. In order to achieve optimal health outcomes, safe and effective prescribing and administering of medications is crucial, especially since the process of pharmacotherapy can cause serious problems, mainly adverse events and/or interactions, that often pass undetected. OBJECTIVE(S) To investigate the feasibility of using community pharmacies as checkpoints to detect errors and failures in prescribing, as well as patients' compliance with pharmacotherapy. To this end, analysis and recording of the prescribing process was carried out and error-prone points were identified. METHODS Patients and caregivers filling prescriptions during the first 4 weeks of November 2017 and February 2018 answered questions in order to evaluate their attendance of regular checkups and their compliance with prescribing instructions. All prescriptions filled at the pharmacy were examined for detection of prescription errors and drug-drug interactions. Statistical analyses, including calculations of the correlation coefficient phi (φ), chi-square, and confidence intervals, were carried out. Detected errors and failures were evaluated by application of the Health Failure Mode Effect Analysis (HFMEA) quality tool. RESULTS A significant number of patients (16.7%) failed to regularly attend checkups regarding known health problems (95% CI: 10.6-22.7%), a corresponding percentage (16%, 95% CI: 10.1-21.9%) did not comply with prescribed pharmacotherapy, and a significant proportion of patients self-medicated regularly (32%, 95% CI: 24.5-39.5%). A total of 8.6% of prescriptions included medication combinations with a potential for severe drug-drug interactions (95% CI: 7.1-10.2%) while 58.7% of the prescriptions included combinations that could lead to moderate ones (95% CI: 56.1-61.4). The HFMEA indicated that all problems recorded required immediate interventions, except for prescribing errors. CONCLUSIONS Community pharmacies can be potential checkpoints for the detection and evaluation of prescribing errors and pharmacotherapy failures.
Collapse
Affiliation(s)
- Chrysanthi Sardeli
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece; (T.A.); (E.S.); (D.K.)
| | | | | | | |
Collapse
|
3
|
Ma M, Yan H, Li M, Tian Y, Zhang K, Men K, Dai J. Determining the quality control frequency of an MR-linac using risk matrix (RM) analysis. J Appl Clin Med Phys 2023:e13984. [PMID: 37095706 PMCID: PMC10402679 DOI: 10.1002/acm2.13984] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 02/28/2023] [Accepted: 03/20/2023] [Indexed: 04/26/2023] Open
Abstract
PURPOSE Quality control (QC) is performed routinely through professional guidelines. However, the recommended QC frequency may not be optimal among different institutional settings. Here we propose a novel method for determining the optimal QC frequency using risk matrix (RM) analysis. METHODS AND MATERIALS A newly installed Magnetic Resonance linac (MR-linac) was chosen as the testing platform and six routine QC items were investigated. Failures of these QC items can adversely affect treatment outcome for the patient. Accordingly, each QC item with its assigned frequency forms a unique failure mode (FM). Using FM-effect analysis (FMEA), the severity (S), occurrence (O), and detection (D) of each FM was obtained. Next, S and D based on RM was used to determine the appropriate QC frequency. Finally, the performance of new frequency for each QC item was evaluated using the metric E = O/D. RESULTS One new QC frequency was the same as the old frequency, two new QC frequencies were less than the old ones, and three new QC frequencies were higher than the old ones. For six QC items, E values at the new frequencies were not less than their values at the old frequencies. This indicates that the risk of machine failure is reduced at the new QC frequencies. CONCLUSIONS The application of RM analysis provides a useful tool for determining the optimal frequencies for routine linac QC. This study demonstrated that linac QC can be performed in a way that maintains high performance of the treatment machine in a radiotherapy clinic.
Collapse
Affiliation(s)
- Min Ma
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Yan
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Minghui Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Tian
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ke Zhang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kuo Men
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianrong Dai
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
4
|
Takemori M, Nakamura S, Sofue T, Ito M, Goka T, Miura Y, Iijima K, Chiba T, Nakayama H, Nakaichi T, Mikasa S, Takano Y, Kon M, Shuto Y, Urago Y, Nishitani M, Kashihara T, Takahashi K, Murakami N, Nishio T, Okamoto H, Chang W, Igaki H. Failure modes and effects analysis study for accelerator-based Boron Neutron Capture Therapy. Med Phys 2023; 50:424-439. [PMID: 36412161 DOI: 10.1002/mp.16104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 11/02/2022] [Accepted: 11/02/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Boron Neutron Capture Therapy (BNCT) has recently been used in clinical oncology thanks to recent developments of accelerator-based BNCT systems. Although there are some specific processes for BNCT, they have not yet been discussed in detail. PURPOSE The aim of this study is to provide comprehensive data on the risk of accelerator-based BNCT system to institutions planning to implement an accelerator-based BNCT system. METHODS In this study, failure mode and effects analysis (FMEA) was performed based on a treatment process map prepared for the accelerator-based BNCT system. A multidisciplinary team consisting of a medical doctor (MD), a registered nurse (RN), two medical physicists (MP), and three radiologic technologists (RT) identified the failure modes (FMs). Occurrence (O), severity (S), and detectability (D) were scored on a scale of 10, respectively. For each failure mode (FM), risk priority number (RPN) was calculated by multiplying the values of O, S, and D, and it was then categorized as high risk, very high risk, and other. Additionally, FMs were statistically compared in terms of countermeasures, associated occupations, and whether or not they were the patient-derived. RESULTS The identified FMs for BNCT were 165 in which 30 and 17 FMs were classified as high risk and very high risk, respectively. Additionally, 71 FMs were accelerator-based BNCT-specific FMs in which 18 and 5 FMs were classified as high risk and very high risk, respectively. The FMs for which countermeasures were "Education" or "Confirmation" were statistically significantly higher for S than the others (p = 0.019). As the number of BNCT facilities is expected to increase, staff education is even more important. Comparing patient-derived and other FMs, O tended to be higher in patient-derived FMs. This could be because the non-patient-derived FMs included events that could be controlled by software, whereas the patient-derived FMs were impossible to prevent and might also depend on the patient's condition. Alternatively, there were non-patient-derived FMs with higher D, which were difficult to detect mechanically and were classified as more than high risk. In O, significantly higher values (p = 0.096) were found for FMs from MD and RN associated with much patient intervention compared to FMs from MP and RT less patient intervention. Comparing conventional radiotherapy and accelerator-based BNCT, although there were events with comparable risk in same FMs, there were also events with different risk in same FMs. They could be related to differences in the physical characteristics of the two modalities. CONCLUSIONS This study is the first report for conducting a risk analysis for BNCT using FMEA. Thus, this study provides comprehensive data needed for quality assurance/quality control (QA/QC) in the treatment process for facilities considering the implementation of accelerator-based BNCT in the future. Because many BNCT-specific risks were discussed, it is important to understand the characteristics of BNCT and to take adequate measures in advance. If the effects of all FMs and countermeasures are discussed by multidisciplinary team, it will be possible to take countermeasures against individual FMs from many perspectives and provide BNCT more safely and effectively.
Collapse
Affiliation(s)
- Mihiro Takemori
- Division of Radiation Safety and Quality Assurance, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.,Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Arakawa-ku, Tokyo, Japan.,Division of Boron Neutron Capture Therapy, National Cancer Center Exploratory Oncology Research & Clinical Trial Center, Chuo-ku, Tokyo, Japan
| | - Satoshi Nakamura
- Division of Radiation Safety and Quality Assurance, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.,Division of Boron Neutron Capture Therapy, National Cancer Center Exploratory Oncology Research & Clinical Trial Center, Chuo-ku, Tokyo, Japan.,Medical Physics Laboratory, Division of Health Science, Graduate School of Medicine, Osaka University, Suita city, Osaka, Japan
| | - Toshimitsu Sofue
- Department of Radiological Technology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Mikiko Ito
- Department of Nursing, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Tomonori Goka
- Department of Radiological Technology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Yuki Miura
- Department of Radiological Technology, National Cancer Center Hospital East, Kashiwa-shi, Chiba, Japan
| | - Kotaro Iijima
- Division of Radiation Safety and Quality Assurance, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Takahito Chiba
- Division of Radiation Safety and Quality Assurance, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.,Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Arakawa-ku, Tokyo, Japan
| | - Hiroki Nakayama
- Division of Radiation Safety and Quality Assurance, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.,Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Arakawa-ku, Tokyo, Japan
| | - Tetsu Nakaichi
- Division of Radiation Safety and Quality Assurance, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Shohei Mikasa
- Division of Radiation Safety and Quality Assurance, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Yuki Takano
- Division of Radiation Safety and Quality Assurance, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Mitsuhiro Kon
- Division of Radiation Safety and Quality Assurance, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.,Department of Radiological Technology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Yasunori Shuto
- Division of Radiation Safety and Quality Assurance, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.,Department of Radiological Technology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Yuka Urago
- Division of Radiation Safety and Quality Assurance, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.,Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Arakawa-ku, Tokyo, Japan
| | - Masato Nishitani
- Division of Radiation Safety and Quality Assurance, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.,Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Arakawa-ku, Tokyo, Japan
| | - Tairo Kashihara
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Kana Takahashi
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Teiji Nishio
- Medical Physics Laboratory, Division of Health Science, Graduate School of Medicine, Osaka University, Suita city, Osaka, Japan
| | - Hiroyuki Okamoto
- Division of Radiation Safety and Quality Assurance, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Weishan Chang
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Arakawa-ku, Tokyo, Japan
| | - Hiroshi Igaki
- Division of Boron Neutron Capture Therapy, National Cancer Center Exploratory Oncology Research & Clinical Trial Center, Chuo-ku, Tokyo, Japan.,Department of Radiation Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| |
Collapse
|
5
|
Intra-Operative Electron Radiation Therapy: An Update of the Evidence Collected in 40 Years to Search for Models for Electron-FLASH Studies. Cancers (Basel) 2022; 14:cancers14153693. [PMID: 35954357 PMCID: PMC9367249 DOI: 10.3390/cancers14153693] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/13/2022] [Accepted: 07/22/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Four decades ago, intraoperative electron radiation therapy (IOeRT) was developed to improve precision in local cancer treatment by combining real-time surgical exploration and resection with high-energy electron irradiation. The technology of ultra-high dose rate electron and other radiation beams known as FLASH irradiation sharply increases its interests, as data from preclinical experiments have proven a marked favorable effect on the therapeutic index: similar cancer control with a clearly improved tolerance of many normal tissues to high doses of irradiation. The knowledge and tools regarding technology, physics, biology, and preclinical results in heterogeneous cancers opens great opportunities towards the path of developing the first clinical applications of the emerging FLASH technology via clinical trials based on state-of-the-art medical practice with IOeRT. Abstract Introduction: The clinical practice and outcome results of intraoperative electron radiation therapy (IOeRT) in cancer patients have been extensively reported over 4 decades. Electron beams can be delivered in the promising FLASH dose rate. Methods and Materials: Several cancer models were approached by two alternative radiobiological strategies to optimize local cancer control: boost versus exclusive IOeRT. Clinical outcomes are revisited via a bibliometric search performed for the elaboration of ESTRO/ACROP IORT guidelines. Results: In the period 1982 to 2020, a total of 19,148 patients were registered in 116 publications concerning soft tissue sarcomas (9% of patients), unresected and borderline-resected pancreatic cancer (22%), locally recurrent and locally advanced rectal cancer (22%), and breast cancer (45%). Clinical outcomes following IOeRT doses in the range of 10 to 25 Gy (with or without external beam fractionated radiation therapy) show a wide range of local control from 40 to 100% depending upon cancer site, histology, stage, and treatment intensity. Constraints for normal tissue tolerance are important to maintain tumor control combined with acceptable levels of side effects. Conclusions: IOeRT represents an evidence-based approach for several tumor types. A specific risk analysis for local recurrences supports the identification of cancer models that are candidates for FLASH studies.
Collapse
|
6
|
Nishioka S, Okamoto H, Chiba T, Sakasai T, Okuma K, Kuwahara J, Fujiyama D, Nakamura S, Iijima K, Nakayama H, Takemori M, Tsunoda Y, Kaga K, Igaki H. Identifying risk characteristics using failure mode and effect analysis for risk management in online magnetic resonance-guided adaptive radiation therapy. Phys Imaging Radiat Oncol 2022; 23:1-7. [PMID: 35712526 PMCID: PMC9194450 DOI: 10.1016/j.phro.2022.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/15/2022] [Accepted: 06/02/2022] [Indexed: 11/03/2022] Open
Abstract
Failure mode and effect analysis with process map revealed risks. High-risk failure modes and their corrective measures were identified. Hazardous processes and characteristics of the treatment were identified. All failure modes including those identified in previous papers were summarized and compared.
Background and purpose Materials and methods Results Conclusion
Collapse
|
7
|
Hilliard EN, Carver RL, Chambers EL, Kavanaugh JA, Erhart KJ, McGuffey AS, Hogstrom KR. Planning and delivery of intensity modulated bolus electron conformal therapy. J Appl Clin Med Phys 2021; 22:8-21. [PMID: 34558774 PMCID: PMC8504596 DOI: 10.1002/acm2.13386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/30/2020] [Accepted: 06/23/2021] [Indexed: 12/05/2022] Open
Abstract
PURPOSE Bolus electron conformal therapy (BECT) is a clinically useful, well-documented, and available technology. The addition of intensity modulation (IM) to BECT reduces volumes of high dose and dose spread in the planning target volume (PTV). This paper demonstrates new techniques for a process that should be suitable for planning and delivering IM-BECT using passive radiotherapy intensity modulation for electrons (PRIME) devices. METHODS The IM-BECT planning and delivery process is an addition to the BECT process that includes intensity modulator design, fabrication, and quality assurance. The intensity modulator (PRIME device) is a hexagonal matrix of small island blocks (tungsten pins of varying diameter) placed inside the patient beam-defining collimator (cutout). Its design process determines a desirable intensity-modulated electron beam during the planning process, then determines the island block configuration to deliver that intensity distribution (segmentation). The intensity modulator is fabricated and quality assurance performed at the factory (.decimal, LLC, Sanford, FL). Clinical quality assurance consists of measuring a fluence distribution in a plane perpendicular to the beam in a water or water-equivalent phantom. This IM-BECT process is described and demonstrated for two sites, postmastectomy chest wall and temple. Dose plans, intensity distributions, fabricated intensity modulators, and quality assurance results are presented. RESULTS IM-BECT plans showed improved D90-10 over BECT plans, 6.4% versus 7.3% and 8.4% versus 11.0% for the postmastectomy chest wall and temple, respectively. Their intensity modulators utilized 61 (single diameter) and 246 (five diameters) tungsten pins, respectively. Dose comparisons for clinical quality assurance showed that for doses greater than 10%, measured agreed with calculated dose within 3% or 0.3 cm distance-to-agreement (DTA) for 99.9% and 100% of points, respectively. CONCLUSION These results demonstrated the feasibility of translating IM-BECT to the clinic using the techniques presented for treatment planning, intensity modulator design and fabrication, and quality assurance processes.
Collapse
Affiliation(s)
- Elizabeth N. Hilliard
- Department of Physics and AstronomyLouisiana State UniversityBaton RougeLouisianaUSA
| | - Robert L. Carver
- Department of Physics and AstronomyLouisiana State UniversityBaton RougeLouisianaUSA
- Mary Bird Perkins Cancer CenterBaton RougeLouisianaUSA
| | - Erin L. Chambers
- Department of Physics and AstronomyLouisiana State UniversityBaton RougeLouisianaUSA
| | - James A. Kavanaugh
- Department of Radiation OncologyWashington University School of MedicineSaint LouisMissouriUSA
| | | | - Andrew S. McGuffey
- Department of Physics and AstronomyLouisiana State UniversityBaton RougeLouisianaUSA
| | - Kenneth R. Hogstrom
- Department of Physics and AstronomyLouisiana State UniversityBaton RougeLouisianaUSA
- Mary Bird Perkins Cancer CenterBaton RougeLouisianaUSA
| |
Collapse
|
8
|
State of the art in breast intraoperative electron radiation therapy after intraoperative ultrasound introduction. Radiol Oncol 2021; 55:333-340. [PMID: 33991470 PMCID: PMC8366729 DOI: 10.2478/raon-2021-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 04/06/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Breast intraoperative electron radiation therapy (B-IOERT) can be used in clinical practice both as elective irradiation (partial breast irradiation - APBI) in low risk breast cancer patients, and as an anticipated boost. The procedure generally includes the use of a shielding disk between the residual breast and the pectoralis fascia for the protection of the tissues underneath the target volume. The aim of the study was to evaluate the role of intraoperative ultrasound (IOUS) in improving the quality of B-IOERT. PATIENTS AND METHODS B-IOERT was introduced in Trieste in 2012 and its technique was improved in 2014 with IOUS. Both, needle and IOUS were used to measure target thickness and the latter was used even to check the correct position of the shielding disk. The primary endpoint of the study was the evaluation of the effectiveness of IOUS in reducing the risk of a disk misalignment related to B-IOERT and the secondary endpoint was the analysis of acute and late toxicity, by comparing two groups of patients treated with IOERT as a boost, either measured with IOUS and needle (Group 1) or with needle alone (Group 2). Acute and late toxicity were evaluated by validated scoring systems. RESULTS From the institutional patients who were treated between June 2012 and October 2019, 109 were eligible for this study (corresponding to 110 cases, as one patients underwent bilateral conservative surgery and bilateral B-IOERT). Of these, 38 were allocated to group 1 and 72 to group 2. The target thickness measured with the IOUS probe and with the needle were similar (mean difference of 0.1 mm, p = 0.38). The percentage of patients in which the shield was perfectly aligned after IOUS introduction increased from 23% to more than 70%. Moreover, patients treated after IOUS guidance had less acute toxicity (36.8% vs. 48.6%, p = 0.33) from radiation therapy, which reached no statistical significance. Late toxicity turned out to be similar regardless of the use of IOUS guidance: 39.5% vs. 37.5% (p = 0.99). CONCLUSIONS IOUS showed to be accurate in measuring the target depth and decrease the misalignment between collimator and disk. Furthermore there was an absolute decrease in acute toxicity, even though not statistically significant, in the group of women who underwent B-IOERT with IOUS guidance.
Collapse
|
9
|
Gilmore MDF, Rowbottom CG. Evaluation of failure modes and effect analysis for routine risk assessment of lung radiotherapy at a UK center. J Appl Clin Med Phys 2021; 22:36-47. [PMID: 33835698 PMCID: PMC8130239 DOI: 10.1002/acm2.13238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/19/2021] [Accepted: 03/08/2021] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Explore the feasibility of adopting failure modes and effects analysis (FMEA) for risk assessment of a high volume clinical service at a UK radiotherapy center. Compare hypothetical failure modes to locally reported incidents. METHOD An FMEA for a lung radiotherapy service was conducted at a hospital that treats ~ 350 lung cancer patients annually with radical radiotherapy. A multidisciplinary team of seven people was identified including a nominated facilitator. A process map was agreed and failure modes identified and scored independently, final failure modes and scores were then agreed at a face-to-face meeting. Risk stratification methods were explored and staff effort recorded. Radiation incidents related to lung radiotherapy reported locally in a 2-year period were analyzed to determine their relation to the identified failure modes. The final FMEA was therefore a combination of prospective evaluation and retrospective analysis from an incident learning system. RESULTS Thirty-six failure modes were identified for the pre-existing clinical service. The top failure modes varied according to the ranking method chosen. The process required 30 h of combined staff time. Over the 2-year period chosen, 38 voluntarily reported incidents were identified as relating to lung radiotherapy. Of these, 13 were not predicted by the identified failure modes, with six relating to delays in the process, three issues with appointment times, one communication error, two instances of a failure to image, and one technical fault deemed unpredictable by the manufacturer. Four additional failure modes were added to the FMEA following the incident analysis. CONCLUSION FMEA can be effectively applied to an established high volume service as a risk assessment method. Facilitation by an individual familiar with the FMEA process can reduce resource requirement. Prospective evaluation of risks should be combined with an incident reporting and learning system to produce a more comprehensive analysis of risk.
Collapse
Affiliation(s)
- Martyn D. F. Gilmore
- Medical PhysicsClatterbridge Cancer Centre NHS Foundation TrustBebingtonWirralUK
| | - Carl G. Rowbottom
- Medical PhysicsClatterbridge Cancer Centre NHS Foundation TrustBebingtonWirralUK
| |
Collapse
|
10
|
Mancosu P, Signori C, Clerici E, Comito T, D'Agostino GR, Franceschini D, Franzese C, Lobefalo F, Navarria P, Paganini L, Reggiori G, Tomatis S, Scorsetti M. Critical Re-Evaluation of a Failure Mode Effect Analysis in a Radiation Therapy Department After 10 Years. Pract Radiat Oncol 2020; 11:e329-e338. [PMID: 33197646 DOI: 10.1016/j.prro.2020.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/26/2020] [Accepted: 11/03/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Failure mode effect analysis (FMEA) is a proactive methodology that allows one to analyze a process, regardless of whether an adverse event occurs. In our radiation therapy (RT) department, a first FMEA was performed in 2009. In this paper we critically re-evaluate the RT process after 10 years and present it in terms of a lesson learned. METHODS AND MATERIALS A working group (WG), led by a qualified clinical risk engineer, which included radiation oncologists, physicists, a radiation therapist, and a nurse, evaluated the possible failure modes (FMs) of the RT process. For each FM, the estimated frequency of occurrence (O, range 1-4), the expected severity of the damage (S, range 1-5), and the detectability lack (D, range 1-4) were scored. A risk priority number (RPN) was obtained as RPN = OxSxD. The data were compared with the 2009 edition. RESULTS In the 2020 analysis, 67 FMs were identified (27 in the 2009 series). The absolute risk values of the previous 3 highest FMs were generally reduced. The patient identification risk (highest value in the 2009 analysis) was reduced from 48.0 to 6.9, becoming the 51st RPN score, thanks to a patient barcode recognition within the bunker. The 2020 highest risk values regarded: (i-2020) the patient's inadequate recollection and reporting of his/her medical history (ie, anamnesis) during the first medical examination and (ii-2020) the incorrect interpretation of tumor and normal tissue in computed tomography images. The WG proposed corrective actions. CONCLUSIONS In this single institution experience, the 10-year FMEA analysis showed a reduction in the previous higher RPN values thanks to the corrective actions taken. The new FMs and subsequent RPNs reveal the need for a continuous iterative improvement process.
Collapse
Affiliation(s)
- Pietro Mancosu
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center-IRCCS, Milan, Italy.
| | - Chiara Signori
- Risk Management Unit, Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | - Elena Clerici
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | - Tiziana Comito
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | | | - Davide Franceschini
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | - Ciro Franzese
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center-IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Francesca Lobefalo
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | - Piera Navarria
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | - Lucia Paganini
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | - Giacomo Reggiori
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | - Stefano Tomatis
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center-IRCCS, Milan, Italy
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center-IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| |
Collapse
|
11
|
Liu HC, Zhang LJ, Ping YJ, Wang L. Failure mode and effects analysis for proactive healthcare risk evaluation: A systematic literature review. J Eval Clin Pract 2020; 26:1320-1337. [PMID: 31849153 DOI: 10.1111/jep.13317] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 10/08/2019] [Accepted: 10/28/2019] [Indexed: 12/23/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Failure mode and effects analysis (FMEA) is a valuable reliability management tool that can preemptively identify the potential failures of a system and assess their causes and effects, thereby preventing them from occurring. The use of FMEA in the healthcare setting has become increasingly popular over the last decade, being applied to a multitude of different areas. The objective of this study is to review comprehensively the literature regarding the application of FMEA for healthcare risk analysis. METHODS An extensive search was carried out in the scholarly databases of Scopus and PubMed, and we only chose the academic articles which used the FMEA technique to solve healthcare risk analysis problems. Furthermore, a bibliometric analysis was performed based on the number of citations, publication year, appeared journals, authors, and country of origin. RESULTS A total of 158 journal papers published over the period of 1998 to 2018 were extracted and reviewed. These publications were classified into four categories (ie, healthcare process, hospital management, hospital informatization, and medical equipment and production) according to the healthcare issues to be solved, and analyzed regarding the application fields and the utilized FMEA methods. CONCLUSION FMEA has high practicality for healthcare quality improvement and error reduction and has been prevalently employed to improve healthcare processes in hospitals. This research supports academics and practitioners in effectively adopting the FMEA tool to proactively reduce healthcare risks and increase patient safety, and provides an insight into its state-of-the-art.
Collapse
Affiliation(s)
- Hu-Chen Liu
- School of Economics and Management, Tongji University, Shanghai, People's Republic of China.,College of Economics and Management, China Jiliang University, Hangzhou, People'sRepublic of China
| | - Li-Jun Zhang
- School of Management, Shanghai University, Shanghai, People's Republic of China
| | - Ye-Jia Ping
- School of Management, Shanghai University, Shanghai, People's Republic of China
| | - Liang Wang
- School of Management, Shanghai University, Shanghai, People's Republic of China
| |
Collapse
|
12
|
Rassiah P, Su FF, Huang YJ, Spitznagel D, Sarkar V, Szegedi MW, Zhao H, Paxton AB, Nelson G, Salter BJ. Using failure mode and effects analysis (FMEA) to generate an initial plan check checklist for improved safety in radiation treatment. J Appl Clin Med Phys 2020; 21:83-91. [PMID: 32583912 PMCID: PMC7484852 DOI: 10.1002/acm2.12918] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/14/2020] [Accepted: 04/28/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To apply failure mode and effect analysis (FMEA) to generate an effective and efficient initial physics plan checklist. METHODS A team of physicists, dosimetrists, and therapists was setup to reconstruct the workflow processes involved in the generation of a treatment plan beginning from simulation. The team then identified possible failure modes in each of the processes. For each failure mode, the severity (S), frequency of occurrence (O), and the probability of detection (D) was assigned a value and the risk priority number (RPN) was calculated. The values assigned were based on TG 100. Prior to assigning a value, the team discussed the values in the scoring system to minimize randomness in scoring. A local database of errors was used to help guide the scoring of frequency. RESULTS Twenty-seven process steps and 50 possible failure modes were identified starting from simulation to the final approved plan ready for treatment at the machine. Any failure mode that scored an average RPN value of 20 or greater was deemed "eligible" to be placed on the second checklist. In addition, any failure mode with a severity score value of 4 or greater was also considered for inclusion in the checklist. As a by-product of this procedure, safety improvement methods such as automation and standardization of certain processes (e.g., dose constraint checking, check tools), removal of manual transcription of treatment-related information as well as staff education were implemented, although this was not the team's original objective. Prior to the implementation of the new FMEA-based checklist, an in-service for all the second checkers was organized to ensure further standardization of the process. CONCLUSION The FMEA proved to be a valuable tool for identifying vulnerabilities in our workflow and processes in generating a treatment plan and subsequently a new, more effective initial plan checklist was created.
Collapse
Affiliation(s)
- Prema Rassiah
- Department of Radiation OncologyUniversity of UtahSalt Lake CityUTUSA
| | | | - Y. Jessica Huang
- Department of Radiation OncologyUniversity of UtahSalt Lake CityUTUSA
| | | | - Vikren Sarkar
- Department of Radiation OncologyUniversity of UtahSalt Lake CityUTUSA
| | - Martin W. Szegedi
- Department of Radiation OncologyUniversity of UtahSalt Lake CityUTUSA
| | - Hui Zhao
- Department of Radiation OncologyUniversity of UtahSalt Lake CityUTUSA
| | - Adam B. Paxton
- Department of Radiation OncologyUniversity of UtahSalt Lake CityUTUSA
| | - Geoff Nelson
- Department of Radiation OncologyUniversity of UtahSalt Lake CityUTUSA
| | - Bill J. Salter
- Department of Radiation OncologyUniversity of UtahSalt Lake CityUTUSA
| |
Collapse
|
13
|
García-Vázquez V, Calvo FA, Ledesma-Carbayo MJ, Sole CV, Calvo-Haro J, Desco M, Pascau J. Intraoperative computed tomography imaging for dose calculation in intraoperative electron radiation therapy: Initial clinical observations. PLoS One 2020; 15:e0227155. [PMID: 31923183 PMCID: PMC6953834 DOI: 10.1371/journal.pone.0227155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 12/12/2019] [Indexed: 12/20/2022] Open
Abstract
In intraoperative electron radiation therapy (IOERT) the energy of the electron beam is selected under the conventional assumption of water-equivalent tissues at the applicator end. However, the treatment field can deviate from the theoretic flat irradiation surface, thus altering dose profiles. This patient-based study explored the feasibility of acquiring intraoperative computed tomography (CT) studies for calculating three-dimensional dose distributions with two factors not included in the conventional assumption, namely the air gap from the applicator end to the irradiation surface and tissue heterogeneity. In addition, dose distributions under the conventional assumption and from preoperative CT studies (both also updated with intraoperative data) were calculated to explore whether there are other alternatives to intraoperative CT studies that can provide similar dose distributions. The IOERT protocol was modified to incorporate the acquisition of intraoperative CT studies before radiation delivery in six patients. Three studies were not valid to calculate dose distributions due to the presence of metal artefacts. For the remaining three cases, the average gamma pass rates between the doses calculated from intraoperative CT studies and those obtained assuming water-equivalent tissues or from preoperative CT studies were 73.4% and 74.0% respectively. The agreement increased when the air gap was included in the conventional assumption (98.1%) or in the preoperative CT images (98.4%). Therefore, this factor was the one mostly influencing the dose distributions of this study. Our experience has shown that intraoperative CT studies are not recommended when the procedure includes the use of shielding discs or surgical retractors unless metal artefacts are removed. IOERT dose distributions calculated under the conventional assumption or from preoperative CT studies may be inaccurate unless the air gap (which depends on the surface irregularities of the irradiated volume and on the applicator pose) is included in the calculations.
Collapse
Affiliation(s)
- Verónica García-Vázquez
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Comunidad de Madrid, Spain
- * E-mail: (VGV); (JP)
| | - Felipe A. Calvo
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Comunidad de Madrid, Spain
- Departamento de Oncología, Hospital General Universitario Gregorio Marañón, Madrid, Comunidad de Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Comunidad de Madrid, Spain
- Clínica Universidad de Navarra, Madrid, Comunidad de Madrid, Spain
| | - María J. Ledesma-Carbayo
- Biomedical Image Technologies Laboratory (BIT), Escuela Técnica Superior de Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, Madrid, Comunidad de Madrid, Spain
- CIBER-BBN, Madrid, Comunidad de Madrid, Spain
| | - Claudio V. Sole
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Comunidad de Madrid, Spain
- Department of Radiation Oncology, Instituto de Radiomedicina, Santiago, Región Metropolitana de Santiago, Chile
| | - José Calvo-Haro
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Comunidad de Madrid, Spain
- Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, Comunidad de Madrid, Spain
- Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Comunidad de Madrid, Spain
| | - Manuel Desco
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Comunidad de Madrid, Spain
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Comunidad de Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Comunidad de Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Comunidad de Madrid, Spain
| | - Javier Pascau
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Comunidad de Madrid, Spain
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Comunidad de Madrid, Spain
- * E-mail: (VGV); (JP)
| |
Collapse
|
14
|
Shen J, Wang X, Deng D, Gong J, Tan K, Zhao H, Bao Z, Xiao J, Liu A, Zhou Y, Liu H, Xie C. Evaluation and improvement the safety of total marrow irradiation with helical tomotherapy using repeat failure mode and effects analysis. Radiat Oncol 2019; 14:238. [PMID: 31882010 PMCID: PMC6935229 DOI: 10.1186/s13014-019-1433-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/29/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND & PURPOSE Helical tomotherapy has been applied to total marrow irradiation (HT-TMI). Our objective was to apply failure mode and effects analysis (FMEA) two times separated by 1 year to evaluate and improve the safety of HT-TMI. MATERIALS AND METHODS A multidisciplinary team was created. FMEA consists of 4 main steps: (1) Creation of a process map; (2) Identification of all potential failure mode (FM) in the process; (3) Evaluation of the occurrence (O), detectability (D) and severity of impact (S) of each FM according to a scoring criteria (1-10), with the subsequent calculation of the risk priority number (RPN=O*D*S) and (4) Identification of the feasible and effective quality control (QC) methods for the highest risks. A second FMEA was performed for the high-risk FMs based on the same risk analysis team in 1 year later. RESULTS A total of 39 subprocesses and 122 FMs were derived. First time RPN ranged from 3 to 264.3. Twenty-five FMs were defined as being high-risk, with the top 5 FMs (first RPN/ second RPN): (1) treatment couch movement failure (264.3/102.8); (2) section plan dose junction error in delivery (236.7/110.4); (3) setup check by megavoltage computed tomography (MVCT) failure (216.8/94.6); (4) patient immobilization error (212.5/90.2) and (5) treatment interruption (204.8/134.2). A total of 20 staff members participated in the study. The second RPN value of the top 5 high-risk FMs were all decreased. CONCLUSION QC interventions were implemented based on the FMEA results. HT-TMI specific treatment couch tests; the arms immobilization methods and strategy of section plan dose junction in delivery were proved to be effective in the improvement of the safety.
Collapse
Affiliation(s)
- Jiuling Shen
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430070, People's Republic of China.,Hubei Radiotherapy Quality Control Center, Wuhan University, Wuhan, Hubei, China
| | - Xiaoyong Wang
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430070, People's Republic of China.,Hubei Radiotherapy Quality Control Center, Wuhan University, Wuhan, Hubei, China
| | - Di Deng
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430070, People's Republic of China.,Hubei Radiotherapy Quality Control Center, Wuhan University, Wuhan, Hubei, China
| | - Jian Gong
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430070, People's Republic of China.,Hubei Radiotherapy Quality Control Center, Wuhan University, Wuhan, Hubei, China
| | - Kang Tan
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430070, People's Republic of China.,Hubei Radiotherapy Quality Control Center, Wuhan University, Wuhan, Hubei, China
| | - Hongli Zhao
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430070, People's Republic of China.,Hubei Radiotherapy Quality Control Center, Wuhan University, Wuhan, Hubei, China
| | - Zhirong Bao
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430070, People's Republic of China.,Hubei Radiotherapy Quality Control Center, Wuhan University, Wuhan, Hubei, China
| | - Jinping Xiao
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430070, People's Republic of China.,Hubei Radiotherapy Quality Control Center, Wuhan University, Wuhan, Hubei, China
| | - An Liu
- Divisions of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Yunfeng Zhou
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430070, People's Republic of China.,Hubei Radiotherapy Quality Control Center, Wuhan University, Wuhan, Hubei, China
| | - Hui Liu
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430070, People's Republic of China. .,Hubei Radiotherapy Quality Control Center, Wuhan University, Wuhan, Hubei, China.
| | - Conghua Xie
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430070, People's Republic of China. .,Hubei Radiotherapy Quality Control Center, Wuhan University, Wuhan, Hubei, China.
| |
Collapse
|
15
|
Becker S, Sabouri P, Niu Y, Prado K, Chen S, Nichols E, Yi B. Commissioning and acceptance guide for the GammaPod. ACTA ACUST UNITED AC 2019; 64:205021. [DOI: 10.1088/1361-6560/ab41bd] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
16
|
Evaluating radiotherapy treatment delay using Failure Mode and Effects Analysis (FMEA). Radiother Oncol 2019; 137:102-109. [DOI: 10.1016/j.radonc.2019.04.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 04/13/2019] [Accepted: 04/15/2019] [Indexed: 11/22/2022]
|
17
|
Risk analysis of electronic intraoperative radiation therapy for breast cancer. Brachytherapy 2019; 18:271-276. [DOI: 10.1016/j.brachy.2018.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/29/2018] [Accepted: 10/31/2018] [Indexed: 11/22/2022]
|
18
|
Evaluation of dosimetric properties of shielding disk used in intraoperative electron radiotherapy: A Monte Carlo study. Appl Radiat Isot 2018; 139:107-113. [DOI: 10.1016/j.apradiso.2018.04.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 02/26/2018] [Accepted: 04/30/2018] [Indexed: 11/18/2022]
|
19
|
Vidali C, Severgnini M, Urbani M, Toscano L, Perulli A, Bortul M. FMECA Application to Intraoperative Electron Beam Radiotherapy Procedure As a Quality Method to Prevent and Reduce Patient's Risk in Conservative Surgery for Breast Cancer. Front Med (Lausanne) 2017; 4:138. [PMID: 28894737 PMCID: PMC5581388 DOI: 10.3389/fmed.2017.00138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 08/02/2017] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Failure Mode Effects and Criticalities Analysis (FMECA) represents a prospective method for risk assessment in complex medical practices. Our objective was to describe the application of FMECA approach to intraoperative electron beam radiotherapy (IOERT), delivered using a mobile linear accelerator, for the treatment of early breast cancer as an anticipated boost. MATERIALS AND METHODS A multidisciplinary Working Group, including several different professional profiles, was created before the beginning of clinical practice in 2012, with the purpose of writing the Flow Chart and applying the FMECA methodology to IOERT procedure. Several criticalities were identified a priori in the different steps of the procedure and a list of all potential failure modes (FMs) was drafted and ranked using the risk priority number (RPN) scoring system, based on the product of three parameters: severity, occurrence, and detectability (score between 1 and 5). The actions aimed at reducing the risk were then defined by the Working Group and the risk analysis was repeated in 2014 and in 2016, in order to assess the improvement achieved. RESULTS Fifty-one FMs were identified, which represented the issues prospectively investigated according to the FMECA methodology. Considering a set threshold of 30, the evaluated RPNs show that 33 out of 51 FMs are critical; 6 are included in the moderate risk class (RPN: 31-40); 16 in the intermediate risk class (RPN: 41-50), and 11 in the high risk class (RPN: >50). DISCUSSION The most critical steps concerned the surgical procedure and IOERT set-up. The introduction of the corrective actions into the clinical practice achieved the reduction of the RPNs in the re-analysis of the FMECA worksheet after 2 and 4 years, respectively. CONCLUSION FMECA proved to be a useful tool for prospective evaluation of potential failures in IOERT and contributed to optimize patient safety and to improve risk management culture among all the professionals of the Working Group.
Collapse
Affiliation(s)
- Cristiana Vidali
- Department of Radiation Oncology, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy
| | - Mara Severgnini
- Department of Medical Physics, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy
| | - Monica Urbani
- Department of Surgery, University of Trieste, Trieste, Italy
| | - Licia Toscano
- Department of Physics, University of Trieste, Trieste, Italy
| | - Alfredo Perulli
- Department of Medical Direction, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy
| | - Marina Bortul
- Department of Surgery, University of Trieste, Trieste, Italy
| |
Collapse
|
20
|
Ibanez-Rosello B, Bautista JA, Bonaque J, Perez-Calatayud J, Gonzalez-Sanchis A, Lopez-Torrecilla J, Brualla-Gonzalez L, Garcia-Hernandez T, Vicedo-Gonzalez A, Granero D, Serrano A, Borderia B, Solera C, Rosello J. Failure modes and effects analysis of total skin electron irradiation technique. Clin Transl Oncol 2017; 20:330-365. [PMID: 28779421 DOI: 10.1007/s12094-017-1721-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 07/24/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE Total skin electron irradiation (TSEI) is a radiotherapy technique which consists of an homogeneous body surface irradiation by electrons. This treatment requires very strict technical and dosimetric conditions, requiring the implementation of multiple controls. Recently, the Task Group 100 report of the AAPM has recommended adapting the quality assurance program of the facility to the risks of their processes. MATERIALS AND METHODS A multidisciplinary team evaluated the potential failure modes (FMs) of every process step, regardless of the management tools applied in the installation. For every FM, occurrence (O), severity (S) and detectability (D) by consensus was evaluated, which resulted in the risk priority number (RPN), which permitted the ranking of the FMs. Subsequently, all the management tools used, related to the TSEI process, were examined and the FMs were reevaluated, to analyze the effectiveness of these tools and to propose new management tools to cover the greater risk FMs. RESULTS 361 FMs were identified, 103 of which had RPN ≥80, initially, and 41 had S ≥ 8. Taking this into account the quality management tools FMs were reevaluated and only 30 FMs had RPN ≥80. The study of these 30 FMs emphasized that the FMs that involved greater risk were related to the diffuser screen placement and the patient's position during treatment. CONCLUSIONS The quality assurance program of the facility has been adapted to the risk of this treatment process, following the guidelines proposed by the TG-100. However, clinical experience continually reveals new FMs, so the need for periodic risk analysis is required.
Collapse
Affiliation(s)
- B Ibanez-Rosello
- Radiation Oncology Department, La Fe University and Polytechnic Hospital, Av. Fernando Abril Martorell 106, 46026, Valencia, Spain.
| | - J A Bautista
- Radiation Oncology Department, La Fe University and Polytechnic Hospital, Av. Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - J Bonaque
- Radiation Oncology Department, La Fe University and Polytechnic Hospital, Av. Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - J Perez-Calatayud
- Radiation Oncology Department, La Fe University and Polytechnic Hospital, Av. Fernando Abril Martorell 106, 46026, Valencia, Spain
- Unidad Mixta de Investigación en Radiofísica e Instrumentación Nuclear en Medicina (IRIMED), Instituto de Investigación Sanitaria La Fe (IIS-La Fe)-Universitat de Valencia (UV), 46026, Valencia, Spain
| | - A Gonzalez-Sanchis
- Radiation Oncology Department, ERESA, Hospital General Universitario, 46014, Valencia, Spain
| | - J Lopez-Torrecilla
- Radiation Oncology Department, ERESA, Hospital General Universitario, 46014, Valencia, Spain
| | - L Brualla-Gonzalez
- Medical Physics Department, ERESA, Hospital General Universitario, 46014, Valencia, Spain
| | - T Garcia-Hernandez
- Medical Physics Department, ERESA, Hospital General Universitario, 46014, Valencia, Spain
| | - A Vicedo-Gonzalez
- Medical Physics Department, ERESA, Hospital General Universitario, 46014, Valencia, Spain
| | - D Granero
- Medical Physics Department, ERESA, Hospital General Universitario, 46014, Valencia, Spain
| | - A Serrano
- Medical Physics Department, ERESA, Hospital General Universitario, 46014, Valencia, Spain
| | - B Borderia
- Medical Physics Department, ERESA, Hospital General Universitario, 46014, Valencia, Spain
| | - C Solera
- Medical Physics Department, ERESA, Hospital General Universitario, 46014, Valencia, Spain
| | - J Rosello
- Medical Physics Department, ERESA, Hospital General Universitario, 46014, Valencia, Spain
- Physiology Department, University of Valencia, 46010, Valencia, Spain
| |
Collapse
|
21
|
Marinetto E, Victores JG, García-Sevilla M, Muñoz M, Calvo FÁ, Balaguer C, Desco M, Pascau J. Technical Note: Mobile accelerator guidance using an optical tracker during docking in IOERT procedures. Med Phys 2017; 44:5061-5069. [PMID: 28736930 DOI: 10.1002/mp.12482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 07/14/2017] [Accepted: 07/14/2017] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Intraoperative electron radiation therapy (IOERT) involves the delivery of a high radiation dose during tumor resection in a shorter time than other radiation techniques, thus improving local control of tumors. However, a linear accelerator device is needed to produce the beam safely. Mobile linear accelerators have been designed as dedicated units that can be moved into the operating room and deliver radiation in situ. Correct and safe dose delivery is a key concern when using mobile accelerators. The applicator is commonly fixed to the patient's bed to ensure that the dose is delivered to the prescribed location, and the mobile accelerator is moved to dock the applicator to the radiation beam output (gantry). In a typical clinical set-up, this task is time-consuming because of safety requirements and the limited degree of freedom of the gantry. The objective of this study was to present a navigation solution based on optical tracking for guidance of docking to improve safety and reduce procedure time. METHOD We used an optical tracker attached to the mobile linear accelerator to track the prescribed localization of the radiation collimator inside the operating room. Using this information, the integrated navigation system developed computes the movements that the mobile linear accelerator needs to perform to align the applicator and the radiation gantry and warns the physician if docking is unrealizable according to the available degrees of freedom of the mobile linear accelerator. Furthermore, we coded a software application that connects all the necessary functioning elements and provides a user interface for the system calibration and the docking guidance. RESULT The system could safeguard against the spatial limitations of the operating room, calculate the optimal arrangement of the accelerator and reduce the docking time in computer simulations and experimental setups. CONCLUSIONS The system could be used to guide docking with any commercial linear accelerator. We believe that the docking navigator we present is a major contribution to IOERT, where docking is critical when attempting to reduce surgical time, ensure patient safety and guarantee that the treatment administered follows the radiation oncologist's prescription.
Collapse
Affiliation(s)
- Eugenio Marinetto
- Department of Bioengineering and Aerospace Engineering, Universidad Carlos III, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | - Mónica García-Sevilla
- Department of Bioengineering and Aerospace Engineering, Universidad Carlos III, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Mercedes Muñoz
- Oncology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Felipe Ángel Calvo
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Oncology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Carlos Balaguer
- Department of Systems Engineering and Automation, Universidad Carlos III, Madrid, Spain
| | - Manuel Desco
- Department of Bioengineering and Aerospace Engineering, Universidad Carlos III, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Javier Pascau
- Department of Bioengineering and Aerospace Engineering, Universidad Carlos III, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| |
Collapse
|
22
|
Abstract
Although many error pathways are common to both stereotactic body radiation therapy (SBRT) and conventional radiation therapy, SBRT presents a special set of challenges including short treatment courses and high-doses, an enhanced reliance on imaging, technical challenges associated with commissioning, special resource requirements for staff and training, and workflow differences. Emerging data also suggest that errors occur at a higher rate in SBRT treatments. Furthermore, when errors do occur they often have a greater effect on SBRT treatments. Given these challenges, it is important to understand and employ systematic approaches to ensure the quality and safety of SBRT treatment. Here, we outline the pathways by which error can occur in SBRT, illustrated through a series of case studies, and highlight 9 specific well-established tools to either reduce error or minimize its effect to the patient or both.
Collapse
Affiliation(s)
- Eric Ford
- Department of Radiation Oncology, University of Washington, Seattle, WA.
| | - Sonja Dieterich
- Department of Radiation Oncology, University of California, Davis, CA
| |
Collapse
|
23
|
Calvo FA. Intraoperative irradiation: precision medicine for quality cancer control promotion. Radiat Oncol 2017; 12:36. [PMID: 28148287 PMCID: PMC5288888 DOI: 10.1186/s13014-017-0764-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 01/05/2017] [Indexed: 12/21/2022] Open
Abstract
Intraoperative irradiation was implemented 4 decades ago, pioneering the efforts to improve precision in local cancer therapy by combining real-time surgical exploration/resection with high single dose radiotherapy (Gunderson et al., Intraoperative irradiation: techniques and results, 2011). Clinical and technical developments have led to very precise radiation dose deposit. The ability to deliver a very precise dose of radiation is an essential element of contemporary multidisciplinary individualized oncology. This issue of Radiation Oncology contains a collection of expert review articles and updates with relevant data regarding intraoperative radiotherapy. Technology, physics, biology of single dose and clinical results in a variety of cancer sites and histologies are described and analyzed. The state of the art for advanced cancer care through medical innovation opens a significant opportunity for individualize cancer management across a broad spectrum of clinical practice. The advantage for tailoring diagnostic and treatment decisions in an individualized fashion will translate into precise medical treatment.
Collapse
Affiliation(s)
- Felipe A Calvo
- Department of Radiation Oncology, Department of Oncology, Hospital general Universitario Gregorio Marañon, Complutense University of Madrid, Madrid, Spain. .,Instituto de Investigación Sanitaria Gregorio Marañon, Grupo Oncologia Interdisciplinar y Biotecnológica. Proyecto PI15/02121, Madrid, Spain. .,Instituto de Salud Carlos III. Ministerio de Economía y Competitividad. Gobierno de España, Madrid, Spain.
| |
Collapse
|
24
|
O'Daniel JC, Yin FF. Quantitative Approach to Failure Mode and Effect Analysis for Linear Accelerator Quality Assurance. Int J Radiat Oncol Biol Phys 2017; 98:56-62. [PMID: 28587053 DOI: 10.1016/j.ijrobp.2017.01.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/21/2016] [Accepted: 01/13/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine clinic-specific linear accelerator quality assurance (QA) TG-142 test frequencies, to maximize physicist time efficiency and patient treatment quality. METHODS AND MATERIALS A novel quantitative approach to failure mode and effect analysis is proposed. Nine linear accelerator-years of QA records provided data on failure occurrence rates. The severity of test failure was modeled by introducing corresponding errors into head and neck intensity modulated radiation therapy treatment plans. The relative risk of daily linear accelerator QA was calculated as a function of frequency of test performance. RESULTS Although the failure severity was greatest for daily imaging QA (imaging vs treatment isocenter and imaging positioning/repositioning), the failure occurrence rate was greatest for output and laser testing. The composite ranking results suggest that performing output and lasers tests daily, imaging versus treatment isocenter and imaging positioning/repositioning tests weekly, and optical distance indicator and jaws versus light field tests biweekly would be acceptable for non-stereotactic radiosurgery/stereotactic body radiation therapy linear accelerators. CONCLUSIONS Failure mode and effect analysis is a useful tool to determine the relative importance of QA tests from TG-142. Because there are practical time limitations on how many QA tests can be performed, this analysis highlights which tests are the most important and suggests the frequency of testing based on each test's risk priority number.
Collapse
Affiliation(s)
- Jennifer C O'Daniel
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
| | - Fang-Fang Yin
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
25
|
Failure mode and effects analysis of skin electronic brachytherapy using Esteya ® unit. J Contemp Brachytherapy 2016; 8:518-524. [PMID: 28115958 PMCID: PMC5241381 DOI: 10.5114/jcb.2016.64745] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 11/17/2016] [Indexed: 01/21/2023] Open
Abstract
Purpose Esteya® (Nucletron, an Elekta company, Elekta AB, Stockholm, Sweden) is an electronic brachytherapy device used for skin cancer lesion treatment. In order to establish an adequate level of quality of treatment, a risk analysis of the Esteya treatment process has been done, following the methodology proposed by the TG-100 guidelines of the American Association of Physicists in Medicine (AAPM). Material and methods A multidisciplinary team familiar with the treatment process was formed. This team developed a process map (PM) outlining the stages, through which a patient passed when subjected to the Esteya treatment. They identified potential failure modes (FM) and each individual FM was assessed for the severity (S), frequency of occurrence (O), and lack of detection (D). A list of existing quality management tools was developed and the FMs were consensually reevaluated. Finally, the FMs were ranked according to their risk priority number (RPN) and their S. Results 146 FMs were identified, 106 of which had RPN ≥ 50 and 30 had S ≥ 7. After introducing the quality management tools, only 21 FMs had RPN ≥ 50. The importance of ensuring contact between the applicator and the surface of the patient’s skin was emphasized, so the setup was reviewed by a second individual before each treatment session with periodic quality control to ensure stability of the applicator pressure. Some of the essential quality management tools are already being implemented in the installation are the simple templates for reproducible positioning of skin applicators, that help marking the treatment area and positioning of X-ray tube. Conclusions New quality management tools have been established as a result of the application of the failure modes and effects analysis (FMEA) treatment. However, periodic update of the FMEA process is necessary, since clinical experience has suggested occurring of further new possible potential failure modes.
Collapse
|
26
|
López-Tarjuelo J, Bouché-Babiloni A, Morillo-Macías V, Santos-Serra A, Ferrer-Albiach C. Practical issues regarding angular and energy response in in vivo intraoperative electron radiotherapy dosimetry. Rep Pract Oncol Radiother 2016; 22:55-67. [PMID: 27790075 DOI: 10.1016/j.rpor.2016.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 11/16/2015] [Accepted: 09/15/2016] [Indexed: 10/20/2022] Open
Abstract
AIM To estimate angular response deviation of MOSFETs in the realm of intraoperative electron radiotherapy (IOERT), review their energy dependence, and propose unambiguous names for detector rotations. BACKGROUND MOSFETs have been used in IOERT. Movement of the detector, namely rotations, can spoil results. MATERIALS AND METHODS We propose yaw, pitch, and roll to name the three possible rotations in space, as these unequivocally name aircraft rotations. Reinforced mobile MOSFETs (model TN-502RDM-H) and an Elekta Precise linear accelerator were used. Two detectors were placed in air for the angular response study and the whole set of five detectors was calibrated as usual to evaluate energy dependence. RESULTS The maximum readout was obtained with a roll of 90° and 4 MeV. With regard to pitch movement, a substantial drop in readout was achieved at 90°. Significant overresponse was measured at 315° with 4 MeV and at 45° with 15 MeV. Energy response is not different for the following groups of energies: 4, 6, and 9 MeV; and 12 MeV, 15 MeV, and 18 MeV. CONCLUSIONS Our proposal to name MOSFET rotations solves the problem of defining sensor orientations. Angular response could explain lower than expected results when the tip of the detector is lifted due to inadvertent movements. MOSFETs energy response is independent of several energies and differs by a maximum of 3.4% when dependent. This can limit dosimetry errors and makes it possible to calibrate the detectors only once for each group of energies, which saves time and optimizes lifespan of MOSFETs.
Collapse
Affiliation(s)
- Juan López-Tarjuelo
- Servicio de Radiofísica y Protección Radiológica, Consorcio Hospitalario Provincial de Castellón, Avda. Dr. Clará, 19, Castellón de la Plana 12002, Spain
| | - Ana Bouché-Babiloni
- Servicio de Oncología Radioterápica, Consorcio Hospitalario Provincial de Castellón, Avda. Dr. Clará, 19, Castellón de la Plana 12002, Spain
| | - Virginia Morillo-Macías
- Servicio de Oncología Radioterápica, Consorcio Hospitalario Provincial de Castellón, Avda. Dr. Clará, 19, Castellón de la Plana 12002, Spain
| | - Agustín Santos-Serra
- Servicio de Radiofísica y Protección Radiológica, Consorcio Hospitalario Provincial de Castellón, Avda. Dr. Clará, 19, Castellón de la Plana 12002, Spain
| | - Carlos Ferrer-Albiach
- Servicio de Oncología Radioterápica, Consorcio Hospitalario Provincial de Castellón, Avda. Dr. Clará, 19, Castellón de la Plana 12002, Spain
| |
Collapse
|
27
|
Huq MS, Fraass BA, Dunscombe PB, Gibbons JP, Ibbott GS, Mundt AJ, Mutic S, Palta JR, Rath F, Thomadsen BR, Williamson JF, Yorke ED. The report of Task Group 100 of the AAPM: Application of risk analysis methods to radiation therapy quality management. Med Phys 2016; 43:4209. [PMID: 27370140 PMCID: PMC4985013 DOI: 10.1118/1.4947547] [Citation(s) in RCA: 305] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 03/13/2016] [Accepted: 03/14/2016] [Indexed: 12/25/2022] Open
Abstract
The increasing complexity of modern radiation therapy planning and delivery challenges traditional prescriptive quality management (QM) methods, such as many of those included in guidelines published by organizations such as the AAPM, ASTRO, ACR, ESTRO, and IAEA. These prescriptive guidelines have traditionally focused on monitoring all aspects of the functional performance of radiotherapy (RT) equipment by comparing parameters against tolerances set at strict but achievable values. Many errors that occur in radiation oncology are not due to failures in devices and software; rather they are failures in workflow and process. A systematic understanding of the likelihood and clinical impact of possible failures throughout a course of radiotherapy is needed to direct limit QM resources efficiently to produce maximum safety and quality of patient care. Task Group 100 of the AAPM has taken a broad view of these issues and has developed a framework for designing QM activities, based on estimates of the probability of identified failures and their clinical outcome through the RT planning and delivery process. The Task Group has chosen a specific radiotherapy process required for "intensity modulated radiation therapy (IMRT)" as a case study. The goal of this work is to apply modern risk-based analysis techniques to this complex RT process in order to demonstrate to the RT community that such techniques may help identify more effective and efficient ways to enhance the safety and quality of our treatment processes. The task group generated by consensus an example quality management program strategy for the IMRT process performed at the institution of one of the authors. This report describes the methodology and nomenclature developed, presents the process maps, FMEAs, fault trees, and QM programs developed, and makes suggestions on how this information could be used in the clinic. The development and implementation of risk-assessment techniques will make radiation therapy safer and more efficient.
Collapse
Affiliation(s)
- M Saiful Huq
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute and UPMC CancerCenter, Pittsburgh, Pennsylvania 15232
| | - Benedick A Fraass
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California 90048
| | - Peter B Dunscombe
- Department of Oncology, University of Calgary, Calgary T2N 1N4, Canada
| | | | - Geoffrey S Ibbott
- Department of Radiation Physics, UT MD Anderson Cancer Center, Houston, Texas 77030
| | - Arno J Mundt
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California 92093-0843
| | - Sasa Mutic
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri 63110
| | - Jatinder R Palta
- Department of Radiation Oncology, Virginia Commonwealth University, P.O. Box 980058, Richmond, Virginia 23298
| | - Frank Rath
- Department of Engineering Professional Development, University of Wisconsin, Madison, Wisconsin 53706
| | - Bruce R Thomadsen
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin 53705-2275
| | - Jeffrey F Williamson
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia 23298-0058
| | - Ellen D Yorke
- Department of Medical Physics, Memorial Sloan-Kettering Center, New York, New York 10065
| |
Collapse
|
28
|
López-Tarjuelo J, Morillo-Macías V, Bouché-Babiloni A, Boldó-Roda E, Lozoya-Albacar R, Ferrer-Albiach C. Implementation of an intraoperative electron radiotherapy in vivo dosimetry program. Radiat Oncol 2016; 11:41. [PMID: 26980076 PMCID: PMC4793509 DOI: 10.1186/s13014-016-0621-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 03/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intraoperative electron radiotherapy (IOERT) is a highly selective radiotherapy technique which aims to treat restricted anatomic volumes during oncological surgery and is now the subject of intense re-evaluation. In vivo dosimetry has been recommended for IOERT and has been identified as a risk-reduction intervention in the context of an IOERT risk analysis. Despite reports of fruitful experiences, information about in vivo dosimetry in intraoperative radiotherapy is somewhat scarce. Therefore, the aim of this paper is to report our experience in developing a program of in vivo dosimetry for IOERT, from both multidisciplinary and practical approaches, in a consistent patient series. We also report several current weaknesses. METHODS Reinforced TN-502RDM-H mobile metal oxide semiconductor field effect transistors (MOSFETs) and Gafchromic MD-55-2 films were used as a redundant in vivo treatment verification system with an Elekta Precise fixed linear accelerator for calibrations and treatments. In vivo dosimetry was performed in 45 patients in cases involving primary tumors or relapses. The most frequent primary tumors were breast (37 %) and colorectal (29 %), and local recurrences among relapses was 83 %. We made 50 attempts to measure with MOSFETs and 48 attempts to measure with films in the treatment zones. The surgical team placed both detectors with supervision from the radiation oncologist and following their instructions. RESULTS The program was considered an overall success by the different professionals involved. The absorbed doses measured with MOSFETs and films were 93.8 ± 6.7 % and 97.9 ± 9.0 % (mean ± SD) respectively using a scale in which 90 % is the prescribed dose and 100 % is the maximum absorbed dose delivered by the beam. However, in 10 % of cases we experienced dosimetric problems due to detector misalignment, a situation which might be avoided with additional checks. The useful MOSFET lifetime length and the film sterilization procedure should also be controlled. CONCLUSIONS It is feasible to establish an in vivo dosimetry program for a wide set of locations treated with IOERT using a multidisciplinary approach according to the skills of the professionals present and the detectors used; oncological surgeons' commitment is key to success in this context. Films are more unstable and show higher uncertainty than MOSFETs but are cheaper and are useful and convenient if real-time treatment monitoring is not necessary.
Collapse
Affiliation(s)
- Juan López-Tarjuelo
- Servicio de Radiofísica y Protección Radiológica, Consorcio Hospitalario Provincial de Castellón, Avda. Dr. Clará, nº 19, Castellón de la Plana, 12004, Castellón, Spain.
| | - Virginia Morillo-Macías
- Servicio de Oncología Radioterápica, Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
- Unitat predepartamental de Medicina, Facultat de Ciències de la Salut, Universitat Jaume I, Avda. Vicent Sos Baynat, s/n, Castellón de la Plana, 12071, Castellón, Spain
| | - Ana Bouché-Babiloni
- Servicio de Oncología Radioterápica, Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - Enrique Boldó-Roda
- Unidad de Cirugía Oncológica, Servicio de Cirugía, Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - Rafael Lozoya-Albacar
- Unidad de Cirugía Oncológica, Servicio de Cirugía, Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - Carlos Ferrer-Albiach
- Servicio de Oncología Radioterápica, Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
- Departamento de Medicina y Cirugía, Facultad de Ciencias de la Salud, Universidad Cardenal Herrera-CEU, C/ Grecia 31, Castellón de la Plana, 12006, Castellón, Spain
| |
Collapse
|
29
|
Pawlicki T, Samost A, Brown DW, Manger RP, Kim G, Leveson NG. Application of systems and control theory‐based hazard analysis to radiation oncology. Med Phys 2016; 43:1514-30. [DOI: 10.1118/1.4942384] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Todd Pawlicki
- Department of Radiation Medicine and Applied Sciences, UC San Diego, 3385 Health Sciences Drive, La Jolla, California 92093
| | - Aubrey Samost
- Engineering Systems Division, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts 02142
| | - Derek W. Brown
- Department of Radiation Medicine and Applied Sciences, UC San Diego, 3385 Health Sciences Drive, La Jolla, California 92093
| | - Ryan P. Manger
- Department of Radiation Medicine and Applied Sciences, UC San Diego, 3385 Health Sciences Drive, La Jolla, California 92093
| | - Gwe‐Ya Kim
- Department of Radiation Medicine and Applied Sciences, UC San Diego, 3385 Health Sciences Drive, La Jolla, California 92093
| | - Nancy G. Leveson
- Department of Aeronautics and Astronautics, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts 02142
| |
Collapse
|
30
|
López-Tarjuelo J, Morillo-Macías V, Bouché-Babiloni A, Ferrer-Albiach C, Santos-Serra A. Defining Action Levels for In Vivo Dosimetry in Intraoperative Electron Radiotherapy. Technol Cancer Res Treat 2015; 15:453-9. [PMID: 26025385 DOI: 10.1177/1533034615588196] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 04/23/2015] [Indexed: 11/15/2022] Open
Abstract
In vivo dosimetry is recommended in intraoperative electron radiotherapy (IOERT). To perform real-time treatment monitoring, action levels (ALs) have to be calculated. Empirical approaches based on observation of samples have been reported previously, however, our aim is to present a predictive model for calculating ALs and to verify their validity with our experimental data. We considered the range of absorbed doses delivered to our detector by means of the percentage depth dose for the electron beams used. Then, we calculated the absorbed dose histograms and convoluted them with detector responses to obtain probability density functions in order to find ALs as certain probability levels. Our in vivo dosimeters were reinforced TN-502RDM-H mobile metal-oxide-semiconductor field-effect transistors (MOSFETs). Our experimental data came from 30 measurements carried out in patients undergoing IOERT for rectal, breast, sarcoma, and pancreas cancers, among others. The prescribed dose to the tumor bed was 90%, and the maximum absorbed dose was 100%. The theoretical mean absorbed dose was 90.3% and the measured mean was 93.9%. Associated confidence intervals at P = .05 were 89.2% and 91.4% and 91.6% and 96.4%, respectively. With regard to individual comparisons between the model and the experiment, 37% of MOSFET measurements lay outside particular ranges defined by the derived ALs. Calculated confidence intervals at P = .05 ranged from 8.6% to 14.7%. The model can describe global results successfully but cannot match all the experimental data reported. In terms of accuracy, this suggests an eventual underestimation of tumor bed bleeding or detector alignment. In terms of precision, it will be necessary to reduce positioning uncertainties for a wide set of location and treatment postures, and more precise detectors will be required. Planning and imaging tools currently under development will play a fundamental role.
Collapse
Affiliation(s)
- Juan López-Tarjuelo
- Servicio de Radiofísica y Protección Radiológica, Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - Virginia Morillo-Macías
- Servicio de Oncología Radioterápica, Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - Ana Bouché-Babiloni
- Servicio de Oncología Radioterápica, Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - Carlos Ferrer-Albiach
- Servicio de Oncología Radioterápica, Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain Facultad de Medicina, Universidad Cardenal Herrera-CEU, Castellón de la Plana, Spain
| | - Agustín Santos-Serra
- Servicio de Radiofísica y Protección Radiológica, Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| |
Collapse
|