B Ibanez-Rosello1, J A Bautista2, J Bonaque2, J Perez-Calatayud2,3, A Gonzalez-Sanchis4, J Lopez-Torrecilla4, L Brualla-Gonzalez5, T Garcia-Hernandez5, A Vicedo-Gonzalez5, D Granero5, A Serrano5, B Borderia5, C Solera5, J Rosello5,6. 1. Radiation Oncology Department, La Fe University and Polytechnic Hospital, Av. Fernando Abril Martorell 106, 46026, Valencia, Spain. blanca.ibanez.rosello@gmail.com. 2. Radiation Oncology Department, La Fe University and Polytechnic Hospital, Av. Fernando Abril Martorell 106, 46026, Valencia, Spain. 3. 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. 4. Radiation Oncology Department, ERESA, Hospital General Universitario, 46014, Valencia, Spain. 5. Medical Physics Department, ERESA, Hospital General Universitario, 46014, Valencia, Spain. 6. Physiology Department, University of Valencia, 46010, Valencia, Spain.
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.
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.
Entities:
Keywords:
FMEA; Process map; Quality assurance; Risk analysis; TG-100; TSEI
Authors: Eric E Klein; Joseph Hanley; John Bayouth; Fang-Fang Yin; William Simon; Sean Dresser; Christopher Serago; Francisco Aguirre; Lijun Ma; Bijan Arjomandy; Chihray Liu; Carlos Sandin; Todd Holmes Journal: Med Phys Date: 2009-09 Impact factor: 4.071
Authors: F Yang; N Cao; L Young; J Howard; W Logan; T Arbuckle; P Sponseller; T Korssjoen; J Meyer; E Ford Journal: Med Phys Date: 2015-06 Impact factor: 4.071
Authors: M Saiful Huq; Benedick A Fraass; Peter B Dunscombe; John P Gibbons; Geoffrey S Ibbott; Arno J Mundt; Sasa Mutic; Jatinder R Palta; Frank Rath; Bruce R Thomadsen; Jeffrey F Williamson; Ellen D Yorke Journal: Med Phys Date: 2016-07 Impact factor: 4.071
Authors: G J Kutcher; L Coia; M Gillin; W F Hanson; S Leibel; R J Morton; J R Palta; J A Purdy; L E Reinstein; G K Svensson Journal: Med Phys Date: 1994-04 Impact factor: 4.071
Authors: Qinan Bao; Brian A Hrycushko; Joseph P Dugas; Frederick H Hager; Timothy D Solberg Journal: Radiat Oncol Date: 2012-03-20 Impact factor: 3.481
Authors: Elizabeth N Hilliard; Robert L Carver; Erin L Chambers; James A Kavanaugh; Kevin J Erhart; Andrew S McGuffey; Kenneth R Hogstrom Journal: J Appl Clin Med Phys Date: 2021-09-24 Impact factor: 2.102