Pietro Mancosu1, Giorgia Nicolini2, Giulia Goretti3, Fiorenza De Rose4, Davide Franceschini4, Chiara Ferrari5, Giacomo Reggiori6, Stefano Tomatis6, Marta Scorsetti7. 1. Medical Physicist Group of Radiotherapy and Radiosurgery Dept., Humanitas Clinical and Research Hospital, Milan-Rozzano, Italy. Electronic address: pietro.mancosu@humanitas.it. 2. Medical Physics Team, Radiqa Developments, Bellinzona, Switzerland. 3. Lean Team, Humanitas Clinical and Research Hospital, Milan-Rozzano, Italy. 4. Radiotherapy and Radiosurgery Dept, Humanitas Clinical and Research Hospital, Milan-Rozzano, Italy. 5. Lean Team, Humanitas Clinical and Research Hospital, Milan-Rozzano, Italy; Anaesthesiology Dept, Humanitas Clinical and Research Hospital, Milan-Rozzano, Italy. 6. Medical Physicist Group of Radiotherapy and Radiosurgery Dept., Humanitas Clinical and Research Hospital, Milan-Rozzano, Italy. 7. Radiotherapy and Radiosurgery Dept, Humanitas Clinical and Research Hospital, Milan-Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Milan-Rozzano, Italy.
Abstract
BACKGROUND & PURPOSE: Lean Six Sigma Methodology (LSSM) was introduced in industry to provide near-perfect services to large processes, by reducing improbable occurrence. LSSM has been applied to redesign the 2D-2D breast repositioning process (Lean) by the retrospective analysis of the database (Six Sigma). MATERIALS & METHODS: Breast patients with daily 2D-2D matching before RT were considered. The five DMAIC (define, measure, analyze, improve, and control) LSSM steps were applied. The process was retrospectively measured over 30 months (7/2014-12/2016) by querying the RT Record&Verify database. Two Lean instruments (Poka-Yoke and Visual Management) were considered for advancing the process. The new procedure was checked over 6 months (1-6/2017). RESULTS: 14,931 consecutive shifts from 1342 patients were analyzed. Only 0.8% of patients presented median shifts >1 cm. The major observed discrepancy was the monthly percentage of fractions with almost zero shifts (AZS = 13.2% ± 6.1%). Ishikawa fishbone diagram helped in defining the main discrepancy con-causes. Procedure harmonization involving a multidisciplinary team to increase confidence in matching procedure was defined. AZS was reduced to 4.8% ± 0.6%. Furthermore, distribution symmetry improvement (Skewness moved from 1.4 to 1.1) and outlier reduction, verified by Kurtosis diminution, demonstrated a better "normalization" of the procedure after the LSSM application. CONCLUSIONS: LSSM was implemented in a RT department, allowing to redesign the breast repositioning matching procedure.
BACKGROUND & PURPOSE: Lean Six Sigma Methodology (LSSM) was introduced in industry to provide near-perfect services to large processes, by reducing improbable occurrence. LSSM has been applied to redesign the 2D-2D breast repositioning process (Lean) by the retrospective analysis of the database (Six Sigma). MATERIALS & METHODS: Breast patients with daily 2D-2D matching before RT were considered. The five DMAIC (define, measure, analyze, improve, and control) LSSM steps were applied. The process was retrospectively measured over 30 months (7/2014-12/2016) by querying the RT Record&Verify database. Two Lean instruments (Poka-Yoke and Visual Management) were considered for advancing the process. The new procedure was checked over 6 months (1-6/2017). RESULTS: 14,931 consecutive shifts from 1342 patients were analyzed. Only 0.8% of patients presented median shifts >1 cm. The major observed discrepancy was the monthly percentage of fractions with almost zero shifts (AZS = 13.2% ± 6.1%). Ishikawa fishbone diagram helped in defining the main discrepancy con-causes. Procedure harmonization involving a multidisciplinary team to increase confidence in matching procedure was defined. AZS was reduced to 4.8% ± 0.6%. Furthermore, distribution symmetry improvement (Skewness moved from 1.4 to 1.1) and outlier reduction, verified by Kurtosis diminution, demonstrated a better "normalization" of the procedure after the LSSM application. CONCLUSIONS: LSSM was implemented in a RT department, allowing to redesign the breast repositioning matching procedure.
Authors: Shi Liu; Karl K Bush; Julian Bertini; Yabo Fu; Jonathan M Lewis; Daniel J Pham; Yong Yang; Thomas R Niedermayr; Lawrie Skinner; Lei Xing; Beth M Beadle; Annie Hsu; Nataliya Kovalchuk Journal: J Appl Clin Med Phys Date: 2019-08 Impact factor: 2.102