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Quality Improvement of Treatment Planning Workflow Using FMEA Methodology

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S Lee

S Lee1*, J Cantley2 , Z Xu3 , D Albani1 , T Podder1,3 , (1) University Hospitals Cleveland Medical Center, Cleveland, OH, (2) Genesis Cancer Care Center, Zanesville, OH, (3) Case Western Reserve University, Cleveland, OH


TH-CD-205-8 (Thursday, August 3, 2017) 10:00 AM - 12:00 PM Room: 205

Purpose: To share our experience in process failures identified and assessed by using Failure Mode and Effects Analysis (FMEA) and to improve our quality of clinical workflow in radiation treatment planning process.

Methods: In our clinical workflow, the treatment process steps between CT simulation and first-day of treatment from October 2014 to July 2015 were retrospectively analyzed using FMEA methodology. Adequacy of each occurrence was evaluated and recorded as a failure if a patient started treatment after the original scheduled start date. First fraction of treatment started before the projected date was not considered as a failure. For each occurrence, the following factors were recorded: failure mode, failure detection, local effects, social effects (SE), economical effects (EE), occurrence, severity, detectability, and method of repair. Risk priority number (RPN)(product of the occurrence, severity, and detectability values), was calculated for each treatment delay.

Results: A total of 89 cases out of 966 treatment planning cases were considered eligible for FMEA analysis. Analysis shows that the majority of delays were caused during dosimetric/treatment planning stage due to either not receiving tumor volumes within the time frame specified by clinical workflow (RPN: 17) or changing in tumor volumes or prescription during the planning process (RPN: 13). This accounted for over one-third of the delays, and often had higher RPN than the other delays. The highest RPN (42) was recorded from the patients needed to be rescanned due to errors in the initial CT scanning.

Conclusion: The FMEA was useful for identification of the weaknesses in our clinical workflow for the part of the radiotherapy process from CT-Sim up to the first fraction of treatment. Initial mistake in CT-Sim and non-availability of contours in timely fashion were found to be major weaknesses for improvement.

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