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Radiation Planning Assistant - A Web-based Tool to Support High-quality Radiotherapy in Clinics with Limited Resources

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Published on: October 6, 2023

Categorizing accident sequences in the external radiotherapy for risk analysis.

¹KEPCO International Nuclear Graduate School (KINGS), Ulsan, Korea.

Radiation Oncology Journal

|July 19, 2013

Summary

This summary is machine-generated.

Analyzing past radiotherapy accidents reveals 14 distinct accident sequences. Human error is a major cause, emphasizing the need to focus risk analysis on calibration, not just planning.

Keywords:

Accident Radiotherapy Risk assessment Safety

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Published on: December 25, 2021

Area of Science:

Medical Physics
Radiation Oncology
Patient Safety

Background:

External radiotherapy involves complex procedures with inherent risks.
Previous incidents in radiotherapy require systematic analysis for future prevention.

Purpose of the Study:

To identify and categorize accident sequences in external radiotherapy.
To inform risk analysis applications by understanding past failures.

Main Methods:

Reviewed 59 accidental cases from two retrospective safety analyses.
Investigated accident reports to identify initiating events, safety failures, and consequences.
Classified accidents by treatment stage, error source, failure type, and patient impact.
Grouped accident sequences into 14 categories based on progression.

Main Results:

Risk analysis must include the calibration stage, not solely the planning stage.
Human error is the primary contributor to initiating events and safety measure failures.
An event tree analysis was performed for a calibration-initiated accident sequence.

Conclusions:

Understanding past accident sequences provides valuable insights for prospective risk analysis in radiotherapy.
The categorization of 14 accident sequences offers a framework for improving safety protocols.