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Common Error Pathways in CyberKnife™ Radiation Therapy.

Brandon T Mullins1, Lukasz Mazur2,3, Michael Dance1

  • 1Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC, United States.

Frontiers in Oncology
|August 1, 2020
PubMed
Summary
This summary is machine-generated.

CyberKnife™ (CK) stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) incidents were analyzed. Most incidents had minimal patient impact, often related to billing and scheduling, with human performance as a key factor.

Keywords:
CyberKnifeSBRTSRScommon error pathwaysradiation therapysafety

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Patient Safety

Background:

  • Stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) utilize high radiation doses per fraction, classifying them as high-risk procedures.
  • Incident learning systems (ILS) are crucial for prospectively identifying and analyzing errors in advanced radiation therapy techniques.

Purpose of the Study:

  • To analyze CyberKnife™ (CK) SRS and SBRT-related incidents reported to an in-house ILS.
  • To identify the severity, contributing factors, and common error pathways associated with CK treatments.

Main Methods:

  • Prospective analysis of 221 CK incidents from 4,569 delivered fractions (5.8%) between 2012 and 2019.
  • Incidents were evaluated for severity, contributing factors, and location within the CK process map (tripped, caught, crossed barriers).
  • Categorization of incidents into general error pathways based on the process step where they occurred.

Main Results:

  • The majority of incidents were low severity (grade 1-2, n=205), with no life-threatening events (grade 5-6).
  • Human performance was the most common contributing factor (79%), with incidents frequently occurring during pre-CK simulation requests.
  • The most common error pathways involved billing/scheduling (n=119), plan quality (n=30), IV contrast/pre-medications (n=22), and image guidance (n=12).

Conclusions:

  • Most CyberKnife™ incidents result in minimal to no patient harm, with administrative issues like billing and scheduling being prevalent.
  • Suboptimal human performance is a significant contributing factor to CK-related incidents.
  • Further research is needed to develop and disseminate best practices for enhancing patient safety in CK procedures.