Assessing initial plan check efficacy using TG 275 failure modes and incident reporting.

Area of Science:

• Medical Physics
• Radiation Oncology
• Quality Assurance

Background:

• Robust quality assurance (QA) programs are essential in radiation oncology.
• The American Association of Physicists in Medicine (AAPM) published Task Group (TG) 275 and Medical Physics Practice Guideline (MPPG) 11.A on plan and chart checking.
• Evaluating institutional QA programs against established guidelines is critical for identifying and mitigating risks.

Purpose of the Study:

• To crosswalk initial plan check failure modes from AAPM TG 275 with the institution's QA program and incident data.
• To identify gaps in the current QA process for high-risk failure modes.
• To analyze the efficacy of different QA steps in detecting errors.

Main Methods:

• Ten physicists reviewed 46 high-risk failure modes from the TG 275 report.
• Institutional planning process steps were assessed for coverage of these failure modes.
• A multidisciplinary committee analyzed 1599 incidents from the Radiation Oncology Incident Learning System (ROILS) database.
• Incidents were categorized according to TG 275 failure modes.

Main Results:

• Over half of the 46 high-risk failure modes were partially covered by daily contouring peer-review rounds, upstream of the initial plan check.
• Five failure modes, including those related to pregnancy, pacemakers, and prior dose, were not adequately covered.
• Physics review and initial plan check showed lower error detection rates (31.8% and 31.3%) for certain failure modes.
• Most incidents related to initial plan checks (710 of 1599) were detected before CT simulation (98.8%).

Conclusions:

• Daily contouring peer-review rounds enhance upstream error detection in radiation oncology.
• Gaps in QA processes require attention, particularly for failure modes concerning patient-specific factors.
• Enhancements to policies, procedures, and automation are recommended to improve the QA program.
• Departments should review their internal chart checking policies and procedures, guided by AAPM TG 275 and MPPG 11.A.