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Errors detected during physics plan review for external beam radiotherapy.

Frank-André Siebert1, Markus Hirt1, Marc Delaperrière1

  • 1Clinic of Radiotherapy, University Hospital of Schleswig-Holstein, Campus Kiel, Germany.

Physics and Imaging in Radiation Oncology
|October 3, 2022
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Summary

This study identified common errors in external beam radiotherapy plan reviews, finding no link between errors and staff shortages. Improving treatment planning systems can enhance radiotherapy safety.

Keywords:
Error detectionQuality assuranceRadiotherapyReview processRisk management

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Healthcare Quality Improvement

Background:

  • Risk management is crucial in radiotherapy, yet data on treatment planning errors is limited.
  • External beam radiotherapy planning requires meticulous review to ensure patient safety.
  • Understanding error patterns aids in optimizing radiotherapy workflows.

Purpose of the Study:

  • To investigate and categorize errors during the physics plan review of external beam radiotherapy.
  • To identify the most frequent types of errors, distinguishing between grave and slight errors.
  • To analyze potential correlations between error frequency and factors like treatment machine, technique, site, and staff availability.

Main Methods:

  • A 14-month prospective analysis of errors detected during the physics plan review process.
  • Classification of errors into grave (g-errors) and slight (s-errors) based on clinical impact.
  • Statistical evaluation of error types and their association with treatment parameters and staffing levels.

Main Results:

  • Out of 1056 reviewed plans, 110 errors were detected (41 g-errors, 69 s-errors).
  • The most common grave error was 'Wrong gantry angle at setup field' (19/41), and the most common slight error was 'Wrong field label' (24/69).
  • No significant correlation was found between error frequency and treatment machine, technique, anatomical site, or staff shortage.

Conclusions:

  • Physics plan review is a critical component of radiotherapy risk management.
  • Enhancements in treatment planning systems, digital dose prescription, and planning templates can improve review accuracy.
  • Systematic error analysis is essential for advancing patient safety in external beam radiotherapy.