Mitigating Risks in Cone Beam Computed Tomography Guided Online Adaptive Radiation Therapy: A Preventative Reference...

Area of Science:

• Radiation Oncology
• Medical Physics
• Quality Management

Background:

• Online adaptive radiation therapy (oART) requires robust planning to manage temporal variations and unique risks.
• Evaluating reference plan robustness is crucial for anticipating changes during treatment and preventing deficiencies.

Purpose of the Study:

• To conduct a risk analysis of the cone beam computed tomography (CBCT) guided adaptive workflow.
• To assess an adaptive-specific reference planning review to mitigate risks and prevent treatment deficiencies.

Main Methods:

• Fault tree analysis and failure mode and effects analysis were performed by a quality management team.
• Risk priority numbers (RPNs) were calculated with and without a reference planning checklist.
• Root cause analysis investigated a specific adaptive plan generation failure.

Main Results:

• The reference planning checklist reduced failure modes from 29 to 1 (RPN > 150), including 14 adaptive-specific issues.
• The checklist addressed errors in target dosing and treatment deficiencies, improving plan quality and robustness.
• Contouring, planning, setup, scheduling, and documentation errors were identified, with 29 of 70 being adaptive-specific.

Conclusions:

• The reference planning checklist enhances the detection of failure modes in oART.
• Implementing the checklist improves plan quality and robustness, preventing treatment delays.
• The checklist is adaptable for specific clinic needs and can be integrated at various planning stages.