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Risk analysis of the Unity 1.5T MR-Linac adapt-to-shape workflow.

Jiayi Liang1, Eric Aliotta1, Neelam Tyagi1

  • 1Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, USA.

Journal of Applied Clinical Medical Physics
|April 17, 2025
PubMed
Summary
This summary is machine-generated.

The adapt-to-shape (ATS) workflow in MR-Linac treatment planning has potential risks, particularly in contouring and planning steps. Failure modes and effects analysis (FMEA) identifies these risks, enabling mitigation strategies for safer patient care.

Keywords:
MR‐Linacadaptive treatmentadapt‐to‐shapeprocess mapradiation oncologyrisk analysis

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Radiotherapy Technology

Background:

  • The adapt-to-shape (ATS) workflow on the Unity MR-Linac facilitates comprehensive replanning, including recontouring and reoptimization.
  • Integrating MIM Maestro software with the Monaco treatment planning system adds complexity to the ATS workflow.

Purpose of the Study:

  • To conduct a risk analysis of the adapt-to-shape (ATS) workflow on the Unity MR-Linac.
  • To identify potential failure modes and their associated risks within the ATS workflow, especially when using MIM Maestro and Monaco software.

Main Methods:

  • Failure Modes and Effects Analysis (FMEA) was performed, adhering to Task Group 100 guidelines.
  • A multidisciplinary team mapped the ATS process, identifying failure modes and scoring them by likelihood, severity, and detectability.
  • Mitigation strategies were developed for the highest-ranking failure modes (top 20th percentile).

Main Results:

  • A total of 264 failure modes were identified within the ATS workflow.
  • 82 high-ranking failure modes were found, with 62 concentrated in the contouring and planning stages.
  • Contouring and planning steps emerged as critical areas, unlike in adapt-to-position (ATP) workflows.

Conclusions:

  • The reoptimization capability of the ATS workflow, while beneficial, introduces critical points for potential errors.
  • The ATS workflow presents increased opportunities for errors that could negatively impact radiation dose distribution.
  • FMEA is a valuable tool for identifying and mitigating risks within the complex ATS radiotherapy process.