A group-based hands-on seminar for teaching failure mode and effects analysis in CyberKnife stereotactic radiotherapy

Risk analysis is becoming increasingly important in advanced radiotherapy, as treatment workflows grow more complex and require multidisciplinary expertise. Although failure mode and effects analysis (FMEA) has been recommended for risk-based quality management, opportunities for users to practically learn and apply FMEA within CyberKnife® workflows remain limited.

To evaluate the feasibility and educational value of a group-based, hands-on seminar for teaching FMEA methodology in CyberKnife® stereotactic radiotherapy, using four representative treatment sites as practical examples.

A half-day seminar was conducted for eight radiation technologists and six medical physicists from CyberKnife® institutions, supported by four facilitators. Following a didactic lecture on risk analysis, participants were divided into four site-specific groups (intracranial, lung, spine, and prostate). Each group utilized institution-prepared process maps and a shared Excel-based worksheet to identify potential failure modes, score them using a five-point FMEA scale for occurrence, severity, and detectability, and discuss possible countermeasures. Risk priority numbers (RPNs) were calculated to rank the identified failure modes. A postseminar questionnaire was administered to assess participants' prior experience, level of understanding of risk analysis, and willingness to implement it in clinical practice.

The seminar generated site-specific failure mode lists as educational outputs. The highest-ranked risks were contouring errors for intracranial lesions (RPN 48), irregular respiration for lung lesions (RPN 64), pain-induced patient motion for spinal lesions (RPN 36), and target delineation errors for prostate lesions (RPN 80). Other major risks included inappropriate selection of immobilization devices, prescription and fractionation errors, tracking-related issues, image registration inaccuracies, and incorrect patient-specific QA evaluation criteria. Thirteen participants completed the questionnaire. Most participants had limited prior experience with risk analysis; however, 85% reported a good level of understanding after the seminar, and 92% expressed willingness to implement risk analysis at their institutions.

This group-based seminar provided participants with practical experience in applying FMEA to CyberKnife treatment workflows. The questionnaire responses suggested that most participants gained a better understanding of risk analysis and were interested in applying it at their own institutions. The failure mode lists generated during the seminar were not intended to represent a complete FMEA for any participating institution but may provide practical examples for initiating multidisciplinary risk analysis based on local workflows and clinical practices.