Leadership-Driven Risk Management for Radiation Protection in Iodine-125 Seed Wards: A Quality Improvement Study

Iodine-125 seed implantation requires coordinated radiation protection after patients return to inpatient wards. However, ward-based radiation safety depends on more than individual knowledge; it also requires risk identification, leadership accountability, standardized workflows, and continuous quality monitoring. This study evaluated a leadership-driven, risk-based radiation protection management intervention for iodine-125 seed wards. The intervention was developed and structured using failure mode and effects analysis and the Donabedian structure-process-outcome framework.

Baseline failure mode and effects analysis informed a leadership-driven intervention structured using the Donabedian framework. Total quality-management scores from 33 inspections before and 33 after implementation were analyzed using regression with separate within-period linear trends and heteroskedasticity and autocorrelation consistent covariance estimates. Post-implementation patient and nurse satisfaction were also assessed.

Baseline FMEA identified two critical risks related to nurses' protective practices and two high risks related to nurses' knowledge and patient education. The mean total quality-management score was 75.27 ± 3.42 before implementation and 90.42 ± 3.80 afterward, with a period-mean difference of 15.15 points (95% CI, 13.11-17.19; P < 0.001). All nine items had higher mean scores after implementation. Post-implementation patient satisfaction was 98.5%, and nurse work satisfaction was 99.0%.

A leadership-driven radiation protection management intervention was associated with improved routine ward-level radiation protection quality management in iodine-125 seed wards. The findings provide a practical model for translating radiation protection requirements into coordinated ward management processes.