基于圆束计算机断层扫描的每日自适应辐射疗法和基于圆束计算机断层扫描的单独辐射疗法的比较风险分析
Caroline M Colbert1, Dustin Melancon1, John Kang1
1Department of Radiation Oncology, University of Washington. Division of Radiation Oncology, Fred Hutch Cancer Center, Seattle, Washington.
概括
与传统的图像导向放射治疗 (IGRT) 相比,自适应性辐射疗法 (ART) 显示出更好的患者安全性. 风险分析显示,ART的故障模式显著减少,突出显示了除了剂量测量改进之外的安全益处.
科学领域:
- 辐射瘤学 辐射瘤学
- 医学物理 医学物理
- 患者安全 患者安全
背景情况:
- 采用新的治疗技术需要严格地与既定护理标准进行安全比较.
- 图像引导辐射疗法 (IGRT) 是一种标准技术,而自适应辐射疗法 (ART) 是一个不断进步的技术.
研究的目的:
- 直接比较在线自适应性辐射疗法 (ART) 与传统图像导向辐射疗法 (IGRT) 的安全影响.
- 在使用千伏圆束计算断层扫描 (kV-CBCT) 进行线上ART的环门式线性加速器的情况下评估安全性.
主要方法:
- 使用AAPM任务组100的方法进行了故障模式和影响分析 (FMEA).
- 跨学科团队评估了单独IGRT和IGRT与ART治疗的治疗计划,质量保证和交付中的故障模式.
- 故障模式以严重程度,发生率和可检测性得分,并计算了风险优先级号码 (RPN) 以进行比较分析.
主要成果:
- 仅针对IGRT,就发现了33种独特的故障模式,另外还有针对ART的9种特殊模式.
- 单独使用IGRT的高风险失效模式主要涉及初始治疗计划.
- 高风险的失败模式包括适应性重新规划错误,但在ART设置中,整体中位数RPN从96降至72 (P = .035).
结论:
- 在线ART在适应性重新规划中引入了新的潜在错误,但通过加强人员配置和代审查来缓解.
- 观察到的RPN减少表明,ART可以减少最初治疗计划中产生的系统错误.
- 这种降低风险为ART采用提供了令人信服的患者安全理由,补充了其已知的剂量测量优势.
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