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Open Access 01-12-2019 | Research

Evaluation and improvement the safety of total marrow irradiation with helical tomotherapy using repeat failure mode and effects analysis

Authors: Jiuling Shen, Xiaoyong Wang, Di Deng, Jian Gong, Kang Tan, Hongli Zhao, Zhirong Bao, Jinping Xiao, An Liu, Yunfeng Zhou, Hui Liu, Conghua Xie

Published in: Radiation Oncology | Issue 1/2019

Abstract

Background & purpose

Helical tomotherapy has been applied to total marrow irradiation (HT-TMI). Our objective was to apply failure mode and effects analysis (FMEA) two times separated by 1 year to evaluate and improve the safety of HT-TMI.

Materials and methods

A multidisciplinary team was created. FMEA consists of 4 main steps: (1) Creation of a process map; (2) Identification of all potential failure mode (FM) in the process; (3) Evaluation of the occurrence (O), detectability (D) and severity of impact (S) of each FM according to a scoring criteria (1–10), with the subsequent calculation of the risk priority number (RPN=O*D*S) and (4) Identification of the feasible and effective quality control (QC) methods for the highest risks. A second FMEA was performed for the high-risk FMs based on the same risk analysis team in 1 year later.

Results

A total of 39 subprocesses and 122 FMs were derived. First time RPN ranged from 3 to 264.3. Twenty-five FMs were defined as being high-risk, with the top 5 FMs (first RPN/ second RPN): (1) treatment couch movement failure (264.3/102.8); (2) section plan dose junction error in delivery (236.7/110.4); (3) setup check by megavoltage computed tomography (MVCT) failure (216.8/94.6); (4) patient immobilization error (212.5/90.2) and (5) treatment interruption (204.8/134.2). A total of 20 staff members participated in the study. The second RPN value of the top 5 high-risk FMs were all decreased.

Conclusion

QC interventions were implemented based on the FMEA results. HT-TMI specific treatment couch tests; the arms immobilization methods and strategy of section plan dose junction in delivery were proved to be effective in the improvement of the safety.

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Title: Evaluation and improvement the safety of total marrow irradiation with helical tomotherapy using repeat failure mode and effects analysis
Authors: Jiuling Shen
Xiaoyong Wang
Di Deng
Jian Gong
Kang Tan
Hongli Zhao
Zhirong Bao
Jinping Xiao
An Liu
Yunfeng Zhou
Hui Liu
Conghua Xie
Publication date: 01-12-2019
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2019
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/s13014-019-1433-7

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Evaluation and improvement the safety of total marrow irradiation with helical tomotherapy using repeat failure mode and effects analysis

Abstract

Background & purpose

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background & purpose

Materials and methods

Results

Conclusion

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