A bi-institutional multi-disciplinary failure mode and effects analysis (FMEA) for a Co-60 based total body irradiation technique
Abstract Background We aim to assess the risks associated with total body irradiation (TBI) delivered using a commercial dedicated Co-60 irradiator, and to evaluate inter-institutional and inter-professional variations in the estimation of these risks. Methods A failure mode and effects analysis (FM...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-11-01
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| Series: | Radiation Oncology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13014-021-01894-3 |
| _version_ | 1798032039250755584 |
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| author | Shahbaz Ahmed Todd Bossenberger Adrian Nalichowski Jeremy S. Bredfeldt Sarah Bartlett Kristen Bertone Michael Dominello Mark Dziemianowicz Melanie Komajda G. Mike Makrigiorgos Karen J. Marcus Andrea Ng Marvin Thomas Jay Burmeister |
| author_facet | Shahbaz Ahmed Todd Bossenberger Adrian Nalichowski Jeremy S. Bredfeldt Sarah Bartlett Kristen Bertone Michael Dominello Mark Dziemianowicz Melanie Komajda G. Mike Makrigiorgos Karen J. Marcus Andrea Ng Marvin Thomas Jay Burmeister |
| author_sort | Shahbaz Ahmed |
| collection | DOAJ |
| description | Abstract Background We aim to assess the risks associated with total body irradiation (TBI) delivered using a commercial dedicated Co-60 irradiator, and to evaluate inter-institutional and inter-professional variations in the estimation of these risks. Methods A failure mode and effects analysis (FMEA) was generated using guidance from the AAPM TG-100 report for quantitative estimation of prospective risk metrics. Thirteen radiation oncology professionals from two institutions rated possible failure modes (FMs) for occurrence (O), severity (S), and detectability (D) indices to generate a risk priority number (RPN). The FMs were ranked by descending RPN value. Absolute gross differences (AGD) in resulting RPN values and Jaccard Index (JI; for the top 20 FMs) were calculated. The results were compared between professions and institutions. Results A total of 87 potential FMs (57, 15, 10, 3, and 2 for treatment, quality assurance, planning, simulation, and logistics respectively) were identified and ranked, with individual RPN ranging between 1–420 and mean RPN values ranging between 6 and 74. The two institutions shared 6 of their respective top 20 FMs. For various institutional and professional comparison pairs, the number of common FMs in the top 20 FMs ranged from 6 to 13, with JI values of 18–48%. For the top 20 FMs, the trend in inter-professional variability was institution-specific. The mean AGD values ranged between 12.5 and 74.5 for various comparison pairs. AGD values differed the most for medical physicists (MPs) in comparison to other specialties i.e. radiation oncologists (ROs) and radiation therapists (RTs) [MPs-vs-ROs: 36.3 (standard deviation SD = 34.1); MPs-vs-RTs: 41.2 (SD = 37.9); ROs-vs-RTs: 12.5 (SD = 10.8)]. Trends in inter-professional AGD values were similar for both institutions. Conclusion This inter-institutional comparison provides prospective risk analysis for a new treatment delivery unit and illustrates the institution-specific nature of FM prioritization, primarily due to operational differences. Despite being subjective in nature, the FMEA is a valuable tool to ensure the identification of the most significant risks, particularly when implementing a novel treatment modality. The creation of a bi-institutional, multidisciplinary FMEA for this unique TBI technique has not only helped identify potential risks but also served as an opportunity to evaluate clinical and safety practices from the perspective of both multiple professional roles and different institutions. |
| first_indexed | 2024-04-11T20:06:24Z |
| format | Article |
| id | doaj.art-e087c8efba854649a3f68c72ccbf447f |
| institution | Directory Open Access Journal |
| issn | 1748-717X |
| language | English |
| last_indexed | 2024-04-11T20:06:24Z |
| publishDate | 2021-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Radiation Oncology |
| spelling | doaj.art-e087c8efba854649a3f68c72ccbf447f2022-12-22T04:05:18ZengBMCRadiation Oncology1748-717X2021-11-0116111710.1186/s13014-021-01894-3A bi-institutional multi-disciplinary failure mode and effects analysis (FMEA) for a Co-60 based total body irradiation techniqueShahbaz Ahmed0Todd Bossenberger1Adrian Nalichowski2Jeremy S. Bredfeldt3Sarah Bartlett4Kristen Bertone5Michael Dominello6Mark Dziemianowicz7Melanie Komajda8G. Mike Makrigiorgos9Karen J. Marcus10Andrea Ng11Marvin Thomas12Jay Burmeister13Department of Oncology, Wayne State University School of MedicineGershenson Radiation Oncology Center, Karmanos Cancer CenterDepartment of Oncology, Wayne State University School of MedicineDana Farber/Brigham and Women’s Cancer Center, Harvard Medical SchoolDana Farber/Brigham and Women’s Cancer Center, Harvard Medical SchoolDana Farber/Brigham and Women’s Cancer Center, Harvard Medical SchoolDepartment of Oncology, Wayne State University School of MedicineDepartment of Oncology, Wayne State University School of MedicineGershenson Radiation Oncology Center, Karmanos Cancer CenterDana Farber/Brigham and Women’s Cancer Center, Harvard Medical SchoolDana Farber/Brigham and Women’s Cancer Center, Harvard Medical SchoolDana Farber/Brigham and Women’s Cancer Center, Harvard Medical SchoolGershenson Radiation Oncology Center, Karmanos Cancer CenterDepartment of Oncology, Wayne State University School of MedicineAbstract Background We aim to assess the risks associated with total body irradiation (TBI) delivered using a commercial dedicated Co-60 irradiator, and to evaluate inter-institutional and inter-professional variations in the estimation of these risks. Methods A failure mode and effects analysis (FMEA) was generated using guidance from the AAPM TG-100 report for quantitative estimation of prospective risk metrics. Thirteen radiation oncology professionals from two institutions rated possible failure modes (FMs) for occurrence (O), severity (S), and detectability (D) indices to generate a risk priority number (RPN). The FMs were ranked by descending RPN value. Absolute gross differences (AGD) in resulting RPN values and Jaccard Index (JI; for the top 20 FMs) were calculated. The results were compared between professions and institutions. Results A total of 87 potential FMs (57, 15, 10, 3, and 2 for treatment, quality assurance, planning, simulation, and logistics respectively) were identified and ranked, with individual RPN ranging between 1–420 and mean RPN values ranging between 6 and 74. The two institutions shared 6 of their respective top 20 FMs. For various institutional and professional comparison pairs, the number of common FMs in the top 20 FMs ranged from 6 to 13, with JI values of 18–48%. For the top 20 FMs, the trend in inter-professional variability was institution-specific. The mean AGD values ranged between 12.5 and 74.5 for various comparison pairs. AGD values differed the most for medical physicists (MPs) in comparison to other specialties i.e. radiation oncologists (ROs) and radiation therapists (RTs) [MPs-vs-ROs: 36.3 (standard deviation SD = 34.1); MPs-vs-RTs: 41.2 (SD = 37.9); ROs-vs-RTs: 12.5 (SD = 10.8)]. Trends in inter-professional AGD values were similar for both institutions. Conclusion This inter-institutional comparison provides prospective risk analysis for a new treatment delivery unit and illustrates the institution-specific nature of FM prioritization, primarily due to operational differences. Despite being subjective in nature, the FMEA is a valuable tool to ensure the identification of the most significant risks, particularly when implementing a novel treatment modality. The creation of a bi-institutional, multidisciplinary FMEA for this unique TBI technique has not only helped identify potential risks but also served as an opportunity to evaluate clinical and safety practices from the perspective of both multiple professional roles and different institutions.https://doi.org/10.1186/s13014-021-01894-3FMEATBIBi-institutionalMultidisciplinaryRisk assessmentRisk estimation |
| spellingShingle | Shahbaz Ahmed Todd Bossenberger Adrian Nalichowski Jeremy S. Bredfeldt Sarah Bartlett Kristen Bertone Michael Dominello Mark Dziemianowicz Melanie Komajda G. Mike Makrigiorgos Karen J. Marcus Andrea Ng Marvin Thomas Jay Burmeister A bi-institutional multi-disciplinary failure mode and effects analysis (FMEA) for a Co-60 based total body irradiation technique Radiation Oncology FMEA TBI Bi-institutional Multidisciplinary Risk assessment Risk estimation |
| title | A bi-institutional multi-disciplinary failure mode and effects analysis (FMEA) for a Co-60 based total body irradiation technique |
| title_full | A bi-institutional multi-disciplinary failure mode and effects analysis (FMEA) for a Co-60 based total body irradiation technique |
| title_fullStr | A bi-institutional multi-disciplinary failure mode and effects analysis (FMEA) for a Co-60 based total body irradiation technique |
| title_full_unstemmed | A bi-institutional multi-disciplinary failure mode and effects analysis (FMEA) for a Co-60 based total body irradiation technique |
| title_short | A bi-institutional multi-disciplinary failure mode and effects analysis (FMEA) for a Co-60 based total body irradiation technique |
| title_sort | bi institutional multi disciplinary failure mode and effects analysis fmea for a co 60 based total body irradiation technique |
| topic | FMEA TBI Bi-institutional Multidisciplinary Risk assessment Risk estimation |
| url | https://doi.org/10.1186/s13014-021-01894-3 |
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