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...

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Autores principales:	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
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	FMEA TBI Bi-institutional Multidisciplinary Risk assessment Risk estimation Medical physics. Medical radiology. Nuclear medicine R895-920 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/e087c8efba854649a3f68c72ccbf447f
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spelling	oai:doaj.org-article:e087c8efba854649a3f68c72ccbf447f2021-11-21T12:14:11ZA bi-institutional multi-disciplinary failure mode and effects analysis (FMEA) for a Co-60 based total body irradiation technique10.1186/s13014-021-01894-31748-717Xhttps://doaj.org/article/e087c8efba854649a3f68c72ccbf447f2021-11-01T00:00:00Zhttps://doi.org/10.1186/s13014-021-01894-3https://doaj.org/toc/1748-717XAbstract 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.Shahbaz AhmedTodd BossenbergerAdrian NalichowskiJeremy S. BredfeldtSarah BartlettKristen BertoneMichael DominelloMark DziemianowiczMelanie KomajdaG. Mike MakrigiorgosKaren J. MarcusAndrea NgMarvin ThomasJay BurmeisterBMCarticleFMEATBIBi-institutionalMultidisciplinaryRisk assessmentRisk estimationMedical physics. Medical radiology. Nuclear medicineR895-920Neoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENRadiation Oncology, Vol 16, Iss 1, Pp 1-17 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	FMEA TBI Bi-institutional Multidisciplinary Risk assessment Risk estimation Medical physics. Medical radiology. Nuclear medicine R895-920 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	FMEA TBI Bi-institutional Multidisciplinary Risk assessment Risk estimation Medical physics. Medical radiology. Nuclear medicine R895-920 Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 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
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.
format	article
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
title	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_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_sort	bi-institutional multi-disciplinary failure mode and effects analysis (fmea) for a co-60 based total body irradiation technique
publisher	BMC
publishDate	2021
url	https://doaj.org/article/e087c8efba854649a3f68c72ccbf447f
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A bi-institutional multi-disciplinary failure mode and effects analysis (FMEA) for a Co-60 based total body irradiation technique

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