Quality assurance analysis of a large multicenter practice: does increased complexity of intensity-modulated radiotherapy lead to increased error frequency?
Publication/Presentation Date
1-1-2012
Abstract
PURPOSE: Error reduction is an important concern in clinical medicine. Intensity-modulated radiotherapy (IMRT) is an important advancement in radiation oncology that increases the complexity of treatment, potentially increasing the error risk. We studied the frequency and severity of errors in a large multicenter practice to ascertain the impact of quality improvement interventions over time, IMRT, and type of practice.
METHODS AND MATERIALS: We analyzed prospective data from three academic and 16 community practice sites with 24,775 courses of radiotherapy (9,210 IMRT courses and 15,565 non-IMRT) between January 2006 and December 2009. All IMRT treatment was performed using one centralized dose planning center for all sites.
RESULTS: We prospectively identified various errors or potential errors in 0.14 % vs. 0.40 % of the IMRT vs. non-IMRT courses (13/9,210 vs. 62/15,565, p = 0.0004) and excluding potential errors: 0.03 % for IMRT vs. 0.21% for non-IMRT. We developed the Clinical Radiotherapy Error Severity Scale (CRESS) to classify error severity from 1 to 10, with 1 to 3 for potential or completely correctable errors, 4 to 5 for dose variations5%. Multivariate analyses of CRESS values, severity >4, and any error (including potential) correlated significantly reduced errors with IMRT (p = 0.0001-0.0024) but found no significant difference between the academic and community practice sites and no change in error frequency over time despite implementation of 39 system-wide policy changes by the centralized quality improvement committee.
CONCLUSIONS: Despite the increase in complexity with IMRT compared with conventional radiotherapy, it can be delivered with reduced error frequency.
Volume
82
Issue
1
First Page
77
Last Page
82
ISSN
1879-355X
Published In/Presented At
Olson, A. C., Wegner, R. E., Scicutella, C., Heron, D. E., Greenberger, J. S., Huq, M. S., Bednarz, G., & Flickinger, J. C. (2012). Quality assurance analysis of a large multicenter practice: does increased complexity of intensity-modulated radiotherapy lead to increased error frequency?. International journal of radiation oncology, biology, physics, 82(1), e77–e82. https://doi.org/10.1016/j.ijrobp.2011.01.033
Disciplines
Medicine and Health Sciences
PubMedID
21497453
Department(s)
Department of Surgery
Document Type
Article