Computerized System for Safety Verification of External Beam Radiotherapy Planning

Publication date: Available online 9 March 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Clay Holdsworth, Jacek Kukluk, Christina Molodowitch, Maria Czerminska, Cindy Hancox, Robert A. Cormack, Kevin Beaudette, Joseph H. Killoran
PurposeRadiotherapy (RT) treatment planning is vulnerable to human, software, and technical error. Before first treatment, RT plans go through a quality control review (QCR) by a qualified medical physicist (QMP) as our standard practice. This process is time-consuming and also prone to human error. While errors with severe consequences are rare, small deviations can result in late-stage, time-sensitive plan revisions which carry additional risks. We report an assessment of in-house software, Verifier, developed to improve efficacy and efficiency of the treatment planning process and QCR.MethodsRT plan parameters retrieved from our treatment planning database are used by automated tests to give 75 types of warnings such as prescription and plan discrepancies. The software is continuously updated based on new issues, ideas, and planning policies. Verifier was retrospectively assessed (2007-2015) by examining impact on treatment plan revisions, frequency of Quality Improvement (QI) incident reports of avoidable RT plan related safety events, unaddressed issues, and staff efficiency.ResultsPlan revisions for specific issues declined dramatically in response to implementation of corresponding Verifier tests. Between 2012 and 2015 our institution's total rate of plan revisions dropped from 18.0% to 11.2%. Between 2008 and 2015 specific tests were added to Verifier while the rate of corresponding avoidable safety events was reduced from 0.34% to 0.00% over the same period. Simulations suggest Verifier saves ∼2-5 minutes per QCR.ConclusionsThe decrease in quantifiable metrics of plan revisions and incident reports suggests automatic RT plan checking software enhances patient safety and clinical efficiency. While only modest time savings may be gained using Verifier for the QCR itself, the greater impact on efficiency is through avoiding late stage plan modifications and improving documentation via automation. We encourage other institutions to consider working toward adding similar technologies to enhance their RT Quality Assurance (QA) programs.

Teaser

In-house automatic RT plan checking software, Verifier, was retrospectively assessed by examining the decrease of treatment plan revisions and frequency of Quality Improvement reports. Between 2012 and 2015 our institution's total rate of plan revisions dropped from 18.0% to 11.2%. Between 2008 and 2015 the rate of avoidable safety events was reduced from 0.34% to 0.00%. The decrease in these quantifiable metrics suggests automatic RT plan checking software enhances patient safety and clinical efficiency.


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