Harvard Radiation Oncology Program, Boston, MA, USA.
Int J Radiat Oncol Biol Phys. 2011 Nov 15;81(4):e673-9. doi: 10.1016/j.ijrobp.2011.04.036. Epub 2011 Jun 12.
Technological advances in radiation therapy (RT) delivery have the potential to reduce errors via increased automation and built-in quality assurance (QA) safeguards, yet may also introduce new types of errors. Intensity-modulated RT (IMRT) is an increasingly used technology that is more technically complex than three-dimensional (3D)-conformal RT and conventional RT. We determined the rate of reported errors in RT delivery among IMRT and 3D/conventional RT treatments and characterized the errors associated with the respective techniques to improve existing QA processes.
All errors in external beam RT delivery were prospectively recorded via a nonpunitive error-reporting system at Brigham & Women's Hospital/Dana Farber Cancer Institute. Errors are defined as any unplanned deviation from the intended RT treatment and are reviewed during monthly departmental quality improvement meetings. We analyzed all reported errors since the routine use of IMRT in our department, from January 2004 to July 2009. Fisher's exact test was used to determine the association between treatment technique (IMRT vs. 3D/conventional) and specific error types. Effect estimates were computed using logistic regression.
There were 155 errors in RT delivery among 241,546 fractions (0.06%), and none were clinically significant. IMRT was commonly associated with errors in machine parameters (nine of 19 errors) and data entry and interpretation (six of 19 errors). IMRT was associated with a lower rate of reported errors compared with 3D/conventional RT (0.03% vs. 0.07%, p = 0.001) and specifically fewer accessory errors (odds ratio, 0.11; 95% confidence interval, 0.01-0.78) and setup errors (odds ratio, 0.24; 95% confidence interval, 0.08-0.79).
The rate of errors in RT delivery is low. The types of errors differ significantly between IMRT and 3D/conventional RT, suggesting that QA processes must be uniquely adapted for each technique. There was a lower error rate with IMRT compared with 3D/conventional RT, highlighting the need for sustained vigilance against errors common to more traditional treatment techniques.
放射治疗（RT）技术的进步具有通过增加自动化和内置质量保证（QA）来减少错误的潜力，但也可能引入新的错误类型。调强放射治疗（IMRT）是一种越来越多使用的技术，比三维（3D）适形 RT 和常规 RT 技术更复杂。我们确定了在 IMRT 和 3D/常规 RT 治疗中报告的 RT 传递错误率，并对与各自技术相关的错误进行了特征描述，以改进现有的 QA 流程。
在布莱根妇女医院/达纳-法伯癌症研究所，通过非惩罚性错误报告系统前瞻性记录所有外照射 RT 传递中的错误。错误被定义为任何与预期 RT 治疗的计划偏差，并在每月的部门质量改进会议上进行审查。我们分析了自我们部门常规使用 IMRT 以来的所有报告错误，时间范围为 2004 年 1 月至 2009 年 7 月。使用 Fisher 确切检验确定治疗技术（IMRT 与 3D/常规）与特定错误类型之间的关联。使用逻辑回归计算效应估计值。
在 241546 个分数中（0.06%）有 155 个 RT 传递错误，没有一个是临床显著的。IMRT 通常与机器参数（19 个错误中的 9 个）和数据输入和解释（19 个错误中的 6 个）的错误有关。与 3D/常规 RT 相比，IMRT 报告的错误率较低（0.03%比 0.07%，p=0.001），具体而言，辅助错误（比值比，0.11；95%置信区间，0.01-0.78）和设置错误（比值比，0.24；95%置信区间，0.08-0.79）较少。
RT 传递中的错误率很低。IMRT 和 3D/常规 RT 之间的错误类型有很大的差异，这表明 QA 流程必须针对每种技术进行独特的调整。与 3D/常规 RT 相比，IMRT 的错误率较低，这突出表明需要对更传统治疗技术中常见的错误保持持续警惕。
