Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
Int J Radiat Oncol Biol Phys. 2012 Nov 15;84(4):925-31. doi: 10.1016/j.ijrobp.2012.01.042. Epub 2012 Apr 9.
To review the type and frequency of patient events from external-beam radiotherapy over a time period sufficiently long to encompass significant technology changes.
Ten years of quality assurance records from January 2001 through December 2010 were retrospectively reviewed to determine the frequency of events affecting patient treatment from four radiation oncology process steps: simulation, treatment planning, data entry/transfer, and treatment delivery. Patient events were obtained from manual records and, from May 2007 onward, from an institution-wide database and reporting system. Events were classified according to process step of origination and segregated according to the most frequently observed event types. Events from the institution-wide database were evaluated to determine time trends.
The overall event rate was 0.93% per course of treatment, with a downward trend over time led by a decrease in treatment delivery events. The frequency of certain event types, particularly in planning and treatment delivery, changed significantly over the course of the study, reflecting technologic and process changes. Treatments involving some form of manual intervention carried an event risk four times higher than those relying heavily on computer-aided design and delivery.
Although the overall event rate was low, areas for improvement were identified, including manual calculations and data entry, late-day treatments, and staff overreliance on computer systems. Reducing the incidence of pretreatment events is of particular importance because these were more likely to occur several times before detection and were associated with larger dosimetric impact. Further improvements in quality assurance systems and reporting are imperative, given the advent of electronic charting, increasing reliance on computer systems, and the potentially severe consequences that can arise from mistakes involving complex intensity-modulated or image-guided treatments.
回顾一段时间内来自外照射放射治疗的患者事件的类型和频率，该时间段足以包含重大技术变化。
回顾 2001 年 1 月至 2010 年 12 月的十年质量保证记录，以确定影响四个放射肿瘤学处理步骤（模拟、治疗计划、数据输入/传输和治疗传递）中患者治疗的事件的频率。患者事件是从手动记录中获得的，从 2007 年 5 月起，还从全机构数据库和报告系统中获得。根据起源的处理步骤对事件进行分类，并根据最常观察到的事件类型进行细分。评估全机构数据库中的事件以确定时间趋势。
总的事件发生率为每疗程 0.93%，随着治疗传递事件的减少，呈下降趋势。某些事件类型的频率，特别是在计划和治疗传递方面，在研究过程中发生了显著变化，反映了技术和流程的变化。涉及某种形式的手动干预的治疗比那些严重依赖计算机辅助设计和交付的治疗具有高四倍的事件风险。
尽管总的事件发生率较低，但仍确定了一些需要改进的领域，包括手动计算和数据输入、接近治疗结束时间的治疗以及工作人员过度依赖计算机系统。减少治疗前事件的发生率尤为重要，因为这些事件在被发现之前可能会发生多次，并且与更大的剂量学影响相关。鉴于电子图表、对计算机系统的日益依赖以及涉及复杂强度调制或图像引导治疗的错误可能产生的潜在严重后果，质量保证系统和报告的进一步改进是必要的。
