Department of Radiation Oncology, Stanford University, Stanford, CA, USA.
Davidson College, Davidson, NC, USA.
J Appl Clin Med Phys. 2019 Aug;20(8):56-64. doi: 10.1002/acm2.12678.
To develop and implement an automated plan check (APC) tool using a Six Sigma methodology with the aim of improving safety and efficiency in external beam radiotherapy.
The Six Sigma define-measure-analyze-improve-control (DMAIC) framework was used by measuring defects stemming from treatment planning that were reported to the departmental incidence learning system (ILS). The common error pathways observed in the reported data were combined with our departmental physics plan check list, and AAPM TG-275 identified items. Prioritized by risk priority number (RPN) and severity values, the check items were added to the APC tool developed using Varian Eclipse Scripting Application Programming Interface (ESAPI). At 9 months post-APC implementation, the tool encompassed 89 check items, and its effectiveness was evaluated by comparing RPN values and rates of reported errors. To test the efficiency gains, physics plan check time and reported error rate were prospectively compared for 20 treatment plans.
The APC tool was successfully implemented for external beam plan checking. FMEA RPN ranking re-evaluation at 9 months post-APC demonstrated a statistically significant average decrease in RPN values from 129.2 to 83.7 (P < .05). After the introduction of APC, the average frequency of reported treatment-planning errors was reduced from 16.1% to 4.1%. For high-severity errors, the reduction was 82.7% for prescription/plan mismatches and 84.4% for incorrect shift note. The process shifted from 4σ to 5σ quality for isocenter-shift errors. The efficiency study showed a statistically significant decrease in plan check time (10.1 ± 7.3 min, P = .005) and decrease in errors propagating to physics plan check (80%).
Incorporation of APC tool has significantly reduced the error rate. The DMAIC framework can provide an iterative and robust workflow to improve the efficiency and quality of treatment planning procedure enabling a safer radiotherapy process.
使用六西格玛方法开发和实施自动化计划检查 (APC) 工具，旨在提高外照射放射治疗的安全性和效率。
使用六西格玛定义-测量-分析-改进-控制 (DMAIC) 框架，通过测量向部门事件学习系统 (ILS) 报告的治疗计划中的缺陷来进行测量。将报告数据中观察到的常见错误途径与我们部门的物理计划检查清单和 AAPM TG-275 确定的项目相结合。根据风险优先级数 (RPN) 和严重程度值进行优先级排序后，将检查项添加到使用 Varian Eclipse 脚本应用程序编程接口 (ESAPI) 开发的 APC 工具中。在 APC 实施后 9 个月，该工具包含 89 个检查项，并通过比较 RPN 值和报告错误率来评估其有效性。为了测试效率提高，前瞻性比较了 20 个治疗计划的物理计划检查时间和报告错误率。
成功实施了外部束计划检查的 APC 工具。APC 实施后 9 个月的 FMEA RPN 排名重新评估表明，RPN 值从 129.2 平均显着降低到 83.7（P<.05）。引入 APC 后，报告的治疗计划错误的平均频率从 16.1%降低到 4.1%。对于高严重性错误，处方/计划不匹配的减少了 82.7%，不正确的移位说明减少了 84.4%。对于等中心移位错误，该过程从 4σ 转移到 5σ 质量。效率研究表明，计划检查时间有统计学意义的显着减少（10.1±7.3 分钟，P=0.005），并且错误传播到物理计划检查的数量减少（80%）。
APC 工具的引入显着降低了错误率。DMAIC 框架可以提供一个迭代和强大的工作流程，以提高治疗计划过程的效率和质量，从而实现更安全的放射治疗过程。
