Multi-phase failure modes and effects analysis for low dose bilateral whole lung irradiation of COVID-19 positive patients requiring respiratory ventilation.

PURPOSE: To identify high-priority risks in a clinical trial investigating the use of radiation to alleviate COVID-19 pneumonia using a multi-phase failure modes and effects analysis (FMEA). METHODS: A comprehensive FMEA survey of 133 possible causes of failure was developed for the clinical trial workflow (Phase I). The occurrence, severity, and detection risk of each possible cause of failure was scored by three medical physicists. High-risk potential failure modes were identified using the risk priority number (RPN) and severity scores, which were re-scored by 13 participants in radiation oncology (Phase II). Phase II survey scores were evaluated to identify steps requiring possible intervention and examine risk perception patterns. The Phase II participants provided consensus scores as a group. RESULTS: Thirty high-priority failure modes were selected for the Phase II survey. Strong internal consistency was shown in both surveys using Cronbach's alpha (αc ≥ 0.85). The 10 failures with the largest median RPN values concerned SARS-CoV-2 transmission (N = 6), wrong treatment (N = 3), and patient injury (N = 1). The median RPN was larger for COVID-related failures than other failure types, primarily due to the perceived difficulty of failure detection. Group re-scoring retained 8/10 of the highest-priority risk steps that were identified in the Phase II process, and discussion revealed interpretation differences of process steps and risk evaluation. Participants who were directly involved with the trial working group had stronger agreement on severity scores than those who were not. CONCLUSIONS: The high ranking of failures concerning SARS-CoV-2 transmission suggest that these steps may require additional quality management intervention when treating critically ill COVID-19+ patients. The results also suggest that a multi-phase FMEA survey led by a facilitator may be a useful tool for assessing risks in radiation oncology procedures, supporting future efforts to adapt FMEA to clinical procedures.

The report of AAPM task group 288: Recommendations for guiding radiotherapy event narratives.

Incident reporting and learning systems provide an opportunity to identify systemic vulnerabilities that contribute to incidents and potentially degrade quality. The narrative of an incident is intended to provide a clear, easy to understand description of an incident. Unclear, incomplete or poorly organized narratives compromise the ability to learn from them. This report provides guidance for drafting effective narratives, with particular attention to the use of narratives in incident reporting and learning systems (IRLS). Examples are given that compare effective and less than effective narratives. This report is mostly directed to organizations that maintain IRLS, but also may be helpful for individuals who desire to write a useful narrative for entry into such a system. Recommendations include the following: (1) Systems should allow a one- or two-sentence, free-text synopsis of an incident without guessing at causes; (2) Information included should form a sequence of events with chronology; and (3) Reporting and learning systems should consider using the headings suggested to guide the reporter through the narrative: (a) incident occurrences and actions by role; (b) prior circumstances and actions; (c) method by which the incident was identified; (d) equipment related details if relevant; (e) recovery actions by role; (f) relevant time span between responses; (g) and how individuals affected during or immediately after incident. When possible and appropriate, supplementary information including relevant data elements should be included using numerical scales or drop-down choices outside of the narrative. Information that should not be included in the narrative includes: (a) patient health information (PHI); (b) conjecture or blame; (c) jargon abbreviations or details without specifying their significance; (d) causal analysis.

ASTRO's Advances in Radiation Oncology: Success to date and future plans.

ASTRO's Advances in Radiation Oncology was launched as a new, peer-reviewed scientific journal in December 2015. More than 200 manuscripts have been submitted and 97 accepted for publication as of May 2017. As Advances enters its second year of publication, we have chosen to highlight subjects that will transform the way we practice radiation oncology in special issues or ongoing series: immunotherapy, biomedical analytics, and social media. A teaching case report contest for North American radiation oncology residents will be launched at American Society of Radiation Oncology 2017 to encourage participation in scientific publication by trainees early in their careers. Recognizing our social mission, Advances will also begin a series of articles devoted to highlighting the growing disparities in access to radiation oncology services in vulnerable populations in North America. We wish to encourage the American Society of Radiation Oncology membership to continue its support of the journal through high-quality manuscript submission, participation in the peer review process, and highlighting important manuscripts through sharing on social media.

A tissue-equivalent phantom series for mammography dosimetry.

A breast tissue-equivalent series (BRTES) of phantoms is manufactured to mimic both the attenuation and the density of the range of glandular and adipose tissue compositions encountered in mammography. The BRTES simulates breast tissues across the range of 20% to 70% glandularity and can be assembled in a variety of thicknesses to represent a compressed breast thickness corresponding to glandularity to simulate various patient demographics. The fabrication techniques are presented, and the physical properties of the completed series of phantoms are described. The BRTES phantoms provide a dosimetry comparison with commonly used phantoms, including the American College of Radiology accreditation phantom and BR12, a 50% glandularity tissue-equivalent material. The comparison shows that the average glandular dose is a strong function of compressed breast thickness and tissue composition. Patient doses measured using photo-timed exposures with the BRTES phantoms can be up to a factor of 3 greater than or less than the doses predicted using conventional phantoms.

A survey of radiation dose associated with pediatric plain-film chest X-ray examinations.

BACKGROUND: The effective doses delivered to pediatric patients are not well characterized for many plain-film X-ray examination techniques. The few data available on clinical doses in pediatric radiology are generally outdated because of the changes in X-ray generators and hardware that have taken place over the past decade. OBJECTIVE: This survey characterizes X-ray examination techniques and measures effective doses delivered to a phantom representing a 1 year old in order to identify specific examination features that may result in greater than necessary doses to pediatric patients. MATERIALS AND METHODS: An anthropomorphic phantom representing a 1 year old was developed for use as a survey tool. The phantom incorporates direct reading metal oxide semiconductor field effect transistor (MOSFET) dosimeters that permit the effective dose to be measured for clinical examinations. Seventeen commonly performed examinations were characterized at ten facilities with doses determined for a chest series of exams at each facility. RESULTS: The survey demonstrates that the effective dose for a given examination can vary by an order of magnitude between institutions. Distributions of examination parameters identified those that are most significant for minimizing patient dose. CONCLUSION: Efforts spent to determine pediatric specific radiographic techniques contribute more to effective imaging with low patient doses than utilizing AEC controls or high-frequency generators.