Joel Poder
St George Cancer Care Centre
Radiation Oncology Medical Physics Specialist

Ryan Brown
Radiation Oncology Medical Physics Registrar
St George Cancer Care Centre

Andrew Howie
Senior Radiation Oncology Medical Physics Specialist
St George Cancer Care Centre

Johnson Yuen
Radiation Oncology Medical Physics Specialist
St George Cancer Care Centre

Anna Ralston
Director of Radiation Oncology Medical Physics
St George Cancer Care Centre

Kristine Schrieber
Senior Radiation Therapist
St George Cancer Care Centre

Andrej Bece
Staff Specialist
St George Cancer Care Centre

Joseph Bucci
Staff Specialist
St George Cancer Care Centre

Background and Purpose

A risk based approach was applied to the development of a quality management (QM) program for ultrasound based high dose rate (HDR) prostate brachytherapy (pBT) treatment planning and delivery.

Methods

The QM program was developed by a multi-disciplinary team using two separate risk based techniques. Firstly, an in-house risk and benefit balance impact template (RABBIT) tool was used to develop an initial QM program during the commissioning phase of the technique. Subsequently, a failure modes and effect analysis (FMEA) was performed by three physicists, one radiation therapist and two radiation oncologists familiar with the technique. The QM programs produced by both risk-based techniques were then compared and consolidated.

Results

The RABBIT tool initially identified 26 potential risks during the ultrasound based HDR pBT treatment planning and delivery process. During the FMEA process the authors identified 7 major processes and 35 potential failure modes in ultrasound based HDR pBT. Risk priority numbers (RPNs) were scored and ranged from 14 – 267, with the highest risk identified as the mislabelling of catheters/incorrect transfer tube connection. From the risks analyses a comprehensive QM program was developed.

Conclusions

Both the RABBIT tool and FMEA were shown to be valuable tools in developing a QM program for ultrasound based HDR pBT treatments. Due to the large number of potential failure modes/risks found being due to human or procedural errors, the QM program highlights the importance of checklists and protocols in delivering a safe and effective ultrasound based HDR pBT treatment. Furthermore, the results highlight the benefit of repeating the risk analysis on a periodic basis when implementing a new technique, to ensure that all potential risks/failure modes are identified and accounted for in the quality management schedule.


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