ArticleRadiation oncology (London, England)2021
A bi-institutional multi-disciplinary failure mode and effects analysis (FMEA) for a Co-60 based total body irradiation technique.
Article in Radiation oncology (London, England), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
What it found
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Who cites it
5 citing papers in PubMed.
- Application of an updated severity-based FMEA approach to Radiation Therapy QA: A multi-institutional exercise.Journal of applied clinical medical physics · 2026Article
- Incorporating Intensity Modulated Total Body Irradiation (IMRT-TBI) Into Future Cooperative Group Clinical Trials: An NRG Hematologic Malignancies Working Group-Led Report From the National Clinical Trials Network.International journal of radiation oncology, biology, physics · 2026Article
- Real-time gated proton therapy: Introducing clinical workflow and failure modes and effects analysis (FMEA).Technical innovations & patient support in radiation oncology · 2025Article
- Healthcare Application of Failure Mode and Effect Analysis (FMEA): Is There Room in the Infectious Disease Setting? A Scoping Review.Healthcare (Basel, Switzerland) · 2025Article
- Learning Reimagined: AI's Role in Advancing Education of Cancer Research and Treatment Technology.Technology in cancer research & treatmentArticle
Corrections and comments
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Authors and funding
14 authors.
Funding
Abstract
backgroundWe aim to assess the risks associated with total body irradiation (TBI) delivered using a commercial dedicated Co-60 irradiator, and to evaluate inter-institutional and inter-professional variations in the estimation of these risks.
methodsA failure mode and effects analysis (FMEA) was generated using guidance from the AAPM TG-100 report for quantitative estimation of prospective risk metrics. Thirteen radiation oncology professionals from two institutions rated possible failure modes (FMs) for occurrence (O), severity (S), and detectability (D) indices to generate a risk priority number (RPN). The FMs were ranked by descending RPN value. Absolute gross differences (AGD) in resulting RPN values and Jaccard Index (JI; for the top 20 FMs) were calculated. The results were compared between professions and institutions.
resultsA total of 87 potential FMs (57, 15, 10, 3, and 2 for treatment, quality assurance, planning, simulation, and logistics respectively) were identified and ranked, with individual RPN ranging between 1-420 and mean RPN values ranging between 6 and 74. The two institutions shared 6 of their respective top 20 FMs. For various institutional and professional comparison pairs, the number of common FMs in the top 20 FMs ranged from 6 to 13, with JI values of 18-48%. For the top 20 FMs, the trend in inter-professional variability was institution-specific. The mean AGD values ranged between 12.5 and 74.5 for various comparison pairs. AGD values differed the most for medical physicists (MPs) in comparison to other specialties i.e. radiation oncologists (ROs) and radiation therapists (RTs) [MPs-vs-ROs: 36.3 (standard deviation SD = 34.1); MPs-vs-RTs: 41.2 (SD = 37.9); ROs-vs-RTs: 12.5 (SD = 10.8)]. Trends in inter-professional AGD values were similar for both institutions.
conclusionThis inter-institutional comparison provides prospective risk analysis for a new treatment delivery unit and illustrates the institution-specific nature of FM prioritization, primarily due to operational differences. Despite being subjective in nature, the FMEA is a valuable tool to ensure the identification of the most significant risks, particularly when implementing a novel treatment modality. The creation of a bi-institutional, multidisciplinary FMEA for this unique TBI technique has not only helped identify potential risks but also served as an opportunity to evaluate clinical and safety practices from the perspective of both multiple professional roles and different institutions.
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