ArticleZeitschrift fur medizinische Physik2025
Safety in MR-enhanced daily adaptive SBRT Radiotherapy using a conventional C-arm linear accelerator: An FMEA approach.
Article in Zeitschrift fur medizinische Physik, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.
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Who cites it
3 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Failure modes and effects analysis for clinical implementation of online adaptive radiotherapy: A systematic review.Journal of applied clinical medical physics · 2026Pooled it
- MRI-enhanced online adaptive radiotherapy by virtual integration of a standalone MRI simulator and CBCT-based treatment delivery.Radiation oncology (London, England) · 2026Article
- Adaptive radiotherapy incident-informed team training: a development and feasibility study.Technical innovations & patient support in radiation oncology · 2026Article
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Authors and funding
13 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
background and purposeMR-guided adaptive Radiotherapy has the potential to compensate for interfractional changes in patient anatomy. Modern hybrid devices, which combine MR and linear accelerator technologies, have been clinically implemented but their costs may prevent broad adoption. To accelerate the adoption of MR-guided adaptive radiotherapy, we developed a workflow for MR-enhanced daily adaptive Radiotherapy on a C-arm linac using a dedicated MR simulator and a patient transfer shuttle system. A failure mode and effects analysis (FMEA) was performed to identify possible risks in this newly developed workflow. MATERIALS AND
methodsA workflow for MR-enhanced daily adaptive SBRT (MEDAS) on a Varian Truebeam linac was developed using a stand-alone 1.5T MR-simulator and patient transfer using a shuttle system. The different process steps were conceptualized in a multidisciplinary team and an FMEA of the different process steps was performed as well as measures for mitigation of possible risks were discussed.
resultsThe FMEA identified 23 failure modes across eight process steps, with the majority occurring during base plan preparation and adaptive planning. Seventeen (74%) failure modes were classified as low risk, while six (26%) were assessed as medium risk. No high-risk failure modes were identified. Risk mitigation measures, including workflow automation and checklist enhancements, successfully reduced all failure modes to low risk while not introducing new risks
conclusionWe developed a workflow for MEDAS on a conventional C-Arm linac. In this process, an FMEA was performed in a multidisciplinary team. The FMEA identified and addressed six medium-risk failure modes within the MEDAS workflow. Through further automation and adaption of existing checklists, the occurrence- and discover probability was successfully reduced, such that these failure modes are decreased to a low risk.
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