Delivering radiation therapy in an oncology setting is a high-risk process where system failures are more likely to occur because of increasing utilization, complexity, and sophistication of the equipment and related processes. Healthcare failure mode and effect analysis (FMEA) is a method used to proactively detect risks to the patient in a particular healthcare process and correct potential errors before adverse events occur. FMEA is a systematic, multidisciplinary team-based approach to error prevention and enhancing patient safety. We describe our experience of using FMEA as a prospective risk-management technique in radiation oncology at a national network of oncology hospitals in the United States, capitalizing not only on the use of a team-based tool but also creating momentum across a network of collaborative facilities seeking to learn from and share best practices with each other. The major steps of our analysis across 4 sites and collectively were: choosing the process and subprocesses to be studied, assembling a multidisciplinary team at each site responsible for conducting the hazard analysis, and developing and implementing actions related to our findings. We identified 5 areas of performance improvement for which risk-reducing actions were successfully implemented across our enterprise.

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The relation between the fading and phototendering behaviour of Caledon Yellow GN, 5GK and 4G on cotton cellulose has been examined. A distinction is drawn between the reactions promoted by visible light and those promoted by ultraviolet radiation. Caledon Yellow 5GK is the most efficient phototenderer in visible light and production of the leuco dye accompanies this process. Phototendering by this mechanism can also be identified with Caledon Yellow GN, although to a much smaller extent than with 5GK, and production of the leuco form is accompanied by formation of free radicals. Regeneration of the original dye is best promoted by an atmosphere of moist oxygen. Excitation by short‐ultraviolet radiation leads to irreversible chemical changes in the dyes and degradation of the cellulose. The most efficient phototenderer in visible light (Caledon Yellow 5GK) markedly inhibits the degradation of cotton by ultraviolet radiation, whereas the poor phototenderers in visible light (Caledon Yellow 4G and GN) exert no such marked protection. The mechanisms of these reactions are discussed. Hydrogen abstraction by the excited non‐aggregated dye is the most probable path to the leuco dye and photodegradation in visible light, and the mechanism is thus comparable with the mechanisms elucidated for anthraquinone compounds in solution and on cellulose. Electronic‐energy transfer to the cellulose, in competition with the abstraction process, would be favoured during ultraviolet irradiation, and is the mechanism suggested for the degradation of cellulose under these conditions. The influence of dye aggregation on the reactions and the mechanism of the irreversible chemical changes in the dyes are also discussed.

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