Applying Lean-Six-Sigma Methodology in radiotherapy: Lessons learned by the breast daily repositioning case

Mancosu, P.; Nicolini, G.; Goretti, Giulia; Rose, F. De; Franceschini, Davide; Ferrari, Chiara; Reggiori, G.; Tomatis, S.; Scorsetti, Marta

doi:10.1016/j.radonc.2018.02.019

Cited by 22 publications

(15 citation statements)

References 21 publications

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“…Toyota motors applied lean manufacturing into their production [58]. Lean manufacturing techniques has proven to be positively effective in most of the manufacturing fields [59], like metal industry, automotive industry, hospitals [60], textile industry, for years. Hence, most of the manufacturers wanted to adopt this manufacturing techniques to increase their financial performance [61], or the ergonomic layout of the company [62] or the sustainability of the work [63], by using Just in Time, waste reduction and detect-free production [64] techniques.…”

Section: Implementation and Impact Of Lean Manufacturingmentioning

confidence: 99%

Lean manufacturing: Trends and implementation issues

Duraković

Demir²,

Abat³

et al. 2018

PEN

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Many manufacturing cost reduction initiatives have been introduced over past three decades including lean manufacturing. Waste reduction and efficiency improvement are the main objectives of this initiative. It is developed from a set of tools and techniques and can fit nicely in cost focus or cost leadership competitive advantage strategies. But, keeping competitive advantage under the market circumstances are getting harder with growth of production quantity and product diversity. Therefore, paper's focus is lean manufacturing implementation trends and issues within the various manufacturing sector. Successes and failures of implementation of lean manufacturing in some industries are discussed. It was found that lean principles are good source of competitive advantage, it is applicable for many industries and its expansion and discussion are significantly progressing. The biggest threat in implementing lean is lack of understanding the concept but those who engage consultants were more successful.

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Section: Implementation and Impact Of Lean Manufacturingmentioning

confidence: 99%

Lean manufacturing: Trends and implementation issues

Duraković

Demir²,

Abat³

et al. 2018

PEN

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“…We chose to apply a Six Sigma methodology which provides a structured framework to measure and reduce defects in the process and has been successfully employed in other radiation oncology settings. [18][19][20] To enhance the value of such an APC tool, we used failure mode and effects analysis (FMEA) as the foundation to identify high-severity and high-risk priority numbers (RPN) check items and prioritize them in developing our APC tool. Tailored specifically to the authors' clinic using the eclipse scripting application programming interface (ESAPI, Varian Medical Systems, Palo Alto, CA), the APC tool was built and integrated in the clinical workflow by dosimetrists and physicists.…”

Section: Introductionmentioning

confidence: 99%

Optimizing efficiency and safety in external beam radiotherapy using automated plan check (APC) tool and six sigma methodology

Shi

Bush

Bertini

et al. 2019

J Applied Clin Med Phys

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To develop and implement an automated plan check (APC) tool using a Six Sigma methodology with the aim of improving safety and efficiency in external beam radiotherapy. Methods: The Six Sigma define-measure-analyze-improve-control (DMAIC) framework was used by measuring defects stemming from treatment planning that were reported to the departmental incidence learning system (ILS). The common error pathways observed in the reported data were combined with our departmental physics plan check list, and AAPM TG-275 identified items. Prioritized by risk priority number (RPN) and severity values, the check items were added to the APC tool developed using Varian Eclipse Scripting Application Programming Interface (ESAPI). At 9 months post-APC implementation, the tool encompassed 89 check items, and its effectiveness was evaluated by comparing RPN values and rates of reported errors. To test the efficiency gains, physics plan check time and reported error rate were prospectively compared for 20 treatment plans. Results: The APC tool was successfully implemented for external beam plan checking. FMEA RPN ranking re-evaluation at 9 months post-APC demonstrated a statistically significant average decrease in RPN values from 129.2 to 83.7 (P < .05). After the introduction of APC, the average frequency of reported treatment-planning errors was reduced from 16.1% to 4.1%. For high-severity errors, the reduction was 82.7% for prescription/plan mismatches and 84.4% for incorrect shift note. The process shifted from 4σ to 5σ quality for isocenter-shift errors. The efficiency study showed a statistically significant decrease in plan check time (10.1 ± 7.3 min, P = .005) and decrease in errors propagating to physics plan check (80%). Conclusions: Incorporation of APC tool has significantly reduced the error rate. The DMAIC framework can provide an iterative and robust workflow to improve the efficiency and quality of treatment planning procedure enabling a safer radiotherapy process.

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“…15 Mancosu et al recently reported the application of Lean Six Sigma methodology to improve the image-guided radiation therapy (IGRT) of breast cancer patients. 16 SBRT was initially performed to patients with poor performance status. Thanks to the promising results, SBRT has now enlarged in operable patients.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, Lean approaches were applied to radiotherapy departments, too. [13][14][15][16] The aim of this paper is to report how the adoption of a Lean Thinking mindset in the management of the AIFM/ SBRT-WG contributed to achieve SBRT standardization objectives.…”

Section: Introductionmentioning

confidence: 99%

Lean Thinking to manage a national working group on physics aspects of Stereotactic Body Radiation Therapy

Mancosu

Russo

Antonucci³

et al. 2021

Medical Physics

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To report how the adoption of a Lean Thinking mindset in the management of a national working group (WG) on the physics of stereotactic body radiation therapy (SBRT) contributed to achieve SBRT standardization objectives. Methods: Vision for the WG has been established as fragmentation reduction and process harmonization enhancement in SBRT for Italian centers. Two main research themes of the technical aspects of SBRT emerged as areas with major standardization improvement needs, small field dosimetry and SBRT planning comparisons, to be investigated through multi-institutional studies. The management of the WG leveraged on the Lean concept of fostering self-organization in a non-hierarchical environment. Four progressive involvement levels were defined for each study. No specific "scientific" preexperience was required to propose and coordinate a project, just requiring a voluntary commitment. People engagement was measured in terms of number of published articles. The standardization goals have been conducted through a simplified "5S" (Sort, Set in Order, Shine, Standardize, and Sustain) methodology, first considering a phase of awareness (the first three "S"), then identifying and implementing standardization actions (the last two "S"). Results: Since the beginning, 157 medical physicists joined the AIFM/SBRT-WG. Twenty-four papers/reviews/letters have been published in the period 2014-2019 on major radiation oncology journals, authored by >100 physicists (>50% working in small hospitals). Six over 12 first authors worked in peripheral/small hospitals, with no prior publication as first author. These studies contributed to the awareness and standardization phases for both small-field dosimetry and planning. In particular, errors in small-field measurements in 8% of centers were detected thanks to a generalized output factor curve in function of the effective field size created by averaging data available from different Linacs. Furthermore, planner's experience in SBRT was correlated with dosimetric parameters in the awareness phase; while sharing median dose volume histograms (DVHs) reduced variability among centers while keeping the same level of plan complexity. Finally, all the dosimetric parameters statistically significant to the planner experience during the awareness phase, were no longer significantly different in the standardization phase. Conclusions: The experience of our SBRT-WG has shown how a Lean Thinking mindset could foster the SBRT procedure standardization and spread the physics of SBRT knowledge, enhancing personal growth. Our expectation is to inspire other scientific societies that have to deal with fragmented contexts or pursue processes harmonization through Lean principles.

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Applying Lean-Six-Sigma Methodology in radiotherapy: Lessons learned by the breast daily repositioning case

Cited by 22 publications

References 21 publications

Lean manufacturing: Trends and implementation issues

Lean manufacturing: Trends and implementation issues

Optimizing efficiency and safety in external beam radiotherapy using automated plan check (APC) tool and six sigma methodology

Lean Thinking to manage a national working group on physics aspects of Stereotactic Body Radiation Therapy

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