Automated survey of 8000 plan checks at eight facilities

Halabi, Tarek; Lu, Hsiao Ming; Bernard, Damian; Chu, James C.H.; Kirk, M.; Hamilton, Russell J.; Yu, Long-Chuan; Driewer, J

doi:10.1118/1.4959999

Cited by 7 publications

(11 citation statements)

References 22 publications

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“…Since then there have been numerous studies of various auto detection approaches operating in the treatment planning system (TPS), the OIS, or both. [18][19][20][21][22][23][24][25][26][27][28] Researchers at the University of Iowa have designed a system that queries the treatment management system to automate a number of checks including detection of treatment overrides, inconsistencies in delivery, scheduling, and deviations in couch position, and other verification checks. 26 The system is used to prescreen chart checks such that more time can be spent investigating events and less time searching for them.…”

Section: D a Review Of Automation And Tools To Support Reviewmentioning

confidence: 99%

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Strategies for effective physics plan and chart review in radiation therapy: Report of AAPM Task Group 275

et al. 2020

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Background: While the review of radiotherapy treatment plans and charts by a medical physicist is a key component of safe, high-quality care, very few specific recommendations currently exist for this task. Aims: The goal of TG-275 is to provide practical, evidence-based recommendations on physics plan and chart review for radiation therapy. While this report is aimed mainly at medical physicists, others may benefit including dosimetrists, radiation therapists, physicians and other professionals interested in quality management. Methods: The scope of the report includes photon/electron external beam radiotherapy (EBRT), proton radiotherapy, as well as high-dose rate (HDR) brachytherapy for gynecological applications (currently the highest volume brachytherapy service in most practices). The following review time points are considered: initial review prior to treatment, weekly review, and end-of-treatment review. The Task Group takes a risk-informed approach to developing recommendations. A failure mode and effects analysis was performed to determine the highest-risk aspects of each process. In the case of photon/electron EBRT, a survey of all American Association of Physicists in Medicine (AAPM) members was also conducted to determine current practices. A draft of this report was provided to the full AAPM membership for comment through a 3-week open-comment period, and the report was revised in response to these comments.Results: The highest-risk failure modes included 112 failure modes in photon/electron EBRT initial review, 55 in weekly and end-of-treatment review, 24 for initial review specific to proton therapy, and 48 in HDR brachytherapy. A 103-question survey on current practices was released to all AAPM members who self-reported as working in the radiation oncology field. The response rate was 33%. The survey data and risk data were used to inform recommendations. Discussion: Tables of recommended checks are presented and recommendations for best practice are discussed. Suggestions to software vendors are also provided. Conclusions: TG-275 provides specific recommendations for physics plan and chart review which should enhance the safety and quality of care for patients receiving radiation treatments.

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Section: D a Review Of Automation And Tools To Support Reviewmentioning

confidence: 99%

“…As of 2016, the system had been implemented at eight separate facilities and provided over 8000 plan checks. 22 There are other studies on automated checking in addition to those cited above. Dewhurst et al 19 developed a series of 31 checks operating within a TPS.…”

Section: D a Review Of Automation And Tools To Support Reviewmentioning

confidence: 99%

Strategies for effective physics plan and chart review in radiation therapy: Report of AAPM Task Group 275

et al. 2020

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“…While sharing of the software code between institutions using the same TPS and R&V is certainly feasible, none of the publications have commented on or demonstrated its practicality. One automated checker presented in the literature is both multi‐institutional and multi‐platform, but its functionality is limited to the parsing of documents in portable document format (pdf) and subsequent comparison of plan data consistency between TPS, R&V, and third party applications 3,9 . Recently, commercial companies have also begun to market and sell automated plan check tools.…”

Section: Introductionmentioning

confidence: 99%

Efficiency and safety increases after the implementation of a multi‐institutional automated plan check tool at our institution

Berry

Zhou

Pham

et al. 2020

J Applied Clin Med Phys

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Purpose: The plan check tool (PCT) is the result of a multi-institutional collaboration to jointly develop a flexible automated plan checking framework designed with the versatility to be shared across collaborating facilities while supporting the individual differences between practices. We analyze the effect that PCT has had on the efficiency and effectiveness of initial chart checks at our institution.Methods and Materials: Data on errors identified during initial chart checks were acquired during two time periods: before the introduction of PCT in the clinic (6/24/ 2015 to 7/31/2015, 187 checks) and post-clinical release (4/14/2016 to 5/2/2016, 186 checks). During each time period, human plan checkers were asked to record all issues that they either manually detected or that were detected by PCT as well as the amount of time, less breaks, or interruptions, it took to check each plan.Results: After the clinical release of PCT, there was a statistically significant decrease in the number of issues recorded by the human plan checkers both related to checks explicitly performed by PCT (13 vs 50, P < 0.001) and in issues identified overall (127 vs 200, P < 0.001). The mean and medium time for a plan check decreased by 20%. Conclusions:The use of a multi-institutional, configurable, automated plan checking tool has resulted in both substantial gains in efficiency and moving error detection to earlier points in the planning process, decreasing their likelihood that they reach the patient. The sizeable startup effort needed to create this tool from scratch was mitigated by the sharing, and subsequent co-development, of software code from a peer institution. K E Y W O R D Sautomation, plan checking, quality and safety, treatment planning

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“…In order to detect errors made in the planning process, research has focused on designing manual and automated checks throughout this process 5–16 . Automated checks focus mainly on the technical integrity of a plan and on dosimetric metrics that are established for each treatment site.…”

Section: Introductionmentioning

confidence: 99%

“…The plan technical integrity can be checked using both the manual method (i.e., checklist method) and the automated computer program. Some automatic plan check methods reside outside of the treatment planning system and thus a plan check is often conducted after the treatment plan is completed 8,10,11 . Therefore, if a planning error is detected, the workflow could be interrupted and rework is required, resulting in treatment delay.…”

Section: Introductionmentioning

confidence: 99%

Combining automatic plan integrity check (APIC) with standard plan document and checklist method to reduce errors in treatment planning

Xia

LaHurd

Pan

et al. 2020

J Applied Clin Med Phys

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Purpose/objectives To report our experience of combining three approaches of an automatic plan integrity check (APIC), a standard plan documentation, and checklist methods to minimize errors in the treatment planning process. Materials/methods We developed APIC program and standardized plan documentation via scripting in the treatment planning system, with an enforce function of APIC usage. We used a checklist method to check for communication errors in patient charts (referred to as chart errors). Any errors in the plans and charts (referred to as the planning errors) discovered during the initial chart check by the therapists were reported to our institutional Workflow Enhancement (WE) system. Clinical Implementation of these three methods is a progressive process while the APIC was the major progress among the three methods. Thus, we chose to compared the total number of planning errors before (including data from 2013 to 2014) and after (including data from 2015 to 2018) APIC implementation. We assigned the severity of these errors into five categories: serious (S), near miss with safety net (NM), clinical interruption (CLI), minor impediment (MI), and bookkeeping (BK). The Mann–Whitney U test was used for statistical analysis. Results A total of 253 planning error forms, containing 272 errors, were submitted during the study period, representing an error rate of 3.8%, 3.1%, 2.1%, 0.8%, 1.9% and 1.3% of total number of plans in these years respectively. A marked reduction of planning error rate in the S and NM categories was statistically significant (P < 0.01): from 0.6% before APIC to 0.1% after APIC. The error rate for all categories was also significantly reduced (P < 0.01), from 3.4% before APIC and 1.5% per plan after APIC. Conclusion With three combined methods, we reduced both the number and the severity of errors significantly in the process of treatment planning.

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Automated survey of 8000 plan checks at eight facilities

Cited by 7 publications

References 22 publications

Strategies for effective physics plan and chart review in radiation therapy: Report of AAPM Task Group 275

Strategies for effective physics plan and chart review in radiation therapy: Report of AAPM Task Group 275

Efficiency and safety increases after the implementation of a multi‐institutional automated plan check tool at our institution

Combining automatic plan integrity check (APIC) with standard plan document and checklist method to reduce errors in treatment planning

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