Implementation of total body irradiation using VMAT

Muñoz-Moral, E.; Rodríguez-Laguna, A.; Jiménez-Acosta, J. A.

doi:10.1063/5.0051960

Cited by 1 publication

(2 citation statements)

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“…Other challenges presented in conventional TBI include the reproducibility of patient set‐up, including positioning of lung and kidney shields for upright and lateral set‐ups and difficulties for sick patients to stand for long periods of time (40–50 min), which increase the occurrence of inaccuracies in patient set‐up 8,9 . Recently, multi‐isocentric volumetric‐modulated arc therapy (VMAT) technique have been developed for total body irradiation to improve patient comfort, dose uniformity, and vulnerable tissue protection 10–21 . VMAT‐TBI also allows the use of image guidance to improve the accuracy of patient set‐up.…”

Section: Introductionmentioning

confidence: 99%

“…8,9 Recently, multi-isocentric volumetric-modulated arc therapy (VMAT) technique have been developed for total body irradiation to improve patient comfort, dose uniformity, and vulnerable tissue protection. [10][11][12][13][14][15][16][17][18][19][20][21] VMAT-TBI also allows the use of image guidance to improve the accuracy of patient set-up. However, a major drawback that may limit application of VMAT-TBI is that the process is time consuming and complicated.…”

Section: Introductionmentioning

confidence: 99%

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Implementing failure mode and effect analysis to improve the safety of volumetric modulated arc therapy for total body irradiation

Gray,

Antolak,

Ahmed

et al. 2023

Medical Physics

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Volumetric-modulated arc therapy for total body irradiation (VMAT-TBI) is a novel radiotherapy technique that has been implemented at our institution. The purpose of this work is to investigate possible failure modes (FMs) in the treatment process and to develop a quality control (QC) program for VMAT-TBI following TG-100 guidelines. Methods: We formed a multidisciplinary team to map out the complete treatment process of VMAT-TBI following the AAPM TG-100 guidelines. This process map gives a visual representation of the VMAT-TBI workflow from the CT simulation, image processing, contouring, treatment planning, to treatment delivery. From the process map, potential FMs were identified. The occurrence (O), detectability (D), and severity of impact (S) of each FM were assigned according to scoring criteria (1-10) by the multidisciplinary team. A risk priority number (RPN) was calculated from average O, S, and D of each FM (RPN = O x S x D). High risk FMs were identified as 20% of the FMs having the highest RPN scores. After the FMEA analysis, fault-tree analysis (FTA) was performed for each major step of the treatment process to determine the effects of potential failures to the treatment outcome.Effective QC methods were identified to prevent the high risk failures and to improve the safety of the VMAT-TBI program. Results: We identified a total of 55 sub-processes and 128 FMs from the VMAT-TBI workflow. The top five high-risk FMs were: (1) Prescription and/or OAR constraints changed during planning and not communicated to the planner, (2) Patient moves or breathes too heavily during the upper body CT scan (3) Patient moves during the lower body CT scan,(4) Treatment planning system not calculating total body DVH metrics correctly for TBI, (5) Improper optimization criteria used or not sufficient optimization, resulting in suboptimal dose coverage, OAR sparing or excessive hotspots during treatment planning. Two FMs have average severity scores ≥8: Incorrect PTV subdivision/isocenter placement and Prescription and/or OAR constraints changed during planning and not communicated to the planner. Quality assurance and QC interventions including staff training, standard operating procedures, and quality checklists were implemented based on the FMEA and FTA.

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Section: Introductionmentioning

confidence: 99%