PMID- 25407860
OWN - NLM
STAT- MEDLINE
DCOM- 20150729
LR  - 20160519
IS  - 1879-8519 (Electronic)
IS  - 1879-8500 (Linking)
VI  - 4
IP  - 6
DP  - 2014 Nov-Dec
TI  - Application of failure mode and effects analysis to intracranial stereotactic 
      radiation surgery by linear accelerator.
PG  - 392-7
LID - S1879-8500(14)00008-3 [pii]
LID - 10.1016/j.prro.2014.01.006 [doi]
AB  - PURPOSE: The aim of this study was to analyze the application of the failure 
      modes and effects analysis (FMEA) to intracranial stereotactic radiation surgery 
      (SRS) by linear accelerator in order to identify the potential failure modes in 
      the process tree and adopt appropriate safety measures to prevent adverse events 
      (AEs) and near-misses, thus improving the process quality. METHODS AND MATERIALS: 
      A working group was set up to perform FMEA for intracranial SRS in the framework 
      of a quality assurance program. FMEA was performed in 4 consecutive tasks: (1) 
      creation of a visual map of the process; (2) identification of possible failure 
      modes; (3) assignment of a risk probability number (RPN) to each failure mode 
      based on tabulated scores of severity, frequency of occurrence and detectability; 
      and (4) identification of preventive measures to minimize the risk of occurrence. 
      RESULTS: The whole SRS procedure was subdivided into 73 single steps; 116 total 
      possible failure modes were identified and a score of severity, occurrence, and 
      detectability was assigned to each. Based on these scores, RPN was calculated for 
      each failure mode thus obtaining values from 1 to 180. In our analysis, 112/116 
      (96.6%) RPN values were <60, 2 (1.7%) between 60 and 125 (63, 70), and 2 (1.7%) 
      >125 (135, 180). The 2 highest RPN scores were assigned to the risk of using the 
      wrong collimator's size and incorrect coordinates on the laser target localizer 
      frame. CONCLUSION: Failure modes and effects analysis is a simple and practical 
      proactive tool for systematic analysis of risks in radiation therapy. In our 
      experience of SRS, FMEA led to the adoption of major changes in various steps of 
      the SRS procedure.
FAU - Masini, Laura
AU  - Masini L
AD  - Department of Radiotherapy, University Hospital Maggiore della Carita, Novara, 
      Italy.
FAU - Donis, Laura
AU  - Donis L
AD  - Department of Radiotherapy, University Hospital Maggiore della Carita, Novara, 
      Italy.
FAU - Loi, Gianfranco
AU  - Loi G
AD  - Department of Medical Physics, University Hospital Maggiore della Carita, Novara, 
      Italy.
FAU - Mones, Eleonora
AU  - Mones E
AD  - Department of Medical Physics, University Hospital Maggiore della Carita, Novara, 
      Italy.
FAU - Molina, Elisa
AU  - Molina E
AD  - Department of Radiotherapy, University Hospital Maggiore della Carita, Novara, 
      Italy.
FAU - Bolchini, Cesare
AU  - Bolchini C
AD  - Department of Radiotherapy, University Hospital Maggiore della Carita, Novara, 
      Italy.
FAU - Krengli, Marco
AU  - Krengli M
AD  - Department of Radiotherapy, University Hospital Maggiore della Carita, Novara, 
      Italy; Department of Translational Medicine, University of Piemonte Orientale, 
      Novara, Italy. Electronic address: krengli@med.unipmn.it.
LA  - eng
PT  - Journal Article
DEP - 20140312
PL  - United States
TA  - Pract Radiat Oncol
JT  - Practical radiation oncology
JID - 101558279
SB  - IM
CIN - Pract Radiat Oncol. 2015 Jan-Feb;5(1):e53-4. PMID: 25567160
CIN - Pract Radiat Oncol. 2015 Jan-Feb;5(1):e55. PMID: 25567161
MH  - Brain Neoplasms/pathology/*surgery
MH  - Humans
MH  - *Particle Accelerators
MH  - Radiosurgery/*instrumentation/*methods
MH  - Risk Assessment
EDAT- 2014/11/20 06:00
MHDA- 2015/07/30 06:00
CRDT- 2014/11/20 06:00
PHST- 2013/11/22 00:00 [received]
PHST- 2014/01/27 00:00 [revised]
PHST- 2014/01/29 00:00 [accepted]
PHST- 2014/11/20 06:00 [entrez]
PHST- 2014/11/20 06:00 [pubmed]
PHST- 2015/07/30 06:00 [medline]
AID - S1879-8500(14)00008-3 [pii]
AID - 10.1016/j.prro.2014.01.006 [doi]
PST - ppublish
SO  - Pract Radiat Oncol. 2014 Nov-Dec;4(6):392-7. doi: 10.1016/j.prro.2014.01.006. 
      Epub 2014 Mar 12.