PMID- 30706025
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220331
IS  - 2452-1094 (Print)
IS  - 2452-1094 (Electronic)
IS  - 2452-1094 (Linking)
VI  - 4
IP  - 1
DP  - 2019 Jan-Mar
TI  - FMEA of MR-Only Treatment Planning in the Pelvis.
PG  - 168-176
LID - 10.1016/j.adro.2018.08.024 [doi]
AB  - PURPOSE: To evaluate the implementation of a magnetic resonance (MR)-only 
      workflow (ie, implementing MR simulation as the primary planning modality) using 
      failure mode and effects analysis (FMEA) in comparison with a conventional 
      multimodality (MR simulation in conjunction with computed tomography simulation) 
      workflow for pelvis external beam planning. METHODS AND MATERIALS: To perform the 
      FMEA, a multidisciplinary 9-member team was assembled and developed process maps, 
      identified potential failure modes (FMs), and assigned numerical values to the 
      severity (S), frequency of occurrence (O), and detectability (D) of those FMs. 
      Risk priority numbers (RPNs) were calculated via the product of S, O, and D as a 
      metric for evaluating relative patient risk. An alternative 3-digit composite 
      number (SOD) was computed to emphasize high-severity FMs. Fault tree analysis 
      identified the causality chain leading to the highest-severity FM. RESULTS: Seven 
      processes were identified, 3 of which were shared between workflows. Image fusion 
      and target delineation subprocesses using the conventional workflow added 9 and 
      10 FMs, respectively, with 6 RPNs >100. By contrast, synthetic computed 
      tomography generation introduced 3 major subprocesses and propagated 46 unique 
      FMs, 15 with RPNs >100. For the conventional workflow, the largest RPN scores 
      were introduced by image fusion (RPN range, 120-192). For the MR-only workflow, 
      the highest RPN scores were from inaccuracies in target delineation resulting 
      from misinterpretation of MR images (RPN = 240) and insufficient management of 
      patient- and system-level distortions (RPN = 210 and 168, respectively). 
      Underestimation (RPN = 140) or overestimation (RPN = 192) of bone volume produced 
      higher RPN scores. The highest SODs for both workflows were related to changes in 
      target location because of internal anatomy changes (conventional = 961, MR-only 
      = 822). CONCLUSIONS: FMEA identified areas for mitigating risk in MR-only pelvis 
      RTP, and SODs identified high-severity process modes. Efforts to develop a 
      quality management program to mitigate high FMs are underway.
FAU - Kim, Joshua
AU  - Kim J
AD  - Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan.
FAU - Miller, Brett
AU  - Miller B
AD  - Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan.
FAU - Siddiqui, M Salim
AU  - Siddiqui MS
AD  - Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan.
FAU - Movsas, Benjamin
AU  - Movsas B
AD  - Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan.
FAU - Glide-Hurst, Carri
AU  - Glide-Hurst C
AD  - Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan.
LA  - eng
GR  - R01 CA204189/CA/NCI NIH HHS/United States
PT  - Journal Article
DEP - 20180907
PL  - United States
TA  - Adv Radiat Oncol
JT  - Advances in radiation oncology
JID - 101677247
PMC - PMC6349599
EDAT- 2019/02/02 06:00
MHDA- 2019/02/02 06:01
PMCR- 2018/09/07
CRDT- 2019/02/02 06:00
PHST- 2018/04/03 00:00 [received]
PHST- 2018/08/26 00:00 [revised]
PHST- 2018/08/29 00:00 [accepted]
PHST- 2019/02/02 06:00 [entrez]
PHST- 2019/02/02 06:00 [pubmed]
PHST- 2019/02/02 06:01 [medline]
PHST- 2018/09/07 00:00 [pmc-release]
AID - S2452-1094(18)30174-X [pii]
AID - 10.1016/j.adro.2018.08.024 [doi]
PST - epublish
SO  - Adv Radiat Oncol. 2018 Sep 7;4(1):168-176. doi: 10.1016/j.adro.2018.08.024. 
      eCollection 2019 Jan-Mar.