PMID- 33598932
OWN - NLM
STAT- MEDLINE
DCOM- 20210514
LR  - 20210514
IS  - 2473-4209 (Electronic)
IS  - 0094-2405 (Linking)
VI  - 48
IP  - 4
DP  - 2021 Apr
TI  - Lean Thinking to manage a national working group on physics aspects of 
      Stereotactic Body Radiation Therapy.
PG  - 2050-2056
LID - 10.1002/mp.14783 [doi]
AB  - PURPOSE: 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" pre-experience 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.
CI  - (c) 2021 American Association of Physicists in Medicine.
FAU - Mancosu, Pietro
AU  - Mancosu P
AD  - Medical Physics Unit, Radiotherapy Department, IRCCS Humanitas Research Hospital, 
      Milano, Italy.
FAU - Russo, Serenella
AU  - Russo S
AD  - Medical Physics Unit, Azienda USL Toscana Centro, Firenze, Italy.
FAU - Antonucci, Adriana Rossella
AU  - Antonucci AR
AD  - Agile Couch, Milan, Italy.
FAU - Stasi, Michele
AU  - Stasi M
AD  - Medical Physics Department, A.O. Ordine Mauriziano di Torino, Turin, Italy.
LA  - eng
PT  - Journal Article
DEP - 20210312
PL  - United States
TA  - Med Phys
JT  - Medical physics
JID - 0425746
SB  - IM
MH  - Humans
MH  - Physics
MH  - Radiometry
MH  - *Radiosurgery
MH  - Radiotherapy Dosage
MH  - Radiotherapy Planning, Computer-Assisted
OTO - NOTNLM
OT  - 31.13 (31: TH- External beam- 13: photons extracranial stereotactic/SBRT)
OT  - Lean Thinking
OT  - SBRT
OT  - taxonomy index
OT  - working group management
EDAT- 2021/02/19 06:00
MHDA- 2021/05/15 06:00
CRDT- 2021/02/18 06:16
PHST- 2021/01/21 00:00 [revised]
PHST- 2020/09/01 00:00 [received]
PHST- 2021/02/09 00:00 [accepted]
PHST- 2021/02/19 06:00 [pubmed]
PHST- 2021/05/15 06:00 [medline]
PHST- 2021/02/18 06:16 [entrez]
AID - 10.1002/mp.14783 [doi]
PST - ppublish
SO  - Med Phys. 2021 Apr;48(4):2050-2056. doi: 10.1002/mp.14783. Epub 2021 Mar 12.