Task Group 154 (TG154) of the American Association of Physicists in Medicine (AAPM) was created to produce a guidance document for clinical medical physicists describing recommended quality assurance (QA) procedures for ultrasound (U.S.)-guided external beam radiotherapy localization. This report describes the relevant literature, state of the art, and briefly summarizes U.S. imaging physics. Simulation, treatment planning and treatment delivery considerations are presented in order to improve consistency and accuracy. User training is emphasized in the report and recommendations regarding peer review are included. A set of thorough, yet practical, QA procedures, frequencies, and tolerances are recommended. These encompass recommendations to ensure both spatial accuracy and image quality.

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lay solely with departmental leadership to follow-up on and address incidents. A few still expressed fear of retribution, describing being told not to document an incident by a co-worker. Other barriers such as time and accessibility were commonly described. Learning was often described as increased awareness, resulting from expanded communication, and less frequently from explicit teaching. Practice improvement was rarely perceived as learning. Conclusion: Overall, the opportunity to influence patient safety was perceived as highly relevant by participants. Barriers included logistics and inadequate feedback, but also, despite marked progress, some persistence of hierarchical beliefs and behaviors more consistent with "shame and blame" culture. These results identify the need for procedural, cultural, and educational changes, e.g., web access, more specific and timely feedback to clearly demonstrate positive outcomes, and more transparency, to be made within the department so that all staff members continue to feel comfortable reporting incidents and meaningfully engaging in the system.

PurposeTo report our early experiences with failure mode and effects analysis (FMEA) in a community practice setting.MethodsThe FMEA facilitator received extensive training at the AAPM Summer School. Early efforts focused on department education and emphasized the need for process evaluation in the context of high profile radiation therapy accidents. A multidisciplinary team was assembled with representation from each of the major department disciplines. Stereotactic radiosurgery (SRS) was identified as the most appropriate treatment technique for the first FMEA evaluation, as it is largely self‐contained and has the potential to produce high impact failure modes. Process mapping was completed using breakout sessions, and then compiled into a simple electronic format. Weekly sessions were used to complete the FMEA evaluation. Risk priority number (RPN) values > 100 or severity scores of 9 or 10 were considered high risk. The overall time commitment was also tracked.ResultsThe final SRS process map contained 15 major process steps and 183 subprocess steps. Splitting the process map into individual assignments was a successful strategy for our group. The process map was designed to contain enough detail such that another radiation oncology team would be able to perform our procedures. Continuous facilitator involvement helped maintain consistent scoring during FMEA. Practice changes were made responding to the highest RPN scores, and new resulting RPN scores were below our high‐risk threshold. The estimated person‐hour equivalent for project completion was 258 hr.ConclusionsThis report provides important details on the initial steps we took to complete our first FMEA, providing guidance for community practices seeking to incorporate this process into their quality assurance (QA) program. Determining the feasibility of implementing complex QA processes into different practice settings will take on increasing significance as the field of radiation oncology transitions into the new TG‐100 QA paradigm.