Error rates in clinical radiotherapy.

Abstract

When modern automated error-minimization methods are used along with nonpunitive error reporting systems, clinical radiotherapy seems to be highly safe. Formal error analysis studies may allow the rational design of prevention strategies that are attuned to the frequency, seriousness, and antecedent causes of many classes of potential radiotherapy errors.

The Use of Categorized Time-Trend Reporting of Radiation Oncology Incidents: A Proactive Analytical Approach to Improving Quality and Safety Over Time

“…The three studies that are most similar to ours are those by Macklis et al (25)., Valli et al (26), and Yeung et al (27) Macklis et al (25) report on a prospective study of 1 year of treatment in one institution. They examined planning and treatment delivery with their study focus being the most like the focus of ours.…”

The New Radiation Therapy Clinical Practice: The Emerging Role of Clinical Peer Review for Radiation Therapists and Medical Dosimetrists

“…The first identified is data entry. 6,7,9,10,12,13 Five publications showed that as new information was entered into an electronic information system, deviation rates increased. 6,9 -12 A second major source of deviation occurs when new technologies are introduced into the clinic, 6,9 -11 presumably as a result of the personnel learning curve associated with the new technology.…”

Preventing treatment errors in radiotherapy by identifying and evaluating near misses and actual incidents

“…Macklis et al 16 collected data for incidents where some part of the treatment had been carried out erroneously in comparison with the prescribed dose and method of delivery. Incident reports were collated and errors were categorised as mentioned in an above section.…”

“…Other authors approached this matter differently. Macklis et al 16 utilised a stratification of errors into three risk levels. Level 1 errors were dose discrepancies that resulted in less than 5% overall calculated change in dose to the target volume over the whole course, whereas level 2 errors would either imply more than a 5% change, a clinically detectable increase in acute radiation toxicity caused by the error, or a systematic calculation or operational systems error.…”