Medical Physics Practice Guideline 4.a: Development, implementation, use and maintenance of safety checklists.

The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education and professional practice of medical physics. The AAPM has more than 8,000 members and is the principal organization of medical physicists in the United States.The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner.Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized.The following terms are used in the AAPM practice guidelines:Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline.Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances.

Factors associated with radiation therapy incidents in a large academic institution.

BACKGROUND: This study evaluated factors associated with radiation therapy (RT) planning and delivery incidents at a large academic institution. METHODS AND MATERIALS: The RT incidents (including near-misses) were recorded using an electronic incident reporting system from April 1, 2011 to April 30, 2013. Each incident's origin was categorized according to the step in the treatment process (simulation, physician prescription, treatment planning, scheduling, treatment delivery, and other) in which it occurred. The incident database was linked to the RT delivery (record and verify) database to evaluate the effect of various factors on the rate of RT incidents. RESULTS: There were 189 reported RT incidents (including near-misses) among 326,448 fractions, of which there were 70 (37%) treatment planning incidents and 56 (30%) treatment delivery incidents. The rates of total incidents, planning incidents, and delivery incidents were 136.0, 50.4, and 40.3 per 10,000 patients, respectively. Logistic multivariate analysis showed that fewer work days from plan approval to treatment start, fewer fractions, higher number of prescription items, and longer beam duration were significantly associated with radiation planning incidents. Multivariate analysis also showed that first day of treatment, fewer fractions, higher number of prescription items, and longer beam duration were significantly associated with treatment delivery incidents; intensity modulated radiation therapy was associated with a lower rate of treatment delivery incidents. CONCLUSIONS: More complicated radiation plans, fewer fractions, first day of treatment, and rushed processes were associated with higher risk of RT incidents. We hope that a national incident reporting database will lead to greater understanding of factors influencing the rate of RT incidents.

Rate of radiation therapy events in a large academic institution.

PURPOSE: The goals of this study were to determine the rate of radiation therapy patient events at a large academic institution and to evaluate temporal trends in this rate using statistical process control tools. METHODS: An incident reporting system was used to prospectively collect information on radiation therapy patient events and near misses or good catches, using paper-based reports through December 2010 and an online electronic reporting system from January 2011 onward. Patient events were classified into 3 categories on the basis of their severity. The rate of these events from January 2008 to December 2011 was determined. p charts were used to evaluate trends over time. RESULTS: There were 188 radiation therapy events in the 4-year period, of which 38 were level I or II (more severe) events and 150 were level III (less severe) events. During this 4-year period, a total of 28,488 new patients were treated, and a total of 618,461 radiation fractions were delivered. The rate of radiation therapy events was 0.66% per patient and 0.03% per radiation fraction. There were 358 near misses and good catches in the 4-year period. The p charts indicated that there were no significant changes in the rate of radiation therapy events over time. CONCLUSIONS: The rate of radiation therapy events was very low and remained stable over a 4-year period. In the absence of a national reporting system, single-institution reports can provide valuable information on radiotherapy patient event rates and can augment quality improvement efforts.