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- W2896075432 abstract "The experience of the Radiation Oncology Incident Learning System has demonstrated that incorrect or omitted patient shifts during treatment are events that are often associated with near misses or incidents. In this single-institution experience, we evaluated a quality improvement intervention using a markless isocenter localization workflow from simulation to external beam radiation delivery with enforced absolute couch parameters to improve safety and streamline treatment as compared to traditional three-point treatment setup methods requiring daily shifts. Pediatric patients undergoing radiation therapy were simulated and treated with indexed immobilization devices. User origins were established at simulation based on a limited set of three or four fixed couch top reference positions for the vertical, lateral, and longitudinal planes. In treatment planning, shifts from the user origin to the treatment plan isocenter were converted to absolute couch parameters which were embedded in the setup field parameters. Tight tolerance tables were enforced. Thus, on the first fraction, therapists did not perform any calculations or shifts to establish the correct treatment position. Prior to imaging, setup verification was often supplemented with a surface-guided imaging tool. After image-guidance and small final couch adjustments, couch parameters were acquired and used for subsequent treatments. No skin marks were made or used at any time. An internal audit process was used to evaluate adverse events and near-misses. Over a three-year period, approximately 300 patients were treated with over 5,000 treatment fractions with this isocenter localization and fixed couch parameter workflow. There were no wrong-site treatment errors. Approximately a dozen near-miss events related to the daily setup process occurred, largely on the first treatment. Root-cause analysis of the near-miss events attributed errors to incorrect identification of user origin, miscalculation of couch parameters, usage of incorrect immobilization device, and indexing of immobilization device at the wrong indexing notch. Ongoing quality improvement processes have added quality assurance checks, and as a result of these processes and checklists, there have been no near-miss incidents or adverse events in the nine months preceding this report. In the past three years, we minimized near-miss incidents by using limited simulation user origins, converting user origin to isocenter shifts to absolute couch parameters, and enforcing restrictive tolerance tables to limit delivery parameter changes, coupled with surface-guidance and therapist-friendly quality assurance tools. This technique can be applied across institutions, body sizes and sites, and with or without surface-guidance. With absolute couch parameters, we have removed shifts, a common source of error in the treatment setup, and have obviated the need for skin marks or tattoos." @default.
- W2896075432 created "2018-10-26" @default.
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- W2896075432 date "2018-11-01" @default.
- W2896075432 modified "2023-09-26" @default.
- W2896075432 title "Streamlining Isocenter Localization for External Beam Radiation Therapy: Eliminating Daily Couch Shifts and Skin Marks" @default.
- W2896075432 doi "https://doi.org/10.1016/j.ijrobp.2018.06.303" @default.
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