Quality management in brachytherapy: a risk-based approach

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AIM: The aim of this dissertation was to use the prospective risk assessment methods: process mapping, failure modes and effects analysis (FMEA) and fault tree analysis (FTA) to identify areas of risk in the brachytherapy process and use the results to design a new quality assurance (QA) program. MATERIALS AND METHODS: The study was conducted in three phases in which a multidisciplinary team of professionals participated through completion of questionnaires. Results of the analysis of these feedback were then used to re-design the brachytherapy quality program of the case study private hospital. RESULTS: Over 20 potential failure modes (FMs) were identified along the brachytherapy process. 20% of these FMs were analyzed further based on their risk priority number (RPN). A collective of all these FMs were found to directly or indirectly contribute to the patient’s dose misadministration. Applicator in wrong position ranked the highest. Movement of patients on a stretcher in between departments was identified as one of the main causes. CONCLUSION: New protocols were recommended for dose prescription, imaging and treatment planning. Usage of the kV CBCT in the linac bunker was implemented for brachytherapy imaging and treatment planning. Checklists were developed as QA tools to intercept most of the identified FMs. Additional quality control (QC) tests were also suggested and some traditional tests deemed unnecessary by the prospective methods were excluded from the QA program. Application of risk-based methods helped in assigning resources to the most vulnerable parts of the brachytherapy process in the private hospital.
A dissertation submitted in fulfilment of the requirements for the degree of Master of Science to the Faculty of Science, School of Physics, University of the Witwatersrand, Johannesburg, 2020
Risk assessment, Mapping, Brachytherapy process