Evaluation of the effectiveness of defense measures during radiological risk assessment in gynecological brachytherapy
DOI:
https://doi.org/10.15392/2319-0612.2024.2347Palavras-chave:
risk, gynecologic brachytherapy, FMEA, defenses, EffectivenessResumo
The implementation of risk analysis to all those practices that work with ionizing radiation is of paramount importance. Thanks to the studies published on risk assessment in radiation medicine, a culture on this subject is being created, which has led to the systematization of different methods created for this purpose. Such is the case of the Failure Mode and Effects Analysis (FMEA), the basis on which this research has been developed. The American Association of Physicist in Medicine (AAMP) TG-100 report, which provides all the details on the use of this technique, is used as main reference. On the other hand, the recommendations recently published by AAMP TG-275 report are also used, applying the FMEA methodology to the high dose rate gynecological brachytherapy (B-HDR-GYN), among other practices. The novelty of this research is the implementation of an operational algorithm that improves the analytical capacity of the traditional FMEA approach by allowing the measurement of the effectiveness of defense measures within it. In this study, when the defense measures interact in the FMEA, a decrease of four RPN values of the failure modes (FM) occurs; compared to reference values. This algorithm is based on a synergy of the risk matrix (RM) approach and the information on FMEA available in the TG-100 and TG-275.
Downloads
Referências
Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F.Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians, v.71, n .3, p .209–249, mayo/ junio 2021. Available at: <https://doi.org/10.3322/caac.21660>.
Zubizarreta, E., Van Dyk, J., & Lievens, Y. Analysis of Global Radiotherapy Needs and Costs by Geographic Region and Income Level. Clinical Oncology, v. 29, p .84-92, 2017. Available at: <https://doi.org/10.1016/j.clon.2016.11.011>.
Harding, K., & Thomson, W. H. Radiological protection and safety in medicine - ICRP 73. European Journal of Nuclear Medicine, v. 24, n .10, 1997.
International Atomic Energy Agency (IAEA). Generic procedures for assessment and response during a radiological emergency. Dose Assesment, Iaea-Tecdoc-11162, p .81–122, August 2000. Available at: <http://www-pub.iaea.org/mtcd/publications/pdf/te_1162_prn.pdf>.
International Atomic Energy Agency (IAEA). Application of the Risk Matrix Method to Radiotherapy. IAEA TECDOC-1685, 2016.
Huq, M. S., Fraass, B. A., Dunscombe, P. B., Gibbons, J. P., Ibbott, G. S., Mundt, A. J., Mutic, S., Palta, J. R., Rath, F., Thomadsen, B. R., Williamson, J. F., & Yorke, E. D. (2016). The report of Task Group 100 of the AAPM: Application of risk analysis methods to radiation therapy quality management. Medical Physics, v. 43, n .7, p.4209–4262. Available at: <https://doi.org/10.1118/ 1.4947547>.
Ford, E., Conroy, L., Dong, L., de Los Santos, L. F., Greener, A., Gwe-Ya Kim, G., Johnson, J., Johnson, P., Mechalakos, J. G., Napolitano, B., Parker, S., Schofield, D., Smith, K., Yorke, E., & Wells, M. Strategies for effective physics plan and chart review in radiation therapy: Report of AAPM Task Group 275. Medical Physics, v.47, n.6, p. e236–e272, 2020. Available at: https://doi.org/10.1002/mp.14030.
Teixeira, F.C., de Almeida, C.E., Hug, S. Failure mode and effects analysis-based risk profile assessment for stereotactic radiosurgery programs at three cancer centers in Brazil. Medical physics, v.43, n .1, p.171-178, 2016.
Tonigan, J., Balter, P.A., Johnson, J.L., Kry, S., Court, L.E. et al. An FMEA evaluation of intensity modulated radiation therapy dose delivery failures at tolerance criteria levels. Medical physics, v.44, n .11, 2017. Available at: https://pubmed.ncbi.nlm.nih.gov/28862765/.
Veronese, I., De Martin, E., Martinotti, A.S., Fumagalli, M.L., Vite, C., Redaelli, I., Malatesta, T., et al. Multi-institutional application of Failure Mode and Effects Analysis (FMEA) to CyberKnife Stereotactic Body Radiation Therapy (SBRT). Radiation Oncology, v.10, n .132, 2015. Available at: https://ro-journal.biomedcentral.com/articles/10.1186/s13014-015-0438-0.
Vidali, C., Severgnini, M., Urbani, M., Toscano, L., Perulli, A., Bortul, M. et al. FMECA application to intraoperative electron Beam Radiotherapy Procedure as a Quality method to Prevent and Reduce Patient’s Risk in Conservative surgery for Breast Cancer. Frontier in medicine, v.4, n.138, 2017. Available at: https://pubmed.ncbi.nlm.nih.gov/28894737/.
Perks, J.R., Stanic, S., Stern, R.L., Henk, B. et al. Failure Mode and Effect Analysis for Delivery of Lung Stereotactic Body Radiation Therapy. International Journal of Radiation Oncology-Biology-Physics, v.83, n.4, p .1324-1329, 2012. Available at: https://pubmed.ncbi.nlm.nih.gov/22197236/.
Broggi, S., Cantone, M.C., Chiara, A., Di Muzio, N. et al. Application of failure mode and effects analysis (FMEA) to pretreatment phases in tomotherapy. Journal of Applied Clinical Medical physics, v.15, n.5, 2013. Available at: https://pubmed.ncbi.nlm.nih.gov/24036868/.
Wexler, A., Gu, B., Goddu, S., Mutic, M. et al. FMEA of manual and automated methods for commissioning a radiotherapy treatment planning system. Medical Physics, v.44, n.9, 2017. Available at: https://pubmed.ncbi.nlm.nih.gov/28419482/.
Yuanguang, X.A., Bhatnagar, J., Bednarz, G., Flickinger, J. et al. Failure modes and effects analysis (FMEA) for Gamma Knife radiosurgery. Journal of Applied Clinical Medical Physics, v.18, n.6, p.152-168 2017. Available at: https://pubmed.ncbi.nlm.nih.gov/29082599/.
Sawant, A., Dieterich, S. Failure mode and effect analysis-based quality assurance for dynamic MLC tracking systems. Medical Physics, v.37, n.12, 2010. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016096/.
Manger, R.P., Paxton, A.B.., Pawlicki, T., Kim, G. Failure mode and effects analysis and fault tree analysis of surface image guided cranial radiosurgery. Medical Physics, v.42, n.5, 2015. Available at: https://pubmed.ncbi.nlm.nih.gov/25979038/.
Schuller, B.W., Burns, A., Ceilley, E.A., King, A., et al. Failure mode and effects analysis: A community practice perspective, Journal of Applied Clinical Medical Physics, v.18, n.6, p.258-267, 2017. Available at: https://pubmed.ncbi.nlm.nih.gov/28944980/.
Torre, A., Amador Z., Alfonso, R., Lauren, L., & Hardy, E. SECURE-MR-FMEA código cubano para análisis integral de riesgo de prácticas con radiaciones ionizantes. Nucleus, p.44–55, 2021.
Torres A., Amador Z., Alfonso R., et al. Risk management in medical practices with ionizing radiation, An Acad Cienc Cuba. v.13, n.6, 2023. ISSN 2304-0106 | RNPS 2308 (in Spanish).
Torres A., Alfonso R., Amador Z., SECURE-MR-FMEA: A tool for automating the AAPM TG-275 approach in the physics chart and plan review during EBRT, XXVI Congresso Brasileiro de Física Médica, IX Congresso Latino Americano de Física Médica, Fortaleza – Brasil, June 07 to 11, 2022
Teixeira FC, de Almeida CE, Saiful Huq M. Failure mode and effects analysis based risk profile assessment for stereotactic radiosurgery programs at three cancer centers in Brazil. Med Phys, v.43, n.1, 2016.
Torre, A. USERS MANUAL, SECURE-MR-FMEA, p.132, 2019.
International Atomic Energy Agency (IAEA). Application of the Risk Matrix Method to Radiotherapy. IAEA TECDOC-1685, v.88, 2016.
Downloads
Publicado
Edição
Seção
Licença
Direitos autorais (c) 2024 Brazilian Journal of Radiation Sciences
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Declaro que o presente artigo é original, não tendo sido submetido à publicação em qualquer outro periódico nacional ou internacional, quer seja em parte ou em sua totalidade. Declaro, ainda, que uma vez publicado na revista Brazilian Journal of Radiation Sciences, editada pela Sociedade Brasileira de Proteção Radiológica, o mesmo jamais será submetido por mim ou por qualquer um dos demais co-autores a qualquer outro periódico. Através deste instrumento, em meu nome e em nome dos demais co-autores, porventura existentes, cedo os direitos autorais do referido artigo à Sociedade Brasileira de Proteção Radiológica, que está autorizada a publicá-lo em meio impresso, digital, ou outro existente, sem retribuição financeira para os autores.
Licença
Os artigos do BJRS são licenciados sob uma Creative Commons Atribuição 4.0 Licença Internacional, que permite o uso, compartilhamento, adaptação, distribuição e reprodução em qualquer meio ou formato, desde que você dê o devido crédito ao (s) autor (es) original (is) e à fonte, forneça um link para a licença Creative Commons, e indique se mudanças foram feitas. As imagens ou outro material de terceiros neste artigo estão incluídos na licença Creative Commons do artigo, a menos que indicado de outra forma em uma linha de crédito para o material. Se o material não estiver incluído no licença Creative Commons do artigo e seu uso pretendido não é permitido por regulamentação legal ou excede o uso permitido, você precisará obter permissão diretamente do detentor dos direitos autorais. Para visualizar uma cópia desta licença, visite http://creativecommons.org/licenses/by/4.0/
