Failure modes in stereotactic radiosurgery. A narrative review

A A Sarchosoglou; P Papavasileiou; A Bakas; D Stasinou; E Pappas

doi:10.1016/j.radi.2022.07.007

Failure modes in stereotactic radiosurgery. A narrative review

Radiography (Lond). 2022 Nov;28(4):999-1009. doi: 10.1016/j.radi.2022.07.007. Epub 2022 Jul 31.

Authors

A A Sarchosoglou¹, P Papavasileiou², A Bakas², D Stasinou², E Pappas²

Affiliations

¹ Department of Biomedical Sciences, Radiology & Radiotherapy Sector, University of West Attica, Athens, Greece. Electronic address: asarchosoglou@uniwa.gr.
² Department of Biomedical Sciences, Radiology & Radiotherapy Sector, University of West Attica, Athens, Greece.

PMID: 35921732
DOI: 10.1016/j.radi.2022.07.007

Abstract

Objectives: Stereotactic radiosurgery (SRS) refers to an advanced radiotherapy technique that requires a high level of precision and accuracy and a flawless workflow. Failures within the SRS process can lead to serious consequences due to high doses delivered per treatment. This narrative review aimed to identify the riskiest failure modes (FMs) and the stages at which they occur in the SRS process, as well as the strategies applied to mitigate the risks. It was based on the analysis of published failure mode and effects analysis (FMEA) data.

Key findings: From the literature search in PubMed and Scopus, 7 articles met the eligibility criteria for inclusion in the qualitative synthesis. In total, 9 radiotherapy departments conducted FMEA in the SRS process. 4 of them were community hospitals and 5 were academic centers. Overall, 54 high-risk FMs were identified with treatment planning (FMs: 18), treatment delivery (FMs: 12), consultation and patient registration (FMs: 10) being the riskiest stages. 10 FMs were stereotactic specific, while the remaining 44 could be met in any radiotherapy technique. Failures associated with contouring, medical records review, target reirradiation, and patient positioning were mostly outlined. Risk mitigation strategies included timeouts, double-checks, checklists, training and changes in the working practice.

Conclusion: Our review demonstrated that crucial FMs can occur in all SRS stages. Although generalisations were challenging, the FMs analysis provided a significant source of information about potential high risks and continuous improvement strategies that can be applied both in the SRS and other radiotherapy processes.

Implications for practice: The results of this research will assist radiotherapy facilities in proactive risk management studies and will allow radiotherapy professionals to reflect on their practice and learn from others' experiences.

Keywords: FMEA; Failure modes; Proactive risk management; Risk mitigation strategies; Stereotactic radiosurgery.

Publication types

Review

MeSH terms

Humans
Radiosurgery* / methods
Risk Management