Quantifying clinical severity of physics errors in high-dose rate prostate brachytherapy using simulations Journal Article
| Authors: | Nunez, D. A.; Trager, M.; Beaudry, J.; Cohen, G. N.; Dauer, L. T.; Gorovets, D.; Hassan Rezaeian, N.; Kollmeier, M. A.; Leong, B.; McCann, P.; Williamson, M.; Zelefsky, M. J.; Damato, A. L. |
| Article Title: | Quantifying clinical severity of physics errors in high-dose rate prostate brachytherapy using simulations |
| Abstract: | PURPOSE: To quantitatively evaluate through automated simulations the clinical significance of potential high-dose rate (HDR) prostate brachytherapy (HDRPB) physics errors selected from our internal failure-modes and effect analysis (FMEA). METHODS AND MATERIALS: A list of failure modes was compiled and scored independently by 8 brachytherapy physicists on a one-to-ten scale for severity (S), occurrence (O), and detectability (D), with risk priority number (RPN) = SxOxD. Variability of RPNs across observers (standard deviation/average) was calculated. Six idealized HDRPB plans were generated, and error simulations were performed: single (N = 1722) and systematic (N = 126) catheter shifts (craniocaudal; -1cm:1 cm); single catheter digitization errors (tip and connector needle-tips displaced independently in random directions; 0.1 cm:0.5 cm; N = 44,318); and swaps (two catheters swapped during digitization or connection; N = 528). The deviations due to each error in prostate D90%, urethra D20%, and rectum D1cm3 were analyzed using two thresholds: 5–20% (possible clinical impact) and >20% (potentially reportable events). RESULTS: Twenty-nine relevant failure modes were described. Overall, RPNs ranged from 6 to 108 (average ± 1 standard deviation, 46 ± 23), with responder variability ranging from 19% to 184% (average 75% ± 30%). Potentially reportable events were observed in the simulations for systematic shifts >0.4 cm for prostate and digitization errors >0.3 cm for the urethra and >0.4 cm for rectum. Possible clinical impact was observed for catheter swaps (all organs), systematic shifts >0.2 cm for prostate and >0.4 cm for rectum, and digitization errors >0.2 cm for prostate and >0.1 cm for urethra and rectum. CONCLUSIONS: A high variability in RPN scores was observed. Systematic simulations can provide insight in the severity scoring of multiple failure modes, supplementing typical FMEA approaches. © 2021 American Brachytherapy Society |
| Keywords: | fmea; hdr prostate; error simulations |
| Journal Title: | Brachytherapy |
| Volume: | 20 |
| Issue: | 5 |
| ISSN: | 1538-4721 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2021-09-01 |
| Start Page: | 1062 |
| End Page: | 1069 |
| Language: | English |
| DOI: | 10.1016/j.brachy.2021.05.007 |
| PROVIDER: | scopus |
| PUBMED: | 34193362 |
| PMCID: | PMC9283911 |
| DOI/URL: | |
| Notes: | Article -- Source: Scopus |
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