The MARRTA Project: Safety and Risk Analysis in Radiation Oncology

Abstract

<h3>Purpose/Objective(s)</h3> To improve the patient safety and quality in the radiotherapy treatment, by applying the risk matrix methodology to the process. to obtain a theoretical risk model with the potential errors and failures of that process, and to develop a computer application to introduce the model and offer the possibility of applying this methodology in an exhaustive and as simple as possible way to different professionals involved in the treatment <h3>Materials/Methods</h3> 23 working group meetings at the headquarters of the Spanish Nuclear Safety Council in Madrid, in which the results of the different proposals previously discussed and agreed by the different professional societies involved in the process representatives (Radiation Oncologists, Medical Physicists/Dosimetrists and Radiologic Technologists), were integrated. We analyzed IMRT, IGRT and SBRT techniques performed with LINAC. Radiosurgery, brachytherapy, metabolic treatments with non-encapsulated sources. <h3>Results</h3> Development of a Process Map: The different professional's tasks were analyzed. The process was divided into 7 phases (Therapeutic decision, Volume localization, Volume delineation, Treatment planning, Post-planning verification, Initial treatment session and Daily treatment), and the process map was prepared. Possible errors and failures (Initiating Events) identification: Once the analysis was done, the possible Initiating Events (IE) with consequences for the patients were identified, analyzed and consensed in the working group meetings. A total of 138 initiating events identified, analyzed and consensed are presented, separated in the different stages of the process, in Table 1. Identification of possible Barriers and Reducers of Frequency and Consequences: 125 barriers, 60 frequency reducers and 35 consequence reducers were identified. Computer application development: The MARRTA computer application was developed presenting the risk model resulting that includes: list of stages and sub-stages, flow chart, list of IE with their associated barriers and frequency and consequence reducers, and the risk of each of these IE. One can create new risk models by modifying the existing ones (indicating in the model to modify what applies and what does not to his department) or he can create a new one from scratch. It allows: Calculation of the risk of each one of the IE, statistics of the number of IE of very high risk, high, medium and low risk at each stage/sub-stage and analysis of the importance of the barriers and frequency and consequence reducers. <h3>Conclusion</h3> the MARRTA computer application provides radiotherapy departments with a tool to easily apply the risk matrix methodology to perform risk analysis in an exhaustive and easy way, and to modify the model to adapt to its particular map of processes and risks.