Purpose: To address the details of the development and implementation of Quality Management program for initial physics chart check process in a large network organization. We focus on the methodology of TG-100 implementation in an environment consisting of more than 30 physicists working in over 20 cancer centers under the same organizational umbrella.
Methods: A process tree common across the organization was identified by a core physics group. The matching FMEA scoring table was sent to the UPMC network of physicists who were encouraged to add the potential failure scenarios that might have been overlooked in the first iteration. Scores for Occurrence (O), Severity (S), and Detection (D) were solicited for each identified scenario and the results were analyzed. A re-education session about the purpose and methods of TG-100 was followed by a repeated round of FMEA scoring using the curated list of potential failure modes.
Results: Approximately 100 routine initial physics checks were organized into a process tree of 8 major sub-processes. FMEA scoring consisted of 10 tables with 49 potential failure modes. The RPN (RPN=OxSxD) scores shifted higher after the TG-100 re-education seminar was conducted. Three highest ranked categories were identified pointing to the area targeted for improvement. Findings resulted in modification of the electronic prescription sheet used across the organization
Conclusion: The size of the physicists network enabled us to minimize subjectivity bias by soliciting and averaging a large number of responses. Jump-start of the process through a committee prevented over-saturation of physicists and established a common starting point for FMEA analysis. The effects of re-education on the FMEA grading process, point to the necessity of early education and timely re-education before proceeding with FMEA implementation. The presented methodology established a pattern for implementation of TG-100 across UPMC Hillman Cancer Network.