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Six Sigma-Driven Automated Plan Check (APC) Tool Enhances Safety and Efficiency in External Beam Radiation Therapy

N Kovalchuk1*, S Liu2, S Lim3, J Bertini4, K Bush1, J Lewis1, D Pham1, Y Yang1, T Niedermayr1, L Skinner1, B Beadle1, L Xing1, (1) Stanford University Cancer Center, Palo Alto, CA, (2) Memorial Sloan Kettering Cancer Center, West Harrison, NY, (3) UCSD, San Diego, CA,(4) Davidson College, Chicago, IL


(Sunday, 7/12/2020)   [Eastern Time (GMT-4)]

Room: AAPM ePoster Library

Purpose: To evaluate the impact on safety and efficiency of an in-house developed Automated Plan Check (APC) tool.

Methods: APC tool was created within Six Sigma Define-Measure-Analyze-Implement-Control (DMAIC) framework using Failure Mode and Effects Analysis (FMEA). The tool was built via Eclipse Scripting Application Programming Interface (ESAPI), implemented in the clinic in January 2018 and continually updated within a DMAIC framework. At 2 years post-APC implementation, the tool encompassed 154 plan check items verifying 3D-Conformal, clinical electron, VMAT, SBRT, Total Skin Electron Irradiation (TSEI) and Total Body Irradiation (TBI) plans. The APC effectiveness was assessed by comparing FMEA Risk Priority Numbers (RPN) values and rates of reported errors. To test the efficiency gains, physics plan check time and reported error rate were prospectively compared for 20 treatment plans.

Results: APC tool was successfully implemented for external beam plan checking. Since its implementation, the tool was used to verify 5946 treatment plans. FMEA RPN ranking re-evaluation at 2 years post-APC showed a statistically significant decrease in average RPN values from 129.2±51.1 to 66.1±57.5 (p<0.001). After the introduction of APC, the average frequency of reported treatment-planning errors was reduced from 16.1% to 2.3%. For high-severity errors, the reduction was 82.7% for prescription/plan mismatches and 84.4% for incorrect shift note. There were no reported high-severity treatment planning errors propagating to treatment since the APC introduction. The process shifted from 4s- to 5s-quality for isocenter-shift errors frequent prior to APC implementation. The efficiency study showed a statistically significant gain in plan check time (10.1±7.3 minutes, p=0.005) and 80% decrease in errors propagating to physics plan check.

Conclusion: of APC tool has significantly reduced the error rate. The Six Sigma-driven framework can provide an iterative and robust workflow to improve the efficiency and quality of treatment planning procedure enabling a safer radiotherapy process.


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