Complexity index (COMIX) and not type of treatment predicts undetected errors in radiotherapy planning and delivery

Morganti, Alessio G.; Deodato, Francesco; Zizzari, Simone; Cilla, Savino; Digesu’, Cinzia; Macchia, Gabriella; Panunzi, Simona; Gaetano, Andrea De; Piermattei, Angelo; Cellini, Numa; Valentini, Vincenzo

doi:10.1016/j.radonc.2008.07.009

« Previous Next »Radiotherapy & Oncology
Volume 89, Issue 3 , Pages 320-329, December 2008

Complexity index (COMIX) and not type of treatment predicts undetected errors in radiotherapy planning and delivery

Alessio G. Morganti
- Radiotherapy Department, Catholic University, Campobasso, Italy
Francesco Deodato
- Radiotherapy Department, Catholic University, Campobasso, Italy
Simone Zizzari
- Radiotherapy Department, Catholic University, Rome, Italy
Savino Cilla
- Medical Physic Department, Catholic University, Campobasso, Italy
Cinzia Digesu’
- Radiotherapy Department, Catholic University, Campobasso, Italy
Gabriella Macchia
- Radiotherapy Department, Catholic University, Campobasso, Italy
- Corresponding author. Gabriella Macchia, Radiotherapy Department, “John Paul II” Center for High Technology Research and Education in Biomedical Sciences, Catholic University, Largo A. Gemelli, 1, 86100 Campobasso, Italy.
Simona Panunzi
- CNR-Institute of Systems Analysis and Computer Science (IASI), BioMathLab, Rome, Italy
Andrea De Gaetano
- CNR-Institute of Systems Analysis and Computer Science (IASI), BioMathLab, Rome, Italy
Angelo Piermattei
- Medical Physic Department, Catholic University, Campobasso, Italy
Numa Cellini
- Radiotherapy Department, Catholic University, Rome, Italy
Vincenzo Valentini
- Radiotherapy Department, Catholic University, Rome, Italy

Received 31 March 2008; received in revised form 8 July 2008; accepted 12 July 2008. published online 13 August 2008.

Abstract

Background and Purpose

Quality assurance procedures (QA) may reduce the risk of errors in radiotherapy. The aim of this study was to assess a QA program based on independent check (IC) procedures in patients undergoing 3D, intensity modulated (IMRT) and extracranial stereotactic (ESRT) radiotherapy.

Materials and methods

IC for set-up (IC1) and for radiotherapy treatments (IC2) was tested on 622 patients over a year. Fifteen events/parameters and 17 parameters were verified by IC1 and IC2, respectively. A third evaluation check (IC3) was performed before treatment. Potential errors were classified based on their magnitude. Incidents involving only incorrect or incomplete documentation were segregated. Treatments were classified based on a complexity index (COMIX).

Results

With IC1, 75 documentation incidents and 31 potential errors were checked, and with IC2 111 documentation incidents and 6 potential errors were checked. During the study period 10 errors undetected by standard procedures (IC1, IC2) were detected by chance or by IC3. The incidence of errors and serious errors undetected by standard procedures was 1.6% and 0.6%, respectively. There was no higher incidence of errors undetected in patients undergoing IMRT or ESRT, while there was a higher incidence of errors undetected in more complex treatments (p<0.001).

Conclusions

Systematic QA procedures can reduce the risk of errors. The risk of errors undetected by standard procedures is not correlated with the treatment technological level (3D versus IMRT/ESRT).

Keywords: Radiotherapy, Quality assurance, Independent check