A risk assessment of automated treatment planning and recommendations for clinical deployment

Simple item page
dc.contributor.authorKisling, Kellyen_ZA
dc.contributor.authorJohnson, Jennifer L.en_ZA
dc.contributor.authorSimonds, Hannah M.en_ZA
dc.contributor.authorZhang, Lifeien_ZA
dc.contributor.authorJhingran, Anujaen_ZA
dc.contributor.authorBeadle, Beth M.en_ZA
dc.contributor.authorBurger, Hesteren_ZA
dc.contributor.authorDu Toit, Moniqueen_ZA
dc.contributor.authorJoubert, Nanetteen_ZA
dc.contributor.authorMakufa, Remigioen_ZA
dc.contributor.authorShaw, Williamen_ZA
dc.contributor.authorTrauernicht, Christophen_ZA
dc.contributor.authorBalter, Peteren_ZA
dc.contributor.authorHowell, Rebecca M.en_ZA
dc.contributor.authorSchmeler, Kathleenen_ZA
dc.contributor.authorCourt, Laurenceen_ZA
dc.date.accessioned2021-10-12T09:22:15Z
dc.date.available2021-10-12T09:22:15Z
dc.date.issued2019-06
dc.descriptionCITATION: Kisling, K. et al. 2019. A risk assessment of automated treatment planning and recommendations for clinical deployment. Medical Physics, 46(6): 2567-2574. doi:10.1002/mp.13552
dc.descriptionThe original publication is available at https://aapm.onlinelibrary.wiley.com/journal/24734209
dc.description.abstractPurpose: To assess the risk of failure of a recently developed automated treatment planning tool, the radiation planning assistant (RPA), and to determine the reduction in these risks with implementation of a quality assurance (QA) program specifically designed for the RPA. Methods: We used failure mode and effects analysis (FMEA) to assess the risk of the RPA. The steps involved in the workflow of planning a four-field box treatment of cervical cancer with the RPA were identified. Then, the potential failure modes at each step and their causes were identified and scored according to their likelihood of occurrence, severity, and likelihood of going undetected. Additionally, the impact of the components of the QA program on the detectability of the failure modes was assessed. The QA program was designed to supplement a clinic's standard QA processes and consisted of three components: (a) automatic, independent verification of the results of automated planning; (b) automatic comparison of treatment parameters to expected values; and (c) guided manual checks of the treatment plan. A risk priority number (RPN) was calculated for each potential failure mode with and without use of the QA program. Results: In the RPA automated treatment planning workflow, we identified 68 potential failure modes with 113 causes. The average RPN was 91 without the QA program and 68 with the QA program (maximum RPNs were 504 and 315, respectively). The reduction in RPN was due to an improvement in the likelihood of detecting failures, resulting in lower detectability scores. The top-ranked failure modes included incorrect identification of the marked isocenter, inappropriate beam aperture definition, incorrect entry of the prescription into the RPA plan directive, and lack of a comprehensive plan review by the physician. Conclusions: Using FMEA, we assessed the risks in the clinical deployment of an automated treatment planning workflow and showed that a specialized QA program for the RPA, which included automatic QA techniques, improved the detectability of failures, reducing this risk. However, some residual risks persisted, which were similar to those found in manual treatment planning, and human error remained a major cause of potential failures. Through the risk analysis process, we identified three key aspects of safe deployment of automated planning: (a) user training on potential failure modes; (b) comprehensive manual plan review by physicians and physicists; and (c) automated QA of the treatment plan.en_ZA
dc.description.urihttps://aapm.onlinelibrary.wiley.com/doi/10.1002/mp.13552
dc.description.versionPublisher’s version
dc.format.extent8 pages ; illustrations
dc.identifier.citationKisling, K. et al. 2019. A risk assessment of automated treatment planning and recommendations for clinical deployment. Medical Physics, 46(6): 2567-2574. doi:10.1002/mp.13552
dc.identifier.issn2473-4209 (online)
dc.identifier.issn0094-2405 (print)
dc.identifier.otherdoi:10.1002/mp.13552
dc.identifier.urihttp://hdl.handle.net/10019.1/123208
dc.language.isoen_ZAen_ZA
dc.publisherAmerican Association of Physicists in Medicine
dc.rights.holderAuthors retain rights
dc.subjectFailure mode and effects analysisen_ZA
dc.subjectAutomated treatment planning -- Qualityen_ZA
dc.subjectAutomated treatment planning -- Risk assessmenten_ZA
dc.subjectRadiotherapyen_ZA
dc.subjectCancer -- Radiotherapyen_ZA
dc.subjectQuality assuranceen_ZA
dc.subjectExternal beam radiation therapyen_ZA
dc.subjectHealth planningen_ZA
dc.titleA risk assessment of automated treatment planning and recommendations for clinical deploymenten_ZA
dc.typeArticleen_ZA
Files
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
kisling_risk_2019.pdf
Size:
230.46 KB
Format:
Adobe Portable Document Format
Description:
Download article
Download
License bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
license.txt
Size:
1.71 KB
Format:
Item-specific license agreed upon to submission
Description:
Download
Collections
Research Articles (Radiation Oncology)