Prospective Risk Analysis of Intracranial Stereotactic Radiosurgery Using Failure Mode Effect Analysis and Cost Benefit Analysis of the Use of Flattening Filter Free Beams
G Mamballikalam1*, K Ganesh2, S Kumar3, J Pattaloor Mana4, C CO5, J Calister5, A Basith5, (1) Hamad Medical Corporation, QA (2) Kidwai Memorial Institute of Oncology, Bangalore, ,IN (3) Madurai Medical College, IN (4) Rajagiri Hospital, IN (5) Aster Medcity, IN
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PO-GePV-T-209 (Sunday, 7/10/2022) [Eastern Time (GMT-4)]
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Purpose: The Objective is to analyze the risks associated in treating LINAC based intracranial Stereotactic Radiosurgery (SRS) and to identify methods to mitigate the risks thereby ensuring better patient safety and clinical outcome. The study analyzed the additional risk of utilizing Flattening Filter Free photon beams in treating SRS against the benefits it can offer.
Methods: The study utilizes Varian True Beam LINAC coupled with Brain lab system for planning and treatment delivery. Time and Motion Analysis is utilized for understanding the additional benefits of using Flattening Filter Free (FFF) beams compared to Flattening Filter (FF) photon beams.
Results: Total 17 processes and 86 sub processes were identified with 54 failure modes and 80 potential causes of failure. 21 failure modes have Risk Priority Number (RPN) greater than 200 and considered as high risk. The total RPN recorded for all the failure modes were 10377. All failure modes with higher RPN were considered for risk mitigation resulted in a reduction in RPN values to 2413.Time Motion Analysis showed that the Beam on Time (BOT) reduction was observed significant for FFF beams for higher dose per fraction but subjected to treatment and modulation technique. Percentage beam on time reduction (PBOTR) values are much higher than Percentage total time reduction (PTTR) values. 39.9% of PBOTR resulted in only 8% PTTR for Dynamic Conformal Arc and 65.3% PBOTR resulted in 15.9% PTTR for Volumetric Modulated Arc Therapy plans.Five additional failure modes were identified with the use of FFF beams against FF beams resulting in an increase in RPN by 767, 7.39% of total RPN.
Conclusion: Study analyzed the importance of FMEA in SRS and found to be effective in risk mitigation. Newly defined PBOTR and PTTR factors are very useful indicators to justify the use of FFF beams for SRS treatments.
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