Development of Effective Specialized Checklists for Radiotherapy Special Procedures: Image-Guided Volumetrically Modulated Total Body Irradiation (TBI)
P Galavis*, C Hitchen, J Teruel, S Ayyalasomayajula, M Malin, S Taneja, NYU Langone Health, New York, NY
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PO-GePV-T-214 (Sunday, 7/10/2022) [Eastern Time (GMT-4)]
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Purpose: Complex treatment techniques in radiotherapy require attentiveness of the team carrying out multiple process tasks from simulation through treatment delivery. This work presents our institutional experience using specialized checklists (SCL) to enhance treatment accuracy and patient safety in implementation of a specialized treatment-VMAT total body irradiation (TBI).
Methods: Prior to clinical implementation of a radiotherapy special procedure (VMAT TBI), six physicists and four radiation therapists identified potential errors/severity for CT simulation, independent physics check (IPC), and treatment delivery. Three SCL were developed using the Plan-Do-Study-Act iterative process. Development and validation of each SCL was tested during multiple dry runs of CT-simulation, IPC, and treatment delivery using an anthropomorphic phantom.
Results: SCL development and validation resulted in multiple versions before release to the clinic (October 2020). CT-simulation SCL includes immobilization devices/couch indexing and multiple triangulation fiducials/marks, all of paramount importance for treatment planning and delivery. IPC SCL consists of 19 sections due to the complexity of the treatment plans. Treatment delivery SCL is divided for upper and lower body treatments, with 70 items to ensure accurate treatment delivery. Both IPC SCL and treatment delivery SCL were revised after one year to improve flow and content, based upon physicists’ feedback. SCL for VMAT TBI has resulted in full-time equivalent average hours for CT-simulation (n=20), IPC (n=18), and treatment delivery (n=145) 1.3±0.5, 4.5±0.9, 1.2±0.3, respectively.
Conclusion: SCL development involves multiple steps, tests, iterations and input from multiple team members. Our CT-simulation SCL, independent physics check SCL, and treatment delivery SCL have resulted in efficient patient care, enhanced accuracy and increased patient safety. In the future, we plan to script some items of the IPC SCL.
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