title: Complexity index (COMIX) and not type of treatment predicts undetected errors in radiotherapy planning and delivery.
abstract: OBJECTIVE
  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.
  
  
  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).
authors.affiliation: Radiotherapy Department, Catholic University, Campobasso, Italy.
authors.forename: Alessio G
authors.initials: AG
authors.lastname: Morganti
authors.forename: Francesco
authors.initials: F
authors.lastname: Deodato
authors.forename: Simone
authors.initials: S
authors.lastname: Zizzari
authors.forename: Savino
authors.initials: S
authors.lastname: Cilla
authors.forename: Cinzia
authors.initials: C
authors.lastname: Digesu'
authors.forename: Gabriella
authors.initials: G
authors.lastname: Macchia
authors.forename: Simona
authors.initials: S
authors.lastname: Panunzi
authors.forename: Andrea
authors.initials: A
authors.lastname: De Gaetano
authors.forename: Angelo
authors.initials: A
authors.lastname: Piermattei
authors.forename: Numa
authors.initials: N
authors.lastname: Cellini
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Valentini
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011785:Quality Assurance, Health Care; D016634:Radiosurgery / Q000592:standards*; D011880:Radiotherapy Planning, Computer-Assisted / Q000592:standards*; D050397:Radiotherapy, Intensity-Modulated / Q000592:standards*