title: The impact of new technologies on radiation oncology events and trends in the past decade: an institutional experience.
abstract: OBJECTIVE
  To review the type and frequency of patient events from external-beam radiotherapy over a time period sufficiently long to encompass significant technology changes.
  
  
  METHODS
  Ten years of quality assurance records from January 2001 through December 2010 were retrospectively reviewed to determine the frequency of events affecting patient treatment from four radiation oncology process steps: simulation, treatment planning, data entry/transfer, and treatment delivery. Patient events were obtained from manual records and, from May 2007 onward, from an institution-wide database and reporting system. Events were classified according to process step of origination and segregated according to the most frequently observed event types. Events from the institution-wide database were evaluated to determine time trends.
  
  
  RESULTS
  The overall event rate was 0.93% per course of treatment, with a downward trend over time led by a decrease in treatment delivery events. The frequency of certain event types, particularly in planning and treatment delivery, changed significantly over the course of the study, reflecting technologic and process changes. Treatments involving some form of manual intervention carried an event risk four times higher than those relying heavily on computer-aided design and delivery.
  
  
  CONCLUSIONS
  Although the overall event rate was low, areas for improvement were identified, including manual calculations and data entry, late-day treatments, and staff overreliance on computer systems. Reducing the incidence of pretreatment events is of particular importance because these were more likely to occur several times before detection and were associated with larger dosimetric impact. Further improvements in quality assurance systems and reporting are imperative, given the advent of electronic charting, increasing reliance on computer systems, and the potentially severe consequences that can arise from mistakes involving complex intensity-modulated or image-guided treatments.
authors.affiliation: Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA. huntm@mskcc.org
authors.forename: Margie A
authors.initials: MA
authors.lastname: Hunt
authors.forename: Gerri
authors.initials: G
authors.lastname: Pastrana
authors.forename: Howard I
authors.initials: HI
authors.lastname: Amols
authors.forename: Aileen
authors.initials: A
authors.lastname: Killen
authors.forename: Kaled
authors.initials: K
authors.lastname: Alektiar
mesh_terms: D000465:Algorithms; D016208:Databases, Factual; D006801:Humans; D019300:Medical Errors / Q000145:classification / Q000706:statistics & numerical data* / Q000639:trends; D061214:Patient Safety / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D018787:Radiation Oncology / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends; D011880:Radiotherapy Planning, Computer-Assisted / Q000639:trends; D050397:Radiotherapy, Intensity-Modulated / Q000592:standards / Q000639:trends; D012189:Retrospective Studies; D018570:Risk Assessment; D013679:Technology, Radiologic / Q000592:standards / Q000639:trends; D013997:Time Factors