title: Risk factors for radiotherapy incidents and impact of an online electronic reporting system.
abstract: OBJECTIVE
  To ascertain the rate, type, significance, trends and the potential risk factors associated with radiotherapy incidents in a large academic department.
  
  
  METHODS
  Data for all radiotherapy activities from July 2001 to January 2011 were reviewed from radiotherapy incident reporting forms. Patient and treatment data were obtained from the radiotherapy record and verification database (MOSAIQ) and the patient database (HOSPRO). Logistic regression analyses were performed to determine variables associated with radiotherapy incidents.
  
  
  RESULTS
  In that time, 65,376 courses of radiotherapy were delivered with a reported incident rate of 2.64 per 100 courses. The rate of incidents per course increased (1.96 per 100 courses to 3.52 per 100 courses, p<0.001) whereas the proportion of reported incidents resulting in >5% deviation in dose (10.50 to 2.75%, p<0.001) had decreased after the introduction of an online electronic reporting system. The following variables were associated with an increased rate of incidents: afternoon treatment time, paediatric patients, males, inpatients, palliative plans, head-and-neck, skin, sarcoma and haematological malignancies. In general, complex plans were associated with higher incidence rates.
  
  
  CONCLUSIONS
  Radiotherapy incidents were infrequent and most did not result in significant dose deviation. A number of risk factors were identified and these could be used to highlight high-risk cases in the future. Introduction of an online electronic reporting system resulted in a significant increase in the number of incidents being reported.
authors.affiliation: Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia. Electronic address: David.Chang@petermac.org.
authors.forename: David W
authors.initials: DW
authors.lastname: Chang
authors.affiliation: Department of Radiation Therapy Services, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Lynn
authors.initials: L
authors.lastname: Cheetham
authors.affiliation: Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Luc
authors.initials: L
authors.lastname: te Marvelde
authors.affiliation: Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Mathias
authors.initials: M
authors.lastname: Bressel
authors.affiliation: Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Tomas
authors.initials: T
authors.lastname: Kron
authors.affiliation: Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Suki
authors.initials: S
authors.lastname: Gill
authors.affiliation: Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia.
authors.forename: Keen Hun
authors.initials: KH
authors.lastname: Tai
authors.affiliation: Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Ball
authors.affiliation: Department of Information Technology, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: William
authors.initials: W
authors.lastname: Rose
authors.affiliation: Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Linas
authors.initials: L
authors.lastname: Silva
authors.affiliation: Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia.
authors.forename: Farshad
authors.initials: F
authors.lastname: Foroudi
mesh_terms: D001315:Australia; D005260:Female; D005568:Forms and Records Control / Q000379:methods*; D006801:Humans; D016015:Logistic Models; D008297:Male; D009369:Neoplasms / Q000532:radiotherapy; D009862:Online Systems; D011785:Quality Assurance, Health Care; D011878:Radiotherapy / Q000009:adverse effects* / Q000706:statistics & numerical data*; D061106:Radiotherapy Setup Errors / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012308:Risk Management / Q000379:methods
keywords: Patient safety; Quality assurance; Radiotherapy error; Radiotherapy incident