title: Factors associated with radiation therapy incidents in a large academic institution.
abstract: BACKGROUND
  This study evaluated factors associated with radiation therapy (RT) planning and delivery incidents at a large academic institution.
  
  
  METHODS
  The RT incidents (including near-misses) were recorded using an electronic incident reporting system from April 1, 2011 to April 30, 2013. Each incident's origin was categorized according to the step in the treatment process (simulation, physician prescription, treatment planning, scheduling, treatment delivery, and other) in which it occurred. The incident database was linked to the RT delivery (record and verify) database to evaluate the effect of various factors on the rate of RT incidents.
  
  
  RESULTS
  There were 189 reported RT incidents (including near-misses) among 326,448 fractions, of which there were 70 (37%) treatment planning incidents and 56 (30%) treatment delivery incidents. The rates of total incidents, planning incidents, and delivery incidents were 136.0, 50.4, and 40.3 per 10,000 patients, respectively. Logistic multivariate analysis showed that fewer work days from plan approval to treatment start, fewer fractions, higher number of prescription items, and longer beam duration were significantly associated with radiation planning incidents. Multivariate analysis also showed that first day of treatment, fewer fractions, higher number of prescription items, and longer beam duration were significantly associated with treatment delivery incidents; intensity modulated radiation therapy was associated with a lower rate of treatment delivery incidents.
  
  
  CONCLUSIONS
  More complicated radiation plans, fewer fractions, first day of treatment, and rushed processes were associated with higher risk of RT incidents. We hope that a national incident reporting database will lead to greater understanding of factors influencing the rate of RT incidents.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; School of Biomedical Informatics, University of Texas Health Science Center, Houston, Texas.
authors.forename: Gary V
authors.initials: GV
authors.lastname: Walker
authors.affiliation: Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Johnson
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Timothy
authors.initials: T
authors.lastname: Edwards
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: R Allen
authors.initials: RA
authors.lastname: Gatilao
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Sandra E
authors.initials: SE
authors.lastname: Hayden
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Beverly A
authors.initials: BA
authors.lastname: Riley
authors.affiliation: School of Biomedical Informatics, University of Texas Health Science Center, Houston, Texas.
authors.forename: Dean F
authors.initials: DF
authors.lastname: Sittig
authors.affiliation: Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Michael
authors.initials: M
authors.lastname: Gillin
authors.affiliation: Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Ibbott
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Buchholz
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: PrajDas@mdanderson.org.
authors.forename: Prajnan
authors.initials: P
authors.lastname: Das
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011785:Quality Assurance, Health Care; D011832:Radiation Injuries / Q000453:epidemiology*; D011880:Radiotherapy Planning, Computer-Assisted / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D012308:Risk Management; D055815:Young Adult