title: Safer radiation therapy treatment resulting from an equipment transition: A mixed-methods study.
abstract: OBJECTIVE
  To realize individualized safe radiation therapy, reliable treatment equipment is essential in combination with a system-level improvement approach. We hypothesized that implementation of a system that integrated all required treatment equipment would result in improved safety and stability of the irradiation treatment process.
  
  
  METHODS
  Seven accelerators, portal imaging, and the treatment planning software were replaced by an integrated system that included 6 accelerators. The number of reported safety incidents and root causes were recorded between 2010 and 2014. Time series analysis was performed, and quantitative results were explored by structured interviews. Additionally, downtime was recorded.
  
  
  RESULTS
  From January 2010 to July 2014, 5085 incidents were reported. Reports related to the accelerators decreased from 33% (2010) to 20% (2013-2014) of total reports, whereas the number of delivered fractions per accelerator increased by 20% (2010: 643 per month; 2013: 795 per month). Reports related to portal imaging decreased from 16.5 reports per month (2010) to 3.1 (2013-2014). Of these portal imaging reports, 316 had at least 1 technical cause in 2010, which decreased to 13 in 2013-2014. Interviewees attributed the decreased reporting to the equipment transition, not to decreased safety awareness. Downtime decreased by 46%, from 5.4% in 2010 to 2.9% in 2013.
  
  
  CONCLUSIONS
  The number of reported accelerator- and portal imaging-related incidents decreased significantly, whereas safety awareness remained stable. In addition, accelerator downtime decreased, possibly resulting in less rescheduling of patients and fewer disruptions of work processes. Therefore, we conclude that the risk for serious safety incidents and patient harm decreased after implementation of the new integrated system.
authors.affiliation: MAASTRO clinic, Maastricht, the Netherlands. Electronic address: pascale.simons@maastro.nl.
authors.forename: Pascale A M
authors.initials: PA
authors.lastname: Simons
authors.affiliation: Hasselt University, Faculty of Business Economics, Hasselt, Belgium.
authors.forename: Jochen
authors.initials: J
authors.lastname: Bergs
authors.affiliation: CZ Insurances, Tilburg, the Netherlands.
authors.forename: Madelon
authors.initials: M
authors.lastname: Pijls-Johannesma
authors.affiliation: MAASTRO clinic, Maastricht, the Netherlands.
authors.forename: Huub
authors.initials: H
authors.lastname: Backes
authors.affiliation: Hasselt University, Faculty of Business Economics, Hasselt, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Marneffe
authors.affiliation: Ghent University, Faculty of Medicine and Health Sciences, Ghent, Belgium; Hasselt University, Faculty of Medicine and Life Sciences, Hasselt, Belgium.
authors.forename: Dominique
authors.initials: D
authors.lastname: Vandijck
mesh_terms: D019544:Equipment Failure Analysis / Q000379:methods*; D006801:Humans; D016247:Information Storage and Retrieval / Q000379:methods*; D008284:Maintenance and Engineering, Hospital / Q000379:methods*; D010315:Particle Accelerators / Q000295:instrumentation*; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D012308:Risk Management; D017751:Safety Management; D012984:Software; D014584:User-Computer Interface