title: Influence of planning time and treatment complexity on radiation therapy errors.
abstract: OBJECTIVE
  Radiation treatment planning is a complex process with potential for error. We hypothesized that shorter time from simulation to treatment would result in rushed work and higher incidence of errors. We examined treatment planning factors predictive for near-miss events.
  
  
  METHODS
  Treatments delivered from March 2012 through October 2014 were analyzed. Near-miss events were prospectively recorded and coded for severity on a 0 to 4 scale; only grade 3-4 (potentially severe/critical) events were studied in this report. For 4 treatment types (3-dimensional conformal, intensity modulated radiation therapy, stereotactic body radiation therapy [SBRT], neutron), logistic regression was performed to test influence of treatment planning time and clinical variables on near-miss events.
  
  
  RESULTS
  There were 2257 treatment courses during the study period, with 322 grade 3-4 near-miss events. SBRT treatments had more frequent events than the other 3 treatment types (18% vs 11%, P = .04). For the 3-dimensional conformal group (1354 treatments), univariate analysis showed several factors predictive of near-miss events: longer time from simulation to first treatment (P = .01), treatment of primary site versus metastasis (P < .001), longer treatment course (P < .001), and pediatric versus adult patient (P = .002). However, on multivariate regression only pediatric versus adult patient remained predictive of events (P = 0.02). For the intensity modulated radiation therapy, SBRT, and neutron groups, time between simulation and first treatment was not found to be predictive of near-miss events on univariate or multivariate regression.
  
  
  CONCLUSIONS
  When controlling for treatment technique and other clinical factors, there was no relationship between time spent in radiation treatment planning and near-miss events. SBRT and pediatric treatments were more error-prone, indicating that clinical and technical complexity of treatments should be taken into account when targeting safety interventions.
authors.affiliation: Department of Radiation Oncology, University of Washington Medical Center, Seattle, Washington; Department of Radiation Oncology, Stanford University, Stanford, California. Electronic address: michael.gensheimer@gmail.com.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Gensheimer
authors.affiliation: Department of Radiation Oncology, University of Washington Medical Center, Seattle, Washington.
authors.forename: Jing
authors.initials: J
authors.lastname: Zeng
authors.affiliation: Department of Radiation Oncology, University of Washington Medical Center, Seattle, Washington.
authors.forename: Joshua
authors.initials: J
authors.lastname: Carlson
authors.affiliation: Department of Radiation Oncology, University of Washington Medical Center, Seattle, Washington.
authors.forename: Phil
authors.initials: P
authors.lastname: Spady
authors.affiliation: Department of Radiation Oncology, University of Washington Medical Center, Seattle, Washington.
authors.forename: Loucille
authors.initials: L
authors.lastname: Jordan
authors.affiliation: Department of Radiation Oncology, University of Washington Medical Center, Seattle, Washington.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Kane
authors.affiliation: Department of Radiation Oncology, University of Washington Medical Center, Seattle, Washington.
authors.forename: Eric C
authors.initials: EC
authors.lastname: Ford
mesh_terms: D006801:Humans; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000009:adverse effects* / Q000379:methods*; D013997:Time Factors