title: A consensus-based, process commissioning template for high-dose-rate gynecologic treatments.
abstract: There is a lack of prescriptive, practical information for those doing the work of commissioning high-dose-rate (HDR) gynecologic (GYN) treatment equipment. The purpose of this work is to develop a vendor-neutral, consensus-based, commissioning template to improve standardization of the commissioning process.
  
  
  
  A series of commissioning procedures and tests specific to HDR GYN treatments were compiled within one institution. The list of procedures and tests was then sent to five external reviewers at clinics engaged in HDR GYN treatments. External reviewers were asked to (1) suggest deletions, additions, and improvements/modifications to descriptions, (2) link the procedures and tests to common, severe failure modes based on their effectiveness at mitigating those failure modes, and (3) rank the procedures and tests based on perceived level of importance.
  
  
  
  External reviewers suggested the addition of 14 procedures and tests. The final template consists of 67 procedures and tests. "Treatment process" and "staff training" sections were identified as mitigating the highest number of commonly reported failure modes. The mean perceived importance for all procedures and tests was 4.4 of 5, and the mean for each section ranged from 3.6 to 4.8. Sections of the template that were identified as mitigating the highest number of commonly reported failure modes were not assigned the highest perceived importance.
  
  
  
  The commissioning template developed here provides a standardized approach to process and equipment commissioning. The discord between perceived importance and mitigation of the highest number of failure modes suggests that increased focus should be placed on procedures and tests in "treatment process" and "staff training" sections.
authors.affiliation: Deparment of Radiation Medicine and Applied Sciences, UC San Diego, La Jolla, CA. Electronic address: d7brown@ucsd.edu.
authors.forename: Derek W
authors.initials: DW
authors.lastname: Brown
authors.affiliation: Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA.
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Damato
authors.affiliation: Deparment of Radiation Medicine and Applied Sciences, UC San Diego, La Jolla, CA.
authors.forename: Steven
authors.initials: S
authors.lastname: Sutlief
authors.affiliation: Texas Oncology, Denton, TX.
authors.forename: Serban
authors.initials: S
authors.lastname: Morcovescu
authors.affiliation: Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA.
authors.forename: Sang-June
authors.initials: SJ
authors.lastname: Park
authors.affiliation: Department of Radiation Oncology, Drexel University College of Medicine, Philadelphia, PA.
authors.forename: Jay
authors.initials: J
authors.lastname: Reiff
authors.affiliation: Cancer Treatment Center, Kaiser Permanente Santa Clara, Santa Clara, CA.
authors.forename: Allen
authors.initials: A
authors.lastname: Shih
authors.affiliation: Deparment of Radiation Medicine and Applied Sciences, UC San Diego, La Jolla, CA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Scanderbeg
mesh_terms: D001918:Brachytherapy / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D032921:Consensus; D005260:Female; D005833:Genital Neoplasms, Female / Q000532:radiotherapy*; D006282:Health Personnel / Q000193:education; D006801:Humans
keywords: Commissioning; GYN; HDR; Process; Standardization