title: Failure modes and effects analysis in image-guided high-dose-rate brachytherapy: Quality control optimization to reduce errors in treatment volume.
abstract: Analyze the inputs which cause treatment to the wrong volume in high-dose-rate brachytherapy (HDRB), with emphasis on imaging role during implant, planning, and treatment verification. The end purpose is to compare our current practice to the findings of the study and apply changes where necessary.
  
  
  
  Failure mode and effects analysis was used to study the failure pathways for treating the wrong volume in HDRB. The role of imaging and personnel was emphasized, and subcategories were formed. A quality assurance procedure is proposed for each high-scoring failure mode (FM).
  
  
  
  Forty FMs were found that lead to treating the wrong volume. Of these, 73% were human failures, 20% were machine failures, and 7% were procedural/guideline failures. The use of imaging was found to resolve 85% of the FMs. We also noted that imaging processes were under used in current practice of HDRB especially in pretreatment verification. Twelve FMs (30%) scored the highest, and for each one of them, we propose clinical/practical solutions that could be applied to reduce the risk by increasing detectability.
  
  
  
  This work resulted in two conclusions: the role of imaging in improving failure detection and the emphasized role of human-based failures. The majority of FMs are human failures, and imaging increased the ability to detect 85% of all FMs. We proposed quality assurance practices for each high-scoring FM and have implemented some of them in our own practice.
authors.affiliation: Biomedical Physics Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. Electronic address: salramahi92@kfshrc.edu.sa.
authors.forename: Shada
authors.initials: S
authors.lastname: Wadi-Ramahi
authors.affiliation: Biomedical Physics Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: Waleed
authors.initials: W
authors.lastname: Alnajjar
authors.affiliation: Radiation Oncology Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: Rana
authors.initials: R
authors.lastname: Mahmood
authors.affiliation: Radiation Oncology Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: Noha
authors.initials: N
authors.lastname: Jastaniyah
authors.affiliation: Biomedical Physics Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: Belal
authors.initials: B
authors.lastname: Moftah
mesh_terms: D001918:Brachytherapy / Q000379:methods / Q000592:standards*; D004868:Equipment Failure; D000067495:Healthcare Failure Mode and Effect Analysis; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D011785:Quality Assurance, Health Care / Q000379:methods*; D011786:Quality Control; D058996:Quality Improvement; D011879:Radiotherapy Dosage; D061089:Radiotherapy, Image-Guided / Q000592:standards*; D012307:Risk Factors
keywords: Failure mode and effects analysis; High-dose-rate brachytherapy; Image guided; Quality assurance; Treatment volume