TITLE:
TBI Technique Improvements for Anesthetized Pediatric Patients Based on Near-Miss Incident Reporting
AUTHORS:
Ning Cao, Eric C. Ford, Matthew J. Nyflot, Ralph P. Ermoian, Nicole W. Pelly, Lori Young, Kristi Hendrickson
KEYWORDS:
Pediatric Total Body Irradiation Simulation, Dosimetry, Treatment Setup, Continuous Safety Improvement (CSI)
JOURNAL NAME:
International Journal of Medical Physics, Clinical Engineering and Radiation Oncology,
Vol.5 No.4,
November
10,
2016
ABSTRACT: Purpose: To share our
clinical experience of an optimized and comprehensive pediatric TBI technique. Methods and Materials: Through the use of incident
learning, safety-critical areas were identified in our procedure for total body
irradiation (TBI) for pediatric patients under anesthesia for bone-marrow
transplant. The previous procedure lacked flexibility to accommodate various
requests from the anesthesia team due to the wide range of patient sizes. To
address this issue and to improve the process overall, we updated our procedure
for TBI simulation, dosimetry planning, patient setup during treatment, and in vivo dosimetry. A simulation form was redesigned with
additional detailed instructions and documentation requirements. The dose calculation
procedure was reformulated to remove dependence on setup variations. Tissue
compensation determination and therefore dose uniformity were improved by
introducing rigorous calculation methods. Calculations were performed on 28
previously-treated patients to compare the dose uniformity using the new versus
previous methods. Results: The new procedures improve
interdepartmental communication, simplify the workflow, decrease the risk of
treating patients in a setup that differs from that used during the simulation,
and reduce dose heterogeneity. The new compensator design significantly
improved patient dose uniformity: 0.8% ± 0.4% (new method) vs. 4.2% ± 2.3%
(previous method) (p Conclusion: A near-miss
incident reporting system was used to improve the safety and quality of
pediatric TBI procedures under anesthesia.