Academic Journal
Systems-theoretic process analysis of a CT-guided online adaptive radiation therapy system in a multi-vendor environment.
| Τίτλος: | Systems-theoretic process analysis of a CT-guided online adaptive radiation therapy system in a multi-vendor environment. |
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| Συγγραφείς: | Foote C; Division of Radiation Biophysics, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA., McClatchy DM 3rd; Division of Radiation Biophysics, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA., Yan S; Division of Radiation Biophysics, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA., Olberg S; Division of Radiation Biophysics, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA., Remillard K; Division of Radiation Biophysics, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA., Miles N; Division of Radiation Biophysics, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA., Pursley J; Division of Radiation Biophysics, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA. |
| Πηγή: | Journal of applied clinical medical physics [J Appl Clin Med Phys] 2025 Dec; Vol. 26 (12), pp. e70330. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Wiley on behalf of American Association of Physicists in Medicine Country of Publication: United States NLM ID: 101089176 Publication Model: Print Cited Medium: Internet ISSN: 1526-9914 (Electronic) Linking ISSN: 15269914 NLM ISO Abbreviation: J Appl Clin Med Phys Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2017- : Malden, MA : Wiley on behalf of American Association of Physicists in Medicine Original Publication: Reston, VA : American College of Medical Physics, c2000- |
| Ιατρικοί όροι (MeSH): | Radiotherapy Planning, Computer-Assisted*/methods , Tomography, X-Ray Computed*/methods , Radiotherapy, Image-Guided*/methods , Neoplasms*/radiotherapy , Radiotherapy, Intensity-Modulated*/methods , Systems Theory*, Humans ; Radiotherapy Dosage ; Workflow ; Online Systems |
| Περίληψη: | Background: Online adaptive radiation therapy (ART) is a relatively new process, and it is recommended that institutions starting an online ART program conduct a risk analysis to identify potential hazards. While Failure Modes and Effects Analysis (FMEA) is common, Systems-Theoretic Process Analysis (STPA) has also been used to evaluate online ART workflows. Purpose: An STPA hazard analysis was performed for a CT-guided online ART system in a multi-vendor environment. The goal was to identify potential risks and mitigations to guide the development of adaptive workflows and the quality management (QM) program. Methods: The STPA hazard analysis was performed in four steps. First, process maps for online ART were generated to describe the interactions between users and systems. In the second step, the process maps were refined to a single control structure diagram model. In the third step, potential unsafe control actions (UCAs) were enumerated by the physicists involved in the analysis. Finally, mitigation strategies to address the UCAs were identified. Results: A total of 496 UCAs were identified for 119 control actions, of which 239 (48.2%) were prioritized for mitigation due to having low or medium levels of detectability. The most frequent causal scenarios were accidental omission (20.1%), rushing (17.2%), and lack of training (15.9%). The most common consequences were delays (26.8%) and having to repeat work (13.5%). The two mitigation strategies considered to address the most causal scenarios were requiring trained adaptive staff (28.9%) and having physics oversight (19.9%). Conclusions: The STPA led to valuable insights into the potential causes of unsafe control actions and various mitigation strategies that were used to develop the QM program. Notably, most UCAs were attributable to interactions between users and the system, rather than system failures. It is recommended that every institution starting an online ART program perform a risk assessment for their environment. (© 2025 The Author(s). Journal of Applied Clinical Medical Physics published by Wiley Periodicals LLC on behalf of American Association of Physicists in Medicine.) |
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| Contributed Indexing: | Keywords: adaptive therapy; hazard analysis; safety |
| Entry Date(s): | Date Created: 20251210 Date Completed: 20251211 Latest Revision: 20251214 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC12695457 |
| DOI: | 10.1002/acm2.70330 |
| PMID: | 41372107 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1526-9914 |
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| DOI: | 10.1002/acm2.70330 |