TG100号报告在调强放疗流程质量控制中的应用研究

Application of TG100 report in process quality control of intensity-modulated radiotherapy

目的依据TG100号报告提出的风险分析方法分析本中心调强放疗流程,改进质量控制方法,保证治疗安全和质量。方法基于TG100报告,成立风险分析小组。构建调强放疗总流程图以及各分支步骤;开展失效模式与影响分析方法,确定流程中所有潜在的差错模式;基于设定的评分标准评估该差错模式发生概率、被检查出的概率以及差错模式发生对临床产生影响的严重程度;计算每个差错模式优先值,并按优先值分值从高到低排序,取前20%范围为高危差错模式;对高危差错模式进行差错树分析,改进质量控制方法。结果调强放疗共有11个主步骤,41个支步骤,共发现180个差错模式。计算优先值范围为30~178,共36个高危差错模式。排在前5的高危差错模式优先值分别为摆位差错(178)、电子射野影像装置配准差错(172)、勾画错误(166)、计划执行差错(160)、既往剂量总结差错(156)。结论TG100号报告可操作性和实用性强,能够有效地系统化改进本中心调强放疗流程,为治疗提供安全和质量保证。

Objective To analyze the intensity-modulated radiotherapy(IMRT)process based on the TG100 report,aiming to improve the quality control method and guarantee the safety and quality of IMRT.Methods Based on the TG100 report,a risk analysis team was established.The flow chart of overall and each sub-step of IMRT was constructed.The failure mode and effect analysis method were adopted to determine all potential error modes in the process.The probability of of the error mode,the probability of being checked out and the severity of the effect of the error mode on the clinical bed were evaluated based on the pre-set scoring standard.The priority value of each error mode was calculated and ranked from high to low priority value.The top 20%is defined as the high-risk error mode,which was analyzed by error tree to improve the quality control method.Results IMRT consisted of 11 main steps and 41 sub-steps,and 180 failure modes were detected.The priority values were ranged from 30 to 178.A total of 36 high-risk failure modes were found.The top 5 high-risk failure modes(RPN)consisted of setup error(178),electronic portal imaging device(EPID)registration(172),contouring error(166),treatment delivery error(160)and prescription dose error(156).Conclusion TG100 report is practical and convenient to utilize,which can effectively and systematically improve IMRT process and provide safety and quality assurance of IMRT process.