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Title: SU-F-T-248: FMEA Risk Analysis Implementation (AAPM TG-100) in Total Skin Electron Irradiation Technique

Abstract

Purpose: Total Skin Electron Irradiation (TSEI) is a radiotherapy treatment which involves irradiating the entire body surface as homogeneously as possible. It is composed of an extensive multi-step technique in which quality management requires high consumption of resources and a fluid communication between the involved staff, necessary to improve the safety of treatment. The TG-100 proposes a new perspective of quality management in radiotherapy, presenting a systematic method of risk analysis throughout the global flow of the stages through the patient. The purpose of this work has been to apply TG-100 approach to the TSEI procedure in our institution. Methods: A multidisciplinary team specifically targeting TSEI procedure was formed, that met regularly and jointly developed the process map (PM), following TG-100 guidelines of the AAPM. This PM is a visual representation of the temporal flow of steps through the patient since start until the end of his stay in the radiotherapy service. Results: This is the first stage of the full risk analysis, which is being carried out in the center. The PM provides an overview of the process and facilitates the understanding of the team members who will participate in the subsequent analysis. Currently, the team is implementing themore » analysis of failure modes and effects (FMEA). The failure modes of each of the steps have been identified and assessors are assigning a value of severity (S), frequency of occurrence (O) and lack of detection (D) individually. To our knowledge, this is the first PM made for the TSEI. The developed PM can be useful for those centers that intend to implement the TSEI technique. Conclusion: The PM of TSEI technique has been established, as the first stage of full risk analysis, performed in a reference center in this treatment.« less

Authors:
; ;  [1];  [1];  [2]; ; ; ; ; ; ; ; ;  [3];  [3];  [2]
  1. Hospital La Fe, Valencia, Valencia (Spain)
  2. (Spain)
  3. Hospital General ERESA, Valencia, Valencia (Spain)
Publication Date:
OSTI Identifier:
22648864
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 43; Journal Issue: 6; Other Information: (c) 2016 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
60 APPLIED LIFE SCIENCES; 61 RADIATION PROTECTION AND DOSIMETRY; HAZARDS; IMPLEMENTATION; IRRADIATION; RADIOTHERAPY; RISK ASSESSMENT; SKIN

Citation Formats

Ibanez-Rosello, B, Bautista-Ballesteros, J, Bonaque, J, Perez-Calatayud, J, Clinica Benidorm, Benidorm, Alicante, Gonzalez-Sanchis, A, Lopez-Torrecilla, J, Brualla-Gonzalez, L, Garcia-Hernandez, T, Vicedo-Gonzalez, A, Granero, D, Serrano, A, Borderia, B, Solera, C, Rosello, J, and Universidad de Valencia, Valencia, Valencia. SU-F-T-248: FMEA Risk Analysis Implementation (AAPM TG-100) in Total Skin Electron Irradiation Technique. United States: N. p., 2016. Web. doi:10.1118/1.4956471.
Ibanez-Rosello, B, Bautista-Ballesteros, J, Bonaque, J, Perez-Calatayud, J, Clinica Benidorm, Benidorm, Alicante, Gonzalez-Sanchis, A, Lopez-Torrecilla, J, Brualla-Gonzalez, L, Garcia-Hernandez, T, Vicedo-Gonzalez, A, Granero, D, Serrano, A, Borderia, B, Solera, C, Rosello, J, & Universidad de Valencia, Valencia, Valencia. SU-F-T-248: FMEA Risk Analysis Implementation (AAPM TG-100) in Total Skin Electron Irradiation Technique. United States. doi:10.1118/1.4956471.
Ibanez-Rosello, B, Bautista-Ballesteros, J, Bonaque, J, Perez-Calatayud, J, Clinica Benidorm, Benidorm, Alicante, Gonzalez-Sanchis, A, Lopez-Torrecilla, J, Brualla-Gonzalez, L, Garcia-Hernandez, T, Vicedo-Gonzalez, A, Granero, D, Serrano, A, Borderia, B, Solera, C, Rosello, J, and Universidad de Valencia, Valencia, Valencia. 2016. "SU-F-T-248: FMEA Risk Analysis Implementation (AAPM TG-100) in Total Skin Electron Irradiation Technique". United States. doi:10.1118/1.4956471.
@article{osti_22648864,
title = {SU-F-T-248: FMEA Risk Analysis Implementation (AAPM TG-100) in Total Skin Electron Irradiation Technique},
author = {Ibanez-Rosello, B and Bautista-Ballesteros, J and Bonaque, J and Perez-Calatayud, J and Clinica Benidorm, Benidorm, Alicante and Gonzalez-Sanchis, A and Lopez-Torrecilla, J and Brualla-Gonzalez, L and Garcia-Hernandez, T and Vicedo-Gonzalez, A and Granero, D and Serrano, A and Borderia, B and Solera, C and Rosello, J and Universidad de Valencia, Valencia, Valencia},
abstractNote = {Purpose: Total Skin Electron Irradiation (TSEI) is a radiotherapy treatment which involves irradiating the entire body surface as homogeneously as possible. It is composed of an extensive multi-step technique in which quality management requires high consumption of resources and a fluid communication between the involved staff, necessary to improve the safety of treatment. The TG-100 proposes a new perspective of quality management in radiotherapy, presenting a systematic method of risk analysis throughout the global flow of the stages through the patient. The purpose of this work has been to apply TG-100 approach to the TSEI procedure in our institution. Methods: A multidisciplinary team specifically targeting TSEI procedure was formed, that met regularly and jointly developed the process map (PM), following TG-100 guidelines of the AAPM. This PM is a visual representation of the temporal flow of steps through the patient since start until the end of his stay in the radiotherapy service. Results: This is the first stage of the full risk analysis, which is being carried out in the center. The PM provides an overview of the process and facilitates the understanding of the team members who will participate in the subsequent analysis. Currently, the team is implementing the analysis of failure modes and effects (FMEA). The failure modes of each of the steps have been identified and assessors are assigning a value of severity (S), frequency of occurrence (O) and lack of detection (D) individually. To our knowledge, this is the first PM made for the TSEI. The developed PM can be useful for those centers that intend to implement the TSEI technique. Conclusion: The PM of TSEI technique has been established, as the first stage of full risk analysis, performed in a reference center in this treatment.},
doi = {10.1118/1.4956471},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = 2016,
month = 6
}
  • Total skin electron irradiation (TSEI) is a special treatment technique offered by modern radiation oncology facilities, given for the treatment of mycosis fungoides, a rare skin disease, which is type of cutaneous T-cell lymphoma [1]. During treatment the patient’s entire skin is irradiated with a uniform dose. The aim of this work is to present implementation of total skin electron irradiation treatment using IAEA TRS-398 code of practice for absolute dosimetry and taking advantage of the use of radiochromic films.
  • Twelve consecutive patients with advanced stage mycosis fungoides (MF) were treated with combined total body X ray irradiation (TBI) and total skin electron beam radiotherapy (EBRT). Six had generalized plaque disease and dermatopathic nodes, three had tumor stage disease and node biopsy positive for mycosis fungoides, and three had erythroderma/Sezary syndrome. The treatment regimen consisted of split course total body X ray irradiation, given in twice weekly 15 cGy fractions to 75 cGy, then total skin electron beam radiation therapy given in once weekly 400 cGy fractions to a total dose of 2400 cGy. Underdosed areas and areas of greatestmore » initial involvement were boosted 400 cGy twice weekly for an additional 1200 cGy. This was followed by a second course of total body X ray irradiation, to a total dose of 150 cGy. The total skin electron beam radiotherapy technique is a modification of an established six position EBRT technique for mycosis fungoides. Measurements to characterize the beam with and without a lexan scattering plate, demonstrated that the combination of no-plate beams produced better dose uniformity with a much higher dose rate. This improved technique is particularly advantageous for elderly and/or frail patients. Nine (75%) of the 12 patients achieved complete response (CR). The other three had significant improvement with greater than 80% clearing of their disease and resolution of symptoms. All six patients with generalized plaque disease achieved complete response and remained free of disease from 2 to 16 months. Two of three node positive patients also achieved complete response; one, with massive biopsy-documented mycosis fungoides nodal disease and deep open tumors, remained relapse-free over 2 years. Only one of the three patients with erythroderma/Sezary syndrome achieved a complete response, which was short lived.« less
  • Purpose: Rotational total skin electron irradiation (RTSEI) is used in the treatment of cutaneous T-cell lymphoma. Due to inter-film uniformity variations the dosimetry measurement of a large electron beam of a very low energy is challenging. This work provides a method to improve the accuracy of flatness and symmetry for a very large treatment field of low electron energy used in dual beam RTSEI. Methods: RTSEI is delivered by dual angles field a gantry of ±20 degrees of 270 to cover the upper and the lower halves of the patient body with acceptable beam uniformity. The field size is inmore » the order of 230cm in vertical height and 120 cm in horizontal width and beam energy is a degraded 6 MeV (6 mm of PMMA spoiler). We utilized parallel plate chambers, Gafchromic films and OSLDs as a measuring devices for absolute dose, B-Factor, stationary and rotational percent depth dose and beam uniformity. To reduce inter-film dosimetric variation we introduced a new specific correction method to analyze beam uniformity. This correction method uses some image processing techniques combining film value before and after radiation dose to compensate the inter-variation dose response differences among films. Results: Stationary and rotational depth of dose demonstrated that the Rp is 2 cm for rotational and the maximum dose is shifted toward the surface (3mm). The dosimetry for the phantom showed that dose uniformity reduced to 3.01% for the vertical flatness and 2.35% for horizontal flatness after correction thus achieving better flatness and uniformity. The absolute dose readings of calibrated films after our correction matched with the readings from OSLD. Conclusion: The proposed correction method for Gafchromic films will be a useful tool to correct inter-film dosimetric variation for the future clinical film dosimetry verification in very large fields, allowing the optimizations of other parameters.« less
  • Total skin low energy electron beam irradiation is used to treat superficially widespread skin lesions such as cutaneous T-cell lymphoma. Total skin irradiation involves delivering an adequate dose at a depth of 0.25 to 1.0 cm, while sparing underlying tissue. The dose distributions obtained when using a modified Stanford six-field technique depend upon the beam energy, the beam angle, the diameter and shape of the body part, and other variables. The dose distribution uniformity of six pairs of angulated electron beams has been studied as a function of beam energy, the gantry angle, +/- theta, above and below the horizontalmore » and the diameter of a cylindrical polystyrene phantom. Depth doses and dose uniformity for single and multiple fields have been measured as a function of beam energy, phantom diameter and position.« less
  • Mycosis fungoides is a cutaneous lymphoma that accounts for 2–3% of all lymphomas. Several clinical studies have demonstrated the effectiveness of TSEBT (Total Skin Electron Beam Therapy) in patients with mycosis fungoides. It is important to develop this technique and make it available to a larger number of patients in Mexico. Because large fields for electron TSEBT are required in order to cover the entire body of the patient, beam characterization at conventional treatment distances is not sufficient and a calibration distance of 500cm or higher is required. Materials and methods: Calibration of radiochromic Gafchromic® EBT2 film (RCF) for electronsmore » was performed in a solid water phantom (Scanditronix Wellhöfer) at a depth of 1.4cm and a Source Axis Distance (SAD) of 100cm. A polynomial fit was applied to the calibration curve, in order to obtain the equation relating dose response with optical density. The spatial distribution is obtained in terms of percentage of the dose, placing 3×3cm samples of RCF on the acrylic screen, which is placed in front of the patient in order to obtain maximum absorbed dose on the skin, covering an area of 200×100cm{sup 2}. The Percentage Depth Dose (PDD) curve was obtained placing RCF samples at depths of 0, 1, 1.2, 1.4, 1.5, 2, 3, 4, 5, 6, 7, 8 and 9cm in the solid water phantom, irradiated with an ELEKTA SINERGY Linear Accelerator electron beam, with an energy of 6 MeV, at a Source Skin Distance (SSD) of 500cm, with 1000MU = 100Gy, with a cone of 40×40cm and gantry angle of 90°. The RCFs were scanned on a flatbed scanner (EPSON EXPRESSION 10000 XL) and the images were processed with the ImageJ program using a region of interest (ROI) of 1×1cm{sup 2}. Results: The relative spatial dose distribution and the percentage depth dose for a SSD of 500±0.5cm, over an area of 200×100cm{sup 2} was obtained, resulting to an effective maximum dose depth (Z{sub ref}) for electrons of 1.4±0.05cm. Using the same experimental data, horizontal and vertical beam profiles were also graphed, showing a horizontal symmetry of ±035%, horizontal flatness of ±3.62%, vertical symmetry of ±2.1% and vertical flatness of ±14.2%. Conclusions: The electron beam was characterized and the data obtained were useful to determine the spatial dose distribution to a SSD of 500±0.5cm, in an area of 200×100cm{sup 2}. Dose profiles were obtained both horizontally and vertically, thus allowing to assess electron beam symmetry and flatness. PDD analysis up to a depth of 9±0.05cm, has made possible to establish the depth of electron penetration, assuring an only skin irradiation treatment.« less