Author: Amar K. Basavatia, Lee C. Goddard, Wolfgang A. Tomé, Christian Velten, Ping Yan, Ravindra Yaparpalvi, Maria Stefania diMayorca 👨🔬
Affiliation: Montefiore Medical Center 🌍
Purpose: High dose rate (HDR) brachytherapy planning is a high-risk procedure performed under significant time pressure, with human failure being the leading cause of error. To elevate training for medical physics residents in brachytherapy planning, we developed a learning exercise and evaluation metric in human error detection.
Methods: HDR brachytherapy plans for several gynecological applicators were generated with various combinations of mistakes (or none). Experienced brachytherapy physicists scored each error for Occurrence, Severity, and Detectability scores per TG100 guidance. Residents were asked to review the plans and identify any errors and score each for Occurrence, Severity, and Detectability. This exercise has been provided to residents after their first and second (last) brachytherapy rotations, with each rotation being three months long.
Results: Residents who completed their second brachytherapy rotation identified more of the planning errors than those half-way through their training. Residents who completed both rotations also identified all ten of the highest risk planning errors (the five errors with the highest RPN scores and the five errors with the highest Severity scores as ranked by attending physicists). After the first brachytherapy rotation, residents missed an average of two of the five errors with highest RPN scores and two of five errors with the highest Severity scores. Residents who completed six months of brachytherapy rotations provided O, S, and D scores that agreed more closely with those from experienced brachytherapy physicists.
Conclusion: This training exercise guided residents beyond following internal procedures and planning guides and taught them to independently evaluate brachytherapy plans for quality and accuracy. Additionally, this exercise can be used as an evaluation metric that attending physicists can use to gauge residents’ competency in HDR brachytherapy planning.