An FMEA-Based Approach to Improve the Process and Quality Control on MR Imaging from Outside Diagnostic Imaging Centers to be Used for Radiation Treatment Planning 📝

Author: Olivier Blasi, Eric Cameron, Brad K. Lofton 👨‍🔬

Affiliation: CAMP, Colorado Assn in Medical Phys (CAMP) 🌍

Abstract:

Purpose:
Magnetic Resonance (MR) imaging obtained from external centers for radiation therapy (RT) planning can suffer from suboptimal protocols and geometric distortions. These issues can require repeat scans, delaying treatment and compromising patient care. Through Failure Mode and Effects Analysis (FMEA), we identified common causes of poor MR image quality and partner with community imaging centers to establish a robust quality management program. Our overall goal was to improve image quality and minimize re-imaging.
Methods:
Failure modes related to poor MR image quality, incorrect protocols, and scheduling delays were identified and scored. Using these insights, we formed a multidisciplinary imaging quality team. Radiation oncology MR protocols review, standardized imaging orders, staff training, and machine quality checks were introduced to ensure adherence to RT needs and reduce the risk of repeat imaging.
Results: From our FMEA analysis, we identified fifteen primary failure modes contributing to suboptimal image quality or workflow delays. The highest Risk Priority Number (RPN) was observed due to incorrect ordering for TPS MRI (RPN=245), insufficient protocol optimization for TPS (RPN=200), incorrect magnet strength (RPN=180), and anatomical mismatches between the CT and MRI (RPN=175). Additional issues such as missing distortion corrections and inconsistent QC further underscored the need for standardized review.
In response, we implemented training for non-radiation oncologists on TPS requirements, standardized order forms, established QC checks, and reviewed MR protocols. Staff were trained to check parameters relevant to RT planning. After implementation, repeated MR scans fell from 5–10 a year to fewer than one, demonstrating how FMEA-based interventions can significantly enhance external MRI quality for RT planning.
Conclusion:
By systematically identifying failure modes through FMEA and instituting clear quality management protocols, we successfully reduced the need for repeat MR imaging. Moreover, these findings offer a framework that other institutions can adopt to achieve similar quality improvements.

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