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Davies, S.M., Ramsay, N.K., Klein, J.P., Weisdorf, D.J., Bolwell, B., Cahn, J.Y., Camitta, B,M., Gale, R.P., Giralt, S., Heilmann, C., Henslee-Downey, P.J., Herzig, R.H., Hutchinson, R., Keating, A., Lazarus, H.M., Milone, G.A., Neudorf, S., Perez, W.S., Powles, R.L., Prentice, H.G., Schiller, G., Socié, G., Vowels, M., Wiley, J., Yeager, A. and Horowitz, M.M. (2000) Comparison of Preparative Regimens in Transplants for Children with Acute Lymphoblastic Leukemia. Journal of Clinical Oncology, 18, 340-347.

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• TITLE: TBI Technique Improvements for Anesthetized Pediatric Patients Based on Near-Miss Incident Reporting

  AUTHORS: Ning Cao, Eric C. Ford, Matthew J. Nyflot, Ralph P. Ermoian, Nicole W. Pelly, Lori Young, Kristi Hendrickson

  KEYWORDS: Pediatric Total Body Irradiation Simulation, Dosimetry, Treatment Setup, Continuous Safety Improvement (CSI)

  JOURNAL NAME: International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, Vol.5 No.4, November 10, 2016

  ABSTRACT: Purpose: To share our clinical experience of an optimized and comprehensive pediatric TBI technique. Methods and Materials: Through the use of incident learning, safety-critical areas were identified in our procedure for total body irradiation (TBI) for pediatric patients under anesthesia for bone-marrow transplant. The previous procedure lacked flexibility to accommodate various requests from the anesthesia team due to the wide range of patient sizes. To address this issue and to improve the process overall, we updated our procedure for TBI simulation, dosimetry planning, patient setup during treatment, and in vivo dosimetry. A simulation form was redesigned with additional detailed instructions and documentation requirements. The dose calculation procedure was reformulated to remove dependence on setup variations. Tissue compensation determination and therefore dose uniformity were improved by introducing rigorous calculation methods. Calculations were performed on 28 previously-treated patients to compare the dose uniformity using the new versus previous methods. Results: The new procedures improve interdepartmental communication, simplify the workflow, decrease the risk of treating patients in a setup that differs from that used during the simulation, and reduce dose heterogeneity. The new compensator design significantly improved patient dose uniformity: 0.8% ± 0.4% (new method) vs. 4.2% ± 2.3% (previous method) (p Conclusion: A near-miss incident reporting system was used to improve the safety and quality of pediatric TBI procedures under anesthesia.