基于失效模式与效应分析的放射治疗实施过程风险研究

      Risk Analysis of Radiotherapy Implementation Process Based on Failure Mode and Effect Analysis

      • 摘要: 目的 提供放射治疗实施过程风险评估方法,发现治疗实施流程可能存在的风险,提出降低或预防这些风险的管控措施。方法 组建多中心专家评估团队,绘制了治疗实施过程流程图,通过专家团队对流程图中每个支步骤展开失效模式分析,汇总分析结果并进行RPN(风险优先序数)评分,最终获得整个流程风险的量化评估结果。结果 失效模式中共获得106个失效模式,风险评估获得RPN(前20%)高危风险模式22个和严重度S(≥8)高危风险模式27个,失效原因多为人为差错或软硬件故障。结论 失效模式与效应分析可以较好的用于放疗实施过程的风险评估,为放疗领域的风险管控提供了新的评估工具。

         

        Abstract: Objective Providing a risk assessment method for the implementation of radiotherapy to identify possible risks in the implementation of the treatment process, and proposing measures to reduce or prevent these risks. Methods A multidisciplinary expert evaluation team was developed and the radiotherapy treatment process flow was drawn. Through the expert team, the failure mode analysis is carried out in each step of the flow chart. The results were summarized and the RPN (risk priority ordinal) score was obtained, and the quantitative evaluation results of the whole process risk were obtained. Results One hundred and six failure modes were obtained, risk assessment of RPN (20%) high risk failure model are 22 and severity S (≥ 8) high risk failure model are 27. The reasons for the failures were man-made errors or hardware and software failures. Conclusion Failure mode and effect analysis can be used to evaluate the risk assessment of radiotherapy, and it provides a new solution for risk control in radiotherapy field.

         

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