Radiation Oncology Incident Analysis: Timing and QA Effectiveness
Abstract
Purpose
This study aimed to evaluate the timing of incident occurrence and detection across the radiation oncology workflow to identify error-prone workflow processes and to assess the effectiveness of quality assurance (QA) processes. The findings provide insights to improve QA processes and clinical workflows to enhance patient care.
Methods
Incident reports submitted between August 2021 and July 2025 were retrospectively reviewed. Each incident was categorized by the workflow step when it occurred, workflow step when it was detected, the clinical role that caused the incident, and the QA process or workflow step that identified the incident. Analysis was conducted to determine which processes were most susceptible to cause incidents and which QA processes were most effective in incident detection.
Results
Most incidents were detected within zero or one workflow step, highlighting the effectiveness of self-checks and subsequent QA processes. Noticeable delayed detection was observed with 11% of treatment planning incidents detected during treatment delivery (four steps later) and 18% of simulation incidents detected during treatment delivery (five steps later). The physics initial chart check identified 49% of planning incidents that progressed beyond planning, while the physics weekly chart check detected 40% of treatment-related incidents, with an additional 40% identified before the chart check occurred. Trends in incident reporting suggest an ongoing commitment to safety improvement in the radiation oncology department.
Conclusion
By characterizing when and how incidents occur and are detected, this study provides insight to enhance the effectiveness of QA processes within radiation oncology workflows. Trends in reported events over the study period reflect a commitment to reporting and improving safety within the radiation oncology department.