Enterprise Equipment Replacement In Radiation Oncology: A TG-100–Guided Process Map and FMEA to Improve Predictability and Outcomes
Abstract
Purpose
Radiation oncology equipment replacement is often managed as a capital project, yet failures in portfolio prioritization, enabling work, commissioning, and go-live can create patient access risk, schedule delays, and cost escalation. We developed a TG-100 inspired, risk-based framework to standardize and de-risk enterprise lifecycle replacement across two regions with more than 30 major assets.
Methods
A multidisciplinary team (physicians, physics, therapy, dosimetry, operations, facilities, IT, and vendors) mapped the replacement workflow from enterprise inventory through post-go-live stabilization. A domain-level FMEA was performed across 10 risk domains. Representative failure modes were scored for occurrence, severity, and detectability on a 1 to 10 scale and ranked to drive mitigation planning. The highest risks were translated into stage-gated governance with named owners, readiness checklists for construction and IT, redundancy-preserving sequencing rules, patient transfer and rollback plans, commissioning and training minimum requirements, go-no-go criteria, and a 30, 60, and 90-day stabilization plan.
Results
The three highest-ranked risk domains were: 1) enterprise inventory and prioritization failures that drive incorrect sequencing and loss of regional redundancy, 2) under-scoped construction enabling work (power, HVAC, shielding, permitting) that creates critical-path schedule slip and cascading portfolio delays, and 3) delayed IT, cybersecurity, and integration readiness (network approvals and end-to-end ROIS/R&V interfaces) that blocks installation and go-live. As a result of applying this TG-100 inspired analysis to drive disciplined planning and scope refinement, our enterprise lifecycle program produced more than 30 percent savings across projects completed through 2025, alongside reported gains in market share of 3 to 5 percent, procedure volume of 20 percent in some centers, and contribution margin of 12 percent after technology modernization.
Conclusion
A TG-100 inspired FMEA applied to enterprise equipment replacement provides a repeatable method to prioritize and control risk from pro forma to go-live, improving predictability, protecting patient access, and strengthening lifecycle governance.