217 - Lack of Adoption of the Standard Radiation Therapy Prescription
Presenter(s)
M. J. Dance1, and L. B. Marks2; 1University of North Carolina, Chapel Hill, NC, 2Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
Purpose/Objective(s): Clear and unambiguous communication facilitate safe and effective patient treatments. Standards provide a framework for clear communication and are widely recognized method to reduce errors. In 2016, ASTRO published a white paper recommending standards for the key elements, and their order, for the radiation therapy prescriptions (e.g. Treatment Site, Technique/Modality, Fraction Size (in cGy), Fraction Number and Total Dose). This standard was endorsed by ASTRO, AAPM, AAMD, ACR, and ASRT. We herein assess the extent to which these recommendations have been integrated into current commercially available record and verify, and treatment planning systems since that time. Further, a cursory review of event reporting data was performed to assess for the presence of reported errors related to radiation therapy prescriptions.
Materials/Methods: Three record and verify and five treatment planning systems were reviewed to evaluate where the radiation prescription was displayed and whether each instance of the prescription included the key elements and if they followed the specified order. A limited review of ROILS (Radiation Oncology Incident Learning System) data was performed to assess for the presence of reported errors related to radiation therapy prescriptions.
Results: None of the commercially available software systems adhered to the Standard Prescription. While all three record and verify systems had the key elements of the Standard Prescription, each used their own format and order. One record and verify system used two different orders of the dose, dose per fraction, and total dose within the same prescription view, further increasing the ambiguity and potential confusion. Of the treatment planning systems, 0/5 contained all five key elements in any of their displays of the prescription, with the modality and site being the most often excluded elements. Additionally, a consistent format was not used amongst different systems, nor even within the same system. Prescription-related errors were the topic of ROILS reports/events in 2015, 2016, 2017, 2024.
Conclusion: Despite the Standard Prescription’s content and format being introduced almost ten years ago, and endorsement from multiple professional societies, there has been a lack of implementation within the critical software systems used for patient treatments. Prescription-related errors remain a topic within ROILS reports/events. This finding highlights the need for a unified request from the radiation oncology community to our vendor partners to implement change to adapt a standardized format in an effort to improve patient safety.