目的:本研究通过将失效模式和效应分析(FMEA)方法与时间驱动的基于活动的成本计算(TDABC)相结合,为评估磁共振引导放射治疗(MRgRT)工作流程提供了一个新颖而全面的框架。我们评估工作流程的安全性,质量,和经济影响,提供对MRgRT实施的整体理解。目的是为医疗保健从业人员和管理人员提供有价值的见解,促进有关0.35TMRIdianMR-Linac系统临床工作流程的知情决策。
方法:对于FMEA,一个多学科团队遵循TG-100方法学,以评估MRgRT工作流程的潜在失效模式.在缓解主要故障模式和工作流优化之后,建立了TDABC分析的处理过程。TDABC应用于MRgRT和计算机断层扫描引导的RT(CTgRT),用于典型的五部分立体定向体RT(SBRT)治疗,评估两个治疗工作流程之间的总工作流程和相关成本。
结果:共识别出279种失效模式,有31人被归类为高风险,55为中等风险,其余为低风险。确定每个放射肿瘤护理团队成员的前20%风险优先数(RPN)。评估MRgRT和CTgRT总费用。实施技术进步,如实时多叶准直器(MLC)跟踪与体积调制电弧治疗(VMAT),自动分割,增加直线加速器的剂量率,为MRgRT节省了大量成本。
结论:在这项研究中,我们将FMEA与TDABC相结合,以全面评估MRgRT与常规CTgRT治疗5个部分SBRT的工作流程和相关成本.FMEA分析确定了关键故障模式,提供见解,以提高患者的安全。TDABC分析显示,虽然MRgRT提供了独特的优势,这可能涉及更高的成本。我们的发现强调了探索具有成本效益的策略和关键技术进步的重要性,以确保MRgRT在临床实践中的广泛采用和财务可持续性。
OBJECTIVE: This study presents a novel and comprehensive framework for evaluating magnetic resonance guided radiotherapy (MRgRT) workflow by integrating the Failure Modes and Effects Analysis (
FMEA) approach with Time-Driven Activity-Based Costing (TDABC). We assess the workflow for safety, quality, and economic implications, providing a holistic understanding of the MRgRT implementation. The aim is to offer valuable insights to healthcare practitioners and administrators, facilitating informed decision-making regarding the 0.35T MRIdian MR-Linac system\'s clinical workflow.
METHODS: For
FMEA, a multidisciplinary team followed the TG-100 methodology to assess the MRgRT workflow\'s potential failure modes. Following the mitigation of primary failure modes and workflow optimization, a treatment process was established for TDABC analysis. The TDABC was applied to both MRgRT and computed tomography guided RT (CTgRT) for typical five-fraction stereotactic body RT (SBRT) treatments, assessing total workflow and costs associated between the two treatment workflows.
RESULTS: A total of 279 failure modes were identified, with 31 categorized as high-risk, 55 as medium-risk, and the rest as low-risk. The top 20% risk priority numbers (RPN) were determined for each radiation oncology care team member. Total MRgRT and CTgRT costs were assessed. Implementing technological advancements, such as real-time multi leaf collimator (MLC) tracking with volumetric modulated arc therapy (VMAT), auto-segmentation, and increasing the Linac dose rate, led to significant cost savings for MRgRT.
CONCLUSIONS: In this study, we integrated
FMEA with TDABC to comprehensively evaluate the workflow and the associated costs of MRgRT compared to conventional CTgRT for five-fraction SBRT treatments.
FMEA analysis identified critical failure modes, offering insights to enhance patient safety. TDABC analysis revealed that while MRgRT provides unique advantages, it may involve higher costs. Our findings underscore the importance of exploring cost-effective strategies and key technological advancements to ensure the widespread adoption and financial sustainability of MRgRT in clinical practice.