S568 I. J. Radiation Oncology d Biology d Physics Volume 78, Number 3, Supplement, 2010

a mistake (p = .003). In each of these questions, almost all of the current students answered ‘‘very good’’ to ‘‘excellent,’’ comparedto \ 20% of the prior graduates.

Conclusions: There is an apparent lack of confidence/willingness among some therapists/dosimetrists to speak to physicians aboutpotential errors/mistakes. The current students appear more willing to speak with physicians. This might reflect a positive impact ofour initiative (joint patients-care conferences attended by therapy/dosimetry students/staff and physicians) to reduce communica-tion barriers. The small sample size limits the interpretation and a larger survey would be helpful to better define the scope of theproblem and the pertinent covariates.

Author Disclosure: R.D. Adams, None; R.C. Chen, None; J.E. Bailey, None; L.B. Marks, None.

2815 Assessing the Feasibility of using Volumetric Modulated Arc Therapy Technology to Increase the

Throughput and Quality of Radiotherapy in Developing Countries

S. Chilukuri, V. S. Subramaniam, G. Arun, S. Thirumalaiswamy, M. Kathirvel, S. Kala, J. Amit

Yashoda Cancer Institute, Hyderabad, India

Purpose/Objective(s): Recent studies have documented the superiority of high-precision radiotherapy techniques in reducingtoxicity and improving outcomes. As a result of the economic boom in developing countries, hospitals have acquired high-endtechnology. However, resources are limited and due to the large patient burden most hospitals are not equipped to treat all deservingpatients with IMRT. The purpose of our current study is to assess the feasibility of using RapidArc technology (RA) to increase thethroughput in terms of IMRT treatments per day per machine.

Materials/Methods: In this study we compared the total monitor units (MU) and the treatment delivery time for 75 patients treatedper day with RA on single treatment unit (Varian 2100CD with OBI) with sliding window dynamic multi-leaf collimator IMRT(DIMRT) plans. The site of irradiation was brain (B) in 15, head and neck (H&N) in 20, thorax(T) in 13, abdomen(A) in 10 andpelvic (P) in 17 patients. A majority of RA plans consisted of 1 arc for B, T and A tumors, 2 arcs for H&N and P tumors. All caseswere re-planned with DIMRT using Eclipse [V. 8.9] achieving the same treatment goals. IMRT plans consisted of 4-9 beams. Thetotal treatment time was computed by summing positioning time [mean-3min], alignment time [mean for B- 3 minutes (min), forH&N- 4 min, for P, A and T- 5min], imaging and analysis time [mean-5min] and the beam ON time. The beam ON time for RapidArc treatment was measured on the first day of treatment whereas for IMRT, treatment was simulated on a phantom with plannedparameters. The total treatment time was analyzed for IMRT and RA assuming time other than beam ON time to be identical.

Results: The average Beam ON time and MU was lesser with RA compared to IMRT. The average MUs for RA vs. IMRT, fortumors of B, HN, T, A and P were 320.8 vs. 464.9 (p = 0.06), 459.9 vs. 1340.2 (p = 0.03), 330.4 vs. 944.2 (p = 0.037), 447.1 vs.1204.2 (0.03) and 499.8 vs.1461 (p = 0.034) respectively. The average beam ON time for RA vs. IMRT, for tumors of B, HN,T, A and P were 1.18 min vs. 3.03 min (p = 0.056), 3.03 min vs. 8.66 min (p = 0.032), 1.32 min vs. 7.55 min (p = 0.02), 1.18min vs. 5.51 min (p = 0.035), 2.59 min vs. 8.48 min (p = 0.04), respectively. The treatment time gain in treating 75 patients perday with RA instead of IMRT was 5.9 hrs with reduction of 51,658 MUs. Assuming same proportion of cases, only 55 patients couldhave been treated on IMRT per day as opposed to 75 patients on RA (working hrs- 18/day).

Conclusions: The results of this study show an advantage with RA over DIMRT with a several hours gain of treatment time on themachine with reduced MUs without compromising the treatment goals. RA is an efficient technology with a significant impact inbusy centers with a large load of patients being treated on high precision techniques.

Author Disclosure: S. Chilukuri, None; V.S. Subramaniam, None; G. Arun, None; S. Thirumalaiswamy, None; M. Kathirvel,None; S. Kala, None; J. Amit, None.

2816 Patient Safety in Radiation Oncology: Tools for Improvement

E. C. Ford, S. Terezakis, P. Pronovost, L. Myers, R. Bell, J. Wong, D. Song, R. Zellars, T. DeWeese

Johns Hopkins University, Baltimore, MD

Purpose/Objective(s): Patient safety is a vital concern in radiotherapy. According to estimates based on publicly available data,the rate of serious injury during radiotherapy is approximately 1000 times higher than in industries such as commercial aviation andmodern anesthesiology which are often cited as examples of complex but ultrasafe enterprises. Improvements are warranted. Herewe focus on specific systems-based tools that can be used to reduce errors.

Materials/Methods: Two safety improvement tools were implemented in the department of radiation oncology beginning in2006-2007: an incident reporting system and failure mode and effects analysis (FMEA). The incident reporting system has loggedover 200 reports of near-miss errors. FMEA is a prospective error prevention methodology in which failure modes are identifiedand scored according to severity, occurrence rate and detectability, and are combined into a risk priority number (RPN). FMEA wasperformed in 2006 and 2009, requiring approximately 170 staff hours each time. Individual blinded scoring of each failure modewas performed by a cross-sectional department team of 10 people to assess the statistical properties of FMEA. The results of FMEAwere compared with incident reports.

Results: There was a large variability in FMEA scoring between people, with standard deviations of 76% and 34% for RPN andseverity, respectively. Significant bias between specialty groups was also identified with severity and RPN scores from therapistsbeing significantly lower than those from physicists or treatment planners (p \ 0.001). Severity scores were well-correlated withrisk priority number scores (Pearson r = 0.50), and increased going from consult to treatment delivery (p\0.001). Comparing theFMEA results to error reports over a 3-month period, only 10 of 24 (42%) reported errors were identified in the FMEA process.

Conclusions: Patient safety in radiation oncology needs to be improved if it is to be brought in line with other ultra-safe practices.FMEA is a valuable tool for identifying weak points in a complex system before they become problematic. It is, however, a cum-bersome and time-intensive tool and may not capture all errors actually occurring in the clinic. A streamlined approach is key tosafety improvement. Given the strong correlation between severity and overall RPN score, we propose the use severity-only scoringfor safety analysis.

Proceedings of the 52nd Annual ASTRO Meeting S569

Author Disclosure: E.C. Ford, None; S. Terezakis, None; P. Pronovost, None; L. Myers, None; R. Bell, None; J. Wong, None; D.Song, None; R. Zellars, None; T. DeWeese, None.

2817 Quality Research in Radiation Oncology (QRRO): A Patterns of Care Analysis of Clinical Performance

Measures in the Management of Gastric Cancer (GC)

B. D. Minsky1, N. Khalid2, C. R. Thomas3, L. Kachnic4, C. Crozier2, J. B. Owen2, J. Wilson5, K. Goodman6

1University of Chicago, Chicago, IL, 2ACR Clinical Research Center, Philadelphia, PA, 3Oregon Health and Science University,Portland, OR, 4Boston University Medical Center, Boston, MA, 5Medical College of Wisconsin, Milwaukee, WI, 6MemorialSloan Kettering Cancer Center, New York, NY

Purpose/Objective(s): The ACR Quality Research in Radiation Oncology (QRRO) project is conducting a study of quality andpatterns of care for patients (pts) receiving radiation therapy (RT) for GC with the goal of determining factors associated with com-pliance of evidence-based clinical standards. The specific aim of this analysis is to evaluate penetrance of level one clinical trialresults establishing adjuvant chemoradiation (CRT) as a validated, evidence-based standard-of-care in North America for resect-able GC.

Materials/Methods: A national process survey was conducted from randomly selected RT facilities in the USA, stratified by prac-tice type, and from randomly selected eligible gastric cancer cases treated from 2005-07. ACR clinical data abstractors collectedfacility and process survey data through retrospective on-site pt record review. The survey instruments allow measurement of com-pliance with quality indicators, as well as pt demographics, diagnosis, staging, history, geographic region, practice setting, insurancestatus, treatment, and outcome. The GI committee defined 2 readily evaluable clinical performance measures (CPM) based on resultsof level one clinical trials and national guidelines as quality indicators: 1) Use of adjuvant or neoadjuvant CRT; 2) Completion ofplanned RT course within prescribed time frame.

Results: A total of 223 eligible pts treated for gastric cancer from 42 institutions have been reviewed to date. Median age was 62yrs; 65% male. Pt. Characteristics were white (65%), African-American (22%), Other (7%), and Asian (6%). AJCC 2002 path stagewas 13% stage I, 29% II, 33% IIIA, 9% IIIB, and 12% IV. Most pts (43%) were treated at academic centers with the remainder splitbetween large non-academic centers (31%) and medium-small facilities (26%). CPMs were computed on all data collected throughFeb, 2010. Of 164 pts with Stage IB - IV (non-metastatic) gastric cancer, 122 (74%) received adjuvant CRT after resection, 32(20%) received neoadjuvant CRT, 9 (6%) received both, and 1 was unknown. Over two-thirds (69%) completed RT within theprescribed time frame.

Conclusions: Our selected data suggest that adjuvant CRT for IB-IV gastric cancer has been successfully adopted in the USA.QRRO will provide actual patterns of care to participating facilities to help identify areas for improvement in the adoption ofevidence based recommendations for the use of CRT for gastric cancer.QRRO is supported by the NCI Grant CA065435.

Author Disclosure: B.D. Minsky, None; N. Khalid, None; C.R. Thomas, None; L. Kachnic, None; C. Crozier, None; J.B. Owen,None; J. Wilson, None; K. Goodman, None.

2818 Residents’ Educational Needs during Transition into Radiation Oncology Residency

V. Diavolitsis, H. Shirazi, J. P. Hayes

Northwestern University, Chicago, IL

Purpose/Objective(s): The aim of this study was to assess current practices, strengths, and deficiencies in the orientation processfor incoming radiation oncology (RO) residents.

Materials/Methods: We distributed an IRB-approved anonymous survey electronically to RO residents in their PGY2-5 and firstpostgraduate years. We included questions on the type and utility of orientation materials received by residents prior to and uponentering RO residency. A total of 766 residents were identified via the ARRO directory, and email addresses were available fromthe ARRO and ASTRO directories for 500 (65.3%) of these residents. 194 responses were received, a response rate of 39%,representing 25.3% of all current and recent residents.

Results: Survey respondents were equally distributed on chi-square between years PGY2-5, with a smaller proportion of postgrad-uates responding. Most residents (81.3%) had two or three months of experience rotating in clinical RO. 74.1% of residents re-ceived orientation materials in radiation oncology prior to starting residency. Elements included were rotation schedule(72.8%), call schedule (63.6%), reading materials in clinical RO (31.5%), radiation biology (22.8%), and radiation physics(24.7%), department policies (80.2%), residency expectations (74.1%), and RO department procedures (42.0%). 95.4% of RO res-idents received an orientation at the start of RO residency. Orientation length was less than one hour in 2.8%, one hour to a half-dayin 7.8%, more than a half-day but less than one full day in 21.8%, more than one full day but less than one week in 45.8%, and morethan one week but less than one month in 20.1%. Elements included in formal on-site orientations included introductions tocontouring/dosimetry (39.4%), radiation biology (25.7%), physics (45.1%), clinical RO (37.1%), hospital computer systems(82.9%), and RO computer systems (73.7%), as well as procedural information (49.7%) and tours (79.4%). When asked howhelpful the orientation that they received at the start of RO residency was, 11.3% of residents answered ‘‘essential’’, with24.5%, 50.0%, and 15.1% responding ‘‘very helpful’’, ‘‘somewhat helpful’’, and ‘‘not helpful at all’’, respectively. A statisticallysignificant Spearman correlation (rho) was observed between programs with longer orientation and increased helpfulness oforientation (rho = 0.26, p = 0.008). Residents with more components in their on-site orientations felt their orientation was morehelpful (rho = 0.407, p \ 0.001).

Conclusions: RO residents will benefit from a more comprehensive orientation, including a broader array of materials sent toincoming residents for their review prior to starting residency and a more extensive on-site orientation.

Author Disclosure: V. Diavolitsis, None; H. Shirazi, None; J.P. Hayes, None.