the rollout of aapm tg100: getting engaged in risk...
TRANSCRIPT
M. Saiful Huq, PhD, FAAPM, FInstPProfessor and Director of Medical Physics
Department of Radiation OncologyUniversity of Pittsburgh Cancer Institute and UPMC CancerCenter
Pittsburgh, Pennsylvania, USA
The rollout of AAPM TG100: Getting engaged in risk assessment
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Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
• chair Therapy Physics Committee, AAPM• Vice chair, Science Council, AAPM• Member, Clinical, Translational and Basic Science Advisory
Committee, ASTRO
Disclosures
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Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
• Understand different IHE-RO activities, including plan veto, and how they relate to improving patient safety: Bruce C
• Learn about the key strategies of AAPM TG100 and further resources focused on developing risk based quality management programs : Saiful H
• Learn how the concepts in TG100 can be used to analyze current clinical practice : Per H
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Learning objectives
Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
Acknowledgement
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• Thanks to the members of TG 100 for their commitment to
the work of the TG 100 protocol.
• Thanks to Keli Wilson for some lively discussions
• Many slides shown in this presentation have been taken
from the presentation given by Bruce Thomadsen at the Fall
NCC-AAPM symposium in 2014. Special thanks to Bruce.
Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
Authors of TG 100 (the TG was formed in 2003)
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M. Saiful Huq (Chair)
Benedick Fraass
Peter Dunscombe John Gibbons
Geoffrey Ibbott
Sasa Mutic
Jeffrey Williamson
Bruce Thomadsen
Frank Rath
Jatinder Palta
Arno Mundt
Ellen Yorke (Vice Chair)
Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
From: <Low>, Dan Low <[email protected]>Date: Saturday, December 27, 2014 at 2:26 AM
Colleagues,
The ad-hoc committee has read over the latest version of the TG100 report. That version was a consequence of our Chicago meeting and is ready to send to Medical Physics for review. As we had discussed with Dr. Williamson both parts 1 and 2 will be considered for publication in the journal.
The entire ad-hoc committee, as well as the Science Council appreciate the tremendous effort you have made over the past 10+ years in getting this report ready for publication and we hope that the review process goes smoothly.
Sincerely,Daniel Low and the Ad-Hoc committee.
News of the decade !
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Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015 7
10+ years later – the happy authors !
Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
1. They wrote a high quality protocol2. They are by nature a bunch of happy people3. New year’s partying was just 4 days away4. It’s Christmas5. AAPM finally approved the protocol for publication
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Members of TG100 were happy at Christmas time because
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Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
1. They wrote a high quality protocol2. They are by nature a bunch of happy people3. New year’s partying was just 4 days away4. It’s Christmas5. AAPM finally approved the protocol for publication
Members of TG100 were happy at Christmas time because
Correct answer: 5
Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
1. Regulations involving radiation therapy will change automatically to require compliance with TG100
2. No further task group reports on quality assurance are needed
3. QA methods can be revisited considering the tools of TG100
4. TG100 explicitly replaces all previous task group reports5. TG100 protocol will have to be implemented in the
clinic right away
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The approval of TG100 means that
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Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
1. Regulations involving radiation therapy will change automatically to require compliance with TG100
2. No further task group reports on quality assurance are needed
3. QA methods can be revisited considering the tools of TG100
4. TG100 explicitly replaces all previous task group reports5. TG100 protocol will have to be implemented in the
clinic right away
The approval of TG100 means that
Correct answer: 3
Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
Rationale for TG 100 approach
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2008
2008
2009
2012
1999
Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
Rationale for TG 100 approach
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2008
2008
2009
2012
1999
Retrospective approaches to QM are not sufficient All inclusive QC checks may not be feasibleDevelop proactive approaches to anticipation of failure modesEvaluate risks from each failure modeDevelop a risk based QM program
Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
• Understand the process – Process Map
• Assess the hazard – FMEA
• Establish the failure propagation – Fault Tree
• Address the hazards
Ø From the greatest risk and most severe
Ø Use the most effective tools
• Test and validate
TG 100- risk based QM development
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Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
• Two parts : part 1 and part 2
• Five appendices
• Four tables, four figures, five example checklists
• Glossary
What does TG 100 report look like?
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Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
• Part 1Ø Preface
Ø Charge and scope of the report
Ø Problems with traditional approaches to quality management in RT
Ø Introduction
Ø Quality and Safety: An overview
Ø TG100 risk analysis methodology
Ø TG100 methodology for designing a QM program in RT
Ø Comparisons with previous work
Ø Recommendations for applying risk analysis in RT
Ø Conclusions
What does TG 100 report look like?
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Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
• Part 2 : Application of risk analysis methodologies
developed in Part 1 to design radiation therapy quality
management programs. Used an IMRT case study from one
of the author’s institution to
Ø Design
Ø Process mapping
Ø FMEA
Ø FTA
Ø Design a QM program
What does TG 100 report look like?
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Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
• Appendices
Ø Appendix A: FMEA by process
Ø Appendix B: FMEA by severity
Ø Appendix C: FMEA by RPN
Ø Appendix D: Fault tree
Ø Appendix E: Fault tree with quality management codes
What does TG 100 report look like?
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Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
1. Failure modes and effects analysis alone2. Fault tree analysis alone3. Having Physics determine the key parameter for
analysis4. Use of multiple tools including engagement of all
stakeholders5. Process maps alone
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TG100 protocol recommends the use of tools such as
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Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
1. Failure modes and effects analysis alone2. Fault tree analysis alone3. Having Physics determine the key parameter for
analysis4. Use of multiple tools including engagement of all
stakeholders5. Process maps alone
TG100 protocol recommends the use of tools such as
Correct answer: 4
Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
• A roll-out advisory and coordination committee should be
formed
Ø Best as a committee under ExCom
Ø This is because it needs to coordinate activities of Science Council,
Education Council and Professional Council
• Members should include those council chairs,
representatives of ASTRO, CRCPD, WGEP, ACRO, ABS,
SROA, IROC-Houston, systems engineers, some TG 100
members
What needs to happen for the roll out?
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Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
Ad Hoc Committee for the implementation of TG-100 report
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Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
• There will need to be a strong educational component for
Ø Practicing medical physicists
Ø Radiation oncologists
Ø Administrators
Ø Regulators
Ø Accrediting bodies
What needs to happen for the roll out?
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Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
• Need various types of trainingØ Organize workshops
Ø Develop slide sets or other materials
Ø Videos
Ø Talks and symposia at chapter meetings
Ø Teaching and listening sessions at national meetings such as this one
Ø Individual mentoring
• Need a budget: AAPM has already approved significant money for the rolloutØ 3 medical physics resident will be supported
What needs to happen for the roll out?
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Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
• AAPM website (TG100 corner)Ø Draft of TG100 prior to Med. Phys. publicationØ Brief introduction of TG100Ø Process mappingØ FMEAØ FTAØ Other relevant power point slides
• Summer school resources (copyright issues are discussed)
Planned activities
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Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
• Activities on the horizonØ At least 5 AAPM chapters have requested a speaker for their chapter
meetingsØ Bruce Thomadsen to give a presentation at the meeting of CRCPD
on May 15 on how the regulators should be dealing with TG100Ø Two hour session scheduled at the Annual meeting of AAPMØ One day workshop at the World Congress of Medical PhysicsØ To date TG100 members have given many presentations at various
national and international meetings Ø Had the hands-on session on Fault-tree today
• Identify a representative from ASTRO who will promote TG100 within ASTRO
Planned activities
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Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
• Models and samples for quality management need to be
accessible on a website
Ø Process maps
Ø FMEA
Ø Fault Trees
Ø Quality management program
• This will need a group to vet the models and maintain the
website
What needs to happen for the roll out?
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Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
• Start with a small project or small part of a bigger procedure
Ø Build confidence
Ø Important to have the early project work
• Assemble a team of all the players
Ø Important for getting information and generating ideas
• Be open to new ideas
• Be wary of, but do not exclude, major departures
Adopting the TG 100 approach
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Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
TG 100’s key core requirements for quality
• Standardized procedures
• Adequate staff, physical and IT resources
• Adequate training of staff
• Maintenance of hardware and software resources
• Clear lines of communication among staff
Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
• First, correct any environmental problems – that usually is a
relatively inexpensive but effective operation
• Then consider the key core components identified by
TG100
• Make sure resources are allocated as needed (i.e., staffing
and equipment)
For clinics: prerequisites to quality
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Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
• Participate in an incident reporting system
• Two national systems are available, through
Ø ASTRO-AAPM
Ø The Center for the Assessment of Radiological Sciences (CARS)
Data for the future
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Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
1. Presentations only at national meetings2. A combination of education and work with other
stakeholders and regulators3. A primary emphasis on making online tools available
to perform an FMEA analysis4. A primary emphasis on incident reporting system5. Educating only physicists on TG100 protocol
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The rollout of TG100 strategy includes
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Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
1. Presentations only at national meetings2. A combination of education and work with other
stakeholders and regulators3. A primary emphasis on making online tools available
to perform an FMEA analysis4. A primary emphasis on incident reporting system5. Educating only physicists on TG100 protocol
The rollout of TG100 strategy includes
Correct answer: 2
Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
• TG 100 has been approved ☺
• Significant AAPM efforts are already underway forØ Coordination
Ø Education
Ø Modeling
• In your practiceØ Start small
Ø Ensure the key components and resources
Ø Work as a team
Summary
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Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
• Important events in the world that happened between 2003
– 2014 (from formation to approval of TG100 by the AAPM)
The TG 100 journey
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Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015
The TG 100 journey
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2003TG100 was formed
2003 - Invasion of Iraq2003 - Human genome project completed2003- China launches its first manned
space mission
2004 - Facebook is launched2004- George Bush Elected President
2004TG 100 decides on using
risk-based QM approach for its new protocol
2005 - YouTube launched20052006 – twitter is launched
2006
–Sa
ddam
Hus
sein
ex
ecut
ed
2006 - North Korea conducts first nuclear test2007 – Apples debuts the iPhone2007 - Google street view is launched
2008 – TG100 submits first draft to its parent committee
2008 – Beijing hosts Olympic games2008/09 - Barack Obama becomes the first black President of America
2010
–M
icha
el
Jack
son
dies
2010 – Worst environmental disaster in the USA 2010 – Apple debuts iPad2011 – Royal wedding2011 – Osama Bin Laden dead
2009 – TG100 meets in Chicago
2012 – Psy’s Gangnam style2012 – London hosts Olympics
2013 – TG100 report sent to Science Council for approval
2012/13 – Barack Obama reelected
2014 – TG100 report approved by Science
Council
The Pittsburgh Steelers2014- New world trade center completed
TG 100
Risk – based quality management program
August 27, 2014
Members of Ad Hoc Committee of Science
Council and TG 100 met in Chicago
Saiful Huq –The rollout of AAPM TG100, AAPM Spring Clinical meeting, 2015 41
M. Saiful Huq, PhD, FAAPM, FInstPProfessor and Director of Medical Physics
Department of Radiation OncologyUniversity of Pittsburgh Cancer Institute and UPMC CancerCenter
Pittsburgh, Pennsylvania, USA
The rollout of AAPM TG100: Getting engaged in risk assessment
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