연세의대 / 구지혜, 김동욱*
방사선치료과정을 총 6개의 단계로 나누고 총 144개 항목을 각 단계 별로 배치하여 국내 19명의 의학물리전문인이 FMEA에 따라 계산한 D( Detection)와 O(Occurrence) 및 O x D를 ROSIS 결과와 비교한 그래프입니다. D 값의 경우 Treatment 단계를 제외한 대부분의 단계에서 실제 ROSIS에서의 Event 분포와 비슷한 경향을 보여주고 있으며 본 연구가 의학물리전문인만으로 구성되어 진행되었다는 점과 유럽과 한국간의 치료 절차 및 시스템에서의 차이가 존재할 것이라는 점등을 고려하면 추후, 의사, 간호사, 방사선사 등을 포함하는 다양한 직종이 포함된 연구팀을 구성하고 국내 방사선치료사고 통계에 대한 연구를 수행한다면 그 결과가 매우 흥미로울 것으로 사료됩니다. 따라서, 현재 미국의 ROILS(Radiation Oncology Incident Learning System)와 유럽의 SAFRON(Safety in Radiation Oncology)과 같은 방사선사고 보고시스템의 국내도입 및 데이터베이스 구축이 매우 필요하다고 사료됩니다.
Although current quality assurance systems such as Task Group 142 of the American Association of Physicists in Medicine and other methods used for radiotherapy have greatly contributed to decreasing radiotherapy incidents, there is still scope for improvement. In this study, we attempted to evaluate the reliability of the risk priority number, which was suggested by the AAPM Task Group 100, when it was calculated by an expert group in Korea. By doing this, we aimed at providing preliminary data for applying Failure Modes and Effect Analysis (FMEA), a systematic approach to identify potential failures in Korea. For this purpose, 1,163 incidents data in the Radiation Oncology Safety Information System (ROSIS) database were used. The incident data were categorized into 144 items to create a questionnaire. The expert group consisted of 19 physicists who evaluated the occurrence (O), severity (S), and detectability (D) of each item on a scale from 1 to 10 according to the AAPM Task Group 100. Among these three factors, the values of “O × D” were compared with ROSIS data. When comparing the O × D value between the items ranked in the top 10 of the survey and ROSIS data, no items were duplicated, and “simulation” and “treatment” were most frequent among, in total, eight processes. The average difference of O × D between the survey and ROSIS data was 0.8 ± 1.5, and this difference barely followed a Gaussian distribution. The results of this work indicates that FMEA is a good predictor, but that there were still deviations between actual risk and expectations in some cases, because actual incidents are multifactorial rather than simply proportional to D and O. Further research on radiotherapy risk estimation is needed.
Jihye Koo1, Dong Oh Shin2, Young Kyung Lim3, Soah Park4, Jeong Eun Rah5, Ui Jung Hwang6 and Dong Wook Kim7*
1Department of Physics, University of South Florida, Tampa, FL, United States
2Department of Radiation Oncology, Kyung Hee University Medical Center, Seoul, South Korea
3Proton Therapy Center, National Cancer Center Korea, Goyang, South Korea
4Department of Radiation Oncology, Hallym University College of Medicine, Seoul, South Korea
5Department of Radiation Oncology, Myongji Hospital, Goyang, South Korea
6Department of Radiation Oncology, Chungnam National University Hospital, Daejeon, South Korea
7Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea