A failure modes and effects analysis study for gynecologic high-dose-rate brachytherapy

Jyoti Mayadev, Sonja Dieterich, Rick Harse, Susan Lentz, Mathew Mathai, Sunita Boddu, Marianne Kern, Jean Courquin, Robin L Stern

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


Purpose: To improve the quality of our gynecologic brachytherapy practice and reduce reportable events, we performed a process analysis after the failure modes and effects analysis (FMEA). Methods and Materials: The FMEA included a multidisciplinary team specifically targeting the tandem and ring brachytherapy procedure. The treatment process was divided into six subprocesses and failure modes (FMs). A scoring guideline was developed based on published FMEA studies and assigned through team consensus. FMs were ranked according to overall and severity scores. FM ranking >5% of the highest risk priority number (RPN) score was selected for in-depth analysis. The efficiency of each existing quality assurance to detect each FM was analyzed. Results: We identified 170 FMs, and 99 were scored. RPN scores ranged from 1 to 192. Of the 13 highest-ranking FMs with RPN scores >80, half had severity scores of 8 or 9, with no mode having severity of 10. Of these FM, the originating process steps were simulation (5), treatment planning (5), treatment delivery (2), and insertion (1). Our high-ranking FM focused on communication and the potential for applicator movement. Evaluation of the efficiency and the comprehensiveness of our quality assurance program showed coverage of all but three of the top 49 FMs ranked by RPN. Conclusions: This is the first reported FMEA process for a comprehensive gynecologic brachytherapy procedure overview. We were able to identify FMs that could potentially and severely impact the patient's treatment. We continue to adjust our quality assurance program basedon the results of our FMEA analysis.

Original languageEnglish (US)
StateAccepted/In press - Apr 16 2015


  • Brachytherapy
  • Gynecologic oncology
  • Quality assurance

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging


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